Social Media Anxiety in Clients: New Research Suggests It's Not About Time Spent Online

Research is suggesting it is about how social media is used, rather than time spent. What does this mean for clinical practice?

A recent study found that different types of social media engagement can have vastly different psychological impacts¹ - a finding that gets deeper into the link between social media usage and mental health implications.

What Does the Research Show?

Ozimek and colleagues surveyed around 1,230 participants (majority female) to understand different types of social media behaviour and develop a scale to measure this — the Social Media Activity Questionnaire (SMAQ). Their findings revealed two primary forms of engagement: active and passive use.

The research indicates that passive use - such as scrolling through feeds and pictures without interaction - was more strongly linked to:

• Social comparison behaviour

• Fear of missing out

• Social media addiction tendencies

• Losing track of time online

Meanwhile, active engagement - like posting content and having direct conversations - showed different patterns:

• Stronger correlation with intense Facebook activity

• Higher links to anxiety and depression symptoms

• More conscious awareness of time spent online

They suggest the SMAQ could be used to gather information and about specific use of social media, and to set individual goals with clients around social media use.

However, they note that whilst they have tried to integrate most social media platforms to be measured via the SMAQ, they are not measure for all platforms given the diversity of social media.

Variations in Social Media Networks

Should we include new measures in treatment?

Widely used measurements of social behaviour - including the Social Phobia Inventory (SPIN)², Social Behaviours Questionnaire (SBQ) ³ and the Social Cognition Questionnaire (SCQ)⁴, do not explicitly reference social media use - likely due to the time they were designed and the stage of research.

Are we therefore missing out on a key piece of psychometric information about our clients social (media) lives?

Other measures have begun development and replication.

The Social Anxiety Scale for Social Media Users (SAS-SMU), developed by Alkis et al. (2017) on a Turkish sample began a new approach of measurement⁵.

The SAS-SMU is a self-report questionnaire with 21 items covering four dimensions of social anxiety in connection to social media usage.

Unlike the SMAQ which identified areas of passive and active use, SAS-SMU focuses on four domains:

• Shared content anxiety

• Privacy concern anxiety

• Interaction anxiety

• Self-evaluation anxiety
  

The SAS-SMU has been replicated in multiple cultures and languages, including English⁶, Swedish⁷, Persian⁸ and Chinese⁹. In particular, the Swedish, Persian and Chinese versions were statistically evaluated and found to produce useful psychometric properties.

This raises the question - do we need to start introducing specific social media measures into therapy? In what diagnoses may this be helpful?

“It can be incredibly helpful if socially anxious clients have built up a multitude of safety behaviours and/or avoidance around social media, to have formal measurement of this” says Sophia Spencer, a specialist social anxiety CBT psychotherapist.

However, another therapist, who works in the NHS and wishes to remain anonymous, suggests it’s useful for many diagnoses - “Social media negative coping behaviours are found across depression, GAD and low self esteem - formal measurement could be helpful for them all”. She caveated — “I’m not sure within the NHS remit if we would have time to adequately deal with this so we would be opening a box we may not have time to close”.

Looking Ahead: What This Means for CBT

Despite these emerging insights, the research suggests that the relationship between social media use and mental health isn't one-size-fits-all. While new measurement tools like the SMAQ and SAS-SMU provide valuable frameworks for understanding online behaviour, personal patterns and preferences matter.

As social media continues to evolve, these new measurement tools may help us better understand its impact on mental health and better serve our clients.

But, the development of measures suggests a growing recognition that we need more sophisticated ways to assess and understand social media behaviour and formally recognise this within our diagnosis, formulation and treatment.

In particular, the research indicates that whether engagement is active or passive, and types of anxiety, may matter more than total time spent online - a finding that could reshape how we think about healthy social media use.

What do you think? Tell us in the comments! Or vote in our poll:

We’ve reached out to the authors of both measurements to see if they would provide a copy of their clinical questionnaires for our community.

1. Ozimek, P., Brailovskaia, J., & Bierhoff, H. (2023). Active and passive behavior in social media: Validating the Social Media Activity Questionnaire (SMAQ). Telematics and Informatics Reports, 10, 100048. https://doi.org/10.1016/j.teler.2023.100048

2. KM Connor, et al. Psychometric Properties of the Social Phobia Inventory (SPIN): New Self-Rating Scale. British Journ Psych. 2000.

3. https://www.div12.org/wp-content/uploads/2014/09/Social-Behaviour-Questionnaire.pdf

4. https://oxcadatresources.com/questionnaires/

5. Alkis, Y., Kadirhan, Z., & Sat, M. (2017). Development and validation of social anxiety scale for social media users. Computers in Human Behavior, 72, 296–303. https://doi.org/10.1016/j.chb.2017.03.011

6. https://esource.dbs.ie/server/api/core/bitstreams/b44c21ea-3d7b-4cee-a227-cd49e90d8ee2/content

7. Erliksson, O. J., Lindner, P., & Mörtberg, E. (2020). Measuring associations between social anxiety and use of different types of social media using the Swedish Social Anxiety Scale for Social Media Users: A psychometric evaluation and cross‐sectional study. Scandinavian Journal of Psychology, 61(6), 819–826. https://doi.org/10.1111/sjop.12673

8. Faghani, N., & Moghadasin, M. (2023). Psychometric properties of the Persian version of Social Anxiety Scale for Social Media Users (SAS-SMU). Iranian Journal of Psychiatry. https://doi.org/10.18502/ijps.v18i4.13628

9. Wang, T., Zhang, H., & Bao, S. (2024). Testing, revision and application of the social anxiety scale for Chinese social media users. Frontiers in Psychology, 15. https://doi.org/10.3389/fpsyg.2024.1378093