Psychodynamics in a Computerized World

Educational Objectives

The goal of this program is to improve incorporation of computer use in psychiatry. After hearing and assimilating this program, the clinician will be better able to:

1. Acknowledge the risks and benefits of artificial intelligence and computer use in psychiatry.
2. Screen and treat patients for social media addiction.

Summary

Artificial intelligence (AI): the Turing test was created to determine whether computers can mimic humans; computers are modeled on the brain; neural action potentials are digitized with “1” when turned on and “0” when turned off; neural synapses and voltage-gated ion channels have function similar to semiconductors; circuit boards mimic the neocortex; computer hardware mimics brain memory; machine learning mimics the human brain; several algorithms for machine learning exist, and many of them are based on theories of conditioning; whether computers can mimic consciousness remains unknown

Psychodynamics: refers to the study of moving elements in the unconscious that affect our conscious thoughts, feelings, and behaviors; the consciousness of a computer is its output, and its preconsciousness may be analogous to what is stored, but the unconsciousness of computers is what often causes people to feel uneasy; the question is whether it is our id, ego, or superego that makes us human; id (unconsciousness) represents our innate desires; superego represents what we want computers to do for us; ego refers to inner mental life, relationships, and identity; friendships are an indicator of good psychological health; studies show that selfobject needs are sometimes met in friendships; creativity may be another component that defines being human; currently, AI can mimic based on some constraints if an algorithm is provided; the question is whether the mimicry can be more evocative, and whether AI can develop things that are completely novel and new; computers are good at mimicry, memory, learning, language, and empathy; however, humanness lies in consciousness, virtues, friendships, and creativity

Computers and subconsciousness: information technology has significantly progressed; switching from handwritten to electronic medical records has reduced errors and improved outcomes, with potential for increased efficiency, though has not helped with attention economy or addressed increased administration needs or privacy and security concerns; communication has exponentially risen; the number of calculations per second has vastly increased, and computers are now able to approach the speed at which the brain can communicate; social media is a phenomenon present in everyday life; the question is how computers are bringing our unconsciousness to consciousness and vice versa; many algorithms are addictive and use gambling as an area of study to make phone technology more addictive; continuous scrolling exponentially worsens addictions to social media; content and advertisements are often personalized based on user preferences; videos are set to autoplay; intermittent variable rewards and push notifications are common; receiving likes and comments offer dopamine hits; advantages of social media include building communities, finding partners, and making job connections and friends

Internet addiction: screen all patients for Internet addiction; the Internet can modify mood, and people can develop tolerance to it; people with social media addictions experience withdrawal, conflict, and relapse; gambling is the best known behavioral addiction, but many other addictions are aided by computers (eg, gaming, shopping, sex, exercise, kleptomania); comorbidities include substance use; concurrence exists with major depressive disorder, bipolar disorder, obsessive compulsive disorder, and attention-deficit/hyperactivity disorder; performance has been found to diminish in several aspects; treatment — treatment centers have been established and are the mainstay is therapy; platform interventions, intentional design user interventions, and identifying the issues may help; the book “The Anxious Generation” argues that social media contributes to childhood mental illness, decreases attention span, and creates weak social connections; seeing people in person, rather than virtually or via text, may impact the effectiveness of therapy; reducing smartphone use in schools and increasing free play may help; Internet addictions can lead to scams and contribute to mental illness; it is important to talk with patients about AI tools, fake citations, and fake news; biases are based on demographics of the information feeding the algorithms; echo chambers can lead to political and religious extremism; mass hysteria and psychogenic illnesses have been noticed among social media users, and the evolution of language has become faster; creating more correct information in these spaces can counter some of their effects

Future directions: free chat tools are available that allow people to discuss their problems; avatar-based technologies are also becoming popular, especially for people who are older or have Alzheimer disease; avatar-based technologies can also be used to help orient older adults with caregiver burnout; include screening for social media and Internet use, along with other routine screening; ask patients about their screen time; the GAD-7 scale can be used specifically for social media anxiety; mental health informatics is a burgeoning field; electronic medical record data can be used to improve overall mental health outcomes (through, eg, mobile health applications, telehealth, smartphone applications, precision medicine, natural language processing); disease states in psychiatry can potentially be modeled based on the axes of anxiety, cognition, and mood; artificial neurons or models of artificial brains can be created; a group is working on building detailed digital reconstructions of neural networks in mice, but without simulating consciousness

Readings

Boag S. Ego, drives, and the dynamics of internal objects. Front Psychol. 2014;5:666. doi:10.3389/fpsyg.2014.00666; Hossain MT, Ahammed B, Chanda SK, et al. Social and electronic media exposure and generalized anxiety disorder among people during COVID-19 outbreak in Bangladesh: a preliminary observation. PLoS One. 2020;15(9):e0238974. doi:10.1371/journal.pone.0238974; Kuss DJ, Lopez-Fernandez O. Internet addiction and problematic Internet use: a systematic review of clinical research. World J Psychiatry. 2016;6(1):143-76. doi:10.5498/wjp.v6.i1.143; Lutzow CA, Hubbard G, Giscombe C, et al. Practice change: social media screening questionnaire to identify high-risk adult psychiatric patients. Perspect Psychiatr Care. 2021;57(3):1145-1149. doi:10.1111/ppc.12669; Park S, Jeon HJ, Bae JN, et al. Prevalence and psychiatric comorbidities of internet addiction in a nationwide sample of Korean adults. Psychiatry Investig. 2017;14(6):879-882. doi:10.4306/pi.2017.14.6.879; Piotrowski M. Selfobject experience in long-term friendships of midlife women. Psychoanalytic Social Work. 2018;25(1)17–41. doi:10.1080/15228878.2018.1437757; Singh P, Cumberland WG, Ugarte D, et al. Association between generalized anxiety disorder scores and online activity among US adults during the COVID-19 pandemic: cross-sectional analysis. J Med Internet Res. 2020;22(9):e21490. doi:10.2196/21490; Tripathi S, Augustin A, Dako F, et al. Turing test-inspired method for analysis of biases prevalent in artificial intelligence-based medical imaging. AI Ethics. Published online October 24, 2022. doi:10.1007/s43681-022-00227-8.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose.

Acknowledgements

Dr. Sarker was recorded at the 2024 Regional Integrated Mental Health Conference, held in West Baden Springs, IN, on October 4-6, 2024, and presented by the Indiana Psychiatric Society. For information about upcoming CME activities from this presenter, please visit https://www.pdallc.com. Audio Digest thanks the speakers and the Indiana Psychiatric Society for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.75 CE contact hours.

Lecture ID:

PS540202

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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