This was an Android study. No one used a Blackberry.
For Patients in DBT, Netflix calms the storm; WhatsApp stirs it up
STUDY: Macchia A et al, Comprehensive Psychiatry 2026
STUDY TYPE: Cohort study
FUNDING: Studienstiftung des deutschen Volkes (doctoral scholarship)
Background
Patients with borderline personality disorder (BPD) struggle with intense inner tension and dissociation, both of which fluctuate sharply throughout the day. Smartphone use is nearly universal in this population, and this study tracked in real time how specific apps relate to these core symptoms.
The Study
- 49 inpatients with BPD undergoing an 8-week Dialectical Behavior Therapy (DBT) program in Germany; mostly young women, median age 27.
- Smartphone app use was tracked passively over 56 days via the Insights app, capturing time spent and number of times apps were opened for communication (WhatsApp) and entertainment (Netflix, YouTube).
- Patients rated inner tension and dissociation every two hours throughout the day.
Results
- Netflix and YouTube correlated with lower inner tension in the same hour
- Communication apps correlated the other way. The more frequently patients opened WhatsApp (not how long they spent on it), the higher their inner tension and dissociation at that same hour.
- Incoming phone calls were linked to higher average inner tension and dissociation. Outgoing calls were not.
Limitations
Observational (causation can’t be established. Small sample. Android users only; mostly female and all within a structured inpatient setting, limiting generalizability. Self-ratings of inner tension and dissociation declined substantially after week 3, restricting the within-person analysis to the first 21 days.
Practice Implications
- While Silicon Valley looks for ways to harvest our minds, we need to look out for the ways that digital media can improve mental health, or at least not worsen it.
- On the plus side for BPD, entertainment apps to destress; on the con side, checking messages, with all the rejection sensitivity it entails.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
