|Year : 2016 | Volume
| Issue : 3 | Page : 222-226
A virtual reality: Technology's impact on youth mental health
Benjamin Ian Perry1, Swaran Singh2
1 Coventry and Warwickshire Partnership NHS Trust; Division of Mental Health and Wellbeing, University of Warwick, UK
2 Division of Mental Health and Wellbeing, University of Warwick; Birmingham and Solihull Mental Health Foundation NHS Trust, UK; Faculty of Medicine, Aarlborg University, Denmark
|Date of Web Publication||3-Nov-2016|
Dr. Benjamin Ian Perry
University of Warwick, UK Caludon Centre, Clifford Bridge Road, Coventry CV2 2TE
Source of Support: None, Conflict of Interest: None
2016 will mark as the year when commercially available virtual reality headsets first become available across the world. This is set to be a landmark development and will revolutionize the way we interact with technology, which is already eating up more and more of our time, and is now inextricable from day-to-day life. Adolescents, at a critical stage in both physical and psychological development, are often the first to adopt advances in technology, and therefore also any associated impact on health. We discuss some of the current and important research on the positive and negative implications of technology on the mental health of children and adolescents, and briefly outline how future technological advances may further affect how we diagnose, monitor, and manage our young patients in the psychiatric clinic.
Keywords: CAMHS, child and adolescent mental health, mental health, social media, technology, youth
|How to cite this article:|
Perry BI, Singh S. A virtual reality: Technology's impact on youth mental health. Indian J Soc Psychiatry 2016;32:222-6
| Introduction|| |
By the end of the 1980, the world had taken irrevocable and unprecedented steps in moving closer. Geopolitically, the fall of the Berlin Wall and unraveling of USSR were considered as the “End of History” in the celebrated essay by Fukuyama, who declared: “what we may be witnessing is not just the end of the Cold War, or the passing of a particular period of post-war history, but the end of history as such”. At an individual level, the spread of personal computers along with John Berners–Lee’ first proposal of a “World Wide Web,” an interconnected network initially designed to allow the sharing of information between universities and scientists, became ubiquitous, transforming work, commerce, and information exchange in ways previously unimagined. We now live increasing amount of our time online; a report by Ofcom, the UK communications regulator, found that this now stands at over 20 h per week, double the time spent online in 2005.
In 1970, Alfin Toffler penned “Future Shock,” an influential prediction that our lives would one day be lived via exchanges through computer screens. Toffler got many things right, including the transience of relationships, the prediction that people will become as comfortable with virtual interactions as real ones, and that children will be overstimulated. Toffler’ postindustrial society seems to have arrived, though perhaps even he would not have predicted the scale, speed, and spread of technological advancement such that in the space of 20 min and without moving an inch from the sofa, one could buy a week’ shopping, look through a friends holiday photos, converse “face-to-face” with a family member at the other side of the world, and watch countless home videos of a stranger’ cat. Whether Toffler is considered a genuine visionary or a writer of “pop sociology” whose techno-utopianism is based on a technologically deterministic view of the future, there is no doubt that his fundamental vision of the impact of technology on society appears prescient.
The internet, and the technological advances behind it, has arguably brought us closer together. We are now only a few clicks and swipes away both from those we care about and from those we do not. However, some would argue that our virtual connection across screens and networks is devoid of something essentially human; that virtual relations are only simulations of the real thing, and risk leaving us more isolated and farther apart than ever.
| The Changing Landscape of Childhood|| |
Young people are the biggest consumers of technological advances. A 2011 survey found that 95% of youngsters aged 12–17 use the internet, 81% have a social media account, and 51% admit to checking it daily. These numbers are likely to have risen as technology becomes more advanced and less expensive. This level of use of technology is unprecedented in human history, yet are those arguing against it on to something? The homenet study opportunistically studied people during their first 2 years online in the late 1990s, and found the Internet to be associated in a dose–response relationship to a reduction in communication, a shrinking social circle, and an increase in depressive symptoms and loneliness.
Furthermore, technology is changing the way we learn. School children exposed to more screen time have been found to be better at searching and finding information, yet less able to remember it. Technology may even be changing the way we process emotion. A study of US school children found that those exposed to higher levels of screen time were less able to both read nonverbal cues and show empathy. This finding correlates with several interesting studies that have found marked and sustained rises in traits of psychopathy and narcissism in today’ cohorts of US college students. Some even associate these personality changes as contributors to the 2008 economic market crash, a series of events portrayed most recently in Adam McKay’ The Big Short, culminating in an absolute change of economic landscape and opportunity for millions.
| The Emergence of New Disorders|| |
For the first time, the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)includes the term “Internet Gaming Disorder” under the section “Conditions for further study.” Much of the research on this condition has originated from Eastern Asia and has focused on young males who appear to be disproportionately affected. The condition is more common in players of “Massively Multiplayer Online Role-Playing Games” (MMPORGs), with a cited prevalence of up to 27.5%. Zanetta et al. cites the possibility of achievement, socializing with likeminded individuals, immersion in a virtual reality, relaxation, and escape from true reality as causes for their addictive potential, which at its most severe can been fatal, with over 12 recorded deaths due to dehydration, exhaustion, and cardiac arrhythmia.
Similarly, “Problem Internet Use” is another term used in the literature, and is being studied in increasing amounts in young people. Once proposed as a disorder as a satirical hoax by Ivan Goldberg in 1995, it is now being taken more seriously. Definitions currently vary, where some report it to be akin to a behavioral addiction, others conceptualize the condition as an impulse control disorder. There is work to suggest that rates of the condition are on the rise, correlating with advancing technological developments, with a current cited prevalence of 5–10%.
| The Blurring of Realities|| |
As we collectively spend more time online than ever, there are concerns around the blurring of the virtual world with the physical world, especially among adolescents at a critical time in their psychological development, who may not be able to discern the difference as a maturely developed adult might. This may become pertinent if an adolescent learns attitudes and behaviors from freely available online pornographic content, or has their first lone foray into exploring whole city environments via computer games made famous for their graphically violent content.
However, with regards to the former, a recent study in India, with the aim of assessing the impact of pornography on rates of sexual violence, found no difference in violence rates on women before and after the 1992 liberalization. These findings are in line with analyses from the United States, Denmark, Sweden, and Germany, although a systematic review in 2010 found a correlation between pornography consumption and violence toward females.
Furthermore, despite rising public health concerns on the contrary, a study of European males found no association between consumption of pornography and sexual difficulties such as sexual desire and erectile dysfunction.
| Social Media—The Negatives|| |
Some have postulated the “Zeigarnik” effect as a possible cause for the addictiveness of the internet, with regards to communication on social media. This is explained by the nature of face-to-face contact having distinct start and endpoints, whereas a back-and-forth conversation on social media can linger on in interrupted bursts for hours, if not days, with no discernable beginning, middle, or end; therefore, no closure. Zeigarnik explained this phenomenon in the 1960s as the human desire for, and pursuit of, closure in endeavors, and that interrupted or noncompleted tasks will be more easily remembered.
Our social media profiles present a skewed and selective view of our lives. A carefully selected presentation of smiling holiday photos, excited status updates, and significant life events is but a fraction of our total experience. Displaying the sweet without the bitter, as is usually the way, may amplify feelings of inadequacy, poor self-worth, and alienation in others, leading to a perfect modern depiction of “the grass is always greener.” Use of social media, at a time of important psychological development, as in childhood and early adolescence, has been linked with higher levels of jealousy toward others as well as higher rates of perceived stress, suicidal ideation, substance use, and decreased sleep.
Social media is most frequently the platform for cyberbullying among young people. Cyberbullying has received a wealth of attention from the media, schools, and concerned parents, yet a systematic review found wide-ranging reports of prevalence (7–78%). The paper cites a collective confusion in definition as a cause for this, perhaps as the nature of cyberbullying deviates from the Center for Disease Control definition of bullying with its greater anonymity and the ability for just a single act of aggression to be spread widely and rapidly in the public arena. Furthermore, the large majority of young people simply do not know where to report cyberbullying, which is alarming and may lead to increased feelings of isolation and helplessness.
Akin to many areas of the technological space we live our lives, the speed of advancement is a challenge to creating safe environments with appropriate, safe legislation. A 2013 survey found that teenagers are now sharing significantly more personal and private information on social media websites than in the past, but are still relatively unconcerned about third party or unconsented access to these data. Furthermore, despite efforts by the social media giants to restrict unconsented access to personal information, a group of researchers has displayed the possibility of retrieving large amounts of personal, private information simply from having access to a Facebook friends list. Privacy is becoming more pertinent as we live more of our lives online, and recent events have implicated negatively on the actions of entire organizations and even governments in online privacy violation. Some suggest that the speed of technological advancement and the increasing ease by which we are able to live our lives online has fast outpaced our ability to properly legislate, create a safe environment, or even understand the implications, and this is beginning to, and will need to continue to receive greater focus and attention in future.
| Social Media—The Positives|| |
Alongside the potential risk of harm from social media, there are many positives. Social media, and the opportunity to build one’ own self-identity online, has been shown to boost self-esteem, help introverts develop social skills, and can be very important in helping young people coming to terms with their sexual identity. The impressive rise in popularity of blogging and vlogging, especially among young people, has created a whole new “A-list” of celebrities who boast millions of fans, whose videos and writing may receive more views than big-budget Hollywood movies, and whose content may be helpful, advice-laden, and empowering for youngsters facing difficulty. It is well known that young people may relate better with peers, which may help to explain the popularity of online blogging/vlogging mental health personalities such as Claire Greaves (Mental Illness Talk), Charlotte Walker (purplepersuasion), and John Folk-Williams (Storied Mind). However, the quality of information and advice in online blogs and vlogs can vary, and for each site that promotes mental health and wellbeing, or challenges stigma, there are others who are “antipsychiatric,” and may adversely influence a young person’ decision to seek professional help for mental health issues. Conversely, others argue that some of the negative modern views on the specialty presented by online personalities, who may be current or previous patients, can be illuminating and relevant, and may foster insights into improving patient care.
However, the magnitude of information made readily available by the internet, whether evidence-based or otherwise and often without filter to discern fact from fantasy, has the potential to be damaging, especially for impressionable younger people. There exist websites dedicated to “mind-control,” arguing that symptoms of schizophrenia are actually a genuine manifestation of a world-wide conspiracy to control humanity. An author (Singh) once treated a patient who stopped antipsychotic medication after becoming convinced from one such website that his delusions of mind-control from the Central Intelligence Agency were rooted in reality. Tragically, after a period of noncompliance with medication, he committed suicide.
Technology can nonetheless also be a very useful tool in engagement with young people. Psychiatric research has been benefitted heavily from Facebook advertising, which may run on a cost-effective “pay-by-click” basis, and can be tailored to appear only for specific groups of people (by age, sex, or even hobbies and interests). Social media is also a useful tool for providing information. Psychiatric practice perhaps has not harnessed this to its maximum just yet, but campaigns in other areas such as organ donation have benefitted heavily from a strong social media presence.
Social media and technology have also been cited as useful tools for the monitoring and management of “at-risk” young people. Many studies mention how effective a tool the “collective good” of social media can be in ensuring vulnerable individuals receive the right help, such as in the wide-sharing of self-harm photos, the majority of which receive sympathetic, caring messages, and comments. Furthermore, frequency and intensity of posting on social media platforms such as Facebook have been proposed as potentially useful monitoring tools for early signs of relapse in conditions such as bipolar affective disorder, although some may argue of blurred ethical boundaries in using social media in this fashion.
| Technological Advances in Treatment|| |
Technology has also provided a wealth of advancement in treatment. Although psychiatry cannot perhaps compete in this regard with other specialties such as surgery that can boast achieving complex laparoscopic surgery remotely from countries multiple time-zones away, many psychological interventions are now available quickly and easily through screens. Online cognitive behavioral therapy has been shown to be equally as effective as face-to-face therapy for a myriad of psychiatric disorders with a marked positive effect in young people, perhaps due to their familiarity with the format. Mobile phone “apps” are also a hot topic of debate for use in psychiatry. Psychiatric patients have been found to be amenable to using smart-phone technology in their care, which has been shown to be effective in monitoring, communicating, triaging, and even assisting in diagnosis. Some state that these technologies and the subsequent data analysis may create a paradigm shift with respect to how psychiatric disorders are classified, their diagnostic criteria, and new standards of care. Smartphone “apps” have been used to allow patients with schizophrenia to record symptoms, allowing the possibility to predict patterns of relapse.
Technological advancement will only further infiltrate all of medical practice in the future, including psychiatry. 2016 is the year that the first virtual reality headsets will become commercially available. What once was only a feature in sci-fi movies and in the dreams of sci-fi lovers will truly become a reality, and early demos suggest it will revolutionize the way we interact with technology. Early adopters of the technology in psychiatric research have found positive results in the treatment of a range of psychiatric conditions such as posttraumatic stress disorder, phobias, addictions, eating disorders, psychoses, and even social-skills training for youngsters with autistic spectrum disorder. In addition, where once there were screens, there will now be realistic, tactile worlds, with interaction as human as could feasibly be imagined, and one can only envisage that yet more of our lives may crossover to the virtual. For this to be safe, legislation to protect the vulnerable and the young will need to be robust, further work on the impact of fast-moving technological advances on psychological development will need to be observed, researchers must engage with young people to maximize the potential for technology to aid us as psychiatrists, and finally, one must steer clear from imagining that the storylines from movies such as 2001: A Space Odyssey, The Matrix and most recently Ex Machina rise from the virtual and encroach upon reality.
The authors thank Charlene Cheung (Head of Wellbeing, Alfriston School, UK) and Thomas Figg (Games Developer, BBC, UK) for their insights and inspiration.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fukuyama F.“The End of History?”. The National interest; Summer 1989.
Toffler A. Future shock. Bantam Books New York 1970.
Zakaria W, Alyati WF, Toffler Alvin. Knowledge technology and change in future society. Intl J Islamic Thought 2012;1:54-61.
Richards D, Caldwell PH, Go H. Impact of social media on the health of children and young people. J Paediatr Child Health 2015;51:1152-7.
Messina ES, Iwasaki Y. Internet use and self-injurious behaviors among adolescents and young adults: An interdisciplinary literature review and implications for health professionals. Cyberpsychol Behav Soc Netw 2011;14:161-8.
Kraut R, Patterson M, Lundmark V, Kiesler S, Mukophadhyay T, Scherlis W. Internet paradox: A social technology that reduces social involvement and psychological well-being?. Am Psychol 1998;53:1017.
Uhls YT, Michikyan M, Morris J, Garcia D, Small GW, Zgourou E, Greenfield PM. Five days at outdoor education camp without screens improves preteen skills with nonverbal emotion cues. Comput Human Behav 2014;39:387-92.
Konrath SH, O'Brien EH, Hsing C. Changes in dispositional empathy in American college students over time: A meta-analysis. Pers Soc Psychol Rev 2011;15:180-98.
Konrath SH, Chopik WJ, Hsing CK, O’Brien E. Changes in adult attachment styles in American college students over time: A meta-analysis. Pers Soc Psycho Rev 2014; 1088868314530516
The Big Short. 2015; New York Paramount Pictures
American Psychiatric Association Diagnostic and statistical manual of mental disorders. 2013; 5th ed Arlington, VA American Psychiatric Publishing.
Ko CH, Internet gaming disorder. Curr Addict Rep 2014;1:177-85.
Zanetta DF, Zermatten A, Billieux J, Thorens G, Bondolfi G, Zullino D. Motivations to play specifically predict excessive involvement in massively multiplayer online role-playing games: evidence from an online survey. Eur Addict Res 2011;17:185-9.
Griffiths M. Psychology of computer use: Xlhi. Some comments on “addictive use of the internet” by Young. Psychologic Rep 1997;80:81-2.
Young KS. The emergence of a new clinical disorder. CyberPsycho Behav 1998;1:237-44.
Tam P, Walter G. Problematic internet use in childhood and youth: Evolution of a 21st century affliction. Australas Psychiatry 2013;1039856213509911.
Selkie EM, Fales JL, Moreno MA. Cyberbullying Prevalence Among US Middle and High School–Aged Adolescents: A Systematic Review and Quality Assessment. Journal of Adolescent Health. 2016.29;58:125-33.
Short MB, Black L, Smith AH, Wetterneck CT, Wells DE. A review of Internet pornography use research: Methodology and content from the past 10 years. Cyberpsycho Behav Soc Netw 2012;15:13-23.
Anderson CA, Shibuya A, Ihori N, Swing EL, Bushman BJ, Sakamoto A, Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: A meta-analytic review. Psychol Bull 2010;136:151-173.
Math SB, Viswanath B, Maroky AS, Kumar NC, Cherian AV, Nirmala MC. Sexual crime in India: Is it influenced by pornography? Indian J Psychol Med 2014;36:147-52.
Kutchinsky B. Pornography and rape: Theory and practice. Evidence from crime data in four countries where pornography is easily available? Int J Law Psychiatry 1991;14:47-64.
Hald GM, Malamuth NM, Yuen C. Pornography and attitudes supporting violence against women: Revisiting the relationship in nonexperimental studies. Aggressive Behav 2010;36:14-20.
Landripet I,Štulhofer A. Is pornography use associated with sexual difficulties and dysfunctions among younger heterosexual men?. J Sexl Med 2015;12:1136-9.
Zeigarnik B. On finished and unfinished tasks. A source book of Gestalt psychology A source book of Gestalt Psychology 1938;1:1-5.
Utz S, Beukeboom CJ. The role of social network sites in romantic relationships: Effects on jealousy and relationship happiness. J Comp Mediated Commun 2011;16:511-27.
Selkie EM, Fales JL, Moreno MA. Cyberbullying prevalence among US middle- and high school-aged adolescents: A systematic review and quality assessment. J Adoles Health 2015;58:125-33.
Gladden RM, Vivolo-Kantor AM, Hamburger ME, Lumpkin CD. Bullying surveillance among youths: Uniform definitions for public health and recommended data elements, version 1.0. 2013. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention and U.S. Department of Education, Atlanta, GA.
Yadron D. Facebook, Google and WhatsApp plan to increase encryption of user data [Internet]. The Guardian Available from: https://www.theguardian.com/technology/2016/mar/14/facebook-google-whatsapp-plan-increase-encryption-fbi-apple [Last accessed 2016 Apr 27]
Mislove A, Viswanath B, Gummadi KP, Druschel P. You are who you know: Inferring user profiles in online social networks. In: Proceedings of the third ACM international conference on Web search and data mining. ACM New York, USA. 2010;251-60.
The Week. The Rise of Workplace Spying 2014.
Gonzales AL, Hancock JT. Mirror, mirror on my Facebook wall: Effects of exposure to Facebook on self-esteem. Cyberpsycho Behav Soc Netw 2011;14:79-83.
Barker V. Older adolescents’motivations for social network site use: The influence of gender, group identity, and collective self-esteem. Cyber Psychol Behav 2009;12:209-13.
Kobus K, Peers and adolescent smoking. Addiction 2003;98:37-55.
Amon KL, Campbell AJ, Hawke C, Steinbeck K. Facebook as a recruitment tool for adolescent health research: A systematic review. Acad Pediatr 2014;14:439-47.
Robinson J, Cox G, Bailey E, Hetrick S, Rodrigues M, Fisher S. Social media and suicide prevention: A systematic review. Early Interv Psychiatry 2015;14:439-47.
Monash Alfred Psychiatry Research Centre RMIT University. Facebook use in affective disorders Available from: http://thefadstudy.com.au/
[Last accessed 2016 Apr 19]
Marescaux J, Leroy J, Rubino F, Smith M, Vix M, Simone M. Transcontinental robot-assisted remote telesurgery: Feasibility and potential applications. Ann Surg 2002;235:487-92.
Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided Internet-based vs face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry 2014;13:288-95.
Donovan CL, March S. Online CBT for preschool anxiety disorders: A randomised control trial. Behav Res Therapy 2014;58:24-35.
Cukor J, Gerardi M, Alley S, Reist C, Roy M, Rothbaum BO. Virtual reality exposure therapy for combat-related PTSD. In: Posttraumatic stress disorder and related diseases in combat veterans 2015; Springer International Publishing 69-83.
Parsons TD. Virtual reality exposure therapy for anxiety and specific phobias. Encyclopaedia of Information Science and Technology. 2015;3:288-296.
Gupta S, Chadha B. Virtual reality against addiction. In: Proceedings of the 2015 international conference on computing, communication and automation (ICCCA). IEEE Greater Noida, India 2015; 15:273-78.
Ferrer-Garcia M, Gutiérrez-Maldonado J, Riva G. Virtual reality based treatments in eating disorders and obesity: A review. J Contemp Psychother 2013;43:207-21.
Veling W, Moritz S, van der Gaag M. Brave new worlds—Review and update on virtual reality assessment and treatment in psychosis. Schizophr Bull 2014;40:1194-7.
Kandalaft MR, Didehbani N, Krawczyk DC, Allen TT. Chapman SB, Virtual reality social cognition training for young adults with high-functioning autism. J Autism Dev Disord 2013;43:34-44.