A perspective of yoga on smartphone addiction: A narrative review.

Evolution in technology is drastically becoming automatic and making life easier. Among those technologies, smartphones are fast-changing technology that is equipping humans to work from anywhere. Frequent usage and dependency on smartphones have increased, which in turn contributes to changes in psychosocial behavioral aspects. Addiction plays an important role in modifying the healthy habits of individuals. Problematic usage of smartphones affects both physical and psychosocial health and emerges as a cornerstone of psychosocial disorder. However, there is a dearth of data to understand the core concepts of smartphone addiction and there is a need to understand from the broader perspective. Yoga is considered one of the viable protocols to provide the way for digital detoxification from technology and smartphone addiction by promoting self-regulation. Yoga brings back a healthy living style, which allows individuals to have enough physical activity through asanas, emotional stability, and awareness through meditation and breathing practices. We hypothesize that a holistic approach to yoga can regulate the symptoms associated with smartphone addiction by increasing the stability of the body and mind and promoting emotional detachment and self-regulation, which play an important role in the de-addiction process. Copyright:

Introduction

Technology is becoming ubiquitous. The evolution of smartphones has transformed usage dynamics regardless of age, gender, and economic status. The functions may vary from placing a phone call to checking email, online transactions, texting, surfing the web, playing online games, and listening to music.[1] This problematic overuse has led to addiction in the form of frequent checking of the smartphone.[23] Although addiction has been defined as “a pathological condition that one cannot tolerate without continuous administration of substances,” it is now applied to behavioral addictions, such as gaming and internet use.[4] A growing literature has confirmed that usage of smartphones is more evident among emerging adulthood, with an age range of 18–29 years.[5]

Although smartphone addiction is not recognized as a clinical disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) or International Classification of Diseases (ICD-10), the estimated prevalence of smartphone addiction is in the range of 10% to 20%.[6] Studies have reported a prevalence of problematic smartphone use among children and adolescents as high as 10% in countries such as the United Kingdom,[7] 16.7% in Taiwan,[8]16.9% in Switzerland,[2] 30.9% in Korea,[9] and 31% in India.[10] Further, a survey among the six Asian countries showed the highest prevalence of internet addiction through smartphone ownership is 62%.[11] Studies reported many aspects of problematic smartphone behavior are similar to other recognized behavioral addictions such as gambling disorder and other traditional addictions (e.g., substance use, smoking, and alcohol). The pathological use of smartphones has created a new kind of maladaptive behavior and emerging as a cornerstone of psychosocial disorders. Subsequently, researchers have shown greater interest in studying smartphone addiction.[21213] The symptoms associated with problematic smartphone usage negatively influence physiological and psychosocial behavior[14] with low psychological well-being,[15] depression, loneliness,[14] social anxiety,[16] and cognitive disorders.[17]

Given the current literature, researchers are actively exploring the significance of yoga and meditation as a viable tool for addressing psychological problems and addictive behaviors. Yoga is a communion of mind and body. Problematic smartphone usage is slowly and steadily gaining influence in manipulating psychosocial behavior. There is a dearth of data in this area to understand the core characteristics. Therefore, we hypothesize that there is a need to understand the problem in a much broader spectrum from the purview of yogic texts that can be recommended as primary care intervention.

Understanding Smartphone Addiction from a Biopsychosocial Perspective

The biopsychosocial model of addiction posits that biological/genetic, psychological, and sociocultural factors contribute to substance use and all must be taken into consideration in prevention and treatment efforts.[18]

As explained in [Figure 1], smartphone addiction is a complex and heterogeneous problem,[6] and there is a need to understand it from a biopsychosocial perspective. Griffith has proposed the components model of addiction, which proposes that all addictions comprise a set of criteria that rewards physiological and psychosocial behaviors. He proposed six core components for understanding the biopsychosocial process of smartphone addiction. These are salience, mood modification, tolerance, withdrawal, conflict, and relapse.[19]

Figure 1

Bio psychosocial perspective of smartphone addiction

Salience

Predominant smartphone usage over other activities of life influences feelings (craving), cognitive distortions, and deterioration of social behavior. A study on university students has shown high cognitive absorption levels among the smartphone-addicted group.[20] Cognitive absorption is characterized by temporal dissociation, focused immersion, heightened enjoyment, control, and curiosity.[21] Further, an functional magnetic resonance imaging (fMRI) study reported that smartphone addiction inhibits cognitive control during emotional processing and influences social interaction.[22] Similarly, a neuroimaging study on adolescents with mobile phone addiction correlates higher impulsive scores with altered gray matter volume and white matter integrity.[23] Similarly, subjects with gaming addiction have shown enhanced craving and brain activity in the lateral and prefrontal cortex for gaming stimuli.[24]

Mood modification

The subjective experiences reported using smartphones as a coping strategy to avoid loneliness and dysphoric mood.[25] A study observed that students utilizing their mobile phones as a coping mechanism might get trivial appeasement for loneliness, boredom, and anxiety-induced situations. However, long-term utilization might negatively influence mental health.[26] A study reported that dysfunctional cognitive and emotional processes mediate anxiety, depression, and problematic smartphone usage.[27] Furthermore, smartphone addiction and childhood psychological maltreatment.[28] In a recent study with Indian university students, 43% agreed the mobile phone provides an escape from problems, and 70% agreed that the mobile phone helped them overcome bad moods such as feelings of inferiority, helplessness, guilt, anxiety, and depression.[29]

Tolerance

The prolonged time spent or frequent checking on smartphones to achieve the former mood modifying effects. Earlier studies claim that the frequent checking of smartphones is because of instant access to rewards. Further, social media has reportedly become the source of perceived social support.[30] Currently, people ascribe perceived social support by likes and shares on social networking sites (e.g., Facebook, Instagram, and Twitter) and communicating through icons.[31] A study has shown that Facebook connectedness is related to greater life satisfaction, lower anxiety, and depression levels, and enhanced social capital.[32] In contrast, extroverts and neurotics with a high Facebook usage negatively influence life satisfaction and social relationships.[33]

Withdrawal

Recent studies coined a new word Nomophobia (No mobile phone phobia), and FOMO, “fearing of being without a mobile phone,” which is the condition of feeling anxiety when missing their smartphones. This condition is widely visible in youngsters with low self-esteem, anxiety, impulsiveness, and high extroversion/introversion levels.[34] Another study reported interpersonal sensitivity, obsession-compulsion, and strong predictors for nomophobia.[35]

Conflict

Spending prolonged time on smartphones leads to intrapersonal and interpersonal conflicts, influencing their social relations with family and friends.[25] In addition, texting is a potential distractor among school and college students impacting classroom performance.[36] A study reported that the average time for distraction in class is less than 6 minutes.[37] Furthermore, there has been a decline in face-to-face interactions among teens and making them less talkative to adults.[38]

Relapse

There is not sufficient literature to support the relapse condition in smartphone addiction. This condition tends to check the smartphone to recur the previous hedonic experience after a long period of abstinence. Checking smartphones after waking up and before sleeping to get updated is associated with low self-control.[39]

Understanding the Nature of Smartphone Addiction ThroughYoga

Addiction is defined as a behavior, over which an individual has impaired control with harmful consequences.[40] It can also be viewed as a result of “mindless” states involving escapist attitudes, automatic thinking, emotional reactivity, social isolation, and low self-regulation.[41] Research has pointed out that yoga helps control addictive symptoms by promoting self-regulation.[4243] According to the World Health Organization (WHO), psychological health is one of the key components in defining health. The core concepts of yoga emphasize the nature of the mind and its afflictions (Kleshas). Traditional texts such as Patanjali Yoga Sutras (PYS), Bhagavad Gita (BG), Hatha Yoga Pradipika (HYP), and Yoga Vasistha (YV) have highlighted the mind (Chitta) and the interplay of qualities of a person (Gunas) on mental health, and the afflictions caused in the absence of self-control and self-regulation. Sage Patanjali defines yoga as, when the perplexities of the thoughts are controlled by self-regulation, the mind will reach its pristine (PSY1:2). The afflictions in the mind caused by these perplexing thoughts stem out from ignorance of the truth (Avidya), egoism or identity (Asmita), attachment (raga), aversion (Dwesha), and fear of losing (Abhinivesha) (PSY 2:3). Ayurveda says, “asatmyaindriyarthasannikarsha,” the unhealthy sensory perception causes disharmony in the body either as an increase or decrease of humor (doshas).

Sankhya’s philosophy postulates that qualities (Gunas) play a vital role in defining a person’s temperament (Swabhava). The Guans are classified into three types. Tamas is characterized by dullness, inactive, illusion, depression, laziness, impulsiveness, and excessive sleep. When Rajas is dominant, it symbolizes passion and desire, egoism, self-centeredness, greed, restlessness, ambition, and a sense of self-gratification. Finally, Sattva is associated with stability, self-control, clarity of thought, discipline, self-regulation, one-pointedness, meditative mind, and detachment.[44]

The constant use of smartphones has caused sensory overload invigorating the mind for repeated subjective experiences, and the propensity of these experiences is causing ill effects. According to BG, the pleasures from these sensual indulgences develop an attachment that ignites the desire to have more. When not fulfilled, it leads to anger. From anger comes the delusion, followed by loss of memory, and from that comes the destruction of intellect, leading to the perished mind (BG 2:62-63). Patanjali further explained how these obstacles manifest into afflictions (PSY 1:30 & 31).

The above picture [Figure 2] illustrates how these disturbances of the mind (Chittavikshepas) lead to mental agitation (Adhi) and further as a disease in the body (Vyadhi).

Figure 2

Illustration of mental agitation by Maharshi Patanjali

Researchers have found that personality with openness to experience, neuroticism, and extroversion correlates with the smartphone’s problematic usage.[4546] Afflictions of the mind explain the symptomatic nature of smartphone addiction such as mental laziness (Styana), idleness, and dullness; indecisiveness, doubtful (Samsaya); carelessness, negligence, and procrastination (Pramada); laziness (Alasya); craving for enjoyment, sensuality (Avirati); erroneous perception, false views (Brantidarsana); failing to attain desired results (Alabdhabumikatva); instability (Anavasthitatva). The ramifications of these are transmuted as a disease (Vyadhi) in the body as sorrow (Dukha), depression (Daurmanasya), shaking off the body (Aangamejayatva); unrhythmic breathing (Svasaprasvasa Vikshepa). According to yoga, disease (vyadhi) is of two types, disease born out of mind, stress born psychosomatic ailments, and neurotic problems (Adhija Vyadhi). The second category is external causes such as accidents, infections, injury, and non-stress (AnadhijaVyadhi). According to the Yoga Vasistha, mind (Adhi) and disease (vyadhi) are the sources of suffering. Sometimes they follow each other, and at times they cause each other. At the outset, they both root from ignorance and lack of self-control.[44]

Yoga for digital detoxification

Addiction is in opposition to the idea of autonomy.[4748] Yoga helps develop the ability to connect with life, detox our mind, body, and emotions, and live a harmonious and meaningful life. Current literature has shown that yoga can be a viable tool to manage the afflictions of the body and mind by instigating self-regulation with the combined practices of asana, pranayama, pratyahara, relaxation, and meditation.[41] These are better explained in detail as:

Asanas

Asana is the Sanskrit word for physical posture that helps develop physical and mental stamina and strengthen willpower. In his yoga sutras (PSY), Patanjali expounds that the primary objective of asana is to develop steadiness with ease in the sitting posture and maintain an erect spine for the free flow of energy during meditation (PSY 2.46). The benefits of asana (Asana siddhi) can be reaped with dedication, uninterrupted practice, and a sense of reverence (PSY 1.14). Effects of asana are in the order of somatopsychic, which includes the release of endorphins that induce a sense of relaxation, ease, and well-being in the practitioner.[49] A study reported that after 1 h of a yoga asana session, there had been an increase of 27% in GABA (gamma-aminobutyric acid) levels.[5051] Further, induced stress levels were rescinded with Shavasana compared to supine postures and resting in a chair.[52] Another study reported that techniques using a combination of stimulation followed by relaxation had reduced oxygen consumption, energy expenditure, and physiological arousal compared to other relaxation techniques.[53]

Pranayama

Pranayama is the process of controlling the life force. “Pran”’ means breath, life force; “Ayama” is lengthening or extension through control. Patanjali expounds pranayama is much more than inhalation and exhalation of breath. It is the process of slow and extended inhalation (puraka) followed by (kumbhaka) retention of breath and (rechaka) the slow exhalation PYS (2:49). Regular practice improves the functioning of vital systems of the body. Mind is a complex structure and highly volatile. Controlling it is a daunting task. The breathing process is connected with the brain and the central nervous system, which is the gateway for emotional responses. Pranayama controls the erratic impulses in the brain by regulating the rhythms of breath. Recent evidence suggests that rapid breathing (Bhastrika) pranayama has significantly reduced anxiety and stress levels and affects the brain’s areas involved in processing emotions, attention, and awareness.[54] It has also shown a reduction in craving with smoking addiction,[55] anxiety, and depression.[56] Further, bhramari pranayama enhanced response inhibition and cognitive abilities.[57]

Pratyahara

Pratyahara is the fifth limb of Astanga yoga. Pratyahara has a pivotal role in the process of de-addiction. Pratyahara refers to the conscious withdrawal of the mind from the sensual gratifications (PSY 2:54). Controlling the mind that is conditioned to seek sensual gratifications is challenging. The highest form of pratyahara is not about suppressing the senses; however, sublimating them inward to get into the depths of the mind (PSY 2.55). The other way of doing it is focusing on the space between the two eyebrows with a steady breath; one can gain control over the senses (BG 5.27-28). Addiction is primarily because of craving and lack of self-control.[58] Sensory indulgence is the main form of entertainment prevailing with smartphone addiction. Indriya (senses) Pratyahara helps understand the nature of craving and restrain the senses from external gratification by abstaining from these devices to rejuvenate the mind through awareness and self-control.

Meditation

The outset of meditation transpires through Abhyasa (practice) and Vairagya (detachment) (PSY 1. 13&16). The practice of pratyahara promotes detachment towards the objects of sensuality. Meditation is referred to as dhyana in yoga. The mind with an uninterrupted flow of consciousness is called dhyana (PSY 3.2). Over time, various techniques of mediation have been evolved from different schools of thought. West has shown greater interest in mindfulness and transcendental meditation. They are extensively studied for their therapeutical benefits in physiological and psychosocial disorders. Studies have reported mindfulness meditation increases somatosensory processing,[59] sleep,[60] quality of life,[61] and reduced emotional reactivity.[62] Further, it effectively controls stress,[63] anxiety,[64] and depression levels.[65] Studies on addiction have reported meditation increases prefrontal activation, which might help in the de-automatization of addictive responses[66] and improved cognitive functions,[67] response inhibition,[68] self-control,[69] psychological well-being,[70] and abstinence from craving.[7172]

Discussion

Addiction is defined by the American Society of Addiction Medicine (ASAM) as a primary, chronic disease of the brain’s reward, motivation, memory, and related circuitry. Dysfunction in these circuits results in distinct biological, psychological, social, and spiritual manifestations.[73] According to one study, internet addiction causes an increase in dopamine in the brain, just like any other substance addiction.[74] Excessive use of the internet through smartphones is a relatively new type of addiction. The condition is not officially recognized by the American Psychiatric Association. Nonetheless, many medical professionals and researchers around the world recognize it as a behavioral addiction. According to several studies, excessive use of smartphones, such as gambling, can change and negatively impact an individual over time. Further, issues arising from excessive smartphone use are a growing social issue that is being debated globally. Many studies have found that the prevalence is high among young adults. Mental illness during the critical period of emerging adulthood can result in lifelong disability by impairing an individual’s ability to develop socially, occupationally, and educationally.[75] Currently, individuals visiting the clinics of primary care and psychologists with complaints of anxiety, loneliness, depression, and sleep related problems.[76] Reports suggest that incidence of musculoskeletal pain, pain in the lower back, neck and shoulders are also on the rise.[77]

Further, research has shown that family environment is one of the strong predictors of adolescent internet addiction. Furthermore, studies reported there is a relationship between communication, attitude, and cohesiveness in the family and adolescent internet addiction.[78] This highlights the care that should be taken by family members and primary care physicians to prevent the spread of this maladaptive behavior. Recent evidence shows that the Cognitive Behavioral Model, exercise therapy, and art therapy are effective in reducing anxiety, depression, impulsiveness, and with drawl symptoms for smartphone and internet addiction.[7980] However, there is a dearth of data and further investigations are required to address this problem in a holistic way.

In contrast, yoga is proven to be a viable tool to address physiological, psychosocial, and addictive behaviors by promoting self-regulation and self-control. Yoga is a holistic process of bringing body, mind, and spirit into communion. It has a lineage of more than 5000 years. It has shown a positive effect on perceived stress and quality of life with regular practice among young adults by cultivating subjective well-being.[81] Empirical evidence report that regular practice of yoga in a school has a positive influence on dysphoric moods, emotion regulation, and self-esteem.[82] A review postulated that regular practice of yoga and meditation has enhanced attention and their functional anatomical relationships along with an increase in the gray matter volume enabling individuals to control movement, memory, and emotions.[83] Including yoga as an adjunct treatment modality by the primary care centers and doctors would help in upholding the biopsychosocial dimensions of health in society.

Conclusion

According to recent evidence, researchers are paying more attention to studies on behavioral addictions. Because of its problematic and maladaptive behavior, studies on smartphone addiction have recently increased. Despite this, some studies claim that the prevalence is only 10% to 20%. Because of its market penetration and presence in modern life, there is a need for a broader understanding of the problems associated with it from a biopsychosocial perspective.

Yoga, in contrast, appears to be a promising treatment for addiction and other psychiatric disorders. Its ability to connect with life aids in the detoxification of our minds and bodies, as well as the regulation of emotions, thereby improving our well-being. This is an important aspect of addressing addiction’s craving, compulsive behavior, tolerance, and relapse conditions. As a result, incorporating yoga and meditation into daily life will aid in the regulation of the symptoms of maladaptive behavior associated with smartphone addiction.

Key message

The excessive use of smartphones is negatively influencing people’s behavior. Looking at the problem from a bio-psychosocial standpoint would help us understand its complexities. Yoga is a mind-body medicine, allows us to understand the nature of behaviour in a holistic way, as well as a possible solution to this maladaptive behavior, by promoting self-regulation and by cultivating subjective well-being.

Highlight

• Understanding smartphone addiction from the viewpoint of modern psychology and yoga

• Giving the perspective of yoga as a viable solution to control the symptoms of smartphone addiction.

• Including yoga as an adjunct treatment modality would be beneficial for the family and primary care doctors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.