Behind the Screens: How Mental Health Professionals Can Help Teens Struggling with Social Media Use

A therapist’s firsthand account working in an adolescent mental health unit

Introduction from Zach Rausch:

Who is best positioned to understand the impacts of social media on youth mental health? Beyond the tech companies that create these platforms and the young people who use them, those who work closely with teens—parents, teachers, and mental health professionals—witness what’s happening on the ground every day. In previous posts, we’ve heard from parents and educators. Now, we turn to a third key group: psychologists, psychiatrists, direct care workers, and social workers. What are they observing and hearing from their clients? If social media were truly neutral or harmless (the “null hypothesis”) we’d expect these professionals to rarely hear that it has a direct, negative impact on their clients’ lives. Is that really the case?

Large-scale data on mental health practitioners’ perspectives in the U.S. remains scarce, as far as I know. If you know of any, please add them to the comments. Still, the limited evidence we have raises concern. For instance, a survey from the Australia and New Zealand Academy for Eating Disorders (ANZAED) involving 80¹ frontline workers who treat teens with eating disorders found that 88% favored raising the minimum social media age to 16, and every respondent (100%) agreed that social media has a detrimental impact on body image issues and eating disorders. We hope to find additional data to see whether these findings are representative and can be generalized more broadly.

Here at After Babel, we’ve been eager to feature more clinical voices—both to highlight their experiences and to offer guidance for other therapists, parents, and families who are seeking help. This led me to the work of Helen Thai, a doctoral candidate in clinical psychology at McGill University and a Clinical Psychology Intern at the Goldman Herzl Family Practice Centre in Montreal, Canada. I first came across Helen when Jon and I were engaging in a debate with Stetson University Psychology professor Chris Ferguson about the impact of social media reduction on adolescent anxiety and depression. Helen is the lead author of two of the twenty-seven experiments we discussed (you can read them here and here).

During a Zoom call in early November to discuss these studies, I learned that Helen has been doing clinical work at a teenage health unit, working with many adolescents and teens (13 to 19 years old) presenting with mental health challenges, with many struggling with social media use. I quickly realized how valuable her perspective would be for the Substack. Helen brings a unique point of view, providing high-level research insights along with on the ground experience with teens. In this post, Helen shares a case study from her practice and offers practical advice for clinicians working with struggling teens.

– Zach

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Behind the Screens: How Mental Health Professionals Can Help Teens Struggling with Social Media Use

Source: Shutterstock

When I asked my patient Caroline² about her self-harm, I was struck by how often her response seemed to link her behavior to the online world: Every scar on her body—although carefully hidden from her parents—had been shared openly with thousands of strangers on social media. As she spoke, I could not suppress the question forming in my mind: Why?

Before meeting Caroline, my understanding of social media was shaped largely by my own experiences as a user. My curiosity about its effects began after my first “social media cleanse.” What began as a temporary experiment unexpectedly became a long-term lifestyle change, as I discovered noticeable benefits to my mood, sleep, and concentration. My academic research at the time (Thai et al., 2021; Thai et al., 2024) seemed to validate my personal experience, demonstrating how curated, perfectionist personas online contribute to body image concerns, particularly in youth who already present with emotional distress. The premise was simple: reducing exposure to idealized images could help alleviate insecurities and improve aspects of body image, such as weight and appearance esteem.

Caroline’s story, however, forced me to confront a different reality. Social media is not just a gallery of filtered selfies or polished highlight reels designed to stoke insecurity. For some, it becomes a stage for raw vulnerability. Amid the flood of idealized content, these platforms also serve as spaces where unfiltered expressions of suffering find an audience. Why are people like Caroline compelled to expose their deepest struggles online?

In the rest of this post, I explore how social media platforms shape adolescent psychological experiences, the risks they present, and practical interventions for mental health professionals helping young people navigate this digital landscape.

The Psychology of Screen-agers

Adolescence marks a pivotal stage of physical, social, and psychological development. For Gen Z (those born between 1996-2011) and Gen Alpha (those born after 2011), these formative years increasingly unfold in a digital environment that can often both enrich and endanger. On the one hand, social media provides channels for connection, self-expression, and information-sharing. On the other hand, it amplifies unhealthy behaviors including excessive upward social comparison, bullying, polarization, and superficial validation.

Beyond these well-known issues, social media has reshaped how young people express and experience suffering. What was once confined to an individual’s private world can now be broadcast on a global stage, becoming part of a larger public narrative. Although these platforms have brought important mental health discussions into the mainstream and often serve as hubs for seeking and sharing mental health information (Naslund et al., 2016), this heightened visibility can also reinforce harmful behaviors, such as self-diagnosis and romanticization of symptoms. In some online communities, psychological distress becomes a performance, incentivized by likes, shares, and algorithmic boosts.

Take Caroline, for example. She first encountered self-harm content online, adopting it as a way to manage her emotional turmoil. Over time, this coping mechanism led her to online communities where self-harm functioned as a passport for belonging—an easy way to gain attention and camaraderie. The design of these platforms—the likes, shares, and algorithmic recommendations—incentivized escalating behaviors, from superficial cuts to more dangerous, deeper wounds. Each post garnered instant feedback and dopamine-driven reinforcement, blurring the lines between genuine support and a toxic feedback loop that deepened her identification with self-harm.

For impressionable adolescents still shaping their sense of self, interactions like these can obscure the distinction between seeking authentic help and seeking validation through distress. In this way, social media becomes a double-edged sword. It can serve as a stage for identity exploration and a conduit for connection, but it can also perpetuate psychological distress. Ultimately, the danger lies in how adolescents engage with these platforms—often driven by both their unmet emotional needs and the platforms’ exploitative reward structures.

Updating Our Clinical Approach In the Digital Age

In my work at an adolescent psychology clinic, I’ve seen firsthand how traditional approaches to psychological assessment and intervention must evolve to reflect the realities of the digital world. Human interaction and psychological development now unfold with every scroll, like, and share. Almost all teens today use social media and own a smartphone, with nearly half being online almost constantly (Faverio & Sidoti, 2024).

Because so much of their social world exists online, it’s no longer sufficient to explore only a patient's home environment or face-to-face interactions during intake assessments. Instead, mental health professionals should integrate digital behaviors into routine evaluation by asking about:

• Online engagement (e.g., frequency, specific platforms)

• Content consumed (e.g., self-harm materials, drug-related content, etc.)

• Psychological impact of digital consumption and interactions (e.g., sleep disturbances, cyberbullying, body image concerns, emotional distress, FOMO)

Such an approach also recognizes new digital risks like sextortion, drug sales, and self-harm promotion. These risks require both clinical and systemic responses to ensure safety for users.

The Missing Piece: Reduction Plus Replacement

So, what should we do as mental health professionals when patients say they’re online “almost constantly”? Is the solution to cut back on social media? Yes, but that is just a first step. It will be hard for teens who are online “almost constantly” to regain their mental health. Reduction is not enough. Mental health professionals cannot just address the outward behavior of chronic social media use. They must also address the underlying needs driving it. In my clinical practice, I’ve found that reduction plus replacement is the more effective model:

• Decrease problematic online behaviors (reduction)

• Replace them with healthier, more meaningful pursuits and coping strategies (replacement)

Here’s how we did this with Caroline. Our focus was not solely on stopping her online engagement, but first on understanding its function in her life. Caroline found belonging and validation through self-harm-focused online communities. Although toxic in many respects, her online life wasn’t entirely negative—she also used social media to share her art. Caroline recognized that being known for self-destruction was not the legacy she wanted to leave, but giving it up felt like losing a part of her identity.

Our therapy began by addressing her self-harm, while initially allowing her to maintain her usual social media use. As her physical scars healed, we engaged in values clarification work, helping her rediscover her love for art and writing as more authentic expressions of who she was. Over time, Caroline’s online presence shifted from self-harm communities to spaces where she shared her creativity. By setting boundaries around the content she consumed and the time she spent online, she learned to use digital platforms as a tool rather than a trap. This newfound discipline freed up more time to explore art conventions and meet people who shared a similar appreciation for the craft.

More Ways Mental Health Practitioners Can Help

Mental health practitioners are uniquely positioned to guide young people through the complexities of digital life. While some young people may exhibit compulsive engagement that mirrors addiction, others may struggle with more moderate but still problematic patterns. Recognizing this spectrum is vital for tailoring interventions. There are three specific ways that mental health practitioners can do this.

1. Identify Sensitive Developmental Periods

A study by researchers in the UK found that adolescents experience two key developmental windows when increased social media use correlates more strongly with lower life satisfaction the following year:

• Early adolescence (11-13 years for girls, 14-15 years for boys): coinciding with puberty and its social/biological changes.

• Late adolescence (19 for both genders): when social and identity-related pressures (e.g., leaving school, starting jobs) intensify.

Because gender differences are observed in the first phase of heightened vulnerability, pubertal timing likely plays a role. For patients who are under the age of consent, involving parents and/or teachers in preventive cohort strategies—like curriculum change or early intervention—can help buffer this heightened risk.

2. Adopt Broader Structural Recommendations to Enhance Prevention

An ounce of prevention is worth a pound of cure, and many steps can be taken by societies, communities, schools, and families to prevent or delay mental health problems caused by today’s heavily phone-based childhoods. Drawing on The Anxious Generation, several broader systemic strategies include:

1. Delaying smartphones until high school

2. Delaying social media use until at least age 16

3. Implementing phone-free school environments

4. Encouraging greater real-world independence and unstructured play

These approaches aim to reduce problematic engagement from childhood through adolescence. However, for those already struggling, mental health professionals might need to devise individualized plans involving removal, reduction, and/or replacement of social media use.

3. Consider Healthy Engagement versus Total Abstinence

A key question remains: Should problematic social media use be treated like substance use disorder, where abstinence is often the goal? While some individuals may benefit from total disengagement, for others, a nuanced approach may be more appropriate. Social media is deeply ingrained in modern communication and can also be a platform for networking, creativity, and leisure. While the benefits are sometimes questioned, particularly in cases where the harms are evident, it’s important to recognize that some young people may not want to fully abstain.

Thus, the ultimate goal (for those young people) is to restore agency rather than force permanent and complete avoidance. In some cases, a period of abstinence followed by gradual reintroduction can help reset habits and reduce compulsive patterns.

So, what would healthy engagement entail? Here are some suggestions:

1. Promote Intentional Usage with Concrete Strategies:

   • Encourage young people to critically assess and revise the algorithms shaping their feeds.

   • Use screen time limits (for heavy users, cutting social media use by at least 50% seems to be feasible and beneficial; Thai et al., 2024; Davis & Goldfield, 2025) and grayscale settings to reduce doom-scrolling.

   • Recommend resources like Center for Humane Technology.

2. Establish Offline Alternatives to Digital Life:

   • Encourage in-person social interactions through group activities (e.g., sports, clubs).

   • Suggest shared screen time rules and device-free zones.

   • Develop new hobbies to replace social media’s reinforcement mechanisms (e.g., sense of belonging, achievement).

3. Foster Emotional Regulation and Identity Development:

   • Use cognitive restructuring to manage distressing online experiences.

   • Allow patients to set their own gradual reduction plans, acknowledging trial and error.

   • Promote values-driven work; show them it’s okay not to follow the crowd just because “everyone else is doing it.” (i.e., social media is optional)

   • Discuss the potential short-term and long-term consequences if problematic use persists.

Conclusion

Effectively addressing the mental health challenges associated with adolescent social media use requires a multifaceted strategy that recognizes both the risks and the potential benefits of digital engagement. Youth are especially vulnerable to feelings of isolation, anxiety, and identity confusion amplified by social platforms; yet these same platforms can also foster creativity, self-expression, and meaningful connection, as illustrated by Caroline’s journey. Rather than imposing a one-size-fits-all solution for older adolescents (though group-level norm setting is also important), mental health professional should prioritize understanding the deeper emotional needs driving each young person’s online behaviors. By supporting digital literacy, encouraging offline connections, and equipping adolescents with adaptive coping strategies, mental health professionals can help them cultivate a balanced relationship with technology—one that preserves the advantages of social media while safeguarding their well-being. Ultimately, empowering young people to reclaim agency over their digital lives not only promotes emotional resilience but also lays the groundwork for a more enduring sense of self—one that transcends the screen.

1. Note that the linked article reports that the poll includes 730 ANZAED members. However, after email exchanges with ANAZED staff, we learned that the sample for these questions was confined to 80 members.

2. Note: To uphold privacy and confidentiality, careful revisions have been made to preserve the essence of the patient's story while highlighting the shared human needs that connect us beyond screens. The name "Caroline" is a pseudonym; all identifying details have been altered to protect the individual’s identity.