Understanding Problematic Screen Use

In this webinar, our panel of experts define screen addiction and discuss contributing factors, root causes and treatment options.

Learning objectives include:

  • Formative experiences that lend themselves to screen use problems
  • Identifying and diagnosing screen use problems in clients
  • Treatments and theories relating to problematic screen use
  • Clinical support information on this topic

Featured panelists:

Noelle Carmen, host and moderator
Natalie Davidow, MA, lead therapist at Safe Landing Recovery
Megan Bush, MSW, primary therapist at Safe Landing Recovery
Dr. Daniel Kaufmann, PhD, MA, founding member of the Faculty Advisory Board for the Video Game Disorder
Jody Bechtold, LCSW, ICGC-II, BACC, PC, CEO of The Better Institute in Pittsburgh, PA
Jeremy Edge, LPC, IGDC, international gaming disorder certified counselor

Understanding Problematic Screen Use Podcast, Video and Transcript

CARMEN: 00:06Hi everyone, and welcome to our conversation today on behalf of Niznik Behavioral Health. I’m Noelle Carmen and I am so excited. We have an all-star cast today. We are talking about problematic screen use. Ηow we define it, how we identify it as clinicians and how we treat it. Before we get started, some housekeeping. You should all know that your CE information will be emailed to you after the webinar, so be looking out for that. You will also receive contact information for all of our amazing speakers today, so feel free to send questions. If they didn’t get answers, feel free to reach out in any way. I want to encourage you all to go ahead and ask questions as you go. And most of you know, we will try to have as much conversation as possible and get to all the questions at the end. So without further ado, let’s introduce our amazing cast and jump right into this topic. Jodi Bechtold, owner of the Better Institute. Her clinical experience has always been with addiction. Hi, Jodi. Welcome to the show or [crosstalk].
BECHTOLD: 01:19Thank you.
CARMEN: 01:20Whatever you want to call it, thank you for being here. Jeremy Edge, owner and founder of Escaping the Dotcom. His practice focuses on problematic screen use. Hi Jeremy.
EDGE:
01:30
Hello. Hi Noelle.
CARMEN: 01:32Naja Stryder, did I say that right?
STRYDER: 01:35Yes, you did.
CARMEN: 01:35Ah, good. Technology and video game addiction therapist. She is also founder of Eyes Up Wellness and programs director at Game Quitters. Thank you for being here so very much.
STRYDER: 01:50Thank you.
CARMEN: 01:51Dr. Daniel Kaufmann, assistant professor and lead content developer for graduate programs at Grand Canyon University. Thank you for being here, Dr. Kaufmann.
 KAUFMANN: 02:01Thanks for having me.
CARMEN: 02:03Natalie Davidow, she is a primary therapist for Safe Landing Recovery, a substance use facility for teens in Florida. And Megan Bush, also a primary therapist for Safe Landing as well. Okay. Welcome, everyone, to the conversation and let’s just jump right in. Okay. So the first thing that I feel like we need to do is talk about problematic screen use versus screen addiction and get some clarity around this topic. Jodie, can you start us off?
BECHTOLD: 02:36Yeah, thank you. When I hear problematic screen use, or I hear screen addiction, it’s a very broad term, but it’s also very specific. And I think that today’s conversation, we’re going to only scratch the surface when we talk about what is healthy screen use, what is problematic or at risk, and then potentially what we would view or understand as addiction. And so I define any type of addiction-related behavior as when you have negative consequences and you continue to do that behavior. So it doesn’t matter if it’s a process or if it’s a chemical. Right? So just really looking on that continuum from what’s normative and socially acceptable to add risk to a full disorder.
CARMEN: 03:25Dr. Kaufmann, thoughts on defining it in those terms?
KAUFMANN: 03:30I think that that’s a really great starting point. As soon as you start noticing consequences, there might be some denial, or re-contextualizing the use, or rationalizations all the time to explain things we want to continue. But we know deep down inside that this is going to get pretty bad. But it’s so fun. So that’s how you go from a normal behavior to at-risk to starting to see problems to being diagnosable for categories that have a diagnosis, which the screen ones do not right now in the American APA-based system.
CARMEN: 04:07Jeremy, your thoughts on these definitions. I want to make sure we’re all on the – oops. Sorry – same page in terms of operational definitions and how we’re looking at these things.
EDGE:
04:21
Yeah. I think I would kind of echo both Jodi and Dr. Kaufmann were saying. I think problematic screen use is when whoever we’re seeing that our screen uses is causing problems for us and our overall life. It’s not adding value to us. We’re looking at the four areas of this. There’s recreational, kind of everything that we’re doing within our screen uses is good and healthy. But when we talk about video games, specifically, it’s recreational at risk, or problematic, or disorder. But I think problematic screen use is when this type of screen use you’re doing, whatever that may be, is not adding value to your life. The emails that you’re doing is adding more stress to you than good, or the stuff you’re doing on Netflix watching is causing more problems than good. So I think when we look at the broad term, which is overall, it’s causing more issues than positives.
CARMEN: 05:06Did you just say emails? Are you including emails in with this? We’re all in trouble.
EDGE:
05:12
Yeah, it’s hard. There’s a lot of emails – yeah – to go through. So, yes, it can be anything.
KAUFMANN: 05:20I would just like to say I’m happy you invited me to the panel because I turned to Outlook [inaudible] very cheerfully 30 minutes ago. [laughter]
 CARMEN: 05:27You’re welcome. We’re helping you–
KAUFMANN: 05:29Thank you.
CARMEN: 05:29–with your recovery in all of this. Naja, thoughts in terms of what we’re talking about here and defining this?
STRYDER: 05:39Well, I concur with everyone’s thoughts about what would be considered addiction. The problematic use, for me, falls into whether it is– you can have excessive use that’s required and that can be a problem, or you can be using screens excessively when it’s not required. But when it starts to interfere with relationships, or intimacy, or productivity, whether that school or work, and when it’s a primary, not the only, but when it starts to become a primary coping mechanism, then that’s where, for me, it needs to be addressed.
CARMEN: 06:22Okay. So I’m getting ahead of myself here, but I can’t help but ask this question. When you’re talking about coping mechanism, can you be more specific in terms of what it is you mean? Boots on the ground, what does that look like?
STRYDER: 06:39Well, I think what that looks like is if you’re– let’s say you begin to have some social anxiety – and that’s really common now – but social anxiety, and you seek out connection via screens, you’re trying to cope with loneliness via screens, and that becomes your exclusive way of doing it as opposed to balancing it out, like using a screen as a way to connect with people that you wouldn’t ordinarily have an opportunity to, but then following up in a face-to-face, if possible. And this can be face-to-face now. You can be face-to-face across the country. But we are actually having an interaction that is not purely, I guess, digital. I mean, I’m not sure how to describe that anymore. But that’s typing, or that’s just viewing other people’s lives. So that would be one example for me of primary coping. And then escaping family problems is another way, if that’s your only way of coping with family problems instead of, let’s say, seeking therapy or trying to repair relationships with spouses or children. Again, that becomes problematic. And it’s much easier to do.
CARMEN: 07:56Okay. So this is interesting because when we’re talking about this– and I know earlier there was some conversation in terms of, okay, so substance use and how it may or may not be married in terms of when we’re talking about addiction, we’re talking about screen use, as well. And my question is, when we’re talking about escape, we’re talking about using this in kind of a negative way to cope, doesn’t that look a lot like substance use? Let me throw this over to Natalie and then come back round to our screen experts. Thoughts on this?
DAVIDOW: 08:38Yeah, absolutely. So I love that. Not just that about the escape part of it. So that element there. It’s an unhealthy coping skill. Just like with substance use, we’re using that as an escape from dealing with whatever the negative situation is, whether that’s family conflict, school stress, unhealthy relationships with peers, whatever it is, the trauma, all of these things, and we rely on substance use for our coping mechanism. The same goes for the screen, the problematic screen use, screen time addiction, however you want to call it. But yeah, it can be an unhealthy coping skill for sure.
CARMEN: 09:19Okay, so, Megan, so are we agreeing this is the same or not because I’m actually not even clear now in terms of our previous conversation? Do we feel like they’re married or do we not?
BUSH:
09:35
I mean, I would hesitate from using the term married. There’s a correlation, perhaps, especially in the way that the brain kind of responds through to the dopamine feedback loop. And if you’re talking about that, then there’s ways that it’s definitely similar in that both drugs and screen time kind of give our brains a boost of dopamine that wouldn’t be natural in kind of everyday life. So in that regard, you can see that there is a correlation there. And I’ve read some studies that find correlations. Marriage, I hesitate to go that far.
CARMEN: 10:18Gotcha. So let’s talk about social attitudes because I know this plays a tremendous role in how we interact with others that have problematic screen use, how we as clinicians interact with our clients. So let’s talk about– I’m very curious, what kinds of social attitudes are out there? And I know it runs the gamut. Let’s circle back to you, Jodi.
BECHTOLD: 10:51Well, you first would have kind of the negative, it’s bad, you shouldn’t do it, as if you’re kind of gripping the overall behavior as a negative or inappropriate behavior. I’m just much more always looking at, how do you reduce harm? How do you really employ that harm reduction perspective so that people learn to self-manage or self-regulate? And then it’s not about, is something good versus bad? It’s much more about, are you doing things safely or reducing harm, or are you increasing harm with your behaviors and choices? So I’d kick it off there.
CARMEN: 11:32Dr. Kaufmann?
KAUFMANN: 11:34I think that in order to take this idea that Jodi– and also going back to the substance use conversation, it’s all still the same conversation. And we have to look at the temporal relationship between the coping skill and its consequence. So the problem with the substance being used or the problem with the screen being the distraction is not that the screen exists or the substance exists and you’re putting it in to your body or your mind right now. The problem is that you’re getting blackout drunk when you’re in the living room every Friday night because work is hard, and you can’t stand being around your family. Instead of investing yourself in the family, you become this absent monster that’s just negative behaviors towards other people. So the problem there is maybe you need a different job or maybe you need to invest time in those relationships to try to find the good things that make you enjoy sitting in the same room with such and such person. Same with video games. The problem isn’t that a college student would play video games. The problem is they needed to study for their exam to get a good grade. If you study for the exam and then play video games, it’s now a coping skill like the kind counselors are trying to pass on to you. [laughter] Those friends are now positive influences on your life. But if you play the game first and never get around temporal, that time space relationship, if you never get around to studying, now it’s the bad coping skill the counselors are trying to keep you away from. Now, it is the blackout drunk alcohol. It is the heroin and opiates. It is the life derailing addiction because you haven’t put the sequence of events into your life correctly.
CARMEN: 13:22Let’s step back from this for just a minute and talk about this notion of bad. Where did this notion of bad come from? I can tell you as a parent, completely 100% guilty. The second I see my kids on the screen, I’m like, “No, that is not–” you know what I’m saying. So in general, where does that come from, historically even? Jeremy, can you speak to that?
EDGE:
13:54
Yes, I’ll probably talk to this. So I think part of it is, first off, just not understanding. I think there’s a lot of gaps in certain generations, right? It could be music, or it could be technology. And I think whenever a parent sees their kid playing World of Warcraft or on TikTok, it’s completely foreign to what they’ve seen or that they’ve been exposed to. And they think it’s scary. And so they see it for one with not understanding. And so for one, they’re judging it as it’s a bad thing because they don’t know what it is. But then they see maybe some potential negatives that they’re associating with that. “Well, my kid won’t do their homework or just want to play their game,” or, “They won’t hang out with us because they’re just talking to friends of mine. Whenever I try to get them off and interact with the family or hang out with us at dinnertime, they’re only on their phone.” So that’s the place where I’m saying, “This is the problem. This is the problem,” not how I’m interacting with them or not how they’re able to explore their world and explore their experiences through this platform. One of the biggest problems is just parents’ lack of understanding and not really trying to understand where the kids with this technology is.
CARMEN: 15:00So this segues into the quick fix culture, right? It’s way more entertaining for my kid to sit on the computer and play a game than it is to take time, have an eyeball to eyeball conversation, process through ideas. There’s some of those notions right out there, which is kind of where I was trying to go with this. Naja, do you have thoughts on this where we pop the pills, we want our quick fixes, we want our quick answers, we want everything fast? And surely, that goes to a biochemical interaction as well, right? So can you kind of talk us through that?
STRYDER: 15:49Oh, boy [laughter], that’s a lot.
CARMEN: 15:52Yeah, here we go.
EDGE:
15:53
I think there have been sociocultural factors that have been bringing this along for years and years and years. So it isn’t as if one day we woke up and we found that we wanted more instant gratification, because if you think about it, 150 years ago when we were an agricultural society, there was no instant gratification. And even 50 years ago, instant gratification was much less available. So we’ve moved in every domain of our society in that direction. So it’s sort of no surprise that that’s what our youth is looking for. I concur with Jeremy from the perspective of there’s often a generation gap and with each generation there is sort of a moral panic about how we’re being changed. When the telephone was invented, for example, people thought that would completely diminish face to face interactions. You wouldn’t have to go to your neighbor’s house. So there’s that aspect also. And then I think as originally when mobile devices were used primarily by professionals who needed to now be on the go making deals, answering emails, when that became wider use, there was this assumption that it was frivolous. And so we look at every time– still, I think there’s that belief that when there’s a device in your hand, you must be doing something frivolous. So that becomes the tech shaming. And as we know, it’s not frivolous a substantial amount of the time for many people. Does that answer your question?
CARMEN: 17:38Yes, but it begs many, many more. So I think part of what we’re talking about, maybe on a deeper level, you guys correct me if I’m wrong. We’re also talking about where our connection as a society lies, right? How we communicate. It looks very different than it used to. Like me as a parent, I value sitting down with someone and having a conversation. And so that’s real connection, right? So can we talk about screen use in terms of real connection and how we define that? Dr. Kaufmann?
KAUFMANN: 18:24Well, you just made me realize that for the last month or so of my private practice, I’ve talked with many people who wish that they had a stronger romantic outlet in their life in the sense that they’re not dating anyone. But I haven’t talked at all about people going to bars like I would have a decade ago as a counselor, or restaurants or clubs. It’s only Tinder. And so it’s sort of like apps are the meeting places. Apps are the social lubricant now. And if we’re inclined to have this value judgment against things that happen on screens, I could sit there as a counselor and alienate my client from me in the session and say, “That’s not really putting yourself out there. You’re still in your living room. That’s not really dedicated decision to go meet someone. That’s like, ‘If it happens, it happens and there’s no stakes.’ ” Plus I could also question the importance of that connection in terms of how casual or extra it is, but then again, maybe some really great relationships start because of Tinder, too. And I’m just the old person looking at that app the way so many older people than me have looked at my video games.
STRYDER: 19:41Can I add something to that?
CARMEN: 19:43Yes.
CARMEN: 23:33No, I’m I’m talking about– so we’re talking about this enmeshment with mom for the male. What does that look like on the female side for a woman who also struggles with this addiction?
STRYDER: 19:43That as a social– the social rituals have changed so much. So to deny, to shame somebody for their Tinder use or with younger people, you meet somebody and then you’ve got to send them a Snapchat there’s a whole new social ritual, not dissimilar to what we see in the animal world. They know what they need to do, so as clinicians, if you’re not able to understand and embrace and help people live in a world with these new rituals, and then still manage the amount of time that they’re on screens, and then be able to leave a screen for the next step in the social ritual, that’s when things become problematic. But purely shaming or purely being negative about those rituals is really not helpful.
BECHTOLD: 20:41Well, you’re talking to–
EDGE:
20:41
Can I have one more thing– oh, go ahead.
BECHTOLD: 20:43But you’re talking about the social connections and the social connectedness, and we get caught up in how people get socially connected as right or wrong or better or worse, as opposed to just the importance of the connection, helping people navigate that connection that works for them. And so different generations are going to do that, different personality types. Some people are much more comfortable in social settings than others. Right? And how do we really encourage the connectedness, I think we have to be very mindful about.
CARMEN: 21:20Hey, devil’s advocate here. If we’re not practicing those social connections socially, eyeball to eyeball, those are skills we need. Those are skills that can be developed. Right? So when you’re talking about, say, youth versus adults, so I know I can get on a screen and have a conversation, but I am equally as comfortable eyeball to eyeball. But when we’re talking about formative experiences, don’t we need to be a lot more careful? Who wants to tackle that?
KAUFMANN: 22:00I think from a human development perspective, it’s important to understand that we don’t really have a full dataset of people who grew up with Zoom being their kindergarten class, and how they will look when they’re older adults, senior citizen population. That would be amazing, but we’re not going to have that for about 60 more years. We have to pay attention to it as we go. One of the things about screen use and the value judgment that society makes us sort of buy into automatically is that somehow it’s okay for my students to earn their master’s degree or doctorates interacting even less directly than this, what we’re doing right now. Industry benefits greatly, millions and billions of dollars across the country, using technology to efficiently synthesize out that social component and make it just about the activity, the behavior, and the outcome.
KAUFMANN: 23:05And so that’s what we’re facing now on the individual family-to-family, person-to-person level is, is that really a good thing? But I think that you really can develop friendships inside an app like Discord doing random movie viewings or watching a game stream or rating, doing boss battles together. You don’t make that strong, deep friendship connection with every single person you encounter, just like you don’t do that in elementary school just because you’re on the same playground as everyone. So we’re not really seeing anything different. It just looks different to us. And we’re judging it with black and white thinking like, “Every kid needs to be able to interact wonderfully with every kid on the playground.” It’s like they don’t do that now in person. Well, actually we cut out recess so that they can get their math scores, but if we did give them recess, they might play less things on their screens. And the social development of early childhood is largely being lost anyway. We don’t emphasize play. We’re afraid of it. We demonize it. And as a result, the only positive reinforcement a lot of these kids get comes from their Instagrams and their Snapchats that they’re probably too young to have accounts for anyway.
CARMEN: 24:32No. It’s definitely okay. I think I was really just talking about the prognosis of bringing in a couple. And as Evan mentioned the partners totally surprised. That’s an interesting thing. Too young to have accounts for. I definitely want to talk about that. But before we do that, Natalie and Meghan, can you talk about– you guys are boots on the ground with teens. What are you seeing in terms of connection relationships from your perspective?
BUSH:
25:00
That’s an interesting question because so much is what the teams that we work with know and so much of their interactions primarily have to do with screen usage. So one can make the argument that screens are beneficial for shy, introverted teens to be able to connect with other human beings because otherwise, their social anxiety interferes too much with that connection and normal face-to-face interactions. On the other hand, you can only overcome fears when you confront them. So because they have this outlet where they can just they can continue, quote unquote, interacting with people through a screen, they’re never able to tackle their fears of being face to face with somebody, and they’re never able to develop those interpersonal skills that allow them to engage at a higher caliber with other human beings. So that, in combination with– I think what’s more problematic than just the screen usage and being able to connect with others is the validation that they get through social media and through the screen usage. And anxiety in it as well. There’s something on Snapchat. I can’t remember what it’s called, but it’s like your snap streak or something where Snapchat keeps track of how much daily you’re interacting with another person. And I’ve met teens that have anxiety over the fact that, oh, no, I’m going to lose the streak because I’m in rehab. So now we have these measurement tools that would have never been in place and causing the teens anxiety, that naturally wouldn’t be there. So there are some benefits to it, but it’s really, really hard to balance those with the detrimental components that we see, like the anxiety. And oftentimes the teams are talking about, “I’m sure I have so many texts. Can I please just look at my phone before we delete these contacts? Can I please respond to this?” So the biggest thing that I think and I think Natalie would probably agree, but I’ll let you talk in a second. It’s just the anxiety surrounding the interactions through the phone.
DAVIDOW: 27:31Yeah, and the comparison habits, right, from all of these different social media platforms that they’re using and comparing themselves to each other. But that’s another topic on its own. The one thing I will say with every single teen client that I’ve worked with at Safe Landing, the very first expectation that the parent sets for them upon their return home is you’re not going back on social media. You’re not getting your phone back. That is the first consequence. So for as far as social attitudes go, that speaks big-time to that and the views that parents have on the technology and the usage of their devices.
BUSH:
28:23
And I just wanted to piggyback off that real quick and just loop it back to something that we were talking about before, which would be just parents and older generations misunderstanding about just the fact that now we live in a society where we do have technology. It’s present. It’s part of our day-to-day life. So how do we balance that? And with being able to have the normal human-to-human interactions that we know is essential for healthy development. How do you balance just being in touch with the times with healthy development. It’s difficult.
CARMEN: 29:08Okay, so then that begs the question, what’s the rulebook here? Experiences that begin to cause developmental issues. This is confusing. It’s good. It’s bad. It’s healthy. It’s not healthy. You’re going to be addicted. It’s not problematic yet. So can you as experts start to guide the way in terms of how we are supposed to view this? Tell us what is bad. Tell us what are these developmental things we’re looking, for boots on the ground. Jeremy?
EDGE:
29:46
I kind of want to go back. This is something that Nadia said before the recording started. But I think if we look at it like food, it can be a great way to focus on screens. We all need food. We all need to be able to eat food and really to be healthy, for it to be part of our lives. And now we can eat healthy. And we can model as parents or as caregivers, eating whatever we want, whenever we want. It doesn’t matter. No consequences. But then we’re going to have the problems in our own life. And then our kids are going to probably have those same behaviors. But we could talk about amounts, why we need to eat broccoli, why we need to be able to eat fruits and vegetables, and the benefits of being able to have a well-balanced meal. The same thing goes with technology. If we model, as parents, healthy screen use and being able to have a positive interaction with our devices, all devices, and be able to model, “Look, that this is adding a lot of value to my life. This is going to help, hopefully, add value to your life as well.” Then we can have a healthy balance on all of it. I think it’s just being able to see it as being able to model it at first and not to demonize any part of it. I think that can be a big piece.
BECHTOLD: 30:54But modeling it and making it a family way of behaving– so I always go back to, “Does the family actually have dinner together at least a couple of nights a week? And what does dinner look like? Is everybody looking on their devices at the same time? Is there a rule for no devices?” Right? And so it’s more than just role modeling sometimes. But it’s actually creating and reinforcing the family behaviors individually and collectively.
DAVIDOW: 31:28Yeah. I want to say that, Kelly, you are so right. When they have so much denial about their behavior, they may actually sort of know it in the back of their So I shouldn’t be on my phone while I’m trying to tell my kids not to be on their phones. Is that what you’re trying to say?
BECHTOLD: 31:34Exactly.
KAUFMANN: 31:35Yes.
CARMEN: 31:35Noted. Noted.
STRYDER: 31:37Can I circle back to something that you said just before we lose the plot because I know that for you, as a mother of younger children, the developmental part is something that you’re really– it’s in real-time for you?
CARMEN: 31:51Yes.
STRYDER: 31:51And I think for all of us here, a major concern, and probably what attracted many of us to this, is learning to interact face to face is a developmental task. And learning to do it successfully is a developmental task. And historically, that was the only developmental task that we needed to do around socializing. But I believe and I can’t say that I can point to studies, that a lot of the anxiety that younger people are feeling and older people as well is you need to be simultaneously developing two skill sets. So how do you do this face to face? And how do you successfully also do this online? What do you say in a Snapchat? What do you post on Instagram? When do you comment? What do you hashtag? This is an enormous– or just emailing the quote-unquote. I screamed at my kids all the time, “Just email your teacher. It can’t be that hard.” And stepping back, it is difficult to do because we don’t have a rulebook for how. So I think it’s important to be empathetic as parents and also as clinicians that they have demands that, for us, we’re not understanding how significant they are.
CARMEN: 33:15What–
KAUFMANN: 33:16I would like–
CARMEN: 33:17Oh. Go ahead, Dr. Kaufmann.
KAUFMANN: 33:18Can I’m something to do that?
CARMEN: 33:19Right. Yes. Right.
KAUFMANN: 33:20I think all of these skills we’re talking about, whether it’s talking about the concept of food and we all need food and so the screens, they have to fit into our lives somehow. But we have to really evaluate what that looks like. And then I just have thoughts from the last four people. So Megan, Jeremy, Jodie, and Naja, you all have given me– I’ve been bursting to speak.
CARMEN: 33:45Speak.
KAUFMANN: 33:46We have to chill out when we’re looking at 7-year-olds, 9-year-olds, 12-year-olds, 14-year-olds, 17-year-olds, 19-year-olds, and and just look at what they’re doing at face value a little bit better and realize they have some leveling up to do. If people would’ve looked at me as a 10-year-old and said, “He’s an introverted kid and he plays video games. What will he become in life?” [laughter] well, I might still be on this panel, but I’d be saying something much more angry right now. The whole constellation of video games giving me something to actually do in the field of psychology did not happen until 17 years later for that 10-year-old. And then not everyone is going to be me. And I remind people this as a teacher and as a supervisor and as a counselor, “Your goal is to be the best you that’s possible.” And I think that we’re so worried that, “My 12-year-old is playing Roblox. What are they going to look like as a 25-year-old?” [laughter] It’s like, “Whoa! Whoa!” How about, “What’s the weekend going to look like if I spend time with them and ask them curious questions and show that I love them?” We’re getting way ahead of ourselves. Now, there is problematic screen use, game use, social media use, and all these other apps that pop up and fit into so many different categories in hybrid ways. But if you are worried about a skill developing, remember how skills develop with progression and practice and trial and error. You don’t just tell someone, “Socialize better,” boom, PhD in communications. [laughter] It takes a lot of work to become good at things. And I think that the internet has caused the adults to romanticize the story of how they became good at things and also cover up the things they’re not good at and still tell the story as if they are good at it. And the kids are like, “What is development? I haven’t been given a stage-by-stage opportunity to grow at any point in my life. At five, people have been grooming me to pass a math test that’s designed for 16-year-olds.”
CARMEN: 36:16So set the stage for all of us as clinicians. How do we gauge where we stand on this topic? How do we self-check in order to be able to look at this problem, help our clients? First, we have to come to terms with where we are with this topic. Would you not agree? Jodie, can you speak to that?
BECHTOLD: 36:44Yeah, as you’re saying that, I’m thinking, one of the best ways to understand is to experience it yourself, right, both personally and/or professionally. And so how many of us have actually been very intentional about not being on our phones, intentional about closing the laptop lid and doing that for seven days, right, not just one day, right? Because that really helps to understand when something is more of a challenge or when it’s fairly easy, right? And it also helps us to better share and problem-solve with our clients what will work for them, right? And so we all have to really have that awareness of our own screen use. If we were watching a video of ourselves all day long, what would we actually say about ourselves, right? And so it always comes– for me, it always comes back to that self-awareness before you then know what you want to change or how much you want to change or what your view is on that. So I’ll start with that.
CARMEN: 37:54And that’s important For the war– we as clinicians to be able to self-check on all of that. Jeremy, do you have thoughts on that? Because I know you’re a gamer. So I’m just curious.
EDGE:
38:08
I think a part of that can be trying it ourselves. I think we should look at the people that influence us, like how are we raised? What was our parental influences for us? What do they say about screen use and video games and TV time? We’ll ruin our eyeballs and write like what influences we’re getting. And then what’s society saying, and how do we respond to that? Do we hear news and say, “Oh, yeah, I agree with that. Gosh, violence in video games causes violence in real life.” Or, “Gosh. Yeah, I’ve seen this with my kid.” And, right. And so I think how we’re able to digest information is going to come out with our clients, with our kids, with others as well. And so I think it’s good to know who are the influencing people, consciously, subconsciously, historically? That’s a good way to help us understand what’s our stuff when it comes to screen use. And for the record, no, games do not cause violence in your life.
CARMEN: 39:06Okay. So you’re saying for [inaudible] clinicians, find out who influenced us and put it away for a while and see how that feels for us. Any other words of advice before we move into some real-life examples of stuff you see, boots on the ground. Any other words of advice in terms of gaining perspective before we begin treating our clients?
EDGE:
39:36
I mean, when it comes to treating our clients or kids, I think we should really learn to just explore and have a place of curiosity and talking and learning about what our kids and what our clients are doing online, whatever may be right. But if we’re able to kind of just come at it from a completely exploration curiosity, no judgment time, of just kind of talking and having the person be the expert and we just sort of learning, and it can be really, really eye-opening. Rather than saying, “Oh, you’re just playing Minecraft all day,” and, “You’re not doing your homework,” it’s, “Oh, you’re really building so much.” “You’re really proud of hanging out with your friends, of being the leader and being the one who’s kind of creating these things and doing all stuff.” So there’s a lot of problem- solving, a lot of determination about leadership. I think if we’re able to just explore and learn about what our kids are doing online, what our clients are doing online, that can really give us a good point of view of, “Okay. This is a [inaudible]. This is a really good thing.” Or maybe this is something we need to talk about as far as it’s a problem. But if we see it and learn about that person, that can be a good place to start this.
KAUFMANN: 40:38Especially with Sandbox games like Minecraft II, if you’re a clinician that’s excited by things like Sand Tray or Play Therapy, spend time figuring out exactly to the detail what that kid is actually doing when they play for an hour. You could even make a clinical prompt to ask them to try to accomplish things with their Minecraft materials. It’s not like Minecraft is this foreign language that we can’t possibly understand. It’s an infinite Sand Tray, literally. So if we can call that available therapeutic service when it’s just a tray with sand in it, and we put some dinosaurs and some happy and sad adult figures in it, maybe a dragon. Then, we can absolutely use our clinicians to show our clients that there is actually something very cognitive developmentally interesting about Minecraft and other games like it.
BECHTOLD: 41:38As a clinician, it’s so important for us to create that judgment-free environment, because by the time someone does come to us, we have to understand there’s an element of shame, maybe deep shame or– but there’s something there. And when they can come to. to an environment that’s judgment-free, that’s curious, that’s not trying to give a– pathologize or diagnosis right away. Think of how much more information that we get. And that’s very similar for parents and caregivers. Are we really giving that judgment-free zone and that judgment-free environment to get curious and understand? So that’s a big challenge. And a working goal for all of us is to constantly create that safer environment.
CARMEN: 42:26Okay. So step one, we have concerned clients coming through our doors. And so step one is we’re not going to automatically assume anything. We’re going to ask a lot of questions. We’re going to be very open, very nonjudgmental. Having put away the technology ourselves, we are ready to connect with our clients. So when does the judgment begin? And I ask that jokingly but also kind of seriously in the sense of clinically when we’re looking at, “Okay. Now it’s time to start actually saying there’s a problem,” how does that happen? And how does that transition between, “Oh, you built– you built a building in Minecraft. That’s amazing,” to, “Okay. You’ve got no relationships. You’re your wife is about to divorce you because you’re not spending time any with her”? How do you make that– cross that bridge?
CARMEN: 43:28Yes, Doctor Kaufmann?
KAUFMANN: 43:29Noelle, you just did something that I do during session one all the time with games-related clients coming to my office. And that’s we describe the problem twice, once where we describe it with games being part of the story. And they say, “Okay. This is really good information. I want to hear what this problem sounds like if we don’t get all distracted by the screens. I know how the screens fit because you just described it to me. So what’s the problem without the screens and technology?” And that’s when they start talking about their bad relationships or the job or the school grades or not showing up to things on time, bad time management, poor decision-making. And it’s like, “Okay. So now we can connect those dots,” is whether you quit screens and games and all these social apps altogether or we moderate them and get them in a harm-reduced kind of more functional way. We’ll know if we’re successful when the way you described it, the second time starts to be less and less true over time.
BECHTOLD: 44:30Yeah. What’s the symptom and what’s the cause? Oftentimes we’re so quick to point to technology or something like that as the cause when really it’s a symptom of individuals. We all as human behavior, we struggle to solve a problem. And so we avoid. And so then we– you could look at it as escape. But it’s also just overall avoidance, right, an avoidance to something. I’m going to solve it by getting distracted somewhere else.
CARMEN: 45:00You give us some anecdotes so that we can hang our hats on this, some real-life examples of what you’ve seen to give us a more– a more foundational idea of what this looks like. Anyway, yeah. Go ahead.
CARMEN: 45:21Go ahead, Jeremy.
EDGE:
45:21
Do you want me to start? Okay. Yeah. So the clients I work with, a lot of these have been around gaming. And so one client I was able to work with early on was like, “There are some issues with school. There are some issues with social life.” The more we dug, the more we dug it seemed like there– he was saying that there were some issues with how much time he’s playing online, how much time he’s playing in games. And so I think the more that we’re able to say, “Look, okay, so what are some of the goals you want just kind of in our time, right? You mentioned improved grades and better social life.” And so I think the more that we dug and found that, “Okay. So you’re spending your time– you’re choosing your time to play these games of relaxing hobbies is great. But it seems like maybe you’re choosing this over your grades or over time with friends. And so what do you think about that? I think if we’re able to practice motivational interviewing, it can be a really good clinical way to help work with our clients. And obviously, I’d love to hear what everyone else is thinking about that. But it seems like if we’re able to kind of come from a place of, “This is where you’re at. This is what objectively we’re seeing. And this is the outcome of what you want to have happen. Let’s talk about what the discrepancy looks like.” You’re able to play with your friends online. You’re able to play with your friends, have a good relationship. That’s awesome. That’s great. That’s helping you reach your goal. If you’re able to play games online and that’s helping your social life, fantastic. What does it look like then to be able to utilize that and to grow on it? What does it look like to be able to use that and be able to– how does that translate into academics? And so I think one practical tool is that motivational interviewing and seeing what are some of the goals that you have? And if it’s for kids. You don’t care about your grades. Okay. Your parents do. So what does it look like to just pass? How can we still be able to have a fun hobby but still pass your academics or still do what you need to do and for adults to– what does it look like to maintain these and to have a great relationship with your spouse or friends, but these things to encourage that, basically?
CARMEN: 47:16Other thoughts?
STRYDER: 47:19I think that it’s fair to say that problematic screen use– there’s always a co-occurring either issue or disorder diagnosis, so understanding– and this is sort of what Dr. Kaufmann was saying, too– is understanding what’s co-occurring? And is it chicken or egg? Does that really matter? Unless the co-occurring issues or disorders are also addressed, then you cannot expect to have a long-term positive, sustainable outcome. I think that’s number one for clinicians to think about.
CARMEN: 48:01Yeah. I think that’s–
KAUFMANN: 48:01I think it’s important–
CARMEN: 48:03Oh, go ahead. Sorry.
KAUFMANN: 48:03Just to add to that, it’s important when we’re negotiating what that looks like with our clients to realize that we’re not always spending our time teaching them what to stop. And if we do, we’re letting them down at a certain point. We also have to be using the therapies. Session is a time to figure out what to do in that spot just like a parent saying no more social media. But they’re absent. And they don’t pay attention to their kid when they actually did put the phone down. It’s a double-bind communication. And therapy is not just about learning how to stop an addictive behavior for people who come for that purpose. It’s about how do we live life without that behavior? And we have to remember that.
CARMEN: 48:51So this brings our conversation to that family system topic, which is so important in terms of -even what you just said- everyone’s attitudes, everyone’s interactions, the kid. The partner puts the technology down. But what is the other dynamic? How do we look at all of those dynamics together? Who would like to tackle that?
BECHTOLD: 49:20I’ll do it. I’ll go first. I mean, for me, family– we can look at it two ways. Try and change the system but keep the rules the same. And we keep wondering, is it really going to change. And then overall, where we get the most effective change is when the rules change. And everyone in the family -however you define family- has to follow those new rules. And we made the mistake with substance use disorders that we treat the individual with the disorder. And then we send them back home, but we’ve had that, quote, one family session or the family was invited to attend, and it’s really hard to have the individual change when the rules haven’t changed. So however we look at rules– social dilemma did a great job making fun of and showing what happens at dinner, no devices, and all of that. And how do you change that rule for everyone? So that’s at a really high level. And then with each family, because they’re so unique, you’re looking at what rules need to change and what does each person need to do in that system to follow those new rules. If you’re really going to have longer-term sustained change and a healthier functioning system.
CARMEN: 50:43Because we say that–
BUSH:
50:44
I wanted to build– oh, sorry, Noelle. I wanted to build up what you said, Jodi, because rarely– well, I mean, in any problem, rarely is it just the child or the one individual. We all exist in the system. Your parents are the most most important people in your development in your life. And I had a client who through therapy, we were able to kind of figure out that his substance use had a lot to do with his relationship with his mother and not feeling seen and heard by her. So and a lot of that had to do with he mentioned so many times that he would get scolded for being on his device or playing video games. And yet when he tried to come to her and tell her about his day and tell her about his feelings, she’d be sitting at the kitchen table, scrolling through her phone and halfway listening. So if you’re going to make one rule for a family member, it needs to apply to everybody else. And not something that I hear over and over again with my clients, I’m the one trying, but they’re remaining the same. So I think that parents have to recognize that. I mean, particularly with the screen use, we all exist in a society today where we’ve all got this next to us at all times, right. And it is really tempting to be on it. And as a parent, you don’t really recognize how much your children are observing your behavior. So first and foremost, you have to model that good behavior. And if you’re asking for them to not be on their devices, you have to not be on yours either, because there’s that big issue of being present for relationships. Just like that human connection, you have to model it and create an environment in which it can thrive.
BECHTOLD: 52:38To just build on to what you’re saying also, it creates a perfect storm for a parent whose avoidant. Because have to remember, adults have all kinds of attachment issues. And if you’re an avoidance parent, we can say to the parent, “Oh, you have to model good behavior.” But this is the perfect tool for them to not be intimate with their child. It’s so easily accessible to avoid that intimacy. And then, of course, avoidant parents will raise children who seek substances or devices, let’s say, for comfort, because they’re not getting it where they should be getting it. So I thought that was important to interject and helping parents to understand their own family of origin and how there’s an intergenerational transmission that’s contributing to this.
CARMEN: 53:28And it’s not just parents, right? When we’re talking about the system, I mean, it sounds like we’re talking about educating the system that they are part of the actual problem. I mean, we see it all the time in addiction. It’s like, “I’ve dropped my child off. Could you just fix them and get them back to me,” or “My partner’s really, they’re very problematic. If you could solve that, and then Then everything will be fine. But when the family starts going, “I’m sorry, are you saying I’m part of the problem?” So it really sounds like it’s complex, right? You’re educating not just the offender, but the whole system. And that is not an easy task. Nor is one family session, right, going to solve the problem. So when we’re talking about this– so I see that we are running out of time, which I knew we would. Let’s move into– Jeremy, you mentioned motivational interviewing. Give us other methods of treatment that you use.
EDGE:
54:43
Cognitive behavioral therapy is one that works really well, CBT. Looking at a lot of cognitions, looking at how their core beliefs and what their thinking is about screen use or about games or about whatever it might be, and how that’s causing some problems for them. I think sometimes solution focus can be a good one to be able to see the practical– try to problem solve through something. But really, CBT and motivational interviewing are two big ones that I use in treatment. And acceptance and commitment therapy as well. ACT is really good. Again, there’s so much shame. And so to be able to say, look where you’re at, based on what’s happened, it makes sense. Doesn’t justify a continued use. But let’s talk about what you can get to a different place. But just trying to accept where they are, and help them accept where they are, can be a good place moving forward.
KAUFMANN: 55:32We don’t actually spend a lot of time at the right points in time in people’s lives, helping them, encouraging them to have presence and being deliberate about their decisions. And remember, the screens appealed to us because the apps and the software inside them are designed to manipulate our behavior, to keep us engaged and connected, to come back every day and to have a fun, satisfying experience all the while doing it. Most of the things that we are trying to say, “Don’t do screens, do this instead,” do not do that in a satisfactory way. We have a tough sell as clinicians to our clients because we’re trying to teach them to be mindful in a multitask, “do everything but less efficiently” kind of world. And we’re trying to tell them to be meditative and contemplative in a world where everything has little red numbers on it, including our Q&A thing at the bottom of this screen. And those urges are ever-present. And to learn to just say, “Eh. That two can be a two thousand. I don’t care.” Just kidding. We love your questions and we’ll answer them. Right. Or the text messages or the emails, whatever that red number means, it means, “Look at me now.” And to be able to say, no, I’m good the way I am right now– going back to acceptance, commitment therapy, to teach people that that’s okay to feel and to live by is sometimes hard, depending on your client and what their starting point is and what they need to learn to accomplish that.
STRYDER: 57:19Can I add one more thing to that? Just also, when you were talking about families and parents and children, credibility for parents when they’re being critical about social media or critical about gaming gets highly diminished when being a social media director is a career. Learning to be– digital use is a major in college. Your high school or your college can have a gaming team. So being able to have a conversation with your children when that is real, how can you demonize it and be credible is important, I think, for families.
CARMEN: 58:03Want to end with a word of encouragement, because we all know we all have been frustrated, and I know there are individuals are who are very frustrated right now. Their relationships are in a place where they may even feel helpless in terms of how to even move forward. So can we get a word of encouragement there? There are practical ways to address this issue and move out of maybe a stuck space where someone might feel that they are right now. Anyone want to speak to that on a closing note?
BECHTOLD: 58:42I would just say it’s so helpful to talk to someone because we all deserve to feel good. In our own ways, right, it’s good to feel good and go talk to someone, because it really does help, and we can really reduce and fully eradicate the stigma related to asking for help in mental health.
CARMEN: 59:06I love it. I want to thank each and every one of you, Daniel, Natalie, Megan, Jeremy, Jody, Nadia. Thank you so much for just giving your time. This is actually one of my favorite webinars we’ve done. What a fantastic conversation. Thank you so much for being here. On behalf of music, behavioral health, I want to thank everyone who joined in. Be on the lookout for our next webinar. It will be on gambling. So be on the lookout. Have an amazing afternoon. Thank you guys for being here. Thank you.