How can mental health apps solve the body image problems caused by Instagram?

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How can mental health apps solve the body image

problems caused by Instagram?

Anne Burggraaf – 11874619 Supervisor: Matthew Dennis Program: BSc Business Administration

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Statement of originality

This document is written by Anne Burggraaf who declares to take full responsibility for the contents of this document.

I declare that the text and the work presented in this document is original and that no sources other than those mentioned in the text and its references have been used in creating it. The Faculty of Economics and Business is responsible solely for the supervision of completion of the work, not for the contents.

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Abstract

People around the world are increasingly using social media. However, social media harms people’s mental health, Instagram especially. This literature review aims to find out if mental health apps could solve these mental health issues. Building on existing research, the question “How can mental health apps solve the body image caused by Instagram?” is answered.

In this essay, the focus lies on apps for people with eating disorders or body image problems. For social media apps, the focus lies mostly on Instagram.

Analysis of the existing research literature on these topics found that mental health apps are effective for helping people with their mental health. Mental health apps might be especially helpful for people who suffer from eating disorders as they are a low barrier option for getting help. However, there aren’t a lot of mental health apps available for people with eating disorders currently, and the ones that exist need improvement. Instagram also needs to make adjustments and be more considerate of the negative effect they have on body image. If the suggestions at the end of the essay are implemented in real life, mental health apps could solve the body image problems caused by Instagram.

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Introduction

During the current COVID-19 pandemic, people have been more reliant on their smartphones than ever before (Jones, 2020). The physical world is slowing down and people have been increasingly using apps for daily tasks. Compared to the same quarter in 2019, app use has increased by 20 percent (Jones, 2020). A positive correlation between smartphone use and depression has been found before (Demirci, Akgönül, & Akpinar, 2015). Smartphone use has also been linked to other emotional problems and poor peer relationships (Wang et al., 2019). In addition to this, increased screen time has been linked to worsening symptoms of depression and anxiety (Maras et al., 2015). With smartphone usage going up between 70 and 80 percent during the pandemic, the question should be raised whether this means increased depressive symptoms for everyone (Sebire, 2020). And most importantly, how these mental health problems caused by smartphones could be solved.

Even though certain apps, such as Airbnb, have been slowing in growth, healthcare apps are experiencing explosive growth during the pandemic (Jones, 2020). Mental health apps are available for all kinds of mental health problems: depression, anxiety, PTSD (post-traumatic stress disorder), eating disorders, and addiction (Anthes, 2016). They have been proven to help people who suffer from depression (Henson, Wisniewski, Hollis, Keshavan, & Torous, 2019). About 30 to 35 percent of people who suffer from depression or other severe mental disorders did not receive any treatment at all in a previous year (Basavarajappa & Chand, 2017). Technology has great potential to help solve this treatment gap (Rebello, Marques, Gureje, & Pike, 2014). Furthermore, technology can be used to make mental health care easily accessible, it can reach a larger group of users, including those that live in remote areas (Rebello et al., 2014). It can also help people who can’t go to a therapist because of the current pandemic, which prevents people from leaving their house. Technological mental health care can also help to decrease the stigma that comes with getting help for mental disorders (Rebello et al., 2014).

Research on mental health apps has found that they have the potential to offer help to people who suffer from depression (Henson et al., 2019). Especially smartphone apps that used cCBT (computerized cognitive behavioral therapy), mindfulness, and mood observation, were found to significantly decrease depressive symptoms in their users (Firth et al., 2017). This shows that research on mental health apps so far has had promising results.

However, screen time has been previously linked to increased depressive and anxious symptoms (Maras et al., 2015). Using mental health apps would increase screen time even further, which in turn could then increase depressive and anxious symptoms again (Maras et

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al., 2015). This leaves the question of whether mental health apps can be helpful when smartphone use comes with negative effects on mental health.

And screen time is not the only smartphone-related problem that has been associated with increased symptoms of mental disorders: use of social media apps can create depressive symptoms as well (Fardouly, Willburger, & Vartanian, 2017). Social media is becoming increasingly important in people’s lives, but it has also been linked to body image problems. Facebook, for example, has been linked to an increased level of self-objectification in young women, as well as increased body image concerns (Fardouly et al., 2017). This forms a problem because self-objectification and other body image concerns are important predictors of eating disorders and depression in young women. Another app that has been linked to increased self-objectification is Instagram (Fardouly et al., 2017). Instagram is a rapidly growing app, especially popular among women, who on average spend 30 minutes a day on Instagram (Fardouly et al., 2017). Instagram has the main purpose of photo and video sharing (Slater, Varsani, & Diedrichs, 2017). Research has found that photo-sharing activities on social media might be especially influential on people’s body image (Holland & Tiggemann, 2016). Photos allow people to compare themselves to famous people, as well as internalize society’s beauty standards. Society’s beauty standards can be defined as “society’s current notion of feminine perfection” (Argo & Dahl, 2017, p. 984). This means photos allow people to integrate this idea of what a female should look like according to society. Both of these mediate the relationship between Instagram use and body image concerns. This indicates that young women compare themselves to famous people on Instagram which increases their body image concerns. Instagram also causes them to internalize society’s beauty standards which increases their body images concerns as not everyone can live up to these standards (Fardouly et al., 2017). With Instagram already being a popular social media app, and people spending more time on their phone during the pandemic, body image problems could potentially increase further.

This essay will explore what mental health apps have to offer, focusing on people who suffer from body image problems and mental health disorders caused by these body image problems. What is currently being offered for them? How can these apps improve? How does Instagram contribute and what can Instagram do to help? During uncertain times like the ones the world is currently in, technology becomes more important than before. It is amplified how much people rely on technology to solve their problems, including mental health ones. Mental health apps have the potential to solve the existing treatment gap, but what about the social media apps on the same phone? These apps have a negative impact on user’s body image. These

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body image concerns have been previously found to be a good predictor of eating disorders and depression, specifically in young women (Fardouly et al., 2017). This means people are potentially downloading apps to solve mental health problems on the same smartphone that holds the apps that could have caused the mental health problems in the first place. This is a paradox which will be the main point of research in this essay.

The main focus will be on social media apps, specifically Instagram, and how they impact mental health. It will be researched how effective mental health apps can be for mental health problems that are caused or aggravated by social media apps. Literature research will be used to answer the main question: “How can mental health apps solve the body image problems caused by Instagram?”. The essay will look into already existing research on mental health apps, social media apps, and body image problems. The literature review section will evaluate the available research on these topics. This will be followed by a section that focuses on the main research question and sub-questions and provides an answer to these questions. After that, some suggestions will be made on how to solve the proposed problems and how to improve mental health apps. This essay will be finished off with a conclusion that summarizes the findings and offers suggestions for future research.

Literature review

The main focus of this review is finding research literature that can help understand the subject and answer the main research question: “How can mental health apps solve the body image problems caused by Instagram?”. There is a lot of research available on the topic of mental health problems caused by smartphones. However, since the focus of this research paper is on body image problems specifically, the literature available was limited, as well as the research available on mental health apps for people with eating disorders. There was, however, a lot of research available on Instagram and how it affects people’s mental health. This section will start off with a discussion of body image problems and the impact social media has on them. This will be followed by information from the research literature on mental health apps and what they can do for body image problems.

The relationship between body image problems and media

Body image problems have been around since before social media became as widely used as it is now. A study by Grabe, Ward, & Hyde from 2008 describes 50 percent of girls and undergraduate women reporting dissatisfaction with their own bodies. These body image problems develop at a young age and are found across women with different body types and

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races (Grabe et al., 2008). This indicates that body image problems aren’t linked to a certain body type or race, this study found them to be universal for girls and undergraduate women. A longitudinal study that reviewed a group of adolescents from 1999 to 2004 found that lower body satisfaction caused unhealthy weight control behaviors such as binge-eating in both adolescent men and women (Neumark-Sztainer, Paxton, Hannan, Haines, & Story, 2006). According to Grabe et al., (2008) multiple studies have identified body dissatisfaction as an important predictor of several mental health-related problems such as eating disorders, low self-esteem, depression, and obesity. More recent research also identifies body image problems as a predictor of eating disorders and depression in young women (Fardouly et al., 2017). This indicates that people who suffer from body image problems might be more vulnerable to developing eating disorders or depression than people who don’t have body image problems.

A research paper from 1999 by Fouts & Burggraf analyzed main female characters in television shows, an important form of media at that time. They found that the thinner a female character was, the more positive comments she received about her looks from male characters on the show (Fouts & Burggraf, 1999). Their research also indicated a higher percentage of female characters on television being underweight than the actual percentage of the female population that is underweight (Fouts & Burggraf, 1999). This indicates that mass media has pushed an unrealistic thin body type for women for many years. Research by Grabe et al., (2008) measured how exposure to thin ideals in magazines, television commercials, and television shows affected women. They found that exposure to these forms of media caused body dissatisfaction, increased investment in appearance, and increased endorsement of disordered eating behavior (Grabe et al., 2008). These papers are only a fraction of all research that has been done on the relationship between media and body image, but it shows that a thin ideal body being represented in the mass media has been a problem for decades. Exposure to these ideals in the media causes multiple body image problems for women.

How Instagram affects body image

More recently, social media has taken over other forms of mass media as the source where people get their ideas of the idealized body (Perloff, 2014). Other research has found that mass media is the biggest contributor to body dissatisfaction in the general public (Tiggemann & Zaccardo, 2015). This finding has been supported by both correlational and experimental studies. Instagram promotes itself as a safe place for content creators (Instagram, 2020). Nevertheless, people who post pictures that include body hair or period blood have found their pictures to be deleted (Faust, 2017). No ban on these things is mentioned in Instagram’s guidelines (Instagram, 2020). What Instagram does openly prohibit is pictures of female

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nipples, whereas pictures of male nipples are allowed (Instagram, 2020). Faust (2017) found that pictures sexually depicting women were deleted less often that pictures that included women’s natural body functions. According to her research, Instagram supports the unequal treatment of women that happens in real life (Fault, 2017). And also sexualizes women (Fault, 2017).

Tiggemann & Zaccardo (2015) look into the “fitspiration” trend that is seen on photo-sharing based social media platforms. The idea of “fitspiration” is photo-sharing photos to motivate others to live a healthier life and exercise more. “Fitspiration” is very popular on Instagram in particular, where #fitspiration is linked to millions of photos (Tiggemann & Zaccardo, 2015). The main problem Tiggemann & Zaccardo (2015) found with fitspiration pictures often depict women of a certain body type, which is thin and toned. This spreads the idea that only women with this specific body type can be an inspiration for becoming fit. Previous research has found that exercising because of appearance and not because of a desire to become healthier is linked to a negative body image and lower self-esteem (Strelan, Mehaffey, & Tiggemann, 2003). Meaning that if people start exercising because they want to look more like the people they see under #fitspiration, this can harm their mental health. The research by Tiggemann & Zaccardo (2015) ultimately found that fitspiration photos have a negative effect on body image. This hashtag which harms body image is nevertheless very popular on Instagram. The hashtag “fitspiration” at the time of writing has 18.6 million posts attached to it (Instagram, 2020). Showing that people are unaware of the damages popular trends can do to their body image.

Another trend found on photo-sharing social media platforms is “thinspiration”, which consists of sharing photos to motivate others to lose weight and pick up a lifestyle based on eating disorders (Tiggemann & Zaccardo, 2015). This kind of content is hurtful to people’s body image but is highly monitored on most social media platforms and thus not found there very often (Tiggemann & Zaccardo, 2015). #thinspiration has been banned from Instagram, meaning people can’t look it up (Ging & Garvey, 2017). Even though Instagram tries its best to monitor the hurtful images that encourage disordered eating, some users still post such images under modified versions of the #thinspiration (Ging & Garvey, 2017). This makes it hard for Instagram to keep harmful images away from the platform all the time.

As opposed to these potentially harmful hashtags, Instagram users have also been using the hashtag “fatspiration” (Webb, Vinoski, Bonar, Davies, & Etzel, 2017). This hashtag has pictures of people with a higher weight. These Instagram users try to fight against the thin body ideal found under the “fitspiration” hashtag (Webb et al., 2017). Instagram is easily accessible to anyone, which makes the sharing of pictures of different body types very important (Ging &

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Garvey, 2017). However, the hashtag “fatspiration” only had 10,200 posts at the time of writing (Instagram, 2020). This is a lot less than the 18.6 million posts under the “fitspiration” hashtag.

The potential of mental health apps

As mentioned in the introduction, mental health apps have the potential to help people that suffer from depression (Henson et al., 2019). A research paper written by Juarascio, Manasse, Goldstein, Forman, & Butryn (2018) suggests that mental health apps might be especially interesting for people who suffer from eating disorders. People who suffer from an eating disorder have previously been found to be uncertain about changing their lifestyles (Juarascio et al., 2018). They tend to identify with the symptoms that come from their eating disorder which creates a high barrier for seeking out help. This means that there is a big treatment gap for those who suffer from an eating disorder. A mental health app could help solve this problem: (1) it allows people with an eating disorder to go through therapy at their own pace, (2) it has a low entrance barrier, (3) it is affordable, and (4) could solve the problem of the lack of specialists for eating disorder treatment (Jurascio et al., 2018). What Jurascio et al., (2018) found in their research was that most mental health apps targeted at people who suffer from an eating disorder failed to incorporate any empirically supported treatments. Even though these apps can still offer some guidance or help, it should be understood that the methods they use aren’t empirically supported (Jurascio et al., 2018).

Research done by Alqahtani & Orji (2020) analyzed user reviews from 106 mental health apps. This research helps to understand the current offering of mental health apps and what these apps have to offer. Alqahtani & Orji (2020) found that the flaws that were pointed out most often were poor usability, lack of personalization, credibility issues, security issues, and poor customer service. However, for apps that had better usability, more personalization, credibility, no security issues, and good customer service, these were often pointed out as the best features of the app. Meaning that usability, personalization, credibility, security, and customer service, are mental health app features that are important for users (Alqahtani & Orji, 2020). Usability was most frequently mentioned in user reviews, indicating that users find usability a very important feature in a mental health app. Creators of these mental health apps would thus be recommended to focus on good usability. Improving: bugs, poor user interface, difficult instructions, difficult navigation, and lack of orientation, could help improve the engagement of app users (Alqahtani & Orji, 2020).

Research done with university students found that there was a higher percentage of students that were open to using a mental health app than the percentage of students that had

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used a mental health app in the past (Kern, Hong, Song, Lipson, & Eisenberg, 2018). Students that had used mental health services in the past year were especially open to using a mental health app. What the students appreciated in mental health apps was convenience, immediate availability, and confidentiality (Kern et al., 2018). College students are often found to suffer from a mental health problem, with around half of them suffering from a psychiatric disorder (Raghavan, 2014). However, college students also find it hard to get help for these problems, only 20 to 50 percent of those who need it get mental health treatment (Raghavan, 2014). This treatment gap has nudged mental health care providers to come up with innovative solutions to solve the problem (Kern et al., 2018). Mental health apps thus might be exactly the innovative idea needed to close the treatment gap for college students.

When exploring the relationship between body image and mental health apps, no apps were found that focused solely on improving body image. When searching “body image” in the app store, all apps that show up are for retouching pictures to make people’s bodies look different (App Store, 2020). With body image problems being an important predictor of eating disorders and depression in young women (Fardouly et al., 2017). It could be helpful to improve people’s body image before it becomes worse and turns into an eating disorder. In the app store some apps could be found for people with eating disorders, but there weren’t a lot of choices (App Store, 2020). After the first three apps for eating disorders, apps for diets started turning up, which is not what people with an eating disorder want to find (Instagram, 2020). Thus, for this literature review, research is bound to analyzing research on mental health apps for people with eating disorders. An analysis of mental health apps designed specifically for people with an eating disorder found that the apps often provided information that was not satisfactory and sometimes even harmful (Fairburn & Rothwell, 2015). The apps that Fairburn & Rothwell (2015) found, also often offered the possibility for users to assess whether they suffered from an eating disorder, but only a very limited number of apps used a method that would be deemed reliable. They concluded that the most interesting feature of these apps would be self-monitoring. This could also be interesting for clinicians, who can use information collected through the app to see how the client is doing and analyze whether they suffer from a certain eating disorder over a longer time. Making a well-functioning self-monitoring app could have potential because most clients have a smartphone on them most of the time, making it easier to keep up with monitoring (Fairburn & Rothwell, 2015). When looking at the apps from a client perspective Fairburn & Rothwell (2015) found that working with the apps wasn’t a very positive experience, the apps were difficult to use and not as accurate as desired. The apps often

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have preset ways of how the user has to fill out the information, not allowing the user to make an accurate record of how they are feeling (Fairburn & Rothwell, 2015).

Research on technological self-monitoring programs that use texting found that 87% of users followed through with self-monitoring for the intended period (Shapiro et al., 2010). That is a higher percentage compared to self-monitoring using a journal. Shapiro et al., (2010) tested the texting specifically on people who suffered from bulimia nervosa and found it to be very promising for people who had finished treatment as well. It could keep them from relapsing (Shapiro et al., 2010). Other research that was done on an internet-based program to keep people who suffered from anorexia nervosa from relapsing also found promising results (Fichter, Quadflieg, & Lindner, 2013). It kept the participants from relapsing more often than non-internet-based programs (Fichter et al., 2013).

Discussion

What does Instagram do to promote a healthy body image?

In this section of the essay, two sub-questions will be answered to contribute to my guiding the main question: “To what extent can mental health apps solve the body image problems caused by Instagram?”. The sub-questions will explore different assets of this question to come to a greater understanding of the subject. I will start by asking: “What does Instagram do to promote a healthy body image?”.

As mentioned before, the use of social media apps such as Instagram is the largest contributor to people being dissatisfied with their body image (Tiggemann & Zaccardo, 2015). Mental health apps could be used to solve this problem, but what does Instagram itself do to promote a healthy body image? For example, #fitspiration is a frequently used hashtag on Instagram (Tiggemann & Zaccardo, 2015). Under this hashtag, you find pictures that have the goal of motivating people to get into a healthier and fitter lifestyle. However, most of the pictures show women who are thin and toned, giving the impression that you can only be fit if you have that particular body type (Tiggemann & Zaccardo, 2015). Tiggemann & Zaccardo (2015) found that the pictures using the #fitspiration harm women’s body image and self-esteem. Considering a seemingly harmless hashtag can already have a negative impact on women’s body image, it is clear that Instagram contributes to body dissatisfaction. It would be expected that Instagram is aware of this and does something to counter these effects. I imagine it probably would be efficient to tackle body image problems at the root instead of at a later stage.

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Another hashtag on Instagram that has some issues is the #thinspiration (Tiggemann & Zaccardo, 2015). This hashtag is linked to pictures that motivate losing weight in a way that revolves around disordered eating. This can be very hurtful for people’s mental health and body image (Tiggemann & Zaccardo, 2015). As opposed to #fitspiration, #thinspiration has been banned by Instagram (Ging & Garvey, 2017). However, modified versions of the thinspiration hashtag keep appearing, making it hard for Instagram to ban all hashtags that promote eating disorders (Ging & Garvey, 2017). Sharing these thinspiration pictures can be especially hurtful on Instagram because it is very easily accessible to anyone (Ging & Garvey, 2017). Meaning everyone can come in contact with pictures that promote eating disorders.

As opposed to the “thinspiration” and “fitspiration” hashtags on Instagram we discussed earlier, the hashtag “fatspiration” has also become more popular recently (Webb, Vinoski, Bonar, Davies, & Etzel, 2017). Under this hashtag, you can find pictures of people with a higher weight (Webb et al., 2017). The people posting under this hashtag advocate for a better body image for everyone, regardless of what your weight is. They counteract the unrealistic thin ideal body image that is spread under the “fitspiration” and “thinspiration” hashtags (Webb et al., 2017). Under #fatspiration, half of the pictures shared were actively against thinspiration rather than just promoting a more accepting body image (Webb et al., 2017). This goes to show that Instagram users are actively speaking up against the unrealistic body image that is spread on the platform. This could potentially help other users become more aware of the variation in body types and that not everyone looks thin and toned. However, as mentioned before, #fitspiration has 18.6 million posts whereas #fatspiration has only 10,200 posts, which is not in proportion to the amount of ‘fit’ and ‘fat’ people in real life.

Instagram claims to be a platform for a diverse community, they aim to be a ‘safe place for inspiration and expression’ (Instagram, 2020). However, Instagram also prohibits certain pictures on their platform. They don’t allow nudity on Instagram, including pictures of female nipples (Instagram, 2020). This could be because Instagram is an easily accessible platform, anyone can create an account. Making it appropriate for people of all ages is probably Instagram’s main reasoning for prohibiting nudity. Female nipples might be banned because they are often seen as sexual whereas men’s nipples are not. This means they would fall under the prohibition of nudity. Even though Instagram doesn’t mention it in their guidelines, Instagram users have also experienced their pictures of menstrual blood being deleted, sometimes multiple times (Faust, 2017). Pictures where the pubic hair is visible, have also been deleted, even though this also isn’t mentioned in Instagram’s guidelines. Images like these, which are deleted, are posted on the same platform that often does allow revealing, sexual

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pictures of women. This instills the notion that women are sexual objects, and showing their nipples, menstrual blood, or pubic hair is not okay, but showing their sexuality is (Faust, 2017). Of course, showing sexuality should be okay, but showing other natural things such as body hair or period blood should be as well. Women should be able to share more of their bodies, not just the sexuality of it. Instagram also openly supports the unequal treatment of men and women by prohibiting women from posting pictures that show their nipples, because it is seen as a sexual body part, whereas men are allowed to post pictures of their nipples (Faust, 2017). Instagram tries to delete hashtags that include pictures that promote an eating disorder (Ging & Garvey, 2017). However, other hashtags that can include pictures that push the thin ideal body narrative such as #fitspiration are still allowed (Tiggemann & Zaccardo, 2015). These hashtags can be harmful to people’s body image just like the banned hashtags can (Tiggemann & Zaccardo, 2015). Instagram puts time into banning pictures of women’s body hair, menstrual blood, and nipples (Faust, 2017) But fails to put time into banning other pictures or hashtags that have been proven to be harmful. However, they do ban hashtags that promote eating disorders, recognizing the harm these pictures can do. Instagram also allows hashtags such as #fatspiration to create a platform that shows people of every size should be accepted. Instagram is a platform where people can promote diversity, but it also a platform that still contains hashtags that push a harmful thin ideal. Apart from banning hashtags and monitoring pictures, they don’t do much to promote a healthy body image.

What do mental health apps do for people with eating disorders?

Body dissatisfaction is a big predictor of eating disorders, depression, and low self-esteem (Grabe et al., 2008). Recent research identifies body image problems as a predictor of eating disorders and depression in young women in particular (Fardouly et al., 2017). Social media is the place where people get their ideas of the ideal body from nowadays (Perloff, 2014). Instagram in particular has been linked to body objectification. Instagram is particularly popular with young women, who spend 30 minutes a day on the app on average (Fardouly et al., 2017). This indicates young women might be more vulnerable to the mental health problems related to body image than other demographics. They spend the most time on Instagram and are also more likely to have their body image problems evolve into eating disorders.

As suggested in Section 2, mental health apps have the potential to help people with depression (Henson et al., 2019). However, very little research has been done on the effectiveness of mental health apps for people with eating disorders. This is important to change because Juarascio et al., (2019) suggest that mental health apps might be interesting specifically

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for people with eating disorders. People who suffer from an eating disorder often identify with that disorder. They are apprehensive about changing their lifestyle (Juarascio et al., 2019). This means they find it hard to seek help for their disorder. Mental health apps have a low entry barrier, which makes them especially useful for people who find it hard to seek help. Mental health apps could also offer a solution to the lack of specialists in the field of eating disorders. They also are affordable, making them accessible to almost anyone (Juarascio et al., 2019).

Analysis of the few mental health apps that currently exist and are made specifically for people who suffer from an eating disorder found disappointing results (Fairburn & Rothwell, 2015). The apps provided information that wasn’t helpful and sometimes even harmful. The apps also used features that assessed whether the user suffered from an eating disorder. However, they often failed to use methods that were found to be reliable (Fairburn & Rothwell, 2015). The analysis found that self-monitoring would be the most interesting feature for people who suffer from an eating disorder. The apps could also be useful for specialists, who can monitor their patients using these apps (Fairburn & Rothwell, 2015). The app would then make it easier for patients to monitor themselves frequently because they probably have their phones on them most of the time. This also gives the specialist a more detailed insight into the situation of the patient (Fairburn & Rothwell, 2015).

When researching self-monitoring methods that use texting, Shapiro et al. found that 87% of participants adhered to self-monitoring, which is more than when self-monitoring is done with a journal (2010). This research was done specifically with people who suffer from bulimia nervosa, which is an eating disorder (Shapiro et al., 2010). This research mentions that texting could also be a way to keep in contact with patients after they’ve finished treatment because relapse is very common after finishing treatment (Shapiro, 2010). Using a texting format in a mental health app might be effective. Texting can be done throughout the day and eliminates the need of making an appointment with a clinician. It was also found that internet-based intervention can help people who suffered from anorexia nervosa to not relapse (Fichter, Quadflieg, & Lindner, 2013). This indicates that internet- and text-based forms of intervention is promising for people who suffer from eating disorders. And that internet-based intervention (mental health apps) could also decrease the chances of people relapsing. Regular check-ins with a clinician after healing from an eating disorder can take up a lot of time and be costly. Mental health apps could be a way for people to still check up on how they’re doing without having to spend time and money on continuing treatment.

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Suggestions for the future of mental health apps

Limitations and suggestions for future research

Before starting the suggestions section, it should be mentioned that there is a big gap in the field of mental health apps for people who suffer from eating disorders. There is limited availability and thus limited research has been done on the effectiveness of these apps. There are no apps available that focus on helping people with a negative body image. These are significant limitations to the research in this essay. However, this gap does mean there is a lot of room for future research. It would be helpful to research currently existing mental health apps and how effective they can be for people with eating disorders. Also researching the openness of clinicians in the eating disorder field to working with mental health apps. And how their clients would experience working with such an app. Doing this research could help explore the full potential of mental health apps for body image problems and eating disorders. Mental health apps hold a lot of potential for people with eating disorders/body dissatisfaction but a lot of it has gone unused. Further app development and research would be needed to allow stronger support for the findings in this essay.

What mental health apps can do to improve their effectiveness

So far, it has been clear that mental health apps have the potential to help people with their mental illnesses (Henson et al., 2019). Most research done on the effectiveness of mental health apps focused on depression. Little research has been done on the effectiveness of mental health apps for people who suffer from an eating disorder. However, researchers suggest that mental health apps might be very useful for people who suffer from an eating disorder specifically (Juarascio et al., 2019). In this section, some suggestions for the improvement of currently existing mental health apps will be made. These suggestions are made with the focus on helping people with an eating disorder and helping people with their self-image. There currently is an obvious gap in the market for mental health apps geared towards helping people with their body image. There are also not many apps available for people who suffer from an eating disorder. This means there is a lot of room for improvement and development of these apps.

Mental health apps that currently exist and focus on helping people with an eating disorder were found to be disappointing (Fairburn & Rothwell, 2015). They gave information that was not useful and sometimes even harmful (Fairburn & Rothwell, 2015). It would be recommended to have clinicians work with app creators to make sure the apps contain helpful

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information. Clinicians can check that no dangerous information is shared through the app. They can also help to update the app to add any important new information if it becomes available. Clinicians can also help to create reliable methods for assessing whether someone suffers from an eating disorder or is vulnerable to having one. The apps that are currently available fail to assess whether the user suffers from an eating disorder in a legitimate way (Fairburn & Rothwell, 2015). Clinicians could help in digitalizing the methods they use when working with patients in real life.

It could also be helpful for the apps to be directly linked to clinicians. The app could offer to set up contact with a clinician if the app thinks you have an eating disorder or have body image problems that could lead to having one. As people who suffer from an eating disorder are apprehensive about getting help because they feel like the disorder is part of their identity (Juarascio et al., 2019), it could be helpful if the step from using a mental health app to talking to a clinician is made smaller. For example, it could be helpful if the app connects you to a clinician in the area who then gives you a call to discuss further treatment. The clinician then could use the information the client has put into the app to understand their situation better and find a treatment that fits them. Of course, getting in contact with a clinician would be optional, the app should never force real-life treatment on its users.

When Juarascio et al., (2019) reviewed all currently existing mental health apps for people with eating disorders, they found that they barely incorporated any empirically supported treatments. To improve mental health apps, they should implement treatment methods that are empirically supported. App developers should work together with researchers to find treatment methods that have been proven to be effective. They can then transform these methods to make them usable and effective within an app. They should then also do follow-up research after the app has been released, to see how effective the methods are for app users.

It was also found that the best feature of the current apps was thought to be the self-monitoring (Fairburn & Rothwell, 2015). Self-self-monitoring using an app seems to be very promising. It is easy to keep up with as most people have their phones on them most of the time (Fairburn & Rothwell, 2015). It would thus be recommended to perfect the self-monitoring feature of mental health apps focused on eating disorders. The apps could implement a reminder function, that reminds the app users to monitor themselves when it is needed. The self-monitoring feature should also allow for free text input and not just multiple-choice options. The limited options that are sometimes given by apps make it hard for the user to accurately describe how they are feeling (Fairburn & Rothwell, 2015). It might be interesting to develop a chat function within the mental health app. It would be costly to employ clinicians to talk to

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app users all the time but using a chatbot could be a solution. Clinicians could help to collect the right information and create a dialogue for the chatbot. The chatbot could then be available 24/7 to answer app users’ questions and offer some support if needed.

When looking at user reviews of mental health apps, it was found that usability is the most important feature (Alqahtani & Orji, 2020). This means users found it important that the app was easy to use. To improve mental health apps, it would be recommended to focus on good usability. They should try to eliminate bugs and update the app often to keep bugs away. Developing a good user interface is also essential. The app should be easy to navigate and understand for its users. Focusing on making the app fun to use could have a great effect on user engagement (Alqahtani & Orji, 2020). User engagement is important for mental health apps, they are most effective when used consistently. Increasing user engagement through increasing the usability of the app should be a priority for app developers.

How Instagram can decrease their negative affect on mental health

Apart from apps made specifically for improving mental health, Instagram could also do some things to improve their platform to focus more on counteracting the negative effects they have on people’s body image. Such as (1) adding warnings to harmful hashtags, (2) diversifying the recommended page, (3) monitoring for eating disorder-related hashtags, and (4) allowing women to show their body’s natural functions. These things might help decrease the negative effect Instagram has on people’s body image. This would then, in turn, decrease the likelihood body image problems grow into serious mental illness. Instagram could create a pop-up when people click on certain hashtags that informs people of the risks that come with the hashtag. For example, it is logical Instagram does not ban #fitspiration because the pictures posted have no harmful intent. However, they can still be damaging to people’s body image (Tiggemann & Zaccardo, 2015). With a pop-up, Instagram could inform users of these risks, making them more aware of the harm the pictures can do. Instagram could also improve the promotion of healthy body image through people’s recommended page. They could try to include more diversity there, to show people that idealization of a thin physique is not necessary. Instagram could also improve the monitoring of hashtags related to “thinspiration” or eating disorders. Even though they banned this hashtag, people still use modified versions of it to post similar pictures (Ging & Garvey, 2017). Instagram should make sure images like these don’t reach Instagram users to keep them safe from the encouragement of pursuing unhealthy eating habits. This is especially important since Instagram is easily accessible to

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anyone, meaning anyone can (unwillingly) come in contact with these pictures (Ging & Garvey, 2017).

Instagram also prohibits women from posting pictures in which their nipples are visible (Instagram, 2020). And pictures that have period blood or body hair in them are also often banned (Faust, 2017). By doing this, Instagram doesn’t treat women the same way they treat men. Women are objectified, allowed to post sexual, revealing pictures, but not pictures which show other natural things that come with female bodies such as pubic hair. Instagram should stop banning pictures of period blood and body hair. The banning of these pictures is not mentioned in their guidelines. It contributes to the idea women should look a certain way and aren’t allowed to show their bodies in a non-sexual way. This possibly contributes to body dissatisfaction because it tells women they shouldn’t show certain things that come naturally for them.

Lastly, it could also be helpful for apps to promote themselves more. Research done with university students found that more students were open to using a mental health app than students that had used one (Kern et al., 2018). Students liked the idea that an app was immediately available, convenient, and confidential (Kern et al., 2018). A lot of university students suffer from mental health issues and don’t get help (Raghavan, 2014). A mental health app would appeal to university students. App developers should look into how they could make their app a good fit for university students. This could improve the app’s reach. However, this recommendation is most important for the company developing the app as they want to reach as many people as possible. For the users, it wouldn’t be of much importance.

Conclusion

This essay started by introducing the subject: mental health apps and the influence of social media on body image. This subject was then further explored in the literature review, where extensive information about the subject was collected to give a good impression of the already existing literature on the topic. Then the sub-questions: “What does Instagram do to promote a healthy body image?” and “What do mental health apps do for people with eating disorders?” were answered. The answers to these sub-questions provide the basis for answering the main question: “How can mental health apps solve the body image problems caused by Instagram?”.

Body image problems have been around for a long time (Grabe et al., 2008). Various forms of media depict women only of a smaller size, creating a thin ideal body image. Exposure

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to these thin ideals in the media causes body dissatisfaction and an increase in disordered eating habits (Grabe et al., 2008). More recently, as other forms of media have become popular, it was found that the use of social media apps, such as Instagram, is the largest contributor to people being dissatisfied with their body image (Tiggemann & Zaccardo, 2015). Lower satisfaction with body image can cause unhealthy weight control behavior (Neumark-Sztainer et al., 2006). More recent research supports this claim, it found that body image problems are a predictor of eating disorders in young women specifically (Fardouly et al., 2017). It so happens that young women are also the main users of Instagram, an app that has been linked to increased self-objectification before (Fardouly et al., 2017). It can thus be said that the use of Instagram can push the thin body ideal, which decreases young women’s body satisfaction. This body dissatisfaction can in turn cause eating disorders and unhealthy weight control behavior.

Even though (social media) apps might cause mental health problems such as eating disorders, they could also potentially solve them. Mental health problems often go untreated, it was estimated that 30 to 35 percent of severe mental disorders did not receive any treatment in the previous year (Basavarajappa & Chand, 2017). And technology has the potential to solve this treatment gap (Rebello et al., 2014). The technology could make mental health care accessible, affordable, reach a larger audience, and decrease stigma (Rebello et al., 2014). One form of this technology could be mental health apps. Mental health apps might be especially useful for people with an eating disorder as they often find it hard to get help (Juarascio et al., 2019). They often identify with their disorder. Mental health apps lower the barrier of getting help for them (Juarascio et al., 2019)

Instagram currently doesn’t do much to promote a healthy body image. They ban certain hashtags that contain harmful pictures but don’t monitor other (modified) hashtags that push a thin ideal or eating disorders (Ging & Garvey, 2017). Instagram also doesn’t allow pictures of female nipples, while they do allow pictures of male nipples (Instagram, 2020). They also have removed pictures of menstrual blood and pubic hair in the past, even though they don’t prohibit this in their guidelines. Instagram thus accommodates the idea that women are sexual objects and can only post revealing pictures that don’t show the natural things that also belong to women’s bodies (nipples, menstrual blood, and body hair) (Faust, 2017).

Mental health apps could improve body image problems caused by Instagram if they make some adjustments. First of all; more mental health apps focused on body image problems and eating disorders should become available. They should work together with clinicians to incorporate empirically tested methods to help people who suffer from an eating disorder. The app developers should also focus on improving usability, as that was the most important feature

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for app users. Clinicians should be willing to recommend apps for people who suffer from eating disorders, especially as a monitoring device.

Instagram could also create a pop-up function that warns its users of the negative effects their app can have on body image and what the consequences of that could be. It could also undertake some other steps to encourage a healthy body image. Instagram should stop allowing the sexual objectification of women. They should also actively monitor for pictures that promote eating disorders. If Instagram made these adjustments, maybe the app wouldn’t be as harmful to people’s body image anymore. This would decrease the chance of people developing an eating disorder because of Instagram. Even though mental health apps are helpful for people with mental health problems, it would be better if these mental health problems weren’t there at all.

Mental health apps have a lot of potential to help people with eating disorders or body image problems. However, there is still a large gap in the market. Not many apps are offered, and the ones that are aren’t as good as they could be. If app developers took the earlier noted suggestions into account, mental health apps could become really effective. They could lower the barriers of getting help when developing body image issues (due to Instagram). This might prevent these body image issues from growing into an eating disorder. If more mental health apps aimed towards eating disorders/body image problems were developed and implemented the mentioned suggestions, mental health apps could fill the treatment gap and become the future of mental health care for people with eating disorders or body image problems.

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How can mental health apps solve the body image problems caused by Instagram?