I believe I strengthened my ability to integrate ITS skills into real clinical conversations through the materials in this course. I used reflection with a standardized patient discussing opioid use disorder and harm reduction. Naming their ambivalence and validating their fears helped build trust and opened space to talk about treatment options and resources without judgement. In Week 7, learning that 20% of patients treated for mental health conditions also have a co‑occurring SUD reinforced how essential communication skills are. Our patients often don’t present with only one problem. Overall, this asynchronous learning format helped me work on these skills at my own pace, which I really appreciated. 

The song I thought of was “Lean On Me” by Bill Withers. When I listen to this song, I think about supportive communication and working together. Tying back to this course, its theme of non‑judgmental presence mirrors how clinicians should work alongside patients facing mental health challenges, especially in the setting of concomitant SUD. Fun fact: I actually performed this song in my middle school choir :) 

Furthermore, over time, there may be a development of tolerance and experience of irritability, anxiety and mood changes when usage is suddenly decreased just like the symptoms of a withdrawal (Week 7, Slide 13). Mental health conditions disrupt emotions, thinking and behavior. In this regard, social media can be aptly classified as an addiction (Week 4, Slide 9).

However, social media has definite impacts on mental health. In Week 6, we were introduced to Arnett et al's 5 features to emerging adulthood: identity explorations, instability, self-focus, feeling in-between, and possibilities or optimism; social media can lead to disruptions of these facets, leading to development of mental health concerns, including anxiety and depression. With this in mind, I believe behaviors can be addictive, and social media usage is an example.

This song touches on feelings of being overwhelmed and being under the scrutiny of others all the time. It also talks about how hate from outside sources can have huge negative impacts on people and social media is full of them. I think that for me personally these are big reasons I do not like to use social media.

Week 6’s Arnett et al. (2020) finding that 51% of adults aged 18–29 rely on family and social networking sites for support highlights how deeply integrated social media is in young adults’ lives. While it can be a helpful tool, it can also become a crutch, affecting mental health in both positive and negative ways. Have to be careful of social media controlling us and becoming our addiction.

Ref: AAP COUNCIL ON COMMUNICATIONS AND MEDIA. Media Use in School-Aged Children and Adolescents. Pediatrics November 2016,  138 (5) e20162592

On a societal level, this should be concerning. We have started to replace human connection with social media fill-ins that don’t have the same impact. People may turn to social media for support. But people thousands of miles away (or AI) cannot provide support the way a neighbor can. We are getting to know our neighbors less and the internet world more. This is scary, because not only is excessive social media use precipitating  addiction, it also may impede good quality addiction support which is rooted in human connection.  

I absolutely think there should be a ban on social media use for people under 14 years old. When brains are still developing and judgement and impulse control is not yet fully established, it is imperative that we limit exposures for children. This is not so different from banning alcohol use in kids under 21.

Slowly but surely we are discovering the profound impact that social media can have on brain development (especially in regards to reward pathways) and we should do everything in our power to prevent children's' developing brains from being negatively impacted by this.

Reference:

1. Khalaf AM, Alubied AA, Khalaf AM, Rifaey AA. The Impact of Social Media on the Mental Health of Adolescents and Young Adults: A Systematic Review. Cureus. 2023;15(8):e42990. Published 2023 Aug 5. doi:10.7759/cureus.42990

In this video (it’s short, only 6 mins) Arthur Brooks points out that when we reach for our phones every time we feel bored, we lose the quiet moments when we might naturally reflect on deeper questions about meaning and purpose. Over time, that constant distraction can leave people feeling more anxious and lonely. This reminds me of Psalm 46:10, “Be still, and know that I am God”. I think for all of us, stillness is important for clarity and perspective.

Interestingly, in week 10, we discussed the use of generative AI in follow up on homework completion and delivering CBT, but there are also AI apps such as Zario that are designed to help solve the problem of excessive SM use. They use AI coaching to manage access to distracting apps like Instagram or TikTok. Another example in which AI can be used as a tool for mental health in primary care.

I was initially very hesitant about the utility of the ITS modules, but ultimately I found the ITS module empathy helpful. In my street medicine service, showing empathy, and actively listening, is always something I want to do.

In my most recent outreach, it was busy and I was rushing through talking to someone. The ITS module was helpful -- thinking about empathy’s fundamentals helped me slow down and focus on the conversation I was having.

While I do think that reflection, empathy, and cultural responsiveness are best built around other people and with practice, I felt the online course content and ITS modules complemented my formation of these skills.

A specific skill during active listening and motivational interviewing has been the skill of elicit-provide-elicit which has been immensely helpful whenever I feel like a conversation has run up against a wall/obstacle. I feel that my patient interactions have flowed more smoothly and were able to reach their natural conclusions with less friction.