Int J Ment Health Addiction (2017) 15:604–613

DOI 10.1007/s11469-016-9684-0

Mental Health Concerns in the Digital Age

David A. Scott 1 & Bart Valley 1 & Brooke A. Simecka 2

Published online: 17 June 2016

# Springer Science+Business Media New York 2016

Abstract This article provides a comprehensive look at society’s use of technology including the
Internet, smartphones, and other digital devices and it’s apparent effects on people’s mental
health. Negative consequences from technology overuse impact an individual behaviorally,
affectively, and cognitively. Advantageous counseling interventions and treatment options are
discussed as methods to reduce effects of technology abuse and isolation from the real world and
help clients find a balance in connectivity. The authors discuss signs of potential pathological
technology use and concern for Internet addiction as well as the DSM-5’s proposed Internet
Gaming Disorder. Detrimental impacts on adults, adolescents, and children from continual
connectivity are explained. Consequences of attachment to technology include lowered social
skills, self-motivation, emotional intelligence, and empathy and increased conflict with others,
ADHD, and depression in younger populations. Mental health concerns increase with society’s
reduced social interactions resulting from increased technological use and dependence on social
media for communication.

Keywords Internet addiction . Mental health . Addiction . Counseling

Technology is changing almost every facet of our evolving modern lives, and its benefits are
countless. But as technological advances continue to dramatically change the way we live,
they can also have significant effects on our mental health, often redefining normal versus

* David A. Scott
[email protected]

Bart Valley
[email protected]
Brooke A. Simecka
[email protected]

1
Counselor Education Program, Clemson University, 305 Tillman Hall, Clemson, SC 29634-0707,
USA
2
Clemson Career Center, Clemson University, 316 Hendrix Student Center, Clemson, SC 29634-4007,
USA
Int J Ment Health Addiction (2017) 15:604–613 605

abnormal behavior. Connectivity, accessibility, and information overload can contribute to a

variety of mental health problems including stress, anxiety, and depression. Psychological
issues related to the overuse of technology will continue to grow in the digital age, as will the
importance of understanding the impact of technology on mental health and psychological
well-being.
Smartphones, email, texting, Facebook®, Twitter®, 24-h news, and other technological and
communication advances continue to change the way individuals and communities live, work,
play, and socialize. Experts in technological trends report that 68 % of adults in the United
States have a smartphone (Anderson 2015), 3.2 billion people globally are using the internet
(International Telecommunication Union 2015) and already approximately 65 % of individuals
living in developed countries have at least two portable devices (Rosen 2012). However, these
advancements also lend themselves to overuse and abuse. The modern digital world offers
nonstop technology from which it is almost impossible to unplug, and it is increasingly evident
that many psychological problems can be caused or exacerbated by such technology.
By increasing the flood of incoming demands on time and energy, the darker side of
technology (in the form of connectivity, accessibility, and information overload) can have
significant negative effects on mental health. As technological progress continues to push
personal and professional limits, it will become increasingly important to understand and
address these issues in counseling and other mental health settings. These overload issues can
reach across the lifespan and affect individuals in many ways. As related issues continue to
emerge, counselors will need to be aware of potential mental health problems stemming from
technology overload and continue to research and develop the skills needed for effective
interventions. In the digital age, these capabilities will be crucial in helping clients regain and
maintain a healthy balance of life, work, and technology.
Research into technology’s effects on mental health is still emerging; however,
various studies and significant anecdotal evidence from mental health professionals
and experts in other fields point to numerous effects related to technology overload
(Shaw and Black 2008; Weinstein 2010; Young 2009). These effects may be direct or
may increase the severity of other presenting mental health issues. Relevant issues
resulting from too much technological use impact a person on multiple levels and in
multiple areas including: affective, cognitive, and behavioral concerns (Flisher 2010).
Examples of this impact on our lives could include excess stress, decreased emotional
connection, decreased self-esteem, attention fragmentation, erosion of empathy, inabil-
ity to set boundaries, increased need for immediate gratification, and numerous DSM-
5 disorders (i.e. anxiety disorders, mood disorders, ADHD, narcissistic personality
disorder, anti-social personality disorder, and obsessive-compulsive personality disorder).
Although more thorough research is needed in each of these areas, it is clear that understanding
and treating mental health issues related to dependence on technology will be of increasing
importance in coming years.
Although a large majority of research to date has focused primarily on Internet use (Carr
2011; Flisher 2010), findings can also be applied to issues related to various connectivity
technologies such as smart-phones and other digital devices that account for an
increasing share of time spent engaged with technology (email, texting, social media, etc.).
Most agree that obsessive technology use is a growing problem in society. It would be
advantageous for counselors to be skilled in helping clients understand and work through
negative consequences from technology overuse, find and maintain balance, and re-connect to
the real world.
606 Int J Ment Health Addiction (2017) 15:604–613

Technology Addiction?

To date, much of the research in the domain of mental disorders stemming from technology
misuse has focused on what several researchers have labeled Internet addiction (Flisher 2010).
One cannot deny that the Internet is the spearhead of the digital revolution, and it can have a
powerful psychological impact on some people’s lives. There has been an ongoing debate in
recent years over whether pathological Internet use constitutes a true addiction. Very early
studies (Kraut et al. 1998) demonstrated that those who spent more time using the
Internet showed elevated measures of psychological distress. Others have since added
that Internet addiction is a new, and often unrecognized, clinical disorder that can
cause relational, occupational, and social problems (Young 2009). Griffiths and Hunt (1998)
argue for a wider view of technological addictions, a subset of behavioral addictions
that involves human-machine interaction and is non-chemical in nature. Most experts
agree that more and more people are struggling to manage their Internet use, and that
compulsive use often creates personal, family, or social impairment and/or distress. However,
debates over relationships between addiction and certain kinds of compulsive or impulsive
behaviors continue.
Much of this debate came to light throughout the development of the recently updated
Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric
Association (APA) 2013), which only includes Internet Gaming Disorder as a condition for
further study. Gambling disorder remains the only non-substance-related disorder included as
an addictive disorder in the DSM-5 (APA, 2013). The DSM-5 also notes the excessive use of
the Internet not involving the playing of online games is not considered as analogous to
Internet gaming disorder, pointing to the need for additional future research regarding any
wider scope technology addiction (APA, 2013).
Research studies and other literature have proposed and used various names for such a
technology addiction, including Internet addiction, Internet addiction disorder, online addic-
tion, pathological Internet use, and the more recently proposed and more encompassing
pathological use of electronic media (PUEM) (Bowen and Firestone 2011). The most com-
monly used term is Internet addiction, first coined in 1995 by psychiatrist Dr. Ivan Goldberg,
and popularized through the work of Dr. Kimberly Young, one of the leading researchers in
this area (Flisher 2010).
Dr. Young’s original research focused on uncontrollable, damaging use of technology,
viewing Internet addiction as an impulse control disorder similar to pathological gambling,
with overlapping criteria (Young 1998). Various other diagnostic approaches have been
considered in subsequent years with most focusing on maladaptive preoccupation with
Internet use that causes clinically significant distress or impairment in social, occupational,
or other important areas of functioning. Bianchi and Phillips (2005) proposes a more holistic
approach that suggests defining an individual’s psychological state, which includes both
mental and emotional states as well as scholastic, occupational, and social interactions, as
being impaired by overuse of the Internet. Proponents of including Internet addiction as a
separate diagnosis in the DSM-5 argued that the disorder involves excessive use, withdrawal
(feelings of anger, tension, or depression when the technology is unavailable), tolerance (need
for better equipment, newer technology, more usage), and negative repercussions, which prove
to be the common components associated with other compulsive disorders (Young 2009).
Researchers have also stressed technology’s increasing salience in our lives, as it has
commanded an ever increasing presence in our thoughts and behaviors to the extent that
Int J Ment Health Addiction (2017) 15:604–613 607

people feel consumed with thinking about technology and even neglect basic self-care
activities like sleep, eating, and showering (Smahel et al. 2012).
However, placing a diagnosis on Internet addiction is problematic (as evidenced by the
debates that surrounded the DSM-5 publication). First, it is difficult to separate addictive
behaviors from legitimate and purposeful business and personal use of technology. Others
argue that pathological technology use may just be an electronic expression of a pre-existing
condition, rather than a distinct disorder. Skeptics fear that using broad, behavioral based
definitions of addiction might pathologize normal behavior and lead to overdiagnosis and
overtreatment (Markel 2012). Karim and Chaudhri (2012) worry that adding more disorders to
the DSM may dilute pathological behavior and increase the general public’s suspicion of the
validity of psychiatric disorders. Although the idea of an Internet or technology addiction has
received much attention, scientific understanding and consensus to date has lagged, due in part
to the lack of a common definition and consistent terminology (Shaw and Black 2008).
Many Eastern countries, most notably Korea, are already treating Internet addiction as a
serious mental health concern and public health problem (Flisher 2010). Korea has already
opened over 140 facilities (both outpatient and inpatient) specifically for counseling Internet
addiction (Fackler 2007). China has also been at the forefront of developing treatment
programs for Internet addiction, which they consider a serious public health danger.
Debate has continued in the US, most notably as to whether Internet addiction
warranted inclusion in the DSM-5, and now, moving forward, in considering future revisions.
For those in favor of inclusion, the most predominant and compelling view is to classify Internet
addiction (or PUEM) as a distinct disorder of the compulsive/impulsive spectrum (Bowen and
Firestone 2011).
Regardless of this ongoing debate over classification and diagnostic criteria, the maladap-
tive use of technology certainly continues to impact many psychological disorders. The
complex relationship between technology and human needs continues to evolve as digital
devices become more powerful, more portable, and more prevalent. Whether technology
overuse can exacerbate existing disorders or create its own disorders, dependence on technol-
ogy and the inability to be away from it for even short periods of time indicate that the effects
of constant connectivity are an increasingly important area of research and discussion. Impacts
and implications cut across all segments of modern society, and issues may manifest them-
selves in many life roles.

Technology and Work/Life Balance

One domain in which technology related psychological issues are continuing to appear is the
modern world of work. With the growing use of smartphones, tablets, and other portable
digital devices, it is increasingly difficult for people to fully separate themselves from their
work. At the same time, family and relationship issues are never far from the workplace.
Connectivity often impedes the ability to set healthy boundaries, and the line between work
and life outside of work seems to be fading. For many, the connectivity offered by mobile
devices has become an obsession. This blurring of the lines and inability to disconnect can
quickly lead to increased stress levels and can have negative long term impacts on cognitive
processes (creativity and decision making), personal and family relationships, and even
physical health. Depression and anxiety are not uncommon in the workplace, and can be
intensified by feeling overwhelmed by an ever-present connection to the job (Shallcross 2012).
608 Int J Ment Health Addiction (2017) 15:604–613

Work/life boundary issues present themselves in both directions. Whether checking work
email after hours, or logging into social media or personal email during work hours, the pull of
connectivity, particularly with the proliferation of portable devices, can have negative conse-
quences in both the personal and professional domains. With the increasing role and impor-
tance of digital media and communications, distinctions between work and leisure, public and
private, here and there are quickly disappearing, and stress related to misuse of technology
seems to be growing. Missing out on information, whether it is work-related or social, seems to
create a state of anxiety for many.
Rosen (2012) explains that people seem to use technologies compulsively in two different
ways. The first is due to a love of the device, the Internet, the software, or the apps, and the
second is because of a worry about missing out on something (and the resulting need to stay
constantly connected to the digital device). The first type of compulsion is driven by
pleasure, while the second is driven by anxiety and obsessive thoughts. Rosen espouses a form
of disconnection anxiety associated with symptoms of worry, negative emotions (fear or
frustration), and physical distress.
Psychologist Dr. David Greenfield (1999) explains that digital technologies can be addic-
tive because they are psychoactive, mood-altering, and often trigger enjoyable feelings. He
notes that email and texts, in particular, give satisfaction through variable reinforcement ratio,
similar to slot machines. Since the user never knows when they may get a satisfying
email or text, they are drawn to keep checking over and over again. This type of
compulsive behavior can obviously have significant ramifications in both work per-
formance and personal relationships.

Youth and Technology

Issues related to technology’s effects on mental health may be of particular salience when it
comes to the younger generation. A Kaiser Family Foundation (2010) study found youths ages
8 to 18 spent an average of 7 ½ hours a day on digital media. Young people are inundated with
technological input, social media, and virtually non-stop peer-to-peer interactions. This leaves
little, if any, downtime, opportunity to gain distance and perspective, or time for reflection.
There is evidence that this explosion in technology and almost nonstop digital social connec-
tion is manifesting itself in a number of negative ways. Counselors are reporting growing
numbers of teens and young adults presenting with poor social skills, anxiety, ADHD, and
even depression. Counselors also report that emotional intelligence (EQ) traits such as impulse
control, delayed gratification, ability to resolve conflict, cooperation, self-motivation, and most
importantly, empathy, are being negatively affected (Shaw and Black 2008).
Adolescents’ growing use of smartphones may be of particular concern. Recent studies in
Italy, Taiwan, and Australia (Martinotti et al. 2011) have classified problematic mobile phone
use by applying criteria for behavioral addictions, including cognitive salience, conflict with
other persons or activities, euphoria or relief, feelings of short-term pleasure from engaging in
the activity, loss of control over the behavior, withdrawal (experiencing unpleasant feelings
when unable to engage in the behavior), and relapse and reinstatement. Although also a
problem for adults, problematic mobile phone use is especially prevalent among younger
generations. As Young (2009) notes, time spent engaged with mobile devices (texting and
emailing) can impair important and purposeful relationships. The more time spent texting,
emailing, or chatting online, the less intentional and meaningful time is left for family and
Int J Ment Health Addiction (2017) 15:604–613 609

friends. There continues to be a shift away from family and friends and towards media
technologies as the primary socialization agents (Karim and Chaudhri 2012).
Time spent on the Internet and multitasking with multiple technologies is also increasing
among youth. In his recent book, The Shallows, author Nicholas Carr (2011) points to
neuroscience research that reveals how technologies used to find, store, and share information
can literally reroute the brain’s neural pathways. The stimulation to which the mind is exposed
every day is critical in determining how the brain works. There is evidence that today’s youth
are becoming ever more adept at scanning and skimming but are losing capacity for
concentration, contemplation, and reflection. Small and Vorgan (2008) argue that as the brain
evolves and shifts its focus to new technological skills, it drifts away from fundamental social
skills, such as reading facial expressions or grasping the emotional context of subtle gestures.
In another recent book, iDisorder, psychology of technology expert Dr. Larry Rosen (2012)
points to the neuroplasticity of the brain, or the constant process of strengthening and
weakening neural connections in the brain as a function of experiences. The brain continues
to change in response to internal and external stimuli, most notably through the mid-20s.
Studies using functional magnetic resonance imaging (fMRI) technology have shown that the
types of technological multitasking often undertaken by youths (and adults alike) literally leave
the brain buzzing with neural activity. Again, short-term and multiple processing capabilities
may be strengthened, but perhaps at the expense of the development of other deeper
level EQ functions, which are often strengthened through the bottom up process of
contemplation and reflection (neural processes that are inherently slow). Numerous research
studies have shown that periods of rest are important in allowing the brain to synthesize
information, make connections between ideas, and develop the sense of self, all of which are
critical to mental well-being.
The importance of understanding technology’s increasing impact on the human mind and
the resulting implications for affect, cognition, and behavior should not be underestimated. It is
vital to understand both the positive and negatives of increased use of technology and social
media, and in particular for mental health professionals, the ways this use may be affecting
neural development.

Social Media

Facebook®, Twitter®, Instagram®, and other social media tools have grown tremendously in
popularity in recent years, and Facebook has now surpassed Google as the most visited
website worldwide. While there are many positives to come from the sharing and connection
afforded by these sites, there are also many negatives that could manifest in issues presenting
in counseling. Various studies over the last several years have pointed to a number of negative
effects experienced by some users, including feelings of stress and anxiety and lowered self-
esteem. The arm’s-length relationships and emotionally detached communication offered by
the social media tools mentioned above can also serve as a disservice to those inclined towards
narcissism or other antisocial behaviors.
Like other forms of technological connection, social media can create dependency and
addiction like symptoms. The variable reinforcement ratio discussed previously is also of note
when considering the use of social media sites such as the ones mentioned above.
Behaviorally, improper use of social media can also lead to negative consequences in
relationships and marriages, within families, and in the workplace. Just recently, infidelity is
610 Int J Ment Health Addiction (2017) 15:604–613

being defined in the realm of cyberspace. Research reveals that women perceive cyperspace
infidelity more severely than men, and this difference in perspective can be a source of dispute
in relationships. However, overall, emotional relations via the Internet were found to be less
serious than infidelity in person (Whitty and Quigley 2008). The disinhibiting effects of being
behind a screen can cause people to be less cautious and less intentional in their actions. The
instant and continuous connectivity offered by social media sites only heightens the need to
maintain proper boundaries as social interactions continue to migrate to cyberspace.
As previously mentioned, the prevalence of digital communication through social media
may also be adversely affecting today’s youth. Ever-present social media applications may be
altering the values that youth hold most important. A recent study discussed in the ACA’s
Counseling Today showed that tweens (9 to12 year-olds) are placing increasing emphasis on
values such as fame, achievement, popularity, image, and financial success and less emphasis
on values such as benevolence, security, tradition, and spiritualism (Rudow 2011).
Deresiewicz (2009) explains the popularity of social media in that celebrity and connectivity
are both ways of becoming known, which is what the contemporary self wants. This focus on
connection and recognition often comes at the expense of solitude and personal reflection.
Counselors also report underdeveloped social skills (with an overreliance on electronic means
of social connection), lack of privacy (coupled with inappropriate self-disclosure), and
cyberbullying as important issues related to social media.

Gender and Diversity Issues

Problematic use of technology, much like other types of behavioral addictions, can transcend
lines of race, gender, ethnicity, socioeconomic class, and age. Some studies to date have
pointed out gender differences in overuse of certain types of technological activities (men are
higher users of online gaming, pornography, and gambling), but wider studies have failed to
find strong gender differences in overall use of technology (Shaw and Black 2008). Although
the lower cost and easy access to smartphones has aided in their proliferation, there is still a
degree of digital divide by which lower socioeconomic groups often have less access
to and use of technologies. Youth seem to be a higher risk group imply due to their
wider adoption and higher rates of use of new technologies. However, with the multiple types of
technology and connectivity available today, problematic use can be widespread across
varying populations.

Treatment Considerations

Regardless of the future classification of technology related issues or disorders, it is increasingly

important that counselors and other mental health professionals screen for the possibility that
technology is negatively impacting their clients. For most mental health issues related to
technology and connectivity, cognitive behavioral strategies seem to be the most effective for
treatment (King et al. 2012a). Winkler et al. (2013) conducted a meta-analysis of various treatment
options and reported that the preliminary findings did support CBT as an effective mode of
treatment. These techniques afford clients the opportunity to increase their awareness of how their
thoughts and behaviors are helping or hindering them in living life, specifically in regards to the
incorporation of technology and digital media into various life roles. Winkler et al. (2013) also
Int J Ment Health Addiction (2017) 15:604–613 611

reported that individual counseling might be more beneficial than group counseling for treating
internet addiction and there was no significant difference between psychological and
medication interventions. Winkler et al. (2013) did indicate that at the time of the
meta-analysis, there was a limited amount of research on the use of medications to treat internet
addiction. King et al. (2012b) suggest that CBT treatment may also be beneficial working with
children and adolescents. When treating Internet addiction, clinicians may choose treatment
approaches that have proven successful with substance abuse disorders such as psychosocial
treatments. While evidence-based research is still somewhat lacking to back specific treatments
for Internet addiction (Weinstein 2010), the continued discussion and further study
will examine how to successfully treat this growing global issue. It will also be
important to understand the co-morbidity and complex interrelation of problematic technology
use with other DSM disorders.
While cognitive behavioral approaches are most often helpful with these issues, systemic
approaches may also be appropriate depending on the underlying issues. For clients struggling
with identity, roles, and life goals, existential techniques may also be useful. When the client
feels heard, listened to, and empathetically understood, they are more likely to engage in
developing and actively implementing cognitive or behavioral strategies proposed for positive
change moving forward.
Statistics indicate that children in the United States average almost 8 hours of technology/
media use each day (includes cell phones, TV, video games, computer, etc.) and 71 % of
children have a television in their bedroom (Rowan 2010; Rideout et al. 2010). In order to
combat the trend of children’s unlimited access to technology and therefore increase in
physical deprivation and sensory hypostimulation, Rowan (2010) suggests that physicians
assess a family technology usage history. Before prescribing psychotropic medication, one
researcher suggests children engage in an B‘unplug’ trial of 1 month prior to behavior
diagnosis…^(Rowan 2010, p. 65). In addition to a four-week hiatus from technology, media
literacy programs in schools as well as time spent in nature are suggested as ways children can
further disconnect from technology.
It will be important to continue to expand both the awareness of technology’s role in this
struggle for balance and the array of clinical techniques that incorporate this awareness in
addressing the interaction between significant life roles. Lifestyle management, healthy life
balance, and carving out time to unplug, relax, reflect, and recharge are all key in changing
problematic technology use and addressing related mental health issues. Focus on making
mindful, meaningful, and intentional choices—slowing down and finding the time and space
to think— will help clients in need of tempering technology use with a goal of better life
balance.

Looking Forward

Important gaps remain in the understanding of technology related disorders given that they are
a relatively new phenomenon. Much of the existing empirical research has focused on the
Internet, but this ignores the broad and growing overuse of multiple forms of connectivity and
personal technology (notably the constant connectivity provided by smartphones). Bowen and
Firestone (2011) compare addressing the Internet as the sole source of technological abuse as
akin to restricting investigations of psychosis to schizophrenia and recommend further devel-
opment of an entire electronic abuse test battery.
612 Int J Ment Health Addiction (2017) 15:604–613

Smartphones, other mobile devices, 24-h connectivity, and the prevalence of texting as the
primary form of instant communication will continue to grow in importance, as will the need
for deeper understanding of the psychological effects of such technology use. Each year, the
number and type of portable devices grow, and the time we spend in front of screens of all
types continues its seemingly inexorable rise. As Carr (2011) points out, the technology feast
has become a movable one, available anytime, anywhere.
Further clinical studies are needed to understand the etiology of technology related
disorders, to more properly classify them, and establish the effectiveness of specific
interventions. Additional empirical studies and theory-based academic research will
help in this direction. It is clear, however, that we are facing growing problems
related to the overuse of technology across society. Reliance on connection to
electronic media has created an enmeshed relationship with technology, and that
relationship has important ramifications for our psychological well-being. We live in
a world of rapid advances in technology and abundant connectivity, and understanding
the ongoing implications will be of utmost important for professionals in the mental
health field.

Compliance with Ethical Standards All Procedures Followed Were in Accordance with the Ethical Standards
of the Responsible Committee on Human Experimentation (Institutional and National) and with the Helsinki
Declaration of 1975, as Revised in 2000 (5).

Conflict of Interest David A. Scott declares that he has no conflict of interest.

Bart Valley declares that he has no conflict of interest.
Brooke A. Simecka declares that she has no conflict of interest.

Informed Consent Informed consent was obtained from all patients for being included in the study.

Human and Animal Rights No animal or human studies were carried out by the authors for this article

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