How Can Clinicians Address Smartphone Addiction Among Patients?

Smartphone use is now a way of life with approximately 85% of Americans owning a device. However, when smartphone use behavior starts to resemble that of gambling and substance use disorder, clinicians need to step in, according to research presented at the American Psychiatric Nurses Association (APNA) 36th Annual Conference held October 19 to 22, 2022, in Long Beach, California.

Similar to other addictions, problematic smartphone use behaviors include tolerance (more frequent use need to achieve a sense of reward or reinforcement), compulsive urge, and withdrawal symptoms, according to findings from a review by Kate Morris, MSN, RN, PMHNP-BC, and Carol Essenmacher, DNP, RN, PMHCNS-BC, of Indiana University. The authors reviewed 12 peer-reviewed articles on smartphone use and addiction published in the United States between 2018 and 2021.

“Problematic smartphone use is associated with poor self-control, impulsivity, neuroticism, anxiety, novelty seeking, and maladaptive coping,” the study authors noted. Smartphone addiction is highly correlated with insecure adult attachment and may cause an increased sense of belonging in individuals who feel socially isolated or awkward. Smartphone use is an avenue for these individuals to receive frequent reassurance and validation. Device use is also linked to a dopamine boost. 

Notification features may reinforce problematic smartphone use behaviors as they draw the person back to the device. Short and frequent interactions are more likely to form habitual smartphone use behaviors, the researchers found.

Imaging Findings

Studies have demonstrated unique magnetic resonance imaging (MRI) patterns in patients with smartphone addiction. These patients show smaller gray matter volume in the right orbitofrontal cortex, which provides an inhibitory response when the amygdala is overwhelmed, the researchers explained. Increased activation in the anterior insula, anterior cingulate cortex, and occipital cortex has been observed during smartphone use.

Smartphone Addiction Screening Tools

The following screening tools are available for detecting problematic behavior:

• Smartphone Addiction Scale (SAS-short or long form)
• Smartphone Addiction Proneness Scale (SAPS)
• Smartphone Addiction Inventory (SPAI)

Treatment of Smartphone Addiction

Although limited research is available to guide treatment, exercise and mindfulness techniques may benefit patients with problematic smartphone use. Clinicians should evaluate patients for co-occurring disorders such as anxiety and depression. No specific medications or psychotherapies have been researched for smartphone addiction; however, the researchers suggested consideration of transtheoretical stages of change and motivational interviewing principles.

Nurse practitioners and other clinicians should recognize that professional bias can affect the delivery of care by influencing screening, assessment, and treatment. “Self-reflection is valuable for patients and clinicians” when assessing and managing problematic smartphone use, the researchers noted. 

The review findings are limited by the lack of consensus on the definition of smartphone addiction. The studies included in this review largely involved adolescents and young adults and had small sample sizes. Vulnerable populations were not included in most studies and participants with preexisting mental health disorders were typically excluded. Lastly, the findings are typically based on self-reported screening tools, which can limit objectivity.

Reference

Morris K, Essenmacher K. Does your smartphone have you “outsmarted”? Studying Nursing Assessment & Management of Problematic Smartphone Use. Poster presented at: APNA 36th Annual Conference; October 19-22, 2022; Long Beach, CA.

This article originally appeared on Clinical Advisor