Mental Health as Content

Wellbeing is deeply important to me. I workout regularly, choose healthier foods, and work with a therapist when my anxiety becomes overwhelming. The mental health component of wellbeing is often the most challenging for people to talk about, but research shows that stigma around mental health is fading, with each new generation being more open about their struggles than the one before. At least in some measure, we may have social media to thank. According to verywellmind.com, “When … people on the Internet talk about their mental health struggles, [it] makes it easier for others around the world to talk about theirs.”

About a year ago, a good friend of mine was diagnosed with ADHD. She was 36. Like many women, she had gone undiagnosed because her symptoms had been attributed to anxiety. As someone that experiences significant episodes of hyperfocus, she never suspected she had ADHD. Instead she saw her intermittent struggles with focus as a lack of self control and personal failing.  It wasn’t until she saw an instagram reel that that defined ADHD not as an inability to focus, but as an inability to control what you focus on, that she started researching ADHD. 

Hearing her story made me wonder if her experience was common. Were other users learning to better understand themselves through mental health content? A qualitative research course through UCBerkeley’s extension program gave me a chance to explore this topic in depth. For this study, I focused on the viability of content for microlearning. “Microlearning is the act of breaking down larger chunks of information into smaller, more manageable pieces. It’s all about taking things one step at a time, rather than all at once.”

Key Findings

The initial results of this study indicate that social media shows promise for mental health microlearning. 

• All of the participants in this study expressed learning based reactions to mental health content viewed in the course of this study. 

• Mental health practitioners expressed that they saw the benefit of this type of content to support traditional therapy

• This type of content provides community for people who are struggling and helps destigmatize the experience of common mental health challenges. 

• This type of content could help fill the need for developing behavior based skills and mindfulness practices. 

• Learning was more strongly correlated to content from “expert” voices.  Surprisingly, this was higher for coach perspectives than it was for therapists.

In speaking with one of the therapists involved in this study, she cited an overwhelming need for mental health services. She works in Minnesota and said one of the ways MN addresses this is by allowing unlicensed professionals to provide behavior based skills education. There is a range of need and a large portion of this need is education based. Conflict resolution, boundary setting, and self regulation are top behavioral skills that many people are not taught and could effectively be learned through microlearning content.

Content Themes

Recommendations

Recommendations were developed in response to the findings of the study. Solutions are linked to user’s existing mental models of how to find resources and verify information.

Banners with resource links.

Given participant’s tendency to initiate secondary research on topics that interest them, it could be helpful to utilize banners with resource links below content. Instagram already has resources available in their help center for some mental health topics. Utilizing banners for resources could be seen as an expansion of that service, and more intuitive user experience. Instagram could partner with mental health organizations to give creators a list of quality resources that are pre-approved to link from their videos. In addition, if a user is engaging with a high volume of potentially harmful content, a pop up could direct them to resources.

YouTube has already announced a similar approach to address concerns about eating disorder content. These strategies could be effective on other platforms and also for other mental health disorders.

• Content discussing eating disorders will receive a panel below the content with links to resources. 

• Content discussing recovery that may be helpful to some users, but that contains imitable behavior, will be restricted to viewers 18+

Nudging towards mindful content consumption.

A 2005 study found that up to 40% of a person’s happiness is determined by their activities and practices. A regular mindfulness practice is one type of activity that is associated with improved mental health outcomes. Instagram has already made adjustments to their algorithm to “nudge” users away from doom scrolling. They could take that one step further by nudging users towards mindfulness practices with curated prompts that could periodically show up during scrolling sessions. A mockup of what that could look like is shown on the right.

Truthworthy content check.

Users are familiar with the blue checkmark for verified creators. In the same vein, high quality, 3rd party verified content could be given a green checkmark to indicate to users that the content is trustworthy.

Study Details

Participants

Participants included three mental health practitioners (MHPs) and five social media users (SMUs). The majority of participants were female. Although it was not a requirement for the study, the majority of participants had done therapy at some point in their life.

Participant Limitations

There are some important limits to the perspectives reflected in this study. There was no participation from people in the 18-25 range. People in this group have overall higher incidence of mental illness and significantly higher incidence of severe mental illness. In addition all of the participants in this study have a bachelor’s level education or higher. This is important to note because lower education levels are linked to lower income and lower income is linked to a greater prevalence of mental health challenges.

Research Methods

A mix of secondary research and qualitative methods was used in this study. Secondary research was done to supplement and enrich the interviews as well as to provide an understanding of the current social media and mental health landscape. To start the interviews, a range of questions was asked of both participant groups. Social media users were asked questions about their own experiences while mental health professionals were asked both about their own experience and that of their clients. In addition to the interviews, participants completed an activity where they were given links to 14 instagram videos and asked to categorize them based on their reactions.

A blank activity is shown on the left and a completed activity is shown on the right. Participants were given the freedom to create their own labels or edit those that were provided. 

The videos used in the activity were chosen specifically to provide a range of perspectives and styles. Reactions were cross referenced with video length, creator gender, and creator perspective.

• There did not appear to be strong associations between between participant reactions to content and creator gender or video length. 

• Learning was more likely to be reported from content created by mental health experts.

Full Findings

Social Media Use

There were no surprises around how participants use social media.

• Participants from both groups reported using social media for connection, entertainment, news, and not surprisingly, predominantly as a break or distraction. 

• Most users reported being on in it every day, multiple times a day. 

• Also not surprising, millennial participants were more active on instagram, though many still had facebook accounts that they used to keep in contact with older relatives, or to access facebook marketplace. 

• Older participants were more active on facebook. Some indicated that they had tried instagram and didn’t get into it.

What kind of mental health content was compelling to the participants?

When asked what type of content is compelling to them, the top response was personally relatable content. Anxiety, and general health and wellbeing, were a close second. 

I was honored that participants were vulnerable with me about their mental health experiences. Seven out of the eight participants shared that they have a diagnosed mental health condition. When asked how participants knew that their mental health experience wasn’t typical they shared stories of feeling out of control of their thoughts and feelings.

“There was a disconnect between who I felt I was and how I felt.”

“I did not want to be alive”

“I felt out of control.”

“I was hospitalized.”

They also shared that they made assumptions that their experience was universal. This assumption prevented them from seeking help sooner. 

“I thought everyone had it hard and I didn't want to appear less than.”

“I assume that most people feel tough most of the time.”

Content Themes

Learning and Self Reflection

Participants reacted to content from mental health experts with higher levels of self reflection and learning than other content. Videos by experts resulted in higher reports of self reflection and learning. This type of reaction was correlated more strongly with coaching and research experts rather than therapist content. This may have been a shortcoming of the specific videos chosen. Based on user responses, I believe that social media content can help mitigate assumptions that mental health symptoms are a universal experience. This understanding could encourage people to seek help more quickly.

Relatability and Connection

Relatability was one of the most utilized reactions to the content in this study. However, the specific content identified as relatable varied via participant. For example, most participants disregarded the videos that spoke about ADHD, but participants who had ADHD, or were close to someone who does, were drawn to this content. This could suggest that incorrect self diagnosis is a lower risk than assumed, but more research is needed. In many cases relatable content was a reminder of things they already knew, but didn’t always practice. When interacting with content they deemed relatable, participants were more engaged, and indicated feelings of connection and feeling understood by the content. 

Trust and Verify

When asked how they determine if content is trustworthy, participants indicated that they utilize a combination of secondary research and personal experience. They also indicated that they would have to be engaged with and interested in a topic to do additional research.

Humor and Memory

Participants only described 3 of the 14 videos as funny, but 50% of the participants indicated that these videos were the ones they remembered by the end of the activity.  Videos containing humor were more likely to be described as engaging, but participants were less likely to indicate that they learned from these videos. This may have been a shortcoming of the specific videos chosen. More research is needed to determine the value of humor in mental health microlearning.

Complexity and Curiosity

More complex content inspired more curious reactions and was also more likely to challenge participants thinking on a topic. Participants were more likely to consider their position in relation to these topics than to disregard the message entirely. This may have been a limitation of the study as participants also reported feelings of vulnerability in being observed while they watched these videos and having to verbalize their reactions. More research is needed to validate this finding.

Style Considerations

Aggressive messaging or inauthentic presentation received more negative responses. Therapists were more able to see past the style issues and engage with this content than regular issues. Care needs to be taken with style and more research is needed to understand what types of styles are most well received.

The case for change.

The state of mental health in America.

The initial results of this study indicate that social media shows promise for mental health microlearning. However, to understand the need for this type of education, we need to first understand the state of mental health in America. Mental health has a significant impact on society. Untreated mental health challenges cost the US roughly $300 billion annually. More than half of affected individuals do not receive treatment. The reasons are varied and complex, but a significant factor is lack of insurance and access to care.

But how is social media relevant here?

Social media can be great for community building, social skills, and self expression, but it can negatively affect self image, and can provide a platform for bullying. The 4th pillar detailed in Surgeon General’s recent report on loneliness is to “reform digital environments.” The report warns of the negative effects of technology and calls for greater regulation in this space. However, it also acknowledges the benefits of the internet and advocates for the development of “pro-connection technology to promote healthy social connection, create safe environments for discourse, and safeguard the well-being of users.”

Legal and social expectations.

Recent headlines show that there are legal implications for social media sites as well. Since 1996, section 230 of “The Communications Decency Act,” which was intended to prevent minors from viewing sexual content online, has protected tech companies from being held liable for the content posted on their platforms. Since 2020, Congress has filed several bills to repeal or rewrite Section 230 and in February of 2023 a case in the Supreme Court debated the extent of immunity for social media algorithms. 

In the spring of 2023, parents and school districts across the country joined a class action lawsuit claiming social media use can result in mental health issues. They say companies knew the platforms could cause these issues but failed to warn users. It’s clear that the public expects these companies to act responsibly in regards to mental health. 

In the future, expectations may exceed simply moderating content. Users may expect that companies are actively working towards the betterment of society. In a world where users are increasingly connected and expect more from their online experiences, it is in these companies’ best interests to pay attention to these expectations and stay ahead of the curve on wellbeing innovation. 

Some of the changes due to social media have been negative, but do they have to be? How can social media content be harnessed for good? What opportunities are there for social media sites to act as facilitators of resources and accurate information?

Now what?

This study identified a series of initial findings and recommendations for additional testing, but more research is needed. Although users indicated learning behaviors, learning does not necessarily indicate behavior change. One of the most important follow up research questions is whether learning on this topic translates to behavior change. Another important next step is solving for limitations of this study including participant demographics. The ethics for online mental health learning are still evolving and care will need to be taken as this space expands. Mental health is a systemic problem and we know that systems are slow to change. Social media has the freedom to work both outside the system and in partnership with the system. This freedom could provide big impact in the lives of average people. Continued exploration is worthwhile.