Problematic smartphone use
Problematic smartphone use also known smartphone overuse, smartphone addiction, mobile phone overuse, or cell phone dependency, is a proposed by some researchers to be a form of psychological or behavioural dependence on cell phones, closely related to other forms of digital media overuse such as social media addiction or internet addiction disorder. Other researchers have stated that terminology relating to behavioural addictions in regards to smartphone use can cause additional problems both in research and stigmatisation of users, suggesting the term to evolve to problematic smartphone use. Problematic use can include preoccupation with mobile communication, excessive money or time spent on mobile phones, use of mobile phones in socially or physically inappropriate situations such as driving an automobile. Increased use can also lead to increased time on mobile communication, adverse effects on relationships, and anxiety if separated from a mobile phone or sufficient signal.
History and terminology
Founded in current research on the adverse consequences of overusing technology, "mobile phone overuse" has been proposed as a subset of forms of "digital addiction", or "digital dependence", reflecting increasing trends of compulsive behaviour amongst users of technological devices. Researchers have variously termed these behaviours "smartphone addiction", "problematic smartphone use", as well as referring to mobile phones (cell phones) rather than solely smartphones. Forms of technology addiction have been considered as diagnoses since the mid 1990s. Panova and Carbonell published a review in 2018 that specifically encouraged terminology of "problematic use" in regard to technology behaviours, rather than continuing research based on other behavioural addictions.
Unrestrained use of technological devices may affect developmental, social, mental and physical well-being and result in symptoms akin to other behavioural addictions. However, the Diagnostic and Statistical Manual of Mental Disorders has not formally codified the smartphone overuse as a diagnosis. Gaming disorder has been recognised in the International Classification of Diseases (ICD-11). Varied, changing recommendations are in part due to the lack of well established evidence or expert consensus, the differing emphasis of the classification manuals, as well as difficulties utilising animal models for behavioural addictions.
Whilst published studies have shown associations between digital media use and mental health symptoms or diagnoses, causality has not been established, with nuances and caveats of researchers often misunderstood by the general public, or misrepresented by the media. A systematic review of reviews published in 2019 concluded that evidence, although of mainly low to moderate quality, showed an association of screen time with poorer psychological health including symptoms such as inattention, hyperactivity, low self esteem, and behavioural issues in childhood and adolescence. Several studies have shown that females are more likely to overuse social media, and males video games. This has led experts to suggest that digital media overuse may not be a unified phenomenon, with some calling to delineate proposed disorders based on individual online activity.
Due to the lack of recognition and consensus on the concepts, diagnoses and treatments are difficult to standardise or recommend, especially considering that "new media has been subject to such moral panic."
Prevalence of mobile phone overuse depends largely on definition and thus the scales used to quantify a subject's behaviors. Two scales are in use, the 20-item self-reported Problematic Use of Mobile Phones (PUMP) scale, and the Mobile Phone Problem Use Scale (MPPUS), which have been used both with adult and adolescent populations. There are variations in the age, gender, and percentage of the population affected problematically according to the scales and definitions used. The prevalence among British adolescents aged 11–14 was 10%. In India, addiction is stated at 39-44% for this age group. Under different diagnostic criteria, the estimated prevalence ranges from 0 to 38%, with self-attribution of mobile phone addiction exceeding the prevalence estimated in the studies themselves. The prevalence of the related problem of Internet addiction was 4.9-10.7% in Korea, and is now regarded as a serious public health issue.
Behaviors associated with mobile-phone addiction differ between genders. Older people are less likely to develop addictive mobile phone behavior because of different social usage, stress, and greater self-regulation.
Overuse of mobile phones can affect social and psychological well-being and health.
Some people are replacing face-to-face conversations with cybernetic ones. Clinical psychologist Lisa Merlo says, "Some patients pretend to talk on the phone or fiddle with apps to avoid eye contact or other interactions at a party." In a survey made by Gazelle, "More than 25% of respondents reported that they 'almost always' use their smartphone while in a social setting such as during a meal or during a party. In addition, 58% said they use it 'usually' or 'occasionally' during these settings." Furthermore,
- 70% check their phones in the morning within an hour of getting up.
- 56% check their phones before going to bed.
- 48% check their phones over the weekend.
- 51% constantly check their phones during vacation.
- 44% reported they would feel very anxious and irritable if they did not interact with their phones within a week.
This change in style from face-to-face to text-based conversation has also been observed by Sherry Turkle. Her work cites connectivity as an important trigger of social behavior change regarding communication; therefore, this adaptation of communicating is not caused only by the phone itself. In her book, Alone Together: Why We Expect More from Technology and Less from Each Other, Turkle argues that we now find ourselves in a state of "continual co-presence." This means that digital communication allows the occurrence of two or more realities in the same place and time. Subsequently, we also live in a "world of continual partial attention," the process of paying simultaneous attention to a number of sources of incoming information, but at a superficial level. Bombarded with an abundance of emails, texts, messages, we not only find ourselves divesting people of their human characteristics or individuality, but also increasingly treating them as digital units. This is often referred to as depersonalization.
According to Elliot Berkman, a psychology professor at the University of Oregon, the constant checking of our phones is caused by reward learning and the fear of missing out. Berkman explains that, “Habits are a product of reinforcement learning, one of our brain's most ancient and reliable systems,” and we tend, thus, to develop habits of completing behaviors that have rewarded us in the past. For many, using our mobile phone has been enjoyable in the past, leading us to feel excited and positive when we receive a notification from our phones. Berkman also iterates that we often check our smartphones to relieve the social pressure we place upon ourselves to never miss out on exciting things. As Berkman says, “Smartphones can be an escape from boredom because they are a window into many worlds other than the one right in front of you,” helping us feel included and involved in society. When we do not check our mobile phones, we are unable to satisfy this “check habit” or suppress the fear of missing out, leading us to feel anxious and irritable. A survey conducted by Hejab M. Al Fawareh and Shaidah Jusoh also found that people also often feel incomplete without their smartphones. Of the 66 respondents, 61.41% strongly agreed or agreed with the statement, “I feel incomplete when my smartphone is not with me.”
Other implications of cell phone use in mental health symptoms were observed by Thomée et al. in Sweden. This study found a relationship between report of mental health and perceived stress of participants' accessibility, which is defined as the possibility to be disturbed at any moment of day or night.
There is some evidence supporting the claim that excessive mobile phone use can cause or worsen health problems.
Cellular Deficiency Tremors occur when one forgets one's cell phone at home and continually attempts to use the missing cell phone creating a jerky "reach for a phantom phone" phenomenon.
Germs are everywhere, and considering the number of times people interact with their cellphone under different circumstances and places, germs are very likely to transfer from one place to another. Research from the London School of Hygiene & Tropical Medicine at Queen Mary in 2011 indicated that one in six cell phones is contaminated with fecal matter. Under further inspection, some of the phones with the fecal matter were also harboring lethal bacteria such as E. coli, which can result in fever, vomiting, and diarrhea.
According to the article Mobile Phones and Nosocomial Infections, written by researchers at Mansoura University of Egypt, it states that the risk of transmitting the bacteria by the medical staff (who carry their cellphones during their shift) is much higher because cellphones act as a reservoir where the bacteria can thrive.
Cancer, specifically brain cancer, and its correlation with phone use, is under ongoing investigation. Many variables affect the likelihood of hosting cancerous cells, including how long and how frequently people use their phones. There has been no definitive evidence linking cancer and phone use if used moderately, but the International Agency for Research on Cancer of the World Health Organization said in 2011 that radio frequency is a possible human carcinogen, based on heavy usage increasing the risk of developing glioma tumors. Although a relationship has not been fully established, research is continuing based on leads from changing patterns of mobile phone use over time and habits of phone users. Low level radio frequency radiation has also been confirmed as a promoter of tumors in mice. Minor acute immediate effects of radio frequency exposure have long been known such as the Microwave auditory effect which was discovered in 1962.
Studies show that users often associate using a mobile phone with headaches, impaired memory and concentration, fatigue, dizziness and disturbed sleep. There are also concerns that some people may develop electrosensitivity from excessive exposure to electromagnetic fields, although these symptoms may be primarily psychological in origin due to the nocebo effect.
Using a cell phone before bed can cause insomnia, according to a study by scientists from the Karolinska Institute and Uppsala University in Sweden and from Wayne State University in Michigan. The study showed that this is due to the radiation received by the user as stated, "The study indicates that during laboratory exposure to 884 MHz wireless signals, components of sleep believed to be important for recovery from daily wear and tear are adversely affected." Additional adverse health effects attributable to smartphone usage include a diminished quantity and quality of sleep due to an inhibited secretion of melatonin.
In 2014, 58% of World Health Organization states advised the general population to reduce radio frequency exposure below heating guidelines. The most common advice is to use hands-free kits (69%), to reduce call time (44%), use text messaging (36%), avoid calling with low signals (24%) or use phones with low specific absorption rate (SAR) (22%). In 2015 Taiwan banned toddlers under the age of two from using mobile phones or any similar electronic devices, and France banned WiFi from toddlers' nurseries.
As the market increases to grow, more light is being shed upon the accompanying behavioural health issues and how mobile phones can be problematic. Mobile phones continue to become increasingly multifunctional and sophisticated, which this in turn worsens the problem.
According to optician Andy Hepworth, blue violet light, a light that is transmitted from the cell phone into the eye is potentially hazardous and can be "toxic" to the back of the eye. He states that an over exposure to blue violet light can lead to a greater risk of macular degeneration which is a leading cause of blindness.
There are concerns that some mobile phone users incur considerable debt, and that mobile phones are being used to violate privacy and harass others. In particular, there is increasing evidence that mobile phones are being used as a tool by children to bully other children.
There is a large amount of research on mobile phone use, and its positive and negative influence on the human's psychological mind and social communication. Mobile phone users may encounter stress, sleep disturbances and symptoms of depression, especially young adults. Consistent phone use can cause a chain reaction, affecting one aspect of a user's life and expanding to contaminate the rest. It usually starts with social disorders, which can lead to depression and stress and ultimately affect lifestyle habits such as sleeping right and eating right.
According to research done by Jean M. Twenge, a professor of psychology at San Diego State University, there is a correlation between mobile phone overuse and depression. According to Twenge and her colleagues, at the same time that smartphones were on the rise, there was also an increase seen in depressive symptoms and even suicides among adolescents in 2010. The theory behind this research is that adolescents who are being raised as a generation of avid smartphone users are spending so much time on these devices that they forgo actual human interaction which is seen as essential to mental health, “The more time teens spend looking at screens, the more likely they are to report symptoms of depression.” While children used to spend their free time outdoors with others, with the advancement of technology, this free time is seemingly now being spent more on mobile devices.
Psychologist Nancy Colier makes the point that we all have lost sight of what is truly important to us in life. She says that people have become “disconnected from what really matters, from what makes us feel nourished and grounded as human beings.”  Our addiction to technology has deterred neurological and relationship development because tech is being introduced to people at a very young age. People have become so addicted to their phones that they are almost dependent on them. Our bodies are not meant to be constantly staring at a screen as we need time to relax our eyes and more importantly our minds. Colier states, “Without open spaces and downtime, the nervous system never shuts down — it's in constant fight-or-flight mode. “We’re wired and tired all the time. Even computers reboot, but we’re not doing it.”
The amount of time spent on screens appears to have a correlation with happiness levels. A nationally representative study of American 12th graders funded by the National Institute on Drug Abuse titled Monitoring the Future Survey found that “teens who spent more time than average on screen activities are more likely to be unhappy, and those who spend more time than average on non screen activities are more likely to be happy.” One of the most important findings of this study is how the amount of time spent on non screen activities versus on screen activities affects the happiness levels of teenagers.
However, while it is easy to see a correlation between cell phone overuse and these symptoms of depression, anxiety, and isolation, it is much harder to prove that cell phones themselves cause these issues. Studies of correlations cannot prove causation because there are multiple other factors that increase depression in people today. Although parents and other figures share these concerns, according to Peter Etchells, a psychologist at Bath Spa University in England, other possible variables must be reviewed as well. Etchells proposes two possible alternative theories: depression could cause teens to use iPhones more or teens could be more open to discussing the topic of depression in this day and age.
A survey done by a group of independent opticians reviled that 43% of people under the age of 25 experienced anxiety or even irritation when they were not able to access their phone whenever they wanted. This survey shows the psychological effect that cell phones have on people, specifically young people. Checking a cell phone has become a normal daily event for many people over the years just as getting dressed in the morning is, people don't feel right when they don't do it.
Research has found that there is a direct relationship between mobile phone overuse and mobile phone use while driving. Mobile phone overuse can be especially dangerous in certain situations such as texting/browsing and driving or talking on the phone while driving. Over 8 people are killed and 1,161 are injured daily because of distracted driving. At any given daylight moment across America, approximately 660,000 drivers are using cell phones or electronic devices while driving. The significant number of injuries and accidents from distracted driving can be contributed at least partially to mobile phone overuse. There is currently no national ban on texting while driving, but many states have implemented laws to try to prevent these accidents.
Tools to prevent or treat mobile phone overuse
The following tools or interventions can be used to prevent or treat mobile phone overuse.
Many studies have found relationships between psychological or mental health issues and smartphone addiction. Hence, behavioral interventions such as individual or family psychotherapy for these issues may help. In fact, studies have found that psychotherapeutic approaches such as Cognitive Behavioral Therapy and Motivational Interviewing are able to successfully treat Internet Addiction and may be useful for mobile phone overuse too. Further, support groups and family therapy may also help prevent and treat internet and smartphone addiction.
Further, complete abstinence from mobile phone use or abstinence from certain apps can also help treat mobile phone overuse. Other behavioral interventions include practicing the opposite (e.g. disrupt their normal routine and re-adapt to new time patterns of use), goal-setting, reminder cards (e.g. listing 5 problems resulting from mobile phone overuse and 5 benefits of limiting overuse), and creating a personal inventory of alternative activities (e.g. exercise, music, art).
In 2019 the World Health Organization issued recommendation about active lifestyle, sleep and screen time for children at age 0-5. The recommendation are:
For children in age less than one year: 30 minute physical activity, 0 hours screen time and 14 – 17 hours of sleep time per day.
For children in age 1 year: 180 minutes physical activity, 0 hours screen time, 11–14 hours of sleep time per day.
For children in age 2 year: 180 minutes physical activity, 1 hour screen time, 11–14 hours of sleep time per day.
For children in age3-4 year: 180 minutes physical activity, 1 hour screen time, 10–13 hours of sleep time per day.
Many smartphone addiction activists (such as Tristan Harris) recommend turning one's phone screen to grayscale mode, which helps reduce time spent on mobile phones by making them boring to look at. Other phone settings alterations for mobile phone non-use included turning on airplane mode, turning off cellular data and/ or WiFi, turning off the phone, removing specific apps, and factory resetting.
German psychotherapist and online addiction expert Bert te Wildt recommends using apps such as Offtime and Menthal to help prevent mobile phone overuse. In fact, there are many apps available on Android and iOS stores which help track mobile usage. For example, in iOS 12 Apple added a function called "Screen Time" that allows users to see how much time they have spent on the phone. These apps usually work by doing one of two things: increasing awareness by sending user usage summaries, or notifying the user when he/ she has exceeded some user-defined time-limit for each app or app category.
Studying and developing interventions for temporary mobile phone non-use is a growing area of research.
Hiniker et al. generated 100 different design ideas for mobile phone non-use belonging to eight organic categories: information (i.e. agnostically providing information to the user about his or her behavior), reward (i.e. rewarding the user for engaging in behaviors that are consistent with his or her self-defined goals), punishment (i.e. punishing the user for engaging in behaviors that are inconsistent with his or her self-defined goals), disruption (i.e. a temporary barrier momentarily prevents the user from engaging in a specific behavior), limit (i.e. certain behaviors are time or context-bound or otherwise constrained within defined parameters), mindfulness (i.e. the user is asked to reflect on his or her choices, before, during or after making them), appeal to values (i.e. reminding the user about the underlying values that shaped his or her decisions about de- sired use and non-use), social support (i.e. opportunities for including other individuals into the intervention). Users found interventions related to information, limit, and mindfulness to be the most useful. The researchers implement an Android app that combined these 3 intervention types and found that users reduced their time with the apps they feel are a poor use of time by 21% while their use of the apps they feel are a good use of time remained unchanged.
AppDetox allows users to define rules that limit their usage of specific apps. PreventDark detects and prevents problematic usage of smartphones in the dark. Using vibrations instead of notifications to limit app usage has also been found to be effective.
Further, researchers have found group-based interventions that rely on users sharing their limiting behaviors with others to be effective.
Mobile Phone use ban
- Digital media use and mental health
- Television addiction
- Underearners Anonymous
- Computer addiction
- Internet addiction disorder
- Nomophobia, a proposed name for the fear of being out of cellular phone contact
- Video game overuse
- Mobile phones and driving safety
- De Quervain syndrome
- Mobile phone radiation and health
- Digital detox, a period of time during which a person refrains from using electronic connecting devices
- Smartphone zombie
- Mobile phone § Health effects
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