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The bulk of our activity on social media takes place in the evening, which is closely followed by morning use, and then during breaks throughout the day. In fact, 1 in 3 minutes spent online are done so on social media.

Technology isn’t going anywhere, and its presence is only going to grow in our digitally connected world, which shines a light on a key consideration for clinicians: mental health professionals need to find a way to analyse the psychological effects of our constant immersion in digital technology.

What is the present-day research telling us?

Initial research suggests that frequent use of social media could trigger or exacerbate a variety of mental illnesses, such as anxiety, body dysmorphia, fear of missing out (FOMO), and depression. But the research is nascent and requires further study on the topic, given we are “still some years away from getting a really good scientific consensus on what’s going on,” according to Dr Wayne Warburton, Associate Professor in Developmental Psychology at the Macquarie University.

“We just need more studies, and while the current studies are indicative, what we want to see is a whole lot more findings in the same direction before we can categorically say one thing or another.

“The bottom line is that we’ll know a lot more in the next few years once we get a larger research base around what’s really going on. And what I suspect is that we’ll find these negative mental health outcomes will start to firm up and we’ll get a clear sense of the people who are more vulnerable to them.”

According to 2020 research, evidence from a variety of cross-sectional, longitudinal and empirical studies suggests social media use can contribute to an increase in mental distress, noting that there appears to be a dose-response relationship – the more exposure to social media and thus the more time spent glued to a screen, the more likely one is to experience distress.

Additionally, excessive social media use may be particularly risky for younger people who are already experiencing mental health challenges, as demonstrated by the two-way relationship between use of media and a decrease in mental health.

Social media use doesn’t equal poor mental health—but it can

As technology is woven into so many aspects of our lives, a challenge for today’s mental health professionals is separating troubling, habitual social media use from regular, positive digital involvement, and educating individuals on the value of a healthy media diet, according to Wayne.

Using social media to connect with friends and families in another city is a productive way to utilise social media, as well as using it to tap into online information for work or study purposes – it is when one's social media use shows signs of being pathological is where it can become problematic. Things like constantly checking social media updates throughout the day where it impacts productivity or having poor sleep quality due to prolonged use at late hours of the evening.

Ultimately, intervention is extremely valuable for individuals who are device dependent, and clinicians have a key role to play in terms of providing education to those experiencing negative emotions and mental distress due to problematic (and unhelpful) social media use.

Finding a balanced use of social media will allow users to get value out of their digital interactions, to think critically about the content they’re consuming, and importantly, to self-govern their screen time for better mental health outcomes.

Continue reading: Australia’s social media landscape in perspective

Continue reading: Social media use, excessive screen time, and device dependency: How is it impacting our mental health?

The description, or rather the clinical denotation of autism, has come a long way. Originally labelled a form of childhood schizophrenia and referenced as a by-product of loveless parenting, autism was not measured as spectrum of conditions. Instead, autism was viewed as a singular condition that, in some cases, institutionalised people until the 1980s.

And since the ‘80s, we have come a long way in our comprehension of how autism manifests in humans, according to Dr Michelle Garnett, clinical psychologist and founder of Minds & Hearts. “We now understand that a child with autism does not always sit in a corner flapping with no language or social interest, which was the public view of autism from the 1940s until the late 1990s.”

We’ve made significant strides in understanding autism as a neurodevelopmental disorder that’s mostly likely caused by genetic and environmental factors, rather than a single disorder that’s pigeon-holed in diagnostic criteria. In addition, the landscape of research is showing signs of shifting from a solely causation (or biological focus), to being a more outcomes-based body of literature that’s embedded in understanding how individuals and their families can find autonomy to live independently, which helps people through the biology of autism.

We better understand autism presentation, but there’s room for improvement in diagnostics and assessment

Dr Garnett says that despite our understanding of autism presentation progressing, diagnostic and assessment processes are playing catch up. She adds that there’s more research required to understand how to detect autism in very young children who are camouflaging their autism, which can lead to prolonged diagnosis evasion and thus can be harmful at a macro level.

“Nevertheless, our diagnostic and assessment processes are still needing to catch up. The autism spectrum is exceedingly broad, and the group of people with diagnosed autism is hence extremely heterogeneous.

“Also, there is a lot of comorbidity, and there are many differential diagnoses to consider. We now know that many people on the autism spectrum use the coping mechanism of camouflaging, that is, they hide their social communication difficulties by observing others closely, and using imitation, masking and personas to be able to be what other people need them to be in their social interactions.”

According to Dr Garnett, autism brings a wealth of talent, character strengths, and abilities — but it also brings about several challenges. Dr Garnett notes that autism isn’t something that needs treatment but instead a deep understanding of one’s unique characteristics.

“As a clinical psychologist, I find that it is helpful to truly understand an individual's profile, in terms of their strengths and challenges, across their learning, language, social communication, personality, emotions, motor skills, sensory processing, and adaptive behaviour, across different settings and with different people. In very young children who have autism but no expressive language, the most important person for treatment becomes the speech and language pathologist to assist them to attain expressive language.”

There are many programs available for effective intervention that assist adults, children and teenagers with autism to enhance their social and emotional skills, says Dr Garnett, as well as to assist with the understanding and acceptance of one’s self, and to increase language skills and sensory processing (and coping).

“We find that the best approach is eclectic, and may include an early intervention program, such as the Early Start Denver Model (ESDM) or the DIRFloortime® model, for young children with more classic Autism. More verbally able autistic children benefit from the application of cognitive behaviour therapy to assist with their emotional and behavioural difficulties, and to learn social communication skills.”

Technology is gaining steam as a tool for autism education

The advancements in autism treatment go beyond the refined perception of autism itself — technology and digital platforms are being increasingly leveraged as educational tools to better understand autism. For Dr Garnett, there are applications available for teaching individuals with autism about emotions, language and the nuance of social communication.

“I think the use of a tablet or a computer is a terrific way to assist people on the autism spectrum to gain the theory behind navigating the social and emotional aspects of life. However, they also need to be able to apply this theoretical knowledge in real life with real people, so an on-site approach, as well as practise across different settings, remains integral to any intervention process.”

Autism education remains essential to positive outcomes, according to Dr Garnett. For parents of a child with autism, understanding the disorder helps with effective interaction and for conversations to be had on a level playing field. And for individuals with autism, education works to empower them.

Dr Garnett says that her primary intention now is to increase autism awareness among health professionals, educators, the broader community and autistic people. As Dr Garnett notes, a lot can be achieved with a positive attitude and greater education of autism.

“Over the 30 odd years that I have been in this field, I have found that the best two interventions for autism include knowledge and attitude. Knowledge about autism, and how autism affects the specific person, and an attitude that accepts and respects diversity, is hopeful and optimistic, that recognises strengths and abilities, as much as it acknowledges the challenges of having autism.

“I believe this so passionately that my own primary motivation and intention now is to increase awareness and understanding of autism amongst our health professional and educators, as well as the broader community and autistic people. With understanding and a positive attitude so much can be achieved, and we need people with autism. They have been at the forefront of every major advance of human endeavour. They take us forward.”

Collaboration between autism counsellors and clinical psychologists is key

Jo White, Melbourne-based autism therapist, special education teacher and director at Autism Counselling, has worked with autism for over 20 years. She says that a big part of her work is based around managing her client’s executive function and helping adults, children and their parents understand autism.

“If the client on the spectrum and if they have poor executive function, we will help express that to them to help them figure out what it is that’s going wrong. So, that’s things like organisational skills, planning, or even making phone calls —all the daily life stuff that are done as a neurotypical can be hard for someone on the spectrum.

“That kind of lack of executive function can often spill into things...so daily life skills are an important aspect to what we do as therapists. There are a lot of different challenges that go along with autism...they all fall into the executive function or emotional regulation areas where they're overloaded sensorily and don’t what to do with that, so they tend to shut down. So, that's where we come in to help make individuals aware of why this is happening and to give them strategies to help them cope and thrive.”

Ms White sees important synergies evolving between autism counsellors and psychologists to increasingly work closely to ensure that individuals (and their families) receive well-rounded, tailored autism support from the wider mental health community.

“I’ve seen a lot of change over the past few years — for example, I'm seeing more upskilling of mental professionals where they’re getting an understanding of how autism can present. There's not just this narrow view anymore to understand the broader ramifications of how autism can present, particularly with girls. The role I've taken now in supervising therapists who come to me for autism-specific supervision...it’s passing on that assistance, and teaching psychoeducation to other mental health professionals, too.”

Continue reading: 4 autism insights from a clinical psychologist

Continue reading: Unpacking autism assessment and intervention, and the need to move away from using the term ‘treatment

The timeline that outlines the progression of our clinical understanding of autism from the moment the condition was first recognised in the 1940s to where we’re at today is telling: it took us a little while to understand autism like we do now.

Albeit at a steady pace, we’ve since come a long way in our understanding of autism’s potential causes, and how it’s assessed and diagnosed. Initially, autism was theorised to be a subset of schizophrenia and it was a condition that was marked with clinical finality — autism wasn’t initially viewed across a spectrum or as a range of neurodevelopmental conditions like it is today.

We’re re-establishing the way we approach autism assessment, which is outlined by the recent release of Australia’s National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders, and according to Dr Anne Chalfant, clinical psychologist and managing director of Annie’s Centre, there remains work to be done in the area of differential diagnosis to really shore up our end-to-end assessment of autism.

“Where we’re at now is we’ve just gone through what was meant to be a recalibration or a re-set in our focus points with assessment and our processes, and that was mostly through the development of the national guidelines for autism spectrum disorder and the work that was done there.

“So, these guidelines came about because we are finding that we’re getting better at picking up on what autism spectrum disorder (ASD) is more broadly, and so our sensitivity with the way we may assess clients and the tools that we might use are improving, but our specificity and our ability to look at this issue of differential diagnosis...is still not very strong, however we are improving. But it’s still a relative weakness in the overall assessment of ASD and the diagnostic guidelines were very much focused on trying to address that in one way.”

Standardised assessment tools are valuable, but to be effective they need to be part of a wider clinical strategy

Dr Chalfant says that there hasn’t been a sizeable shift just yet in terms advancements in diagnostic tools, but notes that there is sound research that suggests that some of the standardised tools that are leveraged today are effective as part of a wider, more comprehensive assessment and diagnostic process, but shouldn’t be leveraged as the clinical be-all and end-all.

“I get concerned when I get reports that come across my desk from clinicians who have done an autism diagnostic observation schedule (ADOS) and have given a diagnosis on that basis only, they are meant to be used as one part of a more comprehensive assessment process.

“We still regard those tools as the gold standard in terms of standardised assessment of ASD, but they're not meant to be an assessment in and of themselves. Where we’re at now is having a tighter structure around our approach to assessment and what should and should not be included in assessment, and who should and should not be a part of ASD assessment at different stages, as well as what tools we should rely on as a part of that process – again, as a part of the process, not to be the only method of assessment.”

We’re moving toward more progressive assessment and the national guidelines may be the catalyst

The release of the national autism guidelines is a sign of a shift towards progressive assessment, says Dr Chalfant, and the next step to put these guidelines into action is the distribution of a tool kit to guide clinicians on implementation. Dr Chalfant says that the release of videos, tip sheets and explainer content will help clinicians better understand the set of guidelines, put them into practice and move forward with advancements in autism assessment that enable a more effective, and indeed individualised, approach.

Dr Chalfant says that, for psychologists, assessment should be thorough and rounded, and should include:

• Screening
• Observation of the client in a natural setting — for example, at preschool or school (or for a very young child, asking the parents to take some video footage at home to feed back to you)
• In-clinic observation (the ADOS-2 is the best tool we have to guide that process in a standardised way)
• Developmental history taking and taking a detailed interview with parents or primary care giver(s)
• Consideration regarding differential diagnosis
• Liaison with a paediatrician to look at the child's overall development and any related medical considerations to rule in or out

Dr Chalfant says that the literature suggests that if there is well-rounded approach to assessment in place, which includes the aforementioned points, such as natural observation, conducting interviews with parents (for younger clients), and the appropriate, targeted use of tools, then it makes for effective assessment outcomes, regardless of the various nuances that are a part of the varying clinical demographics.

“The release of the toolkit is a very immediate next step in terms of where we’re heading. Some of the questions that seem to be increasingly raised are about assessment for particular groups and the applicability (or otherwise) of the core diagnostic criteria to those certain groups – so, for example, some of the issues are around girls versus boys with assessment and how well or not assessments pick up on ASD in girls.

“When you have a comprehensive approach to assessment, such as one that includes natural observation, conducting interviews with parents, direct observation of the client or the use of standardised assessment tools, then that process does just as good a job for girls, as it does for boys — the most recent scientific literature supports that notion. And that, too, will remain a focus for us moving forward.”

Autism isn’t a condition that needs ‘treatment’

Understanding your client’s strengths and weaknesses, and then providing tools for them to understand what to do with that information is key to providing a roadmap to live a meaningful, fulfilling life, says Kathleen Davey, clinical psychologist and founder of Decipher Zone.

Ms Davey notes that it’s not an individual’s autism that needs treatment, but instead ‘treatment’ from a psychologist is for symptoms or co-occurring conditions such as anxiety, otherwise the intervention support given is often skill development in areas such as recognising social-emotional cues, independent living skills, or navigating friendships. Assisting a client to understand and accept their own autistic profile or empowering their support network of parents, friends, colleagues to understand and embrace their autistic profile is one of the most powerful roles we can play.

“I don't look at it as treatment in the traditional sense of the word, autism isn't a thing that needs to be treated or fixed. Autistic individuals or their families can greatly benefit from tools and strategies to support areas of weakness and a process of understanding and accepting neurodiversity in our community. If you look at the autistic community or adult self-advocacy groups, you will see a celebration of autism, a strong sense of autistic identity, and pushback against things called interventions and treatments.

“I would separate the word autism from the specific goals or behavioural challenges that help is being sought for. Usually, the areas that people are focused on are around trying to develop social skills, emotional regulation skills, or sensory management or even flexibility in thinking to achieve certain goals. There are differences between somebody who requires 24-hour care and somebody who can live independently, strangely their autistic profile may be similar, however the former may have a co-occurring intellectual disability, speech and language disorder and trauma/anxiety condition that leads to the level of care needed.

“Yes, there’s management of that person required, and significant support needs, but it's not necessarily their autism that requires intervention, it may be that the sensory environment needs to be changed, they may need to learn new self-help skills, their co-occurring intellectual disability may need to be recognised, or their support network needs to understand how the person thinks.”

Ms Davey says that clinicians need to  choose their words wisely when communicating with parents and individuals around autism, and make a shift towards more delicate, understanding-based language, which she says lends itself to improved clinical outcomes. “I would love to see psychologists be very careful with the language used in their reports and in their communication with parents and the individual themselves around autism. Having more strength and understanding-based messaging has a big impact on people moving forward.”

Autism education is critical, and should be led by clinicians

Regarding adults, there is a long list of situations where people have had autism brought to them or have self-identified as having autism, and their diagnosis is a relief, says Ms Davey. Additionally, she says that autism education helps individuals understand their strengths and weaknesses, and it sets the wheels in motion for an effective exploration (and understanding) of their diagnosis.

“There are many examples where people have learned about autism and have subsequently self-identified as being autistic, or a clinician has identified their autism and they’re response is ‘That explains so much, I wish I had have known this when I was younger’. For some people, there might have been a pre-existing negative association or misunderstanding of what autism is and being diagnosed can be a negative experience, but for a lot of people, and when handled well by the clinician, it allows them to understand themselves properly for the first time...I know many people embrace it and use it to understand themselves like they never have before.”

As for children, the way which the autism education is conveyed is critical, and it’s the clinician’s role to lead the way to ensure it resonates with the individual in a way that is empowering and not devastating. If parents don’t understand autism it can make it difficult to be responsive and attune to their child’s needs.

“It’s critical how you go about presenting the information. For example, if you’re talking to a child’s parent and talking from a deficit model, where the child is in room but you're talking directly to their parents and they're hearing you speak about them in the third person, this can have a really negative impact on the child's understanding of the autism spectrum and themselves.

“If parents don’t understand autism, they might think their child is getting upset about something completely different or not realise that they need something to be explained, for example, why their friend is upset with them and advice on how they can repair that relationship. So, if parents don’t know about autism, they may not realise their child is not picking up friendship cues naturally. As assessing and treating psychologists, our language can impact on a parent's response to an autism diagnosis and their sense of empowerment and vision for their child’s future.”

For psychologists, starting (and succeeding in) your own private practice may be intimidating, but for the reasons highlighted above there are many reasons to take the leap. If you have decided that you would like to start your own private practice, then there are some key considerations you’ll need to be across, such as understanding your personal and professional readiness, as well as your business aptitude, too.

You will know when the time is right to start your private practice

Robyn Stead, Educational Psychologist and Founder of Educational Psychology Services (otherwise known as EDPSYCH), says that starting her private practice was a long-term goal but felt that she needed to be experienced enough to have the confidence to go out on her own. For Robyn, it was time away that gave her the clarity she needed to define her future.

“I built up my networks and I got to the point where I really felt like it’s time to make that decision to start my private practice. I had taken quite a long holiday and went away with my family — it was that break that gave me the chance to ponder what makes me happy and what I really want to do with myself.”

Upon reflection, Robyn says she had accomplished all that she could in her public service career. She started pondering what her next challenge was going to be and it was ultimately that moment when she knew it was time to start her private practice.

“I was a practice leader for the Resource Teachers: Learning and Behaviour Service (RTLB) and knew I didn’t want to be a manager because the role was purely management and very little in terms of an opportunity to be a practicing psychologist. At that time, I was thinking ‘What’s my next challenge? What do I want to do next?’ And that’s when I knew it was time to make that decision to go out on my own.”

Don’t downplay the importance of business skills

Robyn laid out all things that were important to her — personally and professionally — to understand how to truly build a private practice that would succeed and make an impact. She calls it having a “laser vision”, which helps you really get to the granular details of what you want to achieve, why you want to achieve it, and then from there you can start to put the pieces together. The why and the what, or rather the purpose of your private practice, is an ever-present theme that will need revisions and refinements along your journey.

And while it may be tempting to fall back to focusing on your clinical or psychological area of expertise and how you’re going to deliver your service, without a business plan in place you'll hit a roadblock. A robust business plan helps you prioritise with clarity, it gives your private practice strategic direction, and it maps out the road to sustained success.

According to Robyn, business acumen reigns supreme. “I place quite a lot of weight on business acumen, but I think what you need to do, and my best advice to psychologists is that for someone contemplating going into private practice, start by reflecting on what you want to achieve in your own practice. That’s crucial.”

You should place a lot of stock in talking widely to other professionals, according to Robyn, because it gives insight into how others run their businesses, these are invaluable details you can only learn if you cast a wide net in your pool of professional networks.

“It's important to talk widely to people. I started talking to people about what I wanted to do, it's amazing at how kind people were in guiding, coaching and providing advice to me in those areas that I needed to upskill.”

“So, speaking to accountants, marketers, private practitioners and other business owners was an invaluable exercise that helped me take that leap into my own private practice. It’s amazing just telling people ‘This is what I'm doing’ how many of them will come back to you with free advice.”

Additionally, Robyn notes that psychologists have a wide range of talents and transferable skills that can be applied in private practice. “During my university training I was required to use a website building platform to create documentation to support my learning. I was easily able to transfer this skill into building my own website for my business. In this way I was able to build something for a very low cost and can edit it in real time. Many other small business owners I speak to can be frustrated at having to contact an outside agency to change their website each time they want to make a small change. If you are just getting started, paying someone to build a website can be a concern.”

Maintain your networking activities and professional associations

Moving into the private sector does mean that your daily interactions with other psychologists and clinicians will come to a halt, but that doesn’t mean that your professional relationships become a fading memory. For Robyn, starting a private practice required that she made a concerted effort to nurture her networks and maintain her professional connections because, as Robyn notes, they’re all-important.

“It’s critical to have professional associations, especially in private practice. When I was working for schools and in education, my community was right there for me. There were educational psychologists in my office and other offices that I could easily connect with, there were accessible professional development areas, and so on. And as soon as I stepped away from that and into my private practice, I lost all those daily connections.”

Additionally, Robyn had to acknowledge that the elements of her public sector role that she enjoyed would have to be fulfilled in other settings and found in other places. “I recently stepped into the role as the chairperson of the Institute of Educational and Developmental Psychology (IEDP) — influencing wider systems, networking with other people, and the range of professional work I had to acknowledge I wasn’t going to get in my private practice, so the IEDP is a great opportunity to maintain those areas of professional activity.”

Employ a growth, development and fail fast mindset

There are always things to learn and areas to upskill in as a psychologist — the role of continued professional development (CPD) must happen alongside your daily private practice activities to remain current. There’s always time to sharpen your understanding of certain areas by consuming new material and research.

For example, Robyn notes that she has typically used a solution-focused therapeutic approach, and this year she started thinking about doing something a little bit different. “To add to my approach, I've been looking at acceptance and commitment therapy, and have since done quite a lot of professional development online, which has been a great addition to continued further reading as part of my professional development activities.”

Robyn says when you start your private practice there is a danger of becoming too defined in your offering, or hyper-focused on one discipline, which puts you at risk of becoming irrelevant. This doesn’t mean that you must be a generalist to succeed, but know what your strengths and weaknesses are, and find that sweet spot where there’s untapped opportunity.

“I had observed and wondered about when stepping into private practice is that danger of becoming really narrow – you might be really good in one area, but you may be unaware of other contexts, other things happening, and you can become irrelevant quickly. I didn’t want that to happen.”

Upon reflection, Robyn says she wishes she would have been braver earlier on. Ultimately, her advice is direct: accept the “fail fast” concept, and if you realise where you are now is not the right fit, back out and move on. It may be time to start your private practice.

Continue reading: Being a private practitioner doesn’t mean going it alone

When Robyn Stead, Educational Psychologist and Founder of Educational Psychology Services, started her New Zealand-based private practice, she knew that she couldn’t go it alone. As Robyn reflects on launching her business, she made a focused effort to connect with her networks, nurture her relationships and dial up her involvement in professional associations.

“I had always been a member of the New Zealand Psychological Society, but I've become much more proactive in linking in with that since launching my private practice. Overall, this is something I work hard at to maintain my professional connections and associations.”

Robyn also recently stepped into the role of chairperson of the Institute of Educational and Developmental Psychology (IEDP). She says that she acknowledged early on that influencing wider systems, and the nature of networking daily in the office, was something she simply wasn’t going to get in her private practice, so it had to be sourced from different settings. “The IEDP is a great opportunity to maintain those areas of professional activity.”

Having practiced in the public service arena for quite some time, Robyn consolidated her network of like-minded professionals, however, now firmly set up and flourishing in her private practice, she noted that it’s the private practitioner’s responsibility to actively engage with their wider network to keep the dialogue open and the relationships nurtured. Robyn says that as soon as she left her public service role and started her private practice, she lost some key daily interactions.

“It’s critical to have professional associations, especially in private practice. When I was working for schools and in education, my community was right there for me. There were educational psychologists in my office...that I easily could connect with, there were accessible professional development areas, and so on.”

Further to tapping into the psychology-specific networks, Robyn notes that in order to set her private practice up the right way, she opted to speak to additional business professionals, which encompassed accountants, marketers, and website experts to name a few, who helped with the areas that weren't in her wheelhouse.

Robyn says this was “an invaluable exercise” that helped her take the leap into her own private practice with confidence. She says that it’s amazing that by just telling people what you’re setting out to achieve, how many of them will come back to you with indispensable advice.

Once you’re set up, another creative way to scale your private practice is to hold lunch and learn initiatives or workshop sessions. These activities help to build your thought leadership position and establish you as an authority in your field. While working to build your private practice’s brand and your position as an expert, these activities will also open further opportunities to organically grow your professional networks.

Ultimately, launching your own private practice is an exciting time in your career, and it shouldn’t be marred by the fear of going it alone. Robyn’s message to aspiring private practitioners is to be brave, leverage your networks and be clear on the ethos of your practice. With that, you’ll set yourself up with a sustainable business that has a lasting impact.

Continue reading: 6 tips for a well-structured private practitioner’s day

But what are the impacts of these sorts of interactions and routines on our health? As the 21st century continues to produce new electronic media and smarter gadgets, it’s imperative to analyse the psychological effects of our constant immersion in digital technology. Initial research suggests that frequent use of these tools could trigger or exacerbate a variety of mental illnesses, such as anxiety and body dysmorphia.

However, because technology is woven into so many aspects of our lives, the challenge for psychologists is separating troubling habit formation from regular digital involvement. Fortunately, the rapid adoption of innovative healthcare services, such as telehealth, as well as the wider pursuit of wellness and mindfulness, are facilitating a paradigm shift in this area.

Understanding the risks of hyperconnectivity

In order to effectively solve a problem, one must be able to identify it first. That old adage rings true when tackling modern issues like screen addiction. According to Dr James Courtney, Associate Professor and Clinical Psychologist at Monash University, being online 24/7 can give rise to a form of dependency, particularly in developed economies where internet penetration rates are high.

“Digital dependence has emerged as a contemporary construct to seek and maintain a digitally connected lifestyle,” says James, who also oversees clinical governance at the Monash Turner Institute for Brain and Mental Health, a leading research institution focused on novel solutions for mental health challenges in the modern world.

“One of the factors with the strength of any dependency is how quickly things are rewarded. Digital technology can be similar to a drug – the quicker the response, the better the reward, so the more likely you are to use it and rely on it.”

Digital dependency can manifest in numerous forms, for instance, distress when a phone is misplaced, frustration and irritability when the internet fails, or the obsessive monitoring of media, and even turning to the internet to explain minor ailments and seek a medical diagnosis. “In my opinion, these responses are analogous to behavioural drive theories. We experience a state of internal imbalance if we’re disconnected. We don’t feel right, something feels wrong inside,” James explains. “There are these unconscious homeostatic mechanisms that then seek to maintain or restore balance through engagement with digitally delivered information.”

For the moment, a significant proportion of research and public awareness campaigns focus on the influence of social media – notably the compulsive need to log on and participate – on self-esteem and cyberbullying. While there may be obvious links between mental health and the growth of social media platforms, some schools of thought point to the overarching trend of immediate information availability.

The onset of the digital era has made it almost second nature to open a weather app in the morning to check the forecast, or scan the reviews of a product on Amazon before purchasing it, for example. Furthermore, hyperconnectivity has been normalised to the extent where a person could be ridiculed or penalised for not answering a digitally delivered message or email within a few minutes, says James. These patterns suggest technology is altering our behaviour on both micro and macro levels.

Another risk of this desire for instant gratification – fuelled by the internet – is mood disorder. “When we’re feeling sad or anxious, our brain starts to seek out information that’s congruent to the mood. In other words, it’s trying to explain why you’re in a bad mood or stressed. So, people go online in search of mood congruent information, and that confirmation bias can be problematic for those with mental health issues,” he notes.

Encouraging digital wellbeing

As psychologists deepen their study of technologically driven habits, being digitally healthy will progressively be promoted alongside diet, sleep and exercise as a major domain. “It's a matter of balance, of keeping everything under control,” says James.

Moreover, while the internet and modern devices are disruptive, they can also be empowering and harnessed for positive purposes. Case in point: telehealth and digitally delivered packages now provide easier platforms to carry out assessments and deliver treatment to a broader segment of the Australian population, according to James.

“Social media has received bad press, but there's emerging research on how to use social media connections to help people with depression, for example. We now have a large body of work on digital mental health strategies, with interventions that can go out to people who otherwise wouldn’t have convenient access to them,” he adds. "Our rapid adoption of telehealth this year is an absolute major advantage."

Two other approaches James recommends to improve digital wellbeing are Acceptance and Commitment Therapy (ACT) and motivational interviewing. ACT is a values-based approach and incorporates six principles, including cognitive defusion and committed action, to handle painful thoughts and experiences in an effort to enhance the quality of life.

With motivational interviewing, the objective is to collaboratively explore the internal motivation needed to resolve ambivalent feelings and insecurities. It’s a practical counselling method often used to address the behaviours that prevent healthier choices.

Ultimately, the steady transformation of the global economy and human communications means technology will only become more integrated into our everyday lives. The fast-paced digital environment can be overwhelming, but a growing number of psychologists and therapists are embracing a range of promising opportunities to reflect, learn and sharpen their skills to truly understand the evolving spectrum of mental health and treat associated disorders.

Continue reading: Breaking down screen addiction one pixel at a time

Continue reading: Screen addiction and device dependency — what are the impacts of being constantly plugged in?

The reality is clear: technology isn’t going anywhere. In fact, it’s an industry that will see a consistent flow of new electronic media, shiny gadgets and enhanced technologies introduced into the consumer market every year, and as a direct result of this our collective screen use will rise.

With that considered, is screen overuse deemed a clinical concern for global health authorities? Put simply, it is, and there’s growing research in the area of screen addiction to help us better understand its short-term and long-term impact. Additionally, The World Health Organisation (WHO) concluded that human beings can indeed be addicted to screens, as reflected in the 2018 inclusion of what’s considered “gaming disorder" to the 11th revision of the Internal Classification of Diseases.

According to the WHO, gaming disorder is defined as follows: “A pattern of gaming behaviour characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences”.

Despite the growing research in this area, experts have said that we still don’t have enough information to know whether our use of screens is good or bad for our mental and physical health.

So, what is the formative research telling us and what role do parents play in screen addiction?

Dr Wayne Warburton, Associate Professor in Developmental Psychology at the Macquarie University, says that while we still may be some years away from a strong scientific consensus on screen addiction, our understanding of the negative mental health outcomes associated with too much screen time is growing rapidly.

“I think we are still some years away from getting a really good scientific consensus on what’s going on. We just need more studies, and while the current studies are indicative, what we want to see is a whole lot more findings in the same direction before we can categorically say one thing or another. The bottom line is that we’ll know a lot more in the next few years once we get a larger research base around what’s really going on. And what I suspect is that we’ll find these negative mental health outcomes will start to firm up and we’ll get a clear sense of the people who are more vulnerable to them.”

Wayne notes that the learnings from the past 2-3 years of research in the area shows that parents need to model healthy screen use, as their children closely watch how they interact with technology and see that as a mode of inspiration.

“What we have learned from the current research is that kids are watching their parents very closely in terms of what they're doing with media. They're watching their mums and dads on social media and emails, and generally they dislike that they're being told to hold their own media use back, because they see their parents buried in their devices too.”

So, Wayne’s message is clear: if parents want their children to be healthy users of technology, then they need to be well governed users themselves. Additionally, Wayne notes that when parents are interactively involved with their child’s digital activities, it often lends itself to better outcomes.

“Parents are more effective when overseeing their child’s screen use, when they’re actively involved and not just monitoring. It's about being actively involved with what their kids are doing with their media, with what they're playing and watching.

“So, for example, this may look like playing video games with them, or talking about the YouTube clips they’re watching, or listening to the music they’re tuned into. This opens channels of communication, which makes it easier to have a conversation about what's happening and can help in moderating use, too.”

The importance of understanding the relationship between media and human behaviour

In terms of what constitutes screen media, Wayne says that it encompasses everything that’s done on a screen. So, that’s anything you might do on your phone, tablet, computer or video game console — ultimately, anything that’s screen-based.

For Wayne, it’s important for us to understand the effects of media on human behaviour simply because it’s such a big part of daily life. He says that the things we experience and do shape who we are and the way our brains wire up. Things we experience a lot have a bigger impact, and the concern, Wayne says, lies in the numbers.

“In the most recent US poll, kids aged between 5 and 12 used screens for recreational purposes, so not for school-related activities, for about 4 hours and 45 minutes on average. And when you look at teenagers, so those aged 12 to 17, that figure rises to more than 7 hours and 20 minutes per day on average — that's a lot of time. It’s more time than kids spend with teachers or with friends and family, and with many other activities in their life, barring sleeping and sometimes not even that.”

The risks of not addressing pathological levels of screen use

Wayne notes that screen addiction occurs on a continuum. This measurement framework, Wayne says, consists of a not having a problem with screen use to having extreme, pathological levels of use. He’s concerned about the kids who are that far end of the continuum.

“What we’re worried about are kids at one end of that continuum, and in terms of severe problems, which are the kids that have problems that look like an addiction, we think that about 2-3 per cent of those kids have serious, addiction-level problems with video games. We don’t yet know the definitive numbers for other areas like social media addiction, internet addiction, and pornography addiction, but we’re getting a sense of it as the research progresses.”

Wayne says that there’s another demographic where there is some cause for concern, and it’s those whose level of screen time is having a serious impact on at least one key area of their life, such as their schoolwork or their mental health. “We think it’s about 5-10 per cent of kids. But we need to remember that the 2-3 per cent referenced earlier are included in that 5-10 per cent. So, at the top end, we have about 10 per cent of kids who have problematic levels of use.”

Wayne notes that there’s also one large group who aren’t in the top 5-10 per cent, but who remain at risk of developing problematic or pathological levels of screen use. “These kids are using devices at high levels and it’s starting to raise red flags with mum and dad, and what we're looking at here is identifying the risk and stopping them from moving across the continuum where they’re having more problems.”

In extreme scenarios, screen addiction can be the number one threat to a child’s wellbeing. Wayne has seen a case where the person stopped going to school in the middle of year 7 and never went back — they stayed in their room up until their late teens and never left the bedroom. “At the extreme end, it’s extreme,” says Wayne.

Keeping screen overuse at bay

According to Wayne, for children to develop normally they need to spend sufficient time outdoors and having offline active play, which lends itself to stronger face-to-face relationships and better developmental outcomes. He says the argument that ‘I get everything I need with my online friends’ doesn’t hold water developmentally - the online arena is simply not the same.

Wayne adds that adopting a healthy and moderate ‘media diet’, and making a family media plan, can help ensure that screen addiction is kept at bay, and that the positive elements of technology can be leveraged for positive outcomes. It’s a joint effort, however, involving the co-operation between parents, children and mental health experts to ensure that screen use doesn’t get out of hand.

Over 264 million people are affected worldwide by depression, which is a major health concern in Australia as well, according to Jaimie Bloch, a clinical psychologist and founder of Mindmovers Psychology in New South Wales.

In Australia, more than one million adults currently experience depression, and in their lifetimes, as many as one in seven people in the country will be depressed, according to some estimates. Further, looking at the overall state of mental health in the country, another report has found that 20 percent of Australians in the 16 to 85 age group suffer from a mental illness in any given year, with depressive, anxiety and substance use disorders being the most common.

Why are numbers on the rise?

There are a number of factors commonly linked to depression, according to mental health experts who note that it is usually triggered by "a combination of recent events and other longer-term or personal factors, rather than one immediate issue or event".

Contributing factors include long-term issues, such as extended unemployment or prolonged work stress, physical or mental abuse in a relationship, or continued isolation or loneliness. Stress-inducing life events, such as losing a job or death of a close friend or relative, and drug or alcohol abuse can also trigger depression. Family history can play a part as well, with up to 40 percent of the risk for developing depression possibly due to genetic factors, according to the Australian Psychological Society.

Meanwhile, the coronavirus pandemic is contributing to the problem with growing numbers of Australians suffering from depression, as widespread lockdowns and associated job losses affect mental health.

"COVID-19 has created this lack of uncertainty and people who were already suffering from mental health challenges are definitely being impacted the most, especially in lower socio-economic groups and minority groups," says Jaimie. Amid the lockdown, psychologists are "seeing even more isolation", she says, adding that contributing factors like domestic violence have also increased.

But the pandemic has also forced people to pay more attention to mental health. This is a positive development because the key to staying on the front foot against conditions like depression, Jaimie says, is to recognise the problem early by being at the forefront of assessment and analysis – a focus area for Pearson Clinical.

"Pearson Clinical provides such amazing equipment and psychological assessment tools. They really provide great objective measures without which it would be impossible to get baselines and to figure out where a patient might be."

Culture plays a major role

The number of Australians who are diagnosed with depression and anxiety disorders is on the rise and this trend may have its roots in the larger cultural environment that many Australians, and others in the West, find themselves in, says Jaimie.

Many across the developed world have cut themselves off from traditional support networks and living conditions in Australia are also seen worsening feelings of isolation and loneliness more so than in other countries and cultures.

"Unfortunately, Australia [and] a lot of Western countries have very high rates of depression and suicide. There are always many reasons, but a lot of it is due to Western culture and the way that mental health is viewed and looked at," Jaimie says. "There is a lot of stigmatisation around having mental health challenges, which means that people are less likely to reach out for support."

In countries like Australia, a large number of people live within their nuclear families, meaning that there is less familial support structure – from grandparents, cousins, aunts and uncles, for example, than there would be in cultures where multigenerational living is more common. As a result, Jaimie says, there is "less community, less focus around that altruistic connection and more focus on self", noting that research suggests that “the more self-focused you are, the more negative and critical you are and the more depressed you’ll be”.

She also notes that the data presents a surprising dichotomy – Western countries have shown to have both the highest happiness levels, and the highest depression rates.

"There definitely could be this factor of chasing this dream which could make you really happy, but at the same time extremely stressed out and burnt out," she observes.

"Especially in Australia, you have so much stress at home, this never-ending, constant rat race, this cycle that people are stuck on. Because of that you’re going to have moments of happiness and you’re going to have these really deep moments of loneliness and sadness too."

In the Harvard Study of Adult Development, one of the longest-running studies of its kind, researchers are continuing to find that in developed, Western countries "where minimum material living conditions are?often satisfied, people may struggle to become happier because they are targeting material rather than social goals".

An unequal affliction

While depression can hit anyone at any time, Jaimie says that young people – her key clinical group – are at high risk and numbers are on the rise, with one in four adolescents experiencing a mental disorder. Further, early onset of the condition can lay the foundations of depression for later in life, she says.

“There’s plenty of research that shows all mental health disorders are created and the foundations implemented before the age of 25. It’s definitely more prevalent once you hit adulthood but the underpinnings of it are in youth.”

It is a growing concern for Australia’s young people. Mission Australia’s 2019 Youth Survey found that over a third of respondents cited "mental health" as one of the top three issues affecting Australia today, and a similar percentage cited mental health as a top-three personal concern.

More than 40 percent of Year 12 students report symptoms of anxiety and depression, which is higher than the normal range for their age group, and suicide is the leading cause of death for people aged 5-17 years old, according to the Black Dog Institute. Socioeconomic factors also unquestionably play a role, according to Jaimie, with Aboriginal and Torres Straits Islander people having the highest suicide rate among the Australian population.

Prioritising mental health

In response to the scale of the problem, the field of psychology has "exploded" in the last few decades, according to Jaimie. And growing accessibility to a psychologist, awareness in the community to the importance of mental health, and research around the outcomes when people can access support, have been hugely positive steps for Australians.

She sees reason to be hopeful, but adds: "I think that for all mental health it takes time and…obviously there is more work to be done." For her and her peers, finding the right diagnostic material and assessment tools are part of the battle, but she hopes that there is a growing recognition of the need for a cohesive strategy across the board, from the national level down.

Indeed national support has been forthcoming in the age of the coronavirus. With caseloads growing even as assessments become challenging due to the need for social distancing, psychologists and other health professionals are having to innovate rapidly – including with telehealth solutions – to limit in-person appointments to minimise risk.

The government’s support has been invaluable here, Jaimie says, and programmes like Australia’s e-mental health strategy have come into their own. With funds flowing into e-mental health, getting accessibility to people has been prioritised.

"This strategy is obviously a long-term vision, developing accessibility and a high-quality e-mental healthcare system for people."

It is also crucial to involve multiple stakeholders. "People don't change by themselves or in a vacuum and we need community support, so getting everyone in line and onto the same page is crucial," Jaimie says, emphasising the need to help everyone to understand the science and data we have around to understand thoughts and emotions.

Particularly given Australia’s cultural background and the predilection for isolation and stigmatism of mental health, there needs to be much more awareness in the community about the importance of investment in mental health, especially early on.

“I think that a lot of people might not prioritise their mental health until they’re in a crisis, and crisis work is always unhelpful. We want preventative work - so people accessing services or connecting to someone before something becomes really bad."

Continue reading: Placing a lens on depression

Continue reading: Episode 2 — Confronting institutional gaps: Investigating mental health policy and depression

Continue reading: Bringing certainty to the battle against depression

The WHO estimates that more than 264 million people are affected worldwide and says depression is "a leading cause of disability worldwide and is a major contributor to the overall global burden of disease". Given how common the condition has become, diagnosing depression accurately and swiftly is key.

However, the assessment and identification of depression can be "quite complex" because mental health conditions can arise from several factors, according to Valorie O’Keefe, Consultant Psychologist at Pearson Clinical.

"The onset of depression can be triggered by a situation or life event for some individuals, while others can experience more chronic mental health issues," Valorie says. "This could be because they have major depression, or they might have co-morbidities such as anxiety or PTSD alongside the depression, or they might have a more complex personality disorder, which adds complexity to the treatment plan."

Depression: A growing concern for Australians

While depression is a global issue and, as the WHO notes is on the rise, in Australia too its impact is being felt around the country. As many as three million adults experience either anxiety or depression in any given year and nearly half the population, it is estimated, will be affected by a mental health condition at some point.

Compounding the problem is the advent of COVID-19, which has changed both the prevalence of, and approach to treating, depression, Valorie says, with the increase in loneliness and anxiety brought on by the drastic changes in our lives – such as social distancing, isolation at home and remote-working measures put in place to limit the coronavirus outbreak – meaning "there's more and more need for assessment and intervention".

And because the pandemic is preventing psychologists and counsellors from assessing clients in person, "there has been a need to develop more and more telehealth assessments", Valorie says.

Assessments: Key tools in the battle against depression

At the same time, because of the complexity of the underlying conditions, the tests for assessing depression need to be comprehensive.

"The most popular assessment tools are ones that are easy to administer and score, are not too difficult or lengthy for the client to complete, and that are affordable for the practitioner," she says. "It is also vital that the diagnosis be made with the help of a “reliable, valid, and well researched tool".

The Beck Depression Inventory (BDI), for example, measures the presence or absence of depression. If present, it grades the severity level of the condition on a scale from mild through moderate and onto severe, Valorie explains. The self-administered questionnaire determines this in about 25 questions, and often an assessor will use the BDI alongside other Beck Scales, such as the Beck Anxiety Inventory, the Beck Hopelessness Scale and the Beck Scale for Suicide Ideation.

According to Valorie, Pearson Clinical provides several tools that mental health professionals can use effectively. These range from quick screeners, which are able to assess "what is most likely a very straightforward depression that requires treatment", but also tools that measure more complex mental health presentations, such as various aspects of psychopathology, which would require in-depth long-term intervention.

Pearson also offers mental health assessments for children and teenagers, including the BASC 3, Beck Youth Inventories and MACI II, and provides the option of digital assessments through its Q-global online platform, allowing assessors to administer these questionnaires online from their office or practice. They can also deliver the tests to their patients via email using a Q-global feature called Remote OnScreen Administration, allowing questionnaires to be completed at home – a feature that has proven hugely beneficial amid the pandemic.

MMPI: A widely used measure of psychopathology

Pearson also offers other, more in-depth assessments that determine depression alongside a range of psychopathologies. The MMPI-2-RF (Minnesota Multiphasic Personality Inventory), for example, is a questionnaire-based assessment developed by Pearson's US-based team, alongside the University of Minnesota. The MMPI is "one of the most widely researched and used psychological assessment instruments", according to the American Psychological Association.

The test is a "very complex measure of psychopathology, which would include depression and anxiety but also things like PTSD and a variety of personality disorders", Valorie says.

On the horizon is the MMPI-3, the updated version of the MMPI-2-RF, which has been redeveloped, modernised and reformed. It will be available for use by psychologists and psychiatrists around September.

To make the assessment more user-friendly for both assessor and the client, the number of questions has been reduced by half from the original version, from around 600 to 300. The rationale is that the smaller number of questions will be less taxing for anyone with mental health issues, Valorie says, but by refining the focus of the questions, the validity and reliability of the measure is retained, while making it quicker and easier to administer.

With improved testing capabilities, psychologists in Australia and the world over can better diagnose mental health issues – and to do so quickly, enabling earlier intervention. This is especially crucial amid the current global health crisis, which provides all the right conditions for exacerbating an already daunting mental health situation.

But with the right tools, a sense of urgency and the compassion that the field of mental healthcare is known for, practitioners can stay one step ahead and mitigate some of its worst effects.

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Continue reading: From a pub to a private practice – a unique journey to psychology

Robyn Stead, Educational Psychologist and Founder of Educational Psychology Services (or EDPSYCH for short), is one of the professionals whose journey was unique. While she’s currently running her New Zealand-based private practice, the journey to arrive where she is today was far from conventional.

The offbeat path to psychology

Robyn initially graduated with a Bachelor of Arts and despite her interest in education she didn’t feel ready to settle in a career, so she took off overseas and gained experience in all sorts of roles: she worked as a nanny, she worked in pubs, and then in admin for a pharmaceutical company.

After a couple of years in Europe, Robyn decided the time was right to train as a teacher, so she trained to become an English teacher in the United States and taught for several years, but quickly realised that her passion was in special education. So, Robyn did further study to develop her expertise in special education and added another qualification to her resume.

After years in the United States, Robyn moved back to New Zealand and ran into a professional hurdle. At that time, special education was yet to become an in-demand role, so she went back to mainstream teaching and it was at that moment that Robyn encountered the possibility of becoming a psychologist.

“I was working with a psychologist who was working with one of my students and she said, ‘you should train to be a psychologist.’ And I thought, ‘oh no, I've already done enough university training.’

“But I did go on to train to become a psychologist, and I went into a service called the Resource Teachers of Learning and Behaviour, which is a service that works with kids that have mild-to-moderate disabilities. So, I worked there and became a practice leader. And then about two and a half years ago, I started my private practice.”

Importance of staying current

Robyn says that there are a lot of things about her role as an Educational Psychologist that gets her out of bed every morning, but if she was to nominate one thing that stands out above the rest, it’s the privilege of being able to interact with young people and their families, as to support them to ensure they get what they want out of their education journey.

And given the commitment and obligation to continuing professional development (CPD), staying across the latest research, and innovations in assessments and resources is what Robyn says is integral to her work as a psychologist.

“We owe it to all our clients to remain current with what is best practice in the moment and that changes so much depending on what research is coming through. So, it's critical for all of us in our profession to continue to learn - you can't just rest on your laurels as a psychologist.

“I've always thought that if you ever get to the point where you think you know it all, then that is the time to step away and retire. You need to have some degree of uncertainty that sits with you throughout, perhaps an awareness that there's always more to learn.”

Why Pearson Clinical?

Robyn says that Pearson Clinical is a reliable resource that helps her knowledge remain current and has worked closely with Melissa Stephens for over 10 years, who is one of Pearson Clinical’s Consultant Psychologists, to upskill on assessment resources. Psychology assessments are inherently detailed and technical, so for Robyn, this is where her relationship with Pearson Clinical (and namely Melissa) is all-important.

“Melissa gets to the point and understands what you're asking - it’s extremely helpful. I can send Melissa an email about an assessment and she will respond and provide a clear explanation, and she'll even cite the research if it's appropriate.”

For Robyn, Q-interactive is a tool she uses frequently in her work as an Educational Psychologist, and highlights the value of the training videos, which she often references to ensure she’s getting the most out of the platform. She adds that the availability of recommended books helps to contextualise assessment tools, too.

“I can quickly go into the Q-interactive training videos and cross check things, such as: am I handing the blocks to the kids correctly or am I clicking the timer at the right moment? I find that resource really helpful. And that’s true for Pearson’s manuals and book recommendations – they’re an asset that ensures you’re always on the right track.”

Robyn’s message to psychologists seeking assessment solutions is clear: Pearson Clinical’s resources are “easy to access” and “high quality”, and their Consultant Psychologists are a great asset to have to ensure you’re getting the most out of your initiatives.