Exploring how social networking sites impact youth with anxiety: A qualitative study of Facebook stressors among adolescents with an anxiety disorder diagnosis


Adolescents with anxiety disorders often have low self-esteem, poor problem-solving, and a strong desire to be accepted. Combined, these qualities may predispose them to experience unique stressors when using social network sites (SNSs). Focus groups of adolescent Facebook users who have a primary anxiety diagnosis uncovered narratives describing individuals’ perspectives related to how Facebook can influence their anxiety. Qualitative analysis revealed six themes related to Facebook stressors: seeking approval, fearing judgment, escalating interpersonal issues, wanting privacy, negotiating self and social identity, and connecting & disconnecting. Many participants reported a fear of receiving negative comments online and discussed strategies to avoid them, such as posting less content (i.e., comments, photographs) than their peers. Some participants described feeling positive emotions when they received a “like” from a SNS user, however, they also tended to describe these positive emotions as “false”, “unreal” and “fleeting.” Notably, many participants reported comparing themselves to peers on Facebook, which increased feelings of anxiety, as well as compulsive checking behaviours, such as monitoring posted content and friend lists. These findings were coupled with discussions surrounding rumination, privacy, and elevated personal conflict due in part to the public nature of Facebook. The narratives from our exploratory study suggest there are various mechanisms through which Facebook may exacerbate anxiety in adolescents who have pre-existing anxiety disorders and thereby may make them vulnerable to negative online experiences. Understanding the underlying themes of this phenomenon can aid clinicians, school staff, and parents in identifying potential stressors for anxious adolescents who use SNSs, and provide strategies around social media use for this specific patient population. Future quantitative studies are recommended to further understand the relationships between Facebook stressors and expressed anxiety in clinical populations.

Social media; adolescence; anxiety disorders; Facebook; social networking sites

Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children: Prevalence in a large sample from the general population. Archives of general psychiatry, 44, 69-76. https://doi.org/10.1001/archpsyc.1987.01800130081010

Antony, M. M. (2011). Recent advances in the treatment of anxiety disorders. Canadian Psychology/Psychologie canadienne, 52, 1-9. https://doi.org/10.1037/a0022237

Antony, M., & McCabe, R. (2005). Perfectionism. In: A. Freeman, S. H. Felgoise, C. M. Nezu, A. M. Nezu, & M. A. Reinecke (Eds.), Encyclopedia of Cognitive Behavior Therapy (pp. 273-277). Boston, MA: Springer.

Babic, M. J., Smith, J. J., Morgan, P. J., Eather, N., Plotnikoff, R. C., & Lubans, D. R. (2017). Longitudinal associations between changes in screen-time and mental health outcomes in adolescents. Mental Health and Physical Activity, 12, 124-131. https://doi.org/10.1016/j.mhpa.2017.04.001

Bagnell, A., Kutcher, S., & Garcia-Ortega, I. (2011). Identification, diagnosis & treatment of childhood anxiety disorders: A package for first contact health providers. Kutcher and MacCarthy. Retrieved from: http://www.shared-care.ca/files/Child_Anxiety_FINAL_2012.pdf

Bastiaensens, S., Vandebosch, H., Poels, K., Van Cleemput, K., Desmet, A., & De Bourdeaudhuij, I. (2014). Cyberbullying on social network sites. An experimental study into bystanders’ behavioural intentions to help the victim or reinforce the bully. Computers in Human Behavior, 31, 259-271. https://doi.org/10.1016/j.chb.2013.10.036

Bernstein, G. A., & Kinlan, J. (1997). Summary of the practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1639-1641. https://doi.org/10.1097/00004583-199711000-00036

Brown, W. A. (2009). Massachusetts General Hospital Comprehensive Clinical Psychiatry [book review]. JAMA, 301, 2046-2051. https://doi.org/10.1001/jama.2009.720

Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and anxiety, 20, 155-164. https://doi.org/10.1002/da.20039

Chen, W., & Lee, K. H. (2013). Sharing, liking, commenting, and distressed? The pathway between Facebook interaction and psychological distress. Cyberpsychology, Behavior, and Social Networking, 16, 728-734. https://doi.org/10.1089/cyber.2012.0272

Children’s Mental Health Ontario. (2016). Report card: Promoting a seamless, coordinated system of care that puts children, youth and family first. Retrieved from http://cmho.org/documents/cmho-reportcard-2016-en.pdf

Chou, H. T. G., & Edge, N. (2012). “They are happier and having better lives than I am”: The impact of using Facebook on perceptions of others' lives. Cyberpsychology, Behavior, and Social Networking, 15, 117-121. https://doi.org/10.1089/cyber.2011.0324

Connolly, S. D., & Bernstein, G. A. (2007). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 267-283. https://doi.org/10.1097/01.chi.0000246070.23695.06

Costello, E. J., Egger, H., & Angold, A. (2005). 10-year research update review: The epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 972-986. https://doi.org/10.1097/01.chi.0000172552.41596.6f

Crabtree, B. F., & Miller, W. L. (Eds.). (1999). Doing qualitative research. Thousand Oaks, CA: Sage Publications.

Craighead, W. E., & Nemeroff, C. B. (Eds.). (2004). The concise Corsini encyclopedia of psychology and behavioral science. Hoboken, New Jersey: John Wiley & Sons.

de Vries, D. A., Peter, J., de Graaf, H., & Nikken, P. (2016). Adolescents’ social network site use, peer appearance-related feedback, and body dissatisfaction: testing a mediation model. Journal of youth and adolescence, 45, 211-224. https://doi.org/10.1007/s10964-015-0266-4

Denzin, N., & Lincoln, Y. (2011). The SAGE handbook of qualitative research. Thousand Oaks, CA: Sage Publications.

Duggan, M., & Smith, A. (2014). Social media update 2013. Pew Research Center. Retrieved from: http://www.pewinternet.org/2013/12/30/social-media-update-2013/

Ellison, N. B. (2007). Social network sites: Definition, history, and scholarship. Journal of ComputerMediated Communication, 13, 210-230. https://doi.org/10.1111/j.1083-6101.2007.00393.x

Essau, C. A., Lewinsohn, P. M., Olaya, B., & Seeley, J. R. (2014). Anxiety disorders in adolescents and psychosocial outcomes at age 30. Journal of Affective Disorders, 163, 125-132. https://doi.org/10.1016/j.jad.2013.12.033

Fernandez, K. C., Levinson, C. A., & Rodebaugh, T. L. (2012). Profiling: Predicting social anxiety from Facebook profiles. Social Psychological and Personality Science, 3, 706-713. https://doi.org/10.1177/1948550611434967

Fox, J., & Moreland, J. J. (2015). The dark side of social networking sites: An exploration of the relational and psychological stressors associated with Facebook use and affordances. Computers in Human Behavior, 45, 168-176. https://doi.org/10.1016/j.chb.2014.11.083

Fox, J., & Warber, K. M. (2014). Social networking sites in romantic relationships: Attachment, uncertainty, and partner surveillance on Facebook. Cyberpsychology, Behavior, and Social Networking, 17, 3-7. https://doi.org/10.1089/cyber.2012.0667

Görzig, A. (2016). Adolescents’ experience of offline and online risks: Separate and joint propensities. Computers in Human Behavior, 56, 9-13. https://doi.org/10.1016/j.chb.2015.11.006

Harter, S. (1999). The construction of the self: A developmental perspective. New York, NY: Guilford Press.

Hazen, A. L., & Stein, M. B. (1995). Social phobia: Prevalence and clinical characteristics. Psychiatric Annals, 25, 544-549. https://doi.org/10.3928/0048-5713-19950901-08

Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54, 1389-1398. https://doi.org/10.1016/S0006-3223(03)00465-7

Hewitt, P. L., Caelian, C. F., Flett, G. L., Sherry, S. B., Collins, L., & Flynn, C. A. (2002). Perfectionism in children: Associations with depression, anxiety, and anger. Personality and Individual Differences, 32, 1049-1061. https://doi.org/10.1016/S0191-8869(01)00109-X

Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470. https://doi.org/10.1037//0022-3514.60.3.456

Indian, M., & Grieve, R. (2014). When Facebook is easier than face-to-face: Social support derived from Facebook in socially anxious individuals. Personality and Individual Differences, 59, 102-106. https://doi.org/10.1016/j.paid.2013.11.016

Khalid-Khan, S., Santibanez, M. P., McMicken, C., & Rynn, M. A. (2007). Social anxiety disorder in children and adolescents: Epidemiology, diagnosis, and treatment. Pediatric Drugs, 9, 227-237. https://doi.org/10.2165/00148581-200709040-00004

Kramer, A. D., Guillory, J. E., & Hancock, J. T. (2014). Experimental evidence of massive-scale emotional contagion through social networks. Proceedings of the National Academy of Sciences, 111, 8788-8790.

Kross, E., Verduyn, P., Demiralp, E., Park, J., Lee, D. S., Lin, N., ... & Ybarra, O. (2013). Facebook use predicts declines in subjective well-being in young adults. PloS one, 8(8), e69841. https://doi.org/10.1371/journal.pone.0069841

Krueger, R. A., & Casey, M. A. (2014). Focus groups: A practical guide for applied research. Thousand Oaks, CA: Sage Publications.

Labrague L. (2014). Facebook use and adolescents' emotional states of depression, anxiety, and stress. Health Science Journal, 8, 80-89.

Lenhart, A., Duggan, M., Perrin, A., Stepler, R., Rainie, H., & Parker, K. (2015). Teens, social media & technology overview 2015. Pew Research Center. Retrieved from http://www.pewinternet.org/2015/04/09/teens-social-media-technology-2015/

Livingstone, S., Haddon, L., Görzig, A., & Olafsson, K. (2011). Risks and safety on the internet: The perspective of European children: Full findings and policy implications from the EU Kids Online survey of 9-16 year olds and their parents in 25 countries. London, UK: EU Kids Online Network. Retrieved from http://www.lse.ac.uk/media%40lse/research/EUKidsOnline/EU%20Kids%20II%20(2009-11)/EUKidsOnlineIIReports/D4FullFindings.pdf

Masi, G., Mucci, M., Favilla, L., Romano, R., & Poli, P. (1999). Symptomatology and comorbidity of generalized anxiety disorder in children and adolescents. Comprehensive Psychiatry, 40, 210-215. https://doi.org/10.1016/S0010-440X(99)90005-6

McGee, R. O. B., Feehan, M., Williams, S., Partridge, F., Silva, P. A., & Kelly, J. (1990). DSM-III disorders in a large sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 611-619. https://doi.org/10.1097/00004583-199007000-00016

McQuaid, R. J., McInnis, O. A., Paric, A., Al-Yawer, F., Matheson, K., & Anisman, H. (2016). Relations between plasma oxytocin and cortisol: The stress buffering role of social support. Neurobiology of Stress, 3, 52-60. https://doi.org/10.1016/j.ynstr.2016.01.001

Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., ... & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49, 980-989. https://doi.org/10.1016/j.jaac.2010.05.017

Morin-Major, J. K., Marin, M. F., Durand, N., Wan, N., Juster, R. P., & Lupien, S. J. (2016). Facebook behaviors associated with diurnal cortisol in adolescents: Is befriending stressful?. Psychoneuroendocrinology, 63, 238-246. https://doi.org/10.1016/j.psyneuen.2015.10.005

Muris, P., & Dietvorst, R. (2006). Underlying personality characteristics of behavioral inhibition in children. Child Psychiatry and Human Development, 36, 437-445. https://doi.org/10.1007/s10578-006-0014-9

Neira, B., Corey, J., & Barber, B. L. (2014). Social networking site use: Linked to adolescents' social self‐concept, self‐esteem, and depressed mood. Australian Journal of Psychology, 66, 56-64. https://doi.org/10.1111/ajpy.12034

O'Keeffe, G. S., & Clarke-Pearson, K. (2011). The impact of social media on children, adolescents, and families. Pediatrics, 127, 800-804. https://doi.org/10.1542/peds.2011-0054

Page, A. S., Cooper, A. R., Griew, P., & Jago, R. (2010). Children's screen viewing is related to psychological difficulties irrespective of physical activity. Pediatrics, 126, e1011-e1017. https://doi.org/10.1542/peds.2010-1154

Pantic, I., Damjanovic, A., Todorovic, J., Topalovic, D., Bojovic-Jovic, D., Ristic, S., & Pantic, S. (2012). Association between online social networking and depression in high school students: Behavioral physiology viewpoint. Psychiatria Danubina, 24, 90-93.

Patchin, J. W., & Hinduja, S. (2012). Cyberbullying: An update and synthesis of the research. In J. W. Patchin & S. Hinduja (Eds.), Cyberbullying prevention and response: Expert perspectives (pp. 13-35). New York, NY: Routledge/Taylor & Francis Group.

Patton, M. (2014). Qualitative research & evaluation methods(4th ed.). Thousand Oaks, CA: Sage Publications.

Ponzi, D., Muehlenbein, M. P., Geary, D. C., & Flinn, M. V. (2016). Cortisol, salivary alpha-amylase and children’s perceptions of their social networks. Social Neuroscience, 11, 164-174. https://doi.org/10.1080/17470919.2015.1045988

Rauch, S. M., Strobel, C., Bella, M., Odachowski, Z., & Bloom, C. (2014). Face to face versus Facebook: Does exposure to social networking web sites augment or attenuate physiological arousal among the socially anxious?. Cyberpsychology, Behavior, and Social Networking, 17, 187-190. https://doi.org/10.1089/cyber.2012.0498

Rideout, V. J. (2012). Social media, social life: How teens view their digital lives. Common Sense Media. Retrieved from https://www.commonsensemedia.org/research/social-media-social-life-how-teens-view-their-digital-lives

Rosen, L. D., Whaling, K., Rab, S., Carrier, L. M., & Cheever, N. A. (2013). Is Facebook creating “iDisorders”? The link between clinical symptoms of psychiatric disorders and technology use, attitudes and anxiety. Computers in Human Behavior, 29, 1243-1254. https://doi.org/10.1016/j.chb.2012.11.012

Russell, J. J., Moskowitz, D. S., Zuroff, D. C., Bleau, P., Pinard, G., & Young, S. N. (2011). Anxiety, emotional security and the interpersonal behavior of individuals with social anxiety disorder. Psychological Medicine, 41, 545-554. https://doi.org/10.1017/S0033291710000863

Sampasa-Kanyinga, H., & Lewis, R. F. (2015). Frequent use of social networking sites is associated with poor psychological functioning among children and adolescents. Cyberpsychology, Behavior, and Social Networking, 18, 380-385. https://doi.org/10.1089/cyber.2015.0055

Sapru, I., Khalid-Khan, S., Choi, E., Alavi, N., Patel, A., Sutton, C., ... & Calancie, O. G. (2016). Effectiveness of online versus live multi-family psychoeducation group therapy for children and adolescents with mood or anxiety disorders: a pilot study. International Journal of Adolescent Medicine and Health. Advanced online publication. https://doi.org/10.1515/ijamh-2016-0069

Shaw, A. M., Timpano, K. R., Tran, T. B., & Joormann, J. (2015). Correlates of Facebook usage patterns: The relationship between passive Facebook use, social anxiety symptoms, and brooding. Computers in Human Behavior, 48, 575-580. https://doi.org/10.1016/j.chb.2015.02.003

Twenge, J. M. (2000). The age of anxiety? The birth cohort change in anxiety and neuroticism, 1952–1993. Journal of Personality and Social Psychology, 79, 1007-21. https://doi.org/10.1037/0022-3514.79.6.1007

Utz, S., & Breuer, J. (2017). The relationship between use of social network sites, online social support, and well-being: Results from a six-wave longitudinal study. Journal of Media Psychology: Theories, Methods, and Applications, 29, 115-125. https://doi.org/10.1027/1864-1105/a000222

Valkenburg, P. M., Koutamanis, M., & Vossen, H. G. (2017). The concurrent and longitudinal relationships between adolescents' use of social network sites and their social self-esteem. Computers in Human Behavior, 76, 35-41. https://doi.org/10.1016/j.chb.2017.07.008

Valkenburg, P. M., Jochen, P., & Schouten, A. (2006). Friend networking sites and their relationship to adolescents’ well-being & social self-esteem. CyberPsychology & Behaviour, 9, 584-590. https://doi.org/10.1089/cpb.2006.9.584

Verduyn, P., Ybarra, O., Résibois, M., Jonides, J., & Kross, E. (2017). Do Social Network Sites Enhance or Undermine Subjective Well‐Being? A Critical Review. Social Issues and Policy Review, 11, 274-302.

Weidman, A. C., Fernandez, K. C., Levinson, C. A., Augustine, A. A., Larsen, R. J., & Rodebaugh, T. L. (2012). Compensatory internet use among individuals higher in social anxiety and its implications for well-being. Personality and Individual Differences, 53, 191-195. https://doi.org/10.1016/j.paid.2012.03.003

Wittchen, H. U., Kessler, R. C., Pfister, H., Höfler, M., & Lieb, R. (2000). Why do people with anxiety disorders become depressed? A prospective‐longitudinal community study. Acta Psychiatrica Scandinavica, 102(s406), 14-23. https://doi.org/10.1111/j.0065-1591.2000.acp29-03.x


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