Benefits and Risks: The TikTok Phenomenon

Creators are encouraged and coached on how to produce engaging content by the platform and given tips and tricks for growing an audience and getting their message out to the masses. TikTok has developed a real-time streaming option as well as temporary posts that will disappear from the user’s profile after 24 hours. This application utilizes a “recommendation system” that learns topics of interest based on the user’s viewed content and feeds similar videos to the viewer, delivering a virtually non-stop source of visual input (TikTok, 2023b).

Connection from afar

While there are plenty of offerings that stir up “joy and creativity” as promised in this global company’s mission statement (TikTok, 2023a), including cute animals, lip-synching, and home remodels, TikTok has also developed into an outlet and resource center for personal wellness topics like mental health. Professionals and non-professionals alike have taken to their electronic devices and created a massive library of videos for their audience. Mental health therapists can present interventions, affirmations, or psychoeducation to their hearts’ content, while individuals experiencing symptoms associated with varying diagnoses can share their stories and strategies.

This specific facet of TikTok should be of particular interest to MFTs as this platform is becoming a common source of clinical information. While the influence of these mental health advocates seems only to be growing, the ramifications of this access to mental health discussions, resources, and outlets are not as clear-cut. Anecdotal reports vary from helpful to harmful, depending on who is sharing their tale. In my own clinical work, I have heard adult clients sing praises of the content found on TikTok regarding commonly experienced symptoms of depression, anxiety, attention deficit disorder, and autism spectrum disorders. Common themes of their positive experiences are that the information is validating and comforting as the content of the videos serves to assure them they are not alone in their experiences. Daily struggles, cycles, and symptoms are normalized in a judgment-free zone. In this way, an ally to the client system is created that draws on individual strengths, increases perceived connection, and shares the burden of the problem. These criteria are precisely what I would be on the lookout for as I assess a client’s system for supportive parts that can be tapped into during the process of change.

While I have certainly observed the helpful nature of online forums during my time as a therapist and have encouraged clients to consider the usefulness of connecting with online support and information groups, I have been surprised to find this level of enthusiasm for the support found in this virtual form. I have been regaled with other stories that have described the positive impact of this platform on individuals who may not have access or the desire to engage in formal therapeutic services. For some of these users, self-assessment based on viewed content has led to the engagement of clinical services that may not otherwise have been pursued due to lack of awareness, prevailing biases and stigma, or denial of a problem’s existence. As a proponent of mental health awareness and treatment, I am excited and encouraged by these incidents. I can say they have caused me to consider if I, too, want to enter the digital consortium to share my own messages of normalization and validation to those who may never enter my or any other therapist’s office. It seems, at heart, this is the driving force behind much of the platform’s mental health-focused creators: to disperse knowledge for the benefit of others. Or, as TikTok community guidelines state “…the fostering of a safe and welcoming environment for everyone” (TikTok, 2023c).

In some of the formal research on this phenomenon, users have identified experiencing positive feelings due to the access they perceive TikTok provides to information regarding mental health topics as well as to others, affirming they are not alone in their experiences of symptoms associated with mental illnesses (McCashin & Murphy, 2022). A recent study noted the positive impact users seeking mental health support found on TikTok. Citing the sheer number of views (1 billion), the authors classified this activity as a reflection of the positive impact it had on viewers denoting it as evidence that people are out in the virtual world seeking information and, likely, connection with others living out a similar experience to their own mental health journey (Basch et al., 2022).

The unknown impact

There is, as always, a second side to the proverbial coin and it is this alternative impact of TikTok that brings this topic into an imperative focus for MFTs: the negative influence of this virtual part of the system. Warranting perhaps even more curiosity than the phenomenon of non-stop video clips is the apparent adoption, mimicry, or otherwise contagious nature of diagnoses-related language, behaviors, and labels by users.

A frequent topic in my clinical supervision sessions with clinicians in various practice settings and geographical locations is the increased influence of TikTok on their clients. Specifically, I have heard multiple stories regarding female and non-binary identifying minors who have been observed to self-diagnose and spontaneously exhibit symptoms after watching videos on their diagnosis of interest. The former may represent a mild, expected result of impressionable, young minds inundated with nonstop information dumps, while the latter presents a more extreme and concerning effect for a still developing and vulnerable population. While these reports are sourced from subjective points of view and should in no way be interpreted as results of a formal, scientific study, they do represent something is happening in the system. It should also be emphasized that as this is a phenomenon in process, we do not fully know if this impact is positive or negative, helpful or harmful. While TikTok is garnering increased attention in the media and our field of mental health, the consensus is that we do not know enough about it and that more research is needed.

Notably, the clinicians and caregivers I have encountered unanimously warn of the detrimental impact these occurrences have on their own experiences as parts of the system and anticipate them being harmful to the identified client. These witness accounts of youths having language without knowledge regarding mental health jargon seem to serve as a bulkhead of sorts, blocking the connection between the system parts. The other, more dire, tales that recount previously non-symptomatic minors exhibiting criteria of various diagnoses, after watching clips on that particular diagnosis, stir up concerns that these youths are at risk of being misdiagnosed, receiving ill-fitting treatment, and reports of general confusion about how to approach these spontaneous expressions. I have also witnessed a level of skepticism held by the adults in the lives of these adolescents and teens regarding this symptomology resulting in a gamut of responses from disbelief and frustration to acknowledgment that even attention-seeking behavior is valid as attention of some sort is clearly being sought. Popular cultural references to being triggered, depressed, anxious, bipolar, and other mental health phrases are emphasized and reiterated by some TikTok creators which may also lend to a pseudo-science effect as consumers are hearing the same words from contributors with clinical and non-clinical backgrounds alike. This raises questions about how consumers, caregivers, and treating clinicians are to differentiate between the validity and qualifications of the virtual influencers providing this knowledge that is being heartily consumed.

A common framework mentioned by multiple investigators of the impact of social media on individuals is that of the uses and gratification theory (Bucknell et al., 2020; Montag et al., 2021; Montag & Hegelich, 2020). This theory, having been applied to the use of media for decades, posits individuals have needs, stirred up by other parts of their social system, that they will soothe via media access (Katz et al., 1973). Needs for connection, self-expression, fame, self-understanding, and understanding their place in their system and the world (Bucknell et al., 2020; Montag & Hegelich, 2020) could reasonably be assumed as at least one motivation for client engagement in TikTok. Here in TikTok reality, after all, an individual can be who they want to be, present the version of themselves they would like their viewers to accept, and feel the thrill of “likes,” comments, and shares. These researchers express concern about the impact, known and unknown, of TikTok and similar social media sites on users with minors being a specific vulnerable population of concern. There is also agreement that more research needs to be conducted to build greater awareness of what is happening to consumers of these types of media (Bucknell et al., 2020; Montag et al., 2021; Montag & Hegelich, 2020). Interestingly, these publications align with the anecdotal concerns clinical providers have shared with me that are based solely on what they are seeing happening to clients in their offices.

A public affirmation in the U.S. of these questioning and concerned voices is found in a recent lawsuit filed in Washington state by Seattle Public Schools against TikTok and other social media platforms for “harm caused to students’ social, emotional, and mental health” (Seattle Public Schools, 2023). The state of Indiana has also brought a case against the social media platform, stating concerns about child well-being due to mature content (State of Indiana, 2022). While it is beyond the scope of this article to enumerate each of the legal actions taken against TikTok, there is easily found information on lawsuits in Dutch (Kramer, 2022), UK and EU (British Broadcasting Corporation, 2021) courtrooms regarding protections for children. TikTok is also under scrutiny from U.S. congressman Josh Hawley who is seeking to ban the app’s usage citing security concerns adding to the controversial atmosphere around it (Missouri State Senate, 2023).

MFTs into the fray

It is not unique to TikTok that its users discuss mental health issues, as the nature of today’s social media emphasizes the experiences of users as a primary draw for viewers. That, combined with the increased incidents of adults in the U.S. receiving mental health treatment in recent years (Terlizzi & Schiller, 2022) makes it no surprise that these conversations have become increasingly salient in our world. The positive impact of another social platform, Reddit, on individuals in recovery from opioid use (D’Agostino et al., 2017) points to the potential good that can come from these easily accessible outlets. These private and free forums may also provide otherwise inaccessible resources for populations experiencing barriers to mental health treatment. That said, social media usage has been identified as a threat to the mental health of girl users (Twenge et al., 2022).

As MFTs include the TikTok factor in assessment and treatment of a system, we are given the opportunity to consider the context in which these behaviors might hold a reasonable function

While TikTok was not named specifically, social media use, in general, was named as having as significant an impact on the users as binge drinking. One point made worth highlighting is that a youth’s binge drinking behaviors would reasonably be of interest to parties concerned about that youth’s mental and emotional well-being, and so should their social media usage. While these researchers are not citing TikTok or social media platforms as the source of all problems, they do state these activities warrant attention. The downplayed way in which potential impacts of social media usage on mental health in teens has also been criticized (Twenge et al., 2020). If, indeed, this risk has been disregarded in the past, it is imperative that we as MFTs who are on the frontlines of mental health treatment be aware of any malignancy in what may have been previously assumed a benign influence on our teen clients, their parents, healthcare providers, and other significant parties in the system. As MFTs include the TikTok factor in assessment and treatment of a system, we are given the opportunity to consider the context in which these behaviors might hold a reasonable function. We can tap into our training as non-pathologizing clinicians and model empathy and validation for the system’s experience, both for the adults and other witnesses as well as the individuals making these expressions.

Despite its success as one of the most popular social media platforms, we are still learning about the impact TikTok has on the emotional and mental health of its users. As MFTs, this means we need to inform ourselves and help our clients create awareness of the impact this influence is having on their system. There is ample room for us to express our talent for curiosity as we encounter this phenomenon in our therapy rooms and exploring the function of TikTok and its impact on the system is a good place to start. As we invite our clients into an open conversation about their experiences with this platform, we can also model and normalize increased communication between system members regarding rules around mental health discussions, acceptability of symptomatic expressions, connection attempts, and more covert boundaries systems may have in place that necessitate this external means of homeostatic disruption. As we help our clients assess what needs in the system are not being met, we open the door for additional opportunities to discover new healthy and safe supports that may ameliorate the attempted solution this virtual resource appears to be posing.