THE INSTAGRAM EFFECT: Practitioner engagement

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Instagram is widely considered to be bad for mental health, but an increasing number of therapists are taking to the platform to use it for good. In this article, Clinical Psychologist Dr Sophie Mort considers the effects of Instagram on mental health stigma and the way practitioners can engage the platform in psychology education.

Summary points

  • Social media and Instagram often draws focus to social comparison, which can have detrimental effects on mental health.
  • However, social media also offers an opportunity to open up the conversation about mental health, reduce the stigma surrounding it, and makes seeking help more accessible.
  • Psychoeducation allows therapists and psychology practitioners to share expertise in accessible chunks to an audience that may not have otherwise engaged.
  • There is an inherent risk in healthcare professionals sharing techniques in a public forum, and the American Psychological Association has started work to address this.
  • In the meantime, therapists are using their professional judgement to create personalised risk-management policies.

In 2017, Instagram was rated as the single worst social media platform for your mental health. It has been associated with negative body image, fear of missing out (FOMO), bullying, and high levels of depression and anxiety. As one billion people use Instagram, and this number grows by the day, it should be considered a significant factor in global mental health going into the future.

The effect of Instagram on mental health

Instagram and social media in general have changed the way we access each other’s lives. We are no longer solely comparing ourselves to the Joneses up the street. We can now compare ourselves to the lives of others around the world, 24 hours a day, checking to see how we measure up to the heavily curated feeds of friends, acquaintances, celebrities, and even influencer dogs! Leon Festinger’s social comparison theory, which states that individuals determine their own social and personal worth based on how they compare to others, has never been more relevant.

No wonder this has a detrimental effect. We are not just looking at pretty pictures and thinking, ‘Oh, how lovely that that person did x or y today’. No, we are looking at other people’s heavily curated highlight reels, wondering, ‘Hang on, why doesn’t my life look like that? Why don’t I look like that?’.

This comes up in the therapy sessions I have every day. It comes up in the conversations I have with colleagues, friends and family members. As a user of Instagram, I am not embarrassed to say that I too have experienced these effects first-hand.

The reality is that Instagram is shaping the way we see ourselves, what we buy, what we believe and how we interact with others. It is not all negative, however.

Instagram in itself is not inherently good or bad. It is an app for sharing and it is what we do with it that counts. In general it offers an opportunity to start a conversation about mental health, reduce the stigma surrounding it, and make seeking help more accessible.

First came the celebrities (including Justin Bieber and Lena Dunham) and influencers, using Instagram to raise awareness of their own battles with depression, anxiety, loneliness, and eating disorders. This meant that millions of people have been privy to these previously unheard of dialogues. Their honesty has helped to decrease the taboo around the conversation and has given people permission to struggle.

Whole communities sprung up, creating safe spaces for people to open up and talk about the difficulties experienced each day. These were linked to stigma around mental health but also around the experiences that we all know cause distress, such as racism, sexism, homophobia, ableism, and transphobia.

With this came the rise of the non-expert. Thousands of people without qualifications in any kind of psychology offered supportive and compassionate advice on surviving and recovering from trauma, eating disorders and all other mental health-related topics. Non-experts, although well-intentioned, lack the clinical knowledge to handle complex mental health issues and yet reach millions of people a week.

Now, over the last year or so, therapists and qualified mental health professionals have joined the conversation. Mental health nurses, counselors, psychologists and psychiatrists can be found sharing their knowledge, one post at a time. They speak to thousands, rather than the handful of people that make it into the room with them each day. Examples include Dr Vania Manipod (@freudandfashion), Dr Therese Mascardo (@exploring.therapy) and Dr Diane Strachowski (@backtolovedoc).

Insta-therapy versus insta-psychoeducation

This has caught the attention of many global media outlets. The New York times, The guardian, The telegraph, Vice, and Psychology today, among others, have run stories on it. These stories showcase a range of perspectives on the practice with some lauding the work and others damning it due to the risks posed in this uncharted frontier of mental health.

As a result, insta-therapy and insta-therapist have become part of our vernacular. Yet these terms are misleading. There is no such thing as insta-therapy, but there are therapists on Instagram who are sharing the basics about therapy and psychology. Often they are clear that it is only the basics they are able to provide.

Therapy is a relationship where two or more people are in a psychological contact. It is a space where you talk in a nuanced way about the personal experiences of the client or clients. It is a place where the therapist holds your mind in their mind. Instagram does none of that, as it lacks the nuance, confidentiality and the highly personal aspects of therapy. It is a one-way process and it cannot be a replacement for therapy or for community and relationships in real life.

Many therapists on Instagram do include disclaimers in their highlight reels, posts and articles specifically addressing these issues, and give a standard response saying they cannot offer any personalised involvement or advice outside of a direct therapeutic relationship. So, what is it that therapists are doing on Instagram? The guardian recently suggested a new term, insta-psychoeducation and it may be more accurate.

Posts that fall into this category may share basic psychological ideas, scientifically backed coping skills, compassionate words and thoughts. You will find accounts directed solely at overcoming mental health stigma, advocating for mental health reform and promoting charities where proceeds go directly to free services offering help. An example includes Hashtag Therapy Is Cool (@hashtagtherapyiscool) by Dr Christina Iglesia (@dr.christina). There are a number of others that try to simplify the process of finding the right therapist for you or that advertise services on offer.

At the moment the effect of this work is anecdotal. We can only see how people are receiving this work based on comments, direct messages (DMs), and the numbers of people voting with their feet or, in this case, with their fingers when they hit the ‘follow’ button.

And people are responding. Some therapist accounts have increased to over 100k followers, creating huge communities for people to feel part of, e.g. Dr Nicole Le Pera (@the.holistic.psychologist), Lisa Olivera (@lisaoliveratherapy) and Nedra Tawwab (@nedratawwab) and, as a result, are expanding their reach further through speaking and writing engagements. This falls in line with an overall trend of people looking for information of this sort. In 2018, self-help book sales increased by 20%, making it one of the fastest-growing genres of the past year.

Numbers are not the only sign that people are looking for more of this. Public replies on Instagram posts make it clear that people value having a place to learn, to feel seen and heard. You can often see comments from people sharing that they now feel able to open up with others, to look for their own support and/or find a therapist. Lisa Olivera has shared some of these comments anonymously in her recent article, ‘Instagram isn’t therapy: A reminder of what therapists are actually doing on Instagram’, written to remind people what therapists are actually doing online.

Practitioners navigating the Instagram effect

The Instagram effect is multi-faceted. Despite being associated with negative effects on mental health, it has also allowed a decrease in the taboo around the topic, and an increase in the accessibility of therapists. The information therapists are sharing on Instagram is not new, but the way they share it is, and it is reaching audiences that may not have been able to look for the information elsewhere. It removes many of the barriers to accessing support, including stigma, waiting lists, costs, and simply not knowing how to find the right therapist. Although they cannot provide the full experience of therapy on Instagram, therapists on the platform are able to talk about psychology at the same time as showing their humanity. They normalise emotions, distress and vulnerability. They make it feel safe to think about what it is like to be a human in the world right now. They share simple tools that are scientifically backed, that are known to promote soothing and well-being, that people can start using immediately at no cost.

They offer a low barrier space to think and listen.

Social media reach and stigma

At this point, I must confess that I am a therapist who uses Instagram. The reason I use the platform is that I was fed up of seeing the same thing in my clinic: people terrified of their own experiences due to the internalised stigma they carried about mental health; people who had not sought help until they were really struggling, due to fear that sharing how they felt would lead to the judgement of others; people who had been on waiting lists for months at a time; people who lacked the basic psychological knowledge that would have perhaps helped them to understand themselves, and what they were going through, earlier on.

Therefore, I wanted to get basic information out to more than just one person at a time. I wanted to decrease stigma, make it clear that it was okay to seek help, and to share non-personalised psychological knowledge and skills that all people could benefit from.

There is an inherent risk in talking about psychology on Instagram. As healthcare professionals we are trained to be hypervigilant for risk. Good, this should not change. Instagram brings with it a layer of uncertainty that will get our alarm systems going. It is not confidential, people can access you at any time, it cannot deal with personalised issues, let alone crisis, and most importantly it is new.

In a recent Vice article, Myira Khan, Governor at the British Association for Counselling and Psychotherapy, was quoted as having spoken about the responsibility of therapists using Instagram saying that:

‘The space we’re occupying is still very public. When people are commenting or interacting, we have to manage that in a way that is ethical and responsible. Someone might feel vulnerable and exposed [when they post a comment]. But we cannot perpetuate that or encourage further disclosure.’

Guidelines are clearly needed. At the time of writing, the American Psychological Association had stated that it was working to address this and it was unclear when the UK governing bodies will do the same.

In the meantime, therapists are using their professional judgement to create personalised risk-management policies. Whitney Goodman
(@sitwithwhit) recently set out some specific steps for both therapists and consumers in an article for Psychology today. For therapists this included:

‘Create a disclaimer that informs clients that your posts are neither therapy nor a substitute for therapy. Create a disclaimer that informs clients of their resources in an emergency. Create a social media policy for current and future clients that outlines your use of social media and guidelines if they choose to follow you.’

This is a new field and it is growing fast, and changing the way people access, understand and consume information about their wellbeing. It is changing the face of mental health in the digital age. It is giving people, previously unable to access psychological information from professionals, a chance to understand themselves. In this current climate, where sensationalist headlines tell us that we are in a global mental health crisis, this work appears to be both timely and prudent. It is also controversial, and we must continuously weigh the potential benefits against the critiques that will soon be readily available.

As more of our healthcare moves online and incorporates technology we will become better acquainted with the realities of navigating this digital world. For example, many providers now offer digital delivery and provision of services, e.g. Babylon, BetterHelp and Dr Julian, and the use of health-based apps to enhance personalised care. One fascinating example of the impact of the technology of therapy in the digital age includes the work on Oxford VR, who have shown that a fear of heights can be treated in three sessions using virtual reality exposure, a finding that we would be hard pushed to replicate without technology.

The digital world appears to be unstoppable and omnipresent. As therapists we have a duty to keep up to date, to roll with the times and to meet the people where they are. Therefore, whether you agree with Instagram as a platform for this kind of work or not, Instagram and social media are not going away. It is a breeding ground for poor mental health and, as we have an informed and important message that we can share in this space, I believe it is an important place for therapists to consider.

Further information

  • Royal Society for Public Health, ‘Instagram ranked worst for young people’s mental health’, available at: http://bit.ly/2jV8MDo.
  • Z. Brown, M. Tiggemann. ‘Attractive celebrity and peer images on Instagram: Effect on women’s mood and body image’, Body image, 19, December 2016.
  • J. Constine. ‘Instagram hits 1 billion monthly users, up from 800M in September’ available at: https://tcrn.ch/2kuDymP.
  • T. J. Gee. ‘The rise of Insta therapy: Why social media can be good for your mental health’, available at: http://bit.ly/2lE24C8.
  • W. Goodman. ‘Instagram is not therapy and I’m not an Instagram therapist’, available at: http://bit.ly/2kfLB7b.
  • L. Olivera. ‘Instagram isn’t therapy: A reminder of what therapists are actually doing on Instagram’, available at: http://bit.ly/2k4COF2.
  • Reuters. ‘Mental health crisis could cost the world $16 trillion by 2030’, available at: http://bit.ly/2lDKcr3.
  • D. Freeman, P. Haselton, J. Freeman, B. Spanlang, S. Kishore, E. Albery, M. Denne, P. Brown, M. Slater, A. Nickless. ‘Automated psychological therapy using immersive virtual reality for treatment of fear of heights: A single-blind, parallel-group, randomised controlled trial’, The Lancet, 5 (8), August 2018.
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About Author

Dr Sophie Mort

Dr Sophie Mort is a Clinical Psychologist working to get psychology out of the therapy room. She has a private practice seeing clients solely online over video link. She also shares psychology through a blog (drsoph.com/blog) and Instagram (@_drsoph).

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