3 January 2025. The digital age has brought incredible benefits, but it has also introduced complex challenges to mental health and well-being. In his thought-provoking editorial, “Taming the Chimaera–Hydra: Disconnecting from the Net to Fortify Our Mental Health,” published in The British Journal of Psychiatry, Konstantinos Ioannidis, a member of the BootStRaP project team, delves into these dualities. Through vivid analogies and evidence-based insights, he highlights the urgent need to address problematic internet usage (PUI) and its ripple effects on mental health.
Dr Konstantinos Ioannidis, MD, MSc, MRCPsych, AFHEA, PhD; Consultant Psychiatrist, Clinical Lead, Southern Gambling Service, Hampshire and Isle of Wight NHS Foundation Trust and Honorary Senior Clinical Lecturer, University of Southampton
In this exclusive interview, Konstantinos Ioannidis discusses the editorial’s key themes, offering a deeper look into the public health risks posed by excessive internet use, the evolving role of clinicians, and the importance of early intervention. Drawing on his experience with the BootStRaP project, he also shares perspectives on how technological advancements and policy frameworks can help combat PUI. This conversation sheds light on the critical steps society must take to navigate the intricate relationship between our digital and mental lives.
Your recent editorial highlights both the benefits and harms of our digitalized world. What do you see as the most urgent public health risk related to problematic use of the internet (PUI) today?
The most pressing health risk tied to PUI, in my opinion, is achieving a sustainable balance in how children and young people interact with digital devices. While digital tools like gaming, streaming, and social media provide various benefits, they risk displacing real-world experiences critical for social, emotional, and cognitive development. Young people require these experiences to mature into well-rounded, resilient adults. The challenge lies in creating an environment where they can safely consume digital content without missing out on physical activities, community interaction, and interpersonal relationships, essential to developing a healthy sense of self and coping skills.
In the editorial, you mention that problematic internet usage shows both similarities and differences to substance addictions. Could you elaborate on these differences and how they might impact treatment approaches?
A key distinction between substance use disorders and behavioral addictions like PUI is that the latter often starts at an earlier age, with access to digital content that’s generally accepted or even encouraged by society, like gaming or social media. Unlike with substance use, there are few established regulations or restrictions for children using digital media, creating an environment where dependence can grow unchecked. Professional bodies, like the American Academy of Child and Adolescent Psychiatry, may issue guidelines warning of the dangers of excessive screen time, but children and adolescents still often lack the tools or support to manage their usage. This accessibility, combined with the strong, immediate rewards of digital content, presents unique challenges for clinicians. Treatment approaches must take into account the normalization of digital use from an early age and incorporate strategies that help young users build self-regulation skills, resilience, and awareness of the risks of excessive digital engagement.
How do you see the role of clinicians evolving in assessing and intervening with PUI, especially given the fast pace of technological change?
Clinicians, especially those in mental health, will need to adapt to the rapid technological landscape and expand their role to address PUI as part of a holistic approach to health. Increasingly, clinicians are seeing PUI as a contributing factor in a range of issues, from depression and social anxiety to physical conditions like obesity, eye strain, and sleep disorders. Clinicians will need to develop expertise in recognizing PUI among patients presenting with other primary issues and to understand the ways it may complicate or exacerbate these conditions. Ideally, specialized services focused on assessing PUI, understanding its root causes, and treating it within the context of a person’s broader physical and mental health will emerge. Clinicians will play a crucial role not only in treating PUI directly but also in educating patients and their families on healthier digital habits and promoting awareness of the risks.
The article uses the “Chimaera-Hydra” analogy to describe the evolving nature of online risks. How do you think public health policies can keep up with these constantly changing challenges in the digital world?
Keeping pace with digital risks is, in many ways, a Herculean task. The technology sector evolves rapidly, with companies constantly pushing forward, adapting, and possessing substantial financial resources to drive innovation. Public health policy, on the other hand, often requires years of research and a robust evidence base before implementation. This creates a fundamental challenge: public health must not only catch up with the current state of technology but must also anticipate future risks. Additionally, the burden of proof for harm generally rests on public health researchers and policymakers, rather than on technology developers to demonstrate safety. This accountability gap complicates efforts to protect the public, as establishing effective regulations takes longer than the development of new technologies. Addressing this challenge may require new frameworks that prioritize rapid-response research, proactive monitoring, and agile policy-making to safeguard public health in real-time.
Given your involvement in the international BootStRaP project, what have been the key findings on the factors contributing to PUI?
The BootStRaP project represents an exciting step forward in understanding PUI by investigating its factors. Although it is still in its early stages as a multi-year research endeavor, we anticipate that it will ultimately yield valuable insights into how individual vulnerabilities and environmental influences intersect to contribute to PUI. Currently, it’s too soon to share concrete findings, but the project holds the potential to map out specific factors that heighten the risk of PUI. This could open up pathways to more targeted interventions, allowing us to tailor prevention and treatment strategies to better support those at high risk. The knowledge gained from BootStRaP could be instrumental in developing evidence-based guidelines and recommendations for managing PUI on a global scale.
With the rise of binge-watching and endless scrolling on social media, do you think society is normalizing addictive behaviors, and what might be the long-term consequences of this trend?
It is very hard to predict where this trend will take us. We have the early signs of a society that is at the mercy of streaming and social media platform algorithms for its entertainment, their music or food choices, their choice of government, among other things. I believe that on an individual level, those who have lived before the explosion of online media can appreciate that there is something dystopian about losing control over (even some facets of) your internet usage, which is a common experience nowadays. However, for children and young adults, who’ve never known a world without these technologies, this is simply “normal.” The question is whether, as more people experience this dependency, it becomes accepted as part of modern life rather than seen as a problem. This shift in perception raises significant philosophical and ethical questions about agency, autonomy, and well-being that society will need to address as we move forward.
Your research connects PUI with a range of mental health outcomes like depression and anxiety. How important is early intervention in preventing these outcomes, and what signs should clinicians look for?
Early intervention in PUI could be critical for preventing or mitigating mental health issues, though more research is needed to fully understand its impact. Clinicians should look for individuals who express difficulty controlling their online use despite experiencing negative consequences, such as strained relationships, academic underachievement, vocational issues, financial stress, or mental health challenges. Although the field is in its infancy, the potential benefits of early intervention seem promising. Through BootStRaP, we’re aiming to identify early signs of PUI in young people and intervene during a crucial developmental stage, fostering resilience and helping them establish healthier patterns. By guiding young people toward balanced internet use, we may be able to improve their trajectories and reduce the risk of later mental health complications.
You mention the “opportunity cost” of digital living—missing out on real-world experiences. Do you believe this will significantly affect the younger generation’s development and future mental resilience?
Yes, the potential impact of growing up in a digital-first world is a serious concern. We’re only beginning to understand the “opportunity cost” of missed real-world experiences, and there’s much we don’t know about which of these experiences are fundamental to building resilience and social skills. Physical world experiences—like family meals, group activities, playing music, and participating in sports—provide essential opportunities for young people to develop social bonds and coping skills. For instance, we know that strong friendships are a crucial protective factor for mental health. But are online friendships, lacking in physical presence and shared real-life activities, just as effective in providing that protection? These are critical questions that will shape our understanding of digital living’s true impact on development and mental resilience.
How do you envision the role of future technologies, like virtual and augmented reality, in shaping new forms of problematic usage or potentially mitigating some of the current harms?
While I don’t believe virtual and augmented reality (VR and AR) are inherently harmful, their capacity to create immersive, highly stimulating environments has the potential to engage the brain’s reward circuitry in ways that may foster compulsive use. This is especially true in sectors like gaming, gambling, and pornography, where developers could create experiences that lead to problematic usage patterns. The ethical implications of these technologies are significant: developers have a responsibility to consider public safety when designing VR and AR experiences, but there is a clear tension here, as more addictive designs can also be more profitable. Moving forward, it will be critical for both the tech industry and policymakers to work together in setting ethical standards that prioritise user well-being over commercial gain.
Thank you!
© BootStRaP Communication Team Information
Taming the Chimaera–Hydra: disconnecting from the net to fortify our mental health please find here
03/01/2025
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