The primary motivation for this research is a concern for the potential to cause harm to clients and practitioners via online mental health services, particularly as the boundaries between internet use and daily living continue to blur. This is by no means to suggest online mental health services are, as a whole, more risky than those offered face-to-face, although such a bold claim would require extensive investigation to substantiate. Rather, it is to say that the potential of a harmful event occurring as a result of engaging in online therapy is growing in line with an increasing overall trend of internet usage. This is due to both an increase in absolute numbers of individuals seeking therapy online and the growing proportion of individuals who spend more time online than engaging in any other single activity.
The internet is of growing importance for psychological research and practice with various forms of psychotherapy now being provided online. However, the delivery of counseling and psychotherapeutic services online has developed more quickly than associated research examining its efficacy, particularly in relation to specific applications. This is well exemplified by a substantial body of research examining the efficacy of computerized cognitive-behavioral therapy (cCBT) for depression and anxiety, now commonly given as an online intervention, despite the fact that the vast majority of this research has been conducted on pre-internet stand-alone protocols. An example of where online interventions are evolving faster than associated research can be seen in the provision of real-time video-conferencing, which aims to meet higher security and ethical standards by approximating the process and format of traditional face-to-face counseling appointments.
Impact of Live Streaming Services on Mental Health
Kowal and Fortier (2017) conducted an experiment to determine how social live streaming directly influences feelings of loneliness and social integration in viewers. Fifty-five undergraduate students participated and were either assigned to watch a researcher live stream a popular video game or play the game themselves. It was noted that video gaming is a common activity for students and is typically done in the presence of friends for social enjoyment. They determined that the live stream condition led to significantly greater social loneliness than the playing condition, due to it creating a parasocial interaction between the streamer and viewer. This led to the feeling that the viewers were, in fact, socially substituting the activity with actual social interaction. Consequently, this could have implications for individuals whose primary form of social interaction or entertainment comes through live streaming.
Kuss and Griffiths (2017) suggest that live streaming is likely to have a similar impact to general internet use on an individual’s mental health. However, due to its increased social integration, the psychosocial implications may be greater. The review reports that excessive internet use has been linked with higher rates of depression and anxiety, as well as greater feelings of social isolation and loneliness. Measures of excessive internet use often equate to addictive use, leading Kuss and Griffiths (2017) to suggest that a similar model of an internet-streaming addiction can be applied. This would manifest as an impairment to an individual’s offline weekly activities, leading in turn to negative consequences on the individual’s daily life and mental well-being.
As the applications and usage of live streaming services increase, this has the potential to have numerous effects on mental health. Kuss and Griffiths (2017) provide a comprehensive examination of the psychological implications of excessive live streaming in their conceptual review. They define internet live streaming as an immersive multimedia experience in which viewers and streamers are able to socially interact in real time. Live streaming services add another dimension to the internet experience, as they involve active participation (e.g., through gameplay, music creation, artwork creation, talking) and increased social communication.
Psychological Effects of Excessive Live Streaming
This change will also have a negative effect on the amount of physical activity an individual does. With the advancement of technology and more sedentary job and leisure activities, 60% of consultations to general practitioners have a purely or partially psychosocial component. Avoidance of physical activity is a way to avoid adverse situations or embarrassment, which can be linked to the last point concerning escapism. However, physical exercise has been proven to reduce psychological illnesses, and someone who is not exercising will find live streaming more appealing as a form of entertainment and not a hobby to balance with other activities. This leads to a further derailment from current and future actions as psychosocial issues will still not be addressed.
Furthermore, excessive use of live streaming services can cause a lack of routine and physical activity, two factors that are crucial in maintaining positive psychological well-being. It has been recorded that a lack of routine can increase stress levels and anxiety. If an individual is neglecting other duties for live streaming, there will be a significant change in routine. Reasons for this can include people in between jobs or educational courses, and in such situations, there will be no need to get up at a specific time. Live streaming itself can be a negative trigger for those unemployed as it will have a negative influence on productive activities due to the perception of easy income and fame from being a streamer. Easier and quicker income compared to working in a fast food restaurant or retail store may be tempting for younger individuals and not encourage more useful skills and qualifications for the future. Regardless of employment status, anyone who watches streams will often stay up late to watch a specific stream or watch streams from another country at unsociable hours.
Individuals who excessively use live streaming platforms could have a change in their psychological well-being. Excessive usage of live streaming services can cause addictive behaviors and increase the use of escapism. Escapism is defined as “a mental diversion by means of entertainment or recreation, as an ‘escape’ from the perceived unpleasant or banal aspects of daily life.” In today’s society, this can be seen as a way of ignoring or running away from personal troubles. When individuals are using live streaming platforms excessively, the reasons as to why they are doing so can be associated with the need to escape. This creates negative emotions as they may not wish to face current adversities. Users have also reported an increase in misophonia, which is a disorder characterized by strong emotional responses to sounds, especially sounds of eating or breathing. If live streaming and gaming platforms are used as a way of escaping irritating sounds or to avoid said sounds as mentioned above, this could be a change in behavior that is a negative trigger for misophonia symptoms.
Social Isolation and Loneliness
This section of the report will describe a randomized controlled trial designed to reduce loneliness and social isolation in people with mental health problems in the UK. The IMPACT study aimed to recruit 240 lonely and/or socially isolated individuals who were using mental health services in the community. The intervention was a befriending scheme either through one-to-one linkage with a volunteer or through membership of a social group. Both interventions were expected to reduce loneliness and social isolation by facilitating engagement in satisfactory conversation and activities, leading to the formation of quality friendships and peer relationships. By increasing opportunities for enjoyable, positive social interaction, IMPACT hoped to reduce the perceived stigma associated with mental health problems by demonstrating that individuals with mental health problems were able to form social networks that were satisfying and fulfilling. This component of the study is particularly relevant in the modern digital age, where young people are known to use social networking in an attempt to demonstrate worth and integrate with others their age. Use of an internet-based befriending scheme could be a viable option in breaking the cycles of loneliness experienced by young adults with mental health problems.
Social isolation has been variously defined in terms of an objective lack of social contacts and a lack of satisfactory quality of relationships. It is hypothesized to reflect an absence of satisfactory interactions with others and to indicate an undesirable discrepancy between an individual’s preferred and actual social relationships. Objective social isolation is said to occur when an individual lacks a network of friends, peers, and family. Subjective social isolation refers to the experience of being isolated, the individual’s perception that he or she is isolated, and the individual’s feelings of loneliness. Loneliness is defined as an unpleasant experience that occurs when a person’s network of social relationships is deficient in some important way, either in quality or quantity. Loneliness is a subjective, unwelcome feeling resulting from a comparison of the individual’s ideal and actual social relationships.
Strategies for Maintaining Mental Well-being in a Connected World
Engaging in offline activities and social interactions Going hand in hand with setting boundaries and providing alternate activities, engaging in offline activities and social interactions is an effective method of maintaining mental well-being. With the wealth of live streaming and online activities, it can be easy to forget how we previously spent our free time and the type of activity that we find most relaxing. Planning and engaging in activities that we find enjoyable and stimulating can keep our minds occupied and less likely to resort back to electronic forms of entertainment. This can range from outdoor activities or sports, to hobbies, crafts, music, reading, and home renovation – any activity that does not involve staring at a screen. Volunteering for community activities or spending time with others is effective due to social interactions being a beneficial health determinant. Children can benefit from opportunities for informal social interaction through play with their friends in safe environments as well as engaging in a variety of activities coordinated by parents and teachers.
Setting boundaries and limiting screen time Online social activity has shifted our ‘normal’ contact with one another to a largely digitized and filtered form of communication. With handheld devices and laptops allowing us to be connected from anywhere, many people find it difficult to disconnect from the virtual world. Drawing a line between online and offline interaction and devising a timeframe in which to engage in live streaming and other online activities is crucial in maintaining mental well-being. As suggested by Clemmow and Parker, developing a concrete schedule which marks designated times for going online and a day or two without digital technology can reduce anxiety. Slade recommends limiting television and screen time for children to 1-2 hours a day for children aged over 2, and discouraging television in the background as a means to reduce electronic ‘noise’ in the household.
Setting Boundaries and Limiting Screen Time
Once again, it is important to remember the balance between ensuring sufficient time is spent offline and avoiding isolation by not spending enough time engaging in social activities.
These activities should then be balanced with set periods offline where a person can partake in other activities. It is then important to budget the time spent using the internet so it does not creep into other time that has been set for other activities. This can be achieved using monitoring software to see exactly how much time you are spending online or setting an alarm clock to alert you when your internet time is up.
Setting boundaries and limiting screen time can be a tricky task as the constant connectivity provided by the internet can make one feel as if they should always be online and ready to respond. It is important to distinguish time spent using the internet and time when one is ‘available’ to be using the internet. This means there should be allocated times when the internet is used, such as watching television, reading the news, checking emails or using social networking sites.
Engaging in Offline Activities and Social Interactions
Individuals experiencing depression and anxiety often find solace spending time alone and away from others, though this only worsens their mental health as they lack social interactions that can potentially improve their mood. Shy and introverted people are especially susceptible to worsening mental health from loneliness and social isolation. Unfortunately, the knowledge that social interaction is good for mental health doesn’t necessarily help with people who find it taxing. Patients are more likely to engage in group activities which provide a safe, pressure-free environment. Specific group programs targeting an individual’s particular mental illness should be considered as an alternative to social interactions with friends or regular recreational activities. A mental health support group consists of people with the same diagnosis helping one another, sharing their experiences, coping strategies, and offering each other hope. This serves as a good opportunity to socialize and relieve isolation and loneliness. Studies have shown that pets are very helpful at providing a higher sense of self-worth and companionship for those with mental illnesses. This can be a viable alternative to socializing with other people.
Practicing Mindfulness and Self-Care
While live streaming has rapidly grown over recent years, it has also become connected to an increase in symptoms of depression and anxiety. This may be due to various causes including cyberbullying, low self-esteem, and social isolation. Research published in the Journal of Abnormal Psychology also showed significant associations between social media use and increased depressive symptoms. It is therefore imperative that concurrent with live streaming, individuals are managing their mental well-being effectively. Step one of this process would involve identification of their mental state with use of the DASS (Depression Anxiety Stress Scales) questionnaire. Following this, the individual should then consult a mental health professional to discuss adequate strategies given the requirements of the live streaming industry, which may involve the strategies detailed in Dialectical Behaviour Therapy.
Role of Live Streaming Platforms and Mental Health Support
There are also a variety of smaller changes that can be implemented to promote healthy mental health habits among users. Integrating breaks and reminders to stand up and stretch during long viewing sessions as YouTube now does can help to prevent the deep dives into content consumption that can have negative effects on mental and physical health. Using cookies or user data to track the amount of consecutive time spent on the site and prompting users to take a breather if their usage is becoming excessive.
According to the clip summarizing a meeting between Twitch and several mental health experts, by educating streamers on how to recognize signs of distress in their audience, Twitch hopes to create a first line of defense in addressing mental health concerns on their platform. Additionally, they aim to integrate crisis service information into the interface, which users can access at any time by typing in a simple command. This is highly reminiscent of Facebook’s recent suicide prevention tool and similarly shows recognition that the internet can be a site of mental health crisis for some individuals, so providing easy access to support services is crucial.
Live streaming platforms have come a long way from being a simple stage for streamers to broadcast their content. With increased societal awareness and acceptance of mental health issues, platforms are beginning to implement features to promote healthy usage of their services, as well as providing resources and support for users.
Implementing Features to Promote Healthy Usage
By communicating with users and interviewing professional counseling staff members, our group has researched and received significant insight that they believe should be prioritized. Hillyer asserts that “the power of social connection and support in the face of stress or adversity is an important and potentially protective factor in mental health.” This quote reinforces the idea that during stressful times or when trying to overcome adversity, having a support system or someone to relate to can be the difference between happiness and despair. A support system is something that individuals turn to in times of need and can take many shapes or forms. Ösing et al suggest that individuals are likely to seek social support when they are feeling particularly negative about themselves or about an event that has happened to them, allowing them to avoid loneliness and acting as a type of positive reinforcement. Research papers by D.N. Berry and M.S. Takano each suggest that the presence of others is associated with lower levels of perceived stress, information which highlights the importance of having someone to relate to when under pressure. Based on these suggestions, it is clear that promoting social interaction and the building of support systems can be a valuable asset to individuals who are or have faced mental health issues. Live streams that contain video, audio, and text communication allow users to interact with one another and the streamer at the same time, making it a very powerful tool for building support systems through shared experiences. This kind of interaction has the potential to relieve feelings of isolation and to provide sympathy and encouragement between individuals who may be dealing with stress or depression.
Providing Resources and Support for Users
Public live streaming platforms connect and unite people through their shared lives, experiences, and virtual communities. Over 46% of global live streaming video viewers are aged 16-24, an age bracket that is crucial in terms of mental health development. By publicizing their daily lives, livestreamers have been known to form parasocial relationships with their audience when familiar viewers become attached to the streamer despite the lack of face-to-face contact. Although research into the effect of parasocial relationships on mental health is scarce, some evidence indicates that factors pertaining to the relationship can be damaging. This can be seen when considering that 24% of Twitch users and 9.7% of general US live streaming platform users are reported to have daily or severe daily mental health issues. As a result of parasocial relationship formation and live streaming viewer demographics, it can be considered that public live streaming can have a direct effect on the mental health of both viewers and streamers. With large portions of the younger demographic using these platforms as a form of daily social interaction, it is critical that live streaming platforms have infrastructure in place to mitigate any negativity on mental health while simultaneously being able to support individuals who require assistance.
