Resources

  1. Emotion. Sept 2018; http://dx.doi.org/10.1037/emo0000479
  2. (J Social and Clinical Psychology, Vol. 37, No. 10, 2018, pp. 751-768)








Transcript

Dr. Frank Domino:

John is in your office today and he's pretty upset. When his company closed two months ago, he lost his job. As a 56-year-old engineer, he knows that the job market is going to be very small for someone his age. "They can hire someone half my age and half my salary. I don't know what I'm going to do. I spend all my day, searching job sites, submitting resumes and waiting by the computer." The stress of waiting for job interviews is making it hard for him to sleep. He feels isolated and lonely. He spends his time looking at his social media accounts, but this sometimes only makes him feel worse.

Hi, this is Frank Domino, Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School. With me today, is Alan Ehrlich, Associate Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School and Executive Editor at DynaMed. Alan, thanks for coming today.

Alan Ehrlich:

Hi Frank. Listen, this guy John, he sounds like a complete mess. And... When a patient, with all this stress is coming into your office, it usually has a way of disrupting your schedule. What can you tell us about how people cope with stressors and how we can help them cope with the stress in their life?

Dr. Domino:

Coping with stress is a challenge, but it's got two main areas that it encompasses. First, is the worry, the mental process of, "What if's." The things that we all tend to play in our minds, the little conver... Internal conversations about what can go wrong if we don't solve the problem. The other is the emotions that surround it. Some worry is good. We know, for instance, when we're about to take a written test in our school years, a little bit of stress can actually have a positive effect on performance. But we know that prolonged stress, or very negative stress, can lead to a variety of adverse outcomes. Anything from dysthymia, to depression, to substance abuse, etcetera. So when we think about stressors, in particular, John's stressors, we have two areas we have to be concerned about. Both his state of worry and then his state of emotions.

Alan Ehrlich:

So he's been at this for two months now. And again, from the intro, he sounds in pretty rough shape. What could be done to help him handle this?

Dr. Domino:

Well, a variety of things, obviously. Some counseling, getting some physical exercise. But most importantly, looking at what he's doing wrong and what he might be able to do, otherwise. And two recent papers kinda speak to this. And one, sort of made the news media because it involved the game, Tetris. Tetris is an older video game that's now available on most people's cell phones that involve stacking blocks over a period of time. And the first paper I wanna talk about looks at using Tetris as a way to address stressors. This first paper had three components. The first was, involving law school graduates as they were waiting to get their bar exam. They observed them and asked them, to what degree were they involved in an activity called flow. And they found that folks who were more involved in flow had fewer negative emotions and positive and neg... And more positive emotions.

Alan Ehrlich:

Frank, can I get you just explain what you mean by "flow"?

Dr. Domino:

Sure, flow is focused attention in which we're participating in whatever we're attending to. Flow is commonly used in the sports community to be in the zone. You might hear sports commentators refer to it in that regard. But all of us can be in flow. Think of a time when you've been engaged in something, maybe at work or at home, that you're both consumed in doing and that you're actively participating in. Your building a stone wall at your home or you're building... Doing a puzzle, or anything where you both focus attention and you actively participate in the thing you're attending to. That's flow. And it's something that any of us can achieve, it's not just reserved for elite athletes.

So this study looked at patients self-perception of how focused they were and what activity they participated in while they were focusing. The second study also looked at post-graduate students waiting to hear about job opportunities. And again, measured they're positive and negative emotions, and found that those who actively engage their attention and participated in that had lower rates of negative emotions and higher rates of positive emotions, and lower rates of worry.

Alan Ehrlich:

So are you saying that when a patient comes in, who's stressed out, maybe any number of valid things, we should just say, "Why don't you play some video games for a while. Maybe Tetris would be a good place for you to start." Is that how we're gonna counsel patients now?

Dr. Domino:

So that's a third component of this study. So they took undergrads and they randomized them to playing Tetris or not, and they filed them over time. So this was not an observational, but really an active randomized control trial. And it turned out participating in a video game, like Tetris, improved positive emotions and decreased negative emotions but had no impact on worry. It meant they were still worried about the same things they were worried about ahead of time, but they felt better about it. And I think that's the takeaway point here. I don't know if we need, should be telling John, "You should start playing Tetris." But we should investigate how he's spending his time and what that influence is on his emotions. So he says to us, he sits around, looks at the computer all day and checks out his social media accounts. And I think that should be a real tip-off for us.

Alan Ehrlich:

Why do you say that? What are the risks, and what are the benefits, of time spent engaged in social media?

Dr. Domino:

Well obviously, sometimes the benefits are finding out what your friends and family are up to and communicating in an asynchronous way can be very helpful, but the downside seem much greater than we realize. The second paper, I've posted to the landing page, involves a trial done at the University of Pennsylvania, where they took a group of students and they randomized them to participating in social media as much as they wanted versus only 10 minutes per site, per day. So Instagram, Facebook, and Twitter, were the three major sites, 10 minutes each or 30 minutes total. And they found that over a very short period of weeks, the students who had ad-lib access to their social media had much higher depressive scores.

So here, were students who were engaged, focusing their attention, but they weren't necessarily participating, they weren't in that state of flow. And they actually found that there were an increased negative emotions to the point that depressive symptoms were very common. My takeaway here for John is, that we need to help him identify what he's doing and see if we can help him find another way to cope with his truly stressful situation. We can't find him a job, and we can't help people respond to his resume any quicker. But we can talk to him about how he's focusing his attention and how he's participating in that attention, and maybe suggest some better ways. How, besides playing a video game? Well, it's a huge range. He can do something artistic, he can play the piano, or paint, or... Or learn to sing a song, he can meditate. Meditation is one of those highly simple activities that there are plenty of apps for where you can focus your attention and refocus it, and that refocusing allows you to pay attention and participate in that activity. It takes no time, or it takes very little time, and no extra energy and everyone can do it. What we know is that he's participating in something that does require him to pay attention, but it doesn't necessarily require participation.

It's mindless to watch television, or videos, or participate extensively in social media without getting out and doing other things. It can lead to, what something you were chatting about earlier, that fear of missing out. It can lead to increase of depressive scores and actually worsen worrisome situations.

Alan Ehrlich:

I have one last question for you, Frank. All the studies you've been citing today involve students and, whether it be law students or undergraduates, is there any concern about extrapolating this data to someone like John who's in his 50s and is in a different social setting, and maybe grew up in a different environment, in terms of interacting with media and stuff like that?

Dr. Domino:

It is quite interesting. There are some papers that look at the general population, not just younger folks. And the detriment of social media exposure seems more apparent with folks who are certainly outside the young adult age group, primarily around recognizing that maybe others seem to be going on more trips, or having more fun, or living better lives than they are. So there's... There's this sense of inadequacy that older patients who use social media tend to develop. I don't know that those correlations are as strong as maybe they are with younger people or just that younger people are more apt to spend greater amounts of time on social media. I'm not sure why that's how the studies have played out, but I think there's danger for both young and older populations.

Alan Ehrlich:

Thanks, Frank. There's a lot... Alot here of what we can do better and ways that we can help people minimize the stress that they're under. Thanks.

Dr. Domino:

Thank you, Alan. Practice pointer. To cope better with worry and stressors, help patients identify healthy distractions that include flow, that focused attention in which you're participating in rather than passively observing. To help patients cope better with worry and stressors, encourage patients to find healthy distractions that induce flow, that form of active participation while applying sustained attention.