Dr. Wendy Slusser 00:02
During these uncertain and rapidly changing times, many of us may find ourselves constantly checking the news and social media. However, prolonged and repeated exposure to such media may actually be harmful to our health. Today, I chat with Dr. Roxane Cohen Silver, professor of psychological science, medicine and public health at UC Irvine and the associate director of the UCI Advanced Program in the Office of Inclusive Excellence, about the public health consequences of media exposure. Thank you, Dr. Silver, taking the time to meet with us for our “6-feet-apart” podcast; and you’re just perfect for this podcast and the timing of the podcast because you’re an international expert in the field of stress and coping, and for decades of work studying acute and long-term psychological and physical reactions to stressful life experiences. And I was particularly interested in the paper that you wrote, just one month after the sheltering-at-home that we were all participating in the country. Your research paper was commenting on what it means to have repeated media exposure to community crisis. Can you tell me what you found?
Dr. Roxane Cohen Silver 01:30
Well, actually, the paper was written before the sheltering-in-place. We wrote the paper in mid-February. Colleagues and I were quite certain that as the information started to unfold that more and more attention was being placed on the – it was not yet called the pandemic – but on the the outbreak, the COVID-19 outbreak, and it actually wasn’t even defined as COVID-19. We changed all of these things in our page proofs because we wrote it so early, but –
Dr. Wendy Slusser 02:05
I’m sorry, can I interrupt for a sec? Why did you think that there was going to be –
Dr. Roxane Cohen Silver 02:09
We were starting to see a tension because there was quite an outbreak in China at the time. And I think it was about the second or third week of February when I heard, as I was driving to campus, that the CDC had announced that it was inevitable that – what was soon to be labeled, COVID-19 – that it was inevitable that we were going to have an outbreak in the United States. And at that point, I actually reached out to a program officer at the National Science Foundation to indicate that I was hoping to do a project just as this was starting to unfold, because as it was clearly indicated that it was inevitable to hit the United States, it became obvious to me that this was going to be a potential crisis. I had been following the work in China, I had not at all realized the implications for the United States at that time back in January – end of January, early February; but by the time I’d heard that the research scientists, the epidemiologists and virologists were indicating that this was likely to impact people in the United States, it became all of a sudden clear to me. My colleagues and I had studied the public health “crisis” – and I want to put crisis in quotes – in 2014, of Ebola in the United States, and we were very immersed in studying the impact of the media in exacerbating the stress that people were feeling about Ebola in 2014. And at that point, I believe we were anticipating something similar for what was to be labeled COVID. Of course, again, when we wrote our paper, the pandemic had not been declared. That didn’t happen for some weeks after that, and there was no attention at that time – at the end of February – that this was going to be the kind of outbreak that we have seen over the last several months. But over the last 20 or so years, my colleagues and I have become increasingly interested in the role of the media in amplifying distress that people feel in response to what we’ve labeled collective traumas; these are natural disasters or man-made disasters, mass violence events. And I began to study in the early days after the September 11th terrorist attacks in which we first started to see the the importance of the media. In the early 2000s, there was only television, basically. There was some radio and there was print media, but television was the way in which many people across the United States and indeed across the world learned of the September 11th attacks. And we found in the few years that we studied the 9/11 attacks, that how much television people watched in the week or so after 9/11 was very much tied to their ongoing concerns about terrorism, their ongoing feelings of worry, their ongoing – in the early days we looked at acute stress symptomatology, but over the years, look at post-traumatic stress symptomatology. And, in fact, we found that the amount of time that people spent immersed in television in the days after the 9/11 attacks was linked to physical health consequences over the next several years. And that was a pretty big eye-opener for us. I certainly didn’t have any understanding or interest in media, per se; but I was very interested in how it was that 9/11 became a crisis across the United States. And that’s where we saw that television at the time and media more broadly, was the mechanism through which this trauma was dispersed throughout the United States.
Dr. Wendy Slusser 06:43
Just to clarify: for one week after – is that sort of a sensitive period? Or was it that –
Dr. Roxane Cohen Silver 06:51
We started our study nine days after the 9/11 attacks, and we asked people how much TV they had been watching in the prior week. So – we began our study early, and we could predict many things, over time, over the next 2-3 years from how much television people were watching in that first week.
Dr. Wendy Slusser 07:14
So do you think it was because it was the first week or that –
Dr. Roxane Cohen Silver 07:19
I’m not really sure. What I know is it’s likely to be the case that people who are immersed in television in that first week continued to be immersed in television. We do know that the more people watch television in the first week after 9/11, the more likely they were to watch television at the anniversary – the first anniversary. And so it’s likely to be a signal of some concern at that time about terrorism. And we have a paper that came out in 2013 linking early media exposure to 9/11 to long-term, meaning 2-3 years out, physical and mental health consequences. And the paper came out, I believe, maybe in early 2013. And a few months later, the Boston Marathon bombing occurred. And I received a phone call from a journalist in the day or two after the Boston bombing. Her social media feed was filled with images – very graphic and gruesome images – in the aftermath of the Boston Marathon bombing. And she said to me, “I know you studied television after 9/11, but the media landscape has changed pretty dramatically in the last decade, and now that we have social media, what’s the consequences of these images – these unexpected images of graphic and gruesome, horrible destruction, and injury – what’s the psychological consequences of my being exposed to that?” And I said to this journalist, I have no idea, but we’ll find out for you. Right then, we began a study of the larger media – began a study within a few days after the Boston Marathon bombing in a nationally representative sample, in which we explored the exposure to media of all sorts and looked at the consequences of that on people’s mental health to look at their physical health over time. And we found, much to our surprise, that individuals who were engaged in many hours of media in the aftermath of the Boston Marathon bombing were exhibiting how higher levels of stress response than individuals who were actually at the bombing. This was a paper that we published in 2014. It was very unexpected for us to see that media exposure could be more psychologically – I don’t want to say damaging – but could be more psychologically impactful than actually being at the site of the Boston Marathon bombing. And we’ve come to – over the years since this paper came out in 2014 – we’ve continued to study the role of the media in transmitting or in amplifying distress in the aftermath of mass violence events and also the Ebola public health crisis in 2014. And the link between early exposure to graphic media and ongoing responses to new events that unfold and all of that – this is all a very long-winded way to say – all of that work set us up to expect that medium was likely to play an important role in what was to be soon labeled COVID-19.
Dr. Wendy Slusser 11:20
There’s so many questions that come to mind right now based on what you just were saying to me, so just so I can clarify for myself and also the listeners, when you say higher level of stress response, what does that mean?
Dr. Roxane Cohen Silver 11:33
So we often measure what is called acute stress symptomatology. Acute stress symptomatology can be such things as repeated memories and thoughts and mental pictures about an event; it can be anxiety that is generated when one thinks about an event; it can be disruptions in a person’s ability to stay focused their task at hand; maybe nightmares, maybe disrupted sleep. There are a variety of symptoms, and there is a psychological diagnosis called acute stress disorder that is sometimes diagnosed for individuals who have personally encountered a trauma within the first 30 days, in which they are anxious and distracted and triggered by feelings about an event. The criteria, however, that’s used to make that diagnosis requires that people are directly exposed to that event. So we’re not talking about acute stress disorder because individuals that I study are those who have been exposed merely through the media. So that is an exclusion that individuals who have media-based exposure are not diagnosed with acute stress disorder, nor are they diagnosed with post traumatic stress disorder. Nonetheless, we are looking at the same kinds of symptoms that people who might directly encounter these events might be exhibiting in response to several hours of media-based exposure. It looks as if across our studies that it’s something around 4-6 hours, or above that, a day of media-based exposure. And I don’t want to imply that people are necessarily sitting in front of a television for four or six hours; what we see now is that people are getting media – or learning about and exposed to these kinds of events – from many different sources, simultaneously. So a person might have the television, they might be watching television, perhaps the radio is in the background, maybe they’ve got their laptop on their lap, and they’re scrolling through some social media feeds, their phone then sends them a tweet. So all of these combined exposures is what we are talking about here. The individuals who are engaged for several hours a day in this combined, both traditional and social media exposure, are more likely to be exhibiting symptomatology in the aftermath of one of these kinds of disasters that I’ve studied since, actually, since the 90s.
Dr. Wendy Slusser 14:41
I mean, this is a wealth of knowledge in terms of also and very reflective of the kind of work we do at Semel HCI. Looking at how the mind and the body are connected, too. So you describe this distress and anxiety that is being promoted through the 4-6 hours of media per day after some of these traumatic events. You’re saying that they also have physical ailments. What are they, specifically?
Dr. Roxane Cohen Silver 15:09
Individuals who were exposed to several hours of media and television at the time, in the aftermath of the September 11th attacks, and who continued to worry about terrorism, were more likely to develop new onset cardiovascular ailments, such as hypertension, other ailments, since we also found that across a variety of physical health symptoms – not nearly psychosomatic symptoms, like headaches – but more clear, physical health complaints that individuals were more likely to be reporting new onset physical health complaints over the next 2-3 years. And we’ve been trying to understand what is it about media that might be associated with these kinds of both mental and physical health outcomes? In some of our work after the Boston bombing, it appears that the graphicness and the gruesomeness of the images may play a role. It’s clear that both the amount and the content are likely to play a role in the exacerbation of physical or mental health consequences, in the aftermath of a traumatic event. We’re looking right now in our research at the role that the media might be playing in exacerbating distress that people are feeling as they’re responding to and dealing with COVID-19. That’s work that we’re currently conducting and work that we’re currently analyzing and submitting for peer review, but not yet published.
Dr. Wendy Slusser 16:53
So getting back to two other comments you said about the previous work, you’ve done. One of them that struck me, which is wearing my pediatric hat, we have always counseled parents not to let the kids watch news in general, because it’s very different seeing something that might be violent in a movie, which builds up so you’re not – you’re kind of expecting it to happen – versus the news, which you don’t expect – there is a lack of expectation. So can you comment on that? What is that? Because you mentioned that, like the unexpected, like that news –
Dr. Roxane Cohen Silver 17:32
Yes. Well, one of the very important points that you just made is that there has been a recognition for many decades of the potential negative consequences of repeated media exposure to real news and real graphic images for children. And it was the 9/11 attacks that ushered in a concern also for adults. So prior to that, really, almost everything that had been written on the role of the media had been about the concerns for children without recognition of the potential importance for adults as well. And it wasn’t just our research. There was other research coming out at the time after 9/11 that was suggesting that individuals outside of New York were experiencing a great deal of distress after the 9/11 attacks. And how did they learn about those attacks? Via the media. And that was the start of people’s concerns. We don’t really know yet what it is about media – repetitious media exposure – it is likely to be that many times you are seeing the same event with the same pictures over and over and over again. And we don’t really understand what are the consequences of that for brain function. I have some neuroscientists colleagues who have been thinking about trying to understand that more generally. Communications researchers, however, have told us for a long time because they study the media and the role of the media – not on the psychological consequences of exposure to trauma – but just generally, communications researchers have told us that there is something different about the way people process real news versus fictional content. The communications researchers suggest that there’s something about being able to tell yourself that that’s fake, and that it makes it more psychologically palatable. Also people choose to see those images, and then they can close the television or walk out of the movie theater and just know that was entertainment. And so we know that there is something different about this experience, but I would say we’re still in the infancy about this. Again, this is all very, very recent, because the media landscape has changed so dramatically in the last decade or so that we are really just now starting to understand what the psychological implications might be of exposure to real violence.
Dr. Wendy Slusser 20:28
That’s very informative and sounds like, at least from the pediatric and now the adult point of view, that minimizing exposure to media after these kinds of events can help prevent this trauma.
Dr. Roxane Cohen Silver 20:44
Well, one of the things that we have been arguing is that in the time in which individuals have been sheltering at home and may have more time on their hands, and at a time when there are numerous hours of media that need to be filled, that it’s been all COVID, all the time. We’ve been arguing that that news – which has not only been all COVID, all the time, but all bad news – that constant exposure is not likely to be psychologically beneficial, and indeed, may be psychologically harmful. And we have been arguing for months now about the importance of people monitoring the amount of media to which they’re exposed. Again, we’re talking about all news that’s been, in general, all bad. Moreover, it’s not only just bad, but it’s been getting worse. So we began our data collection in mid-March, when there were 190 COVID-related deaths in the United States, and within 30 days we went to over 18,000 COVID deaths. And so during that period of just 30 days, mid-March to mid-April, not only were we having COVID news all the time and 24/7, but it was all bad news and escalating bad news. And that combination, and being exposed to that over and over again, is not psychologically beneficial.
Dr. Wendy Slusser 22:34
So, say you watched the news at 9/11 for that week, and then maybe even the Boston Marathon, and then you are now entering this COVID pandemic – are those people much more vulnerable to the negative impacts? Is it like a compounding kind of experience?
Dr. Roxane Cohen Silver 22:57
Well, let me say a little bit about the work that we did after the Boston Marathon bombing. We followed several thousand individuals for several years. And during that period of time, a lot of other large-scale disasters occurred in the United States. And in particular, we studied how those individuals who responded to the Boston Marathon bombing, then responded to the Pulse nightclub shooting in Orlando, Florida, in 2016. And what we found was that individuals who were exposed to a lot of media in the week or so after the Boston Marathon bombing, were exhibiting more psychological symptoms about a year later, and they were more likely to be continuing to worry about terrorism. Those worries then seemed to be associated with increased exposure to media about a variety of mass violence events, such that we described a vicious cycle in which individuals were engaged with more media, became more anxious. That anxiety drew them to greater exposure to media, particularly about mass violence, which then was associated with increased distress. And this cyclical nature, we believe, is very difficult to extricate oneself from. So it is very possible – although I don’t have the data to look at this specifically – but it’s very possible that individuals who were exposed to a lot of media about Ebola may have been drawn to more media about COVID because the more people were exposed to media about Ebola, the more worried they were about contracting an infectious disease. And that would then, I would say, be likely to draw them to new media information about infectious disease, which might then lead to increased distress about COVID. And, again, a vicious cycle that is very difficult to extricate oneself from, which is why we have been encouraging, or at least recommending, that people monitor the amount of media to which they’re exposed. I don’t believe that many people necessarily keep track of how much media they’re exposed to. We can go down a cycle of, you know, endless links in which we can check over and over again and learn more and more about the bad news surrounding COVID, without even realizing how much time has passed. And so what we’re encouraging is that people monitor the amount of time and the frequency with which they are exposed to the media. We’re encouraging people to perhaps check the media twice a day, perhaps in the morning, again in the evening, and monitor the amount of time; because we do believe that repeated exposure to escalating bad news is likely to be associated with distress. And that distress may, again, draw people in to try to control their distress, maybe to seek out new information that they hope might minimize their distress. But in the context of an escalating crisis, it’s likely that is not going to be successful. So that’s really good advice. So it’s not just the amount of time, it’s the frequency. So twice a day seems to be okay. And then the amount of time, what would you recommend? It looks across our studies that there’s something about 4-6 hours that seems to be the tipping point. I don’t want to say that for sure, because we don’t yet know how many hours it’s going to be for COVID. It is the case that after the Boston Marathon bombing, we found that symptoms went up linearly with the amount of hours; so more is not better, and it’s likely that staying sort of minimally connected is more psychologically beneficial. I personally engage in almost no media. I read, but I read online news, and I do it with a very limited amount. I believe that I’m as knowledgeable as the next person, but I don’t watch videos, I don’t click on links, I don’t engage at all in social media. And I pretty much practice what I preach.
Dr. Wendy Slusser 28:00
Well that makes you a great leader and example, I would say. You know from a pediatric point of view, reading would probably be a better suggestion for any child who wants to learn about what’s going on in the world. Can I ask you a question? How can you get out of the cycle? For instance, I think about a lot of people I know in New York City, who watched the 9/11 over and over again and experienced it – like they experienced it twice, like physically and also in the media. What would you say to them? If there’s another crisis, would you say, actually, it’d be really – how could you stop watching? How could you keep yourself from watching?
Dr. Roxane Cohen Silver 28:46
Many clinical psychologists would suggest that 1) monitoring that information – you know monitor how much time people are spending. I think people may engage in the media without recognizing how much time they’re spending. The hours just go. And I think part of it is is monitoring. If people find that they are spending too much time, it’s shut the television off, shut the computer, engage in some distraction. One of the challenges for COVID-19 is that many of our sources of distraction were restricted in the early days. So we don’t have professional sports, we couldn’t go out to restaurants, we couldn’t go to bars, we couldn’t do go to parties, we couldn’t socialize with our friends; and so all we had at that time was the media. Fortunately, now we have a little bit of a breather – at least in this moment. And we are encouraged – with proper distancing and wearing cloth, facial coverings – we’re encouraged to to get out more and so we can break away – i think a lot easier – than it was to encourage people to do this two months ago when there was very little else that they could do.
Dr. Wendy Slusser 30:06
So what I’m hearing and what we’ve been sharing at UCLA, as well, is you know moderate your exposure to media, get your information from trusted sources. Nobody identified – you know, I know all the UC’s have trusted pages where people can go that are public, so people can click on and see what is the most current science on COVID-19 and what to do; and then we have, you know, the recommendations in terms of wearing a mask outside or in public gatherings, six feet apart, wash your hands at least five times a day and then more if you’re in public settings, and promoting the culture that we are there to protect each other, right? And that this is a – we need to be altruistic, we need to think about the community, and not go out if you’re sick, you know? If you’re sick, you stay home and you take care of yourself and take care of others. How are we going to get that message out?
Dr. Roxane Cohen Silver 31:11
Well one of the big challenges is that the Coronavirus – the novel Coronavirus – is so novel and so new, that the science is changing rapidly; and that has really made this, I think, very challenging for people to keep up with the news. And therefore, there’s a lot of conflicting information that is presented, or one can find conflicting information in the absence of consistent messaging about the science and in the absence of clear recommendations that are now shifting. Conspiracy theories can develop. There can be a variety of messages that are just not true that can rapidly be disseminated on social media, and that makes it very, very difficult to stay informed. And I know that I read, oftentimes, about information that has been revised in light of new science. So, of course at the very beginning, we were told that people could only shed the virus when they had symptoms; within a few weeks, the science was revised to say that asymptomatic transmission was possible; then a few weeks ago we had some confusing information being delivered from the World Health Organization – you know, is it asymptomatic transmission? Is it pre-symptomatic transmission? All of this becomes very, very confusing for the individual who’s not an epidemiologist or not a virologist. Because that information has been changing, it’s very easy for people to say, “Well, I’m not really sure, so why don’t I go with the news that feels most comfortable for me.” So there’s been confusion about the transmission of the virus. The biggest, I’d say, confusing information has come out about wearing a mask. So at the very beginning, we were discouraged – actively discouraged – from wearing masks because there weren’t adequate number of masks for the first-line health care professionals. Once that was addressed, it became clear that individuals could protect others by wearing a mask, and right now we are in the midst of what appears to be some sort of political posturing about wearing masks versus not wearing masks, and I think that the science is exceedingly clear. I have not read anything that is contradicting the current messaging in mid-June that wearing masks can protect others from the possibility of our transmitting the virus before we know that we have symptoms, and if everybody is wearing a face covering, then we’re all protecting one another. Nonetheless, there has been some conflicting messages coming out from various politicians, for whatever reason, that might drive their recommendations. Nonetheless, I believe the science is pretty clear.
Dr. Wendy Slusser 34:34
Yeah, and it’s – you know you always have to go with common sense, too, right? I think that since we don’t know exactly – you know, the distance you have to be to keep yourself protected; or, you know, I think people need to be thinking about that as a common sensical kind of approach to preventing disease – the same idea as washing your hands. Well, you know, Dr. Silver, you just have so much to offer us, and I can’t wait to read what you’re going to find with this next tragedy that’s happening to our society; and what you’re going to find in terms of outcomes. And I think having had sheltering-in-place and the COVID pandemic hit the United States and the world, now we’re also experiencing protests about racism and – how does that impact the response to the original pandemic? What’s the compounding impact on these kinds of big events, when you have a sequence of events can be quite traumatizing?
Dr. Roxane Cohen Silver 35:40
There’s been very little research on this. Fortunately, for many people, we haven’t had this level of compounding or cascading traumas. However, my colleagues and I did some research in the aftermath of the very large earthquake in 2010 in Chile. And that was actually a multi-pronged trauma – so it started with an earthquake, followed by a tsunami, followed by rioting. And what we found was that individuals were experiencing all of those events simultaneously. Some individuals experienced the tsunami as the most distressing, but there were others who experienced the rioting and the earthquake itself as most distressing. I think that what we’re experiencing right now is a cascading set of traumas, but starting with the pandemic, which then clearly led to over 40 million individuals in the United States becoming unemployed. That initial set of crises left many people with extra time on their hands during a time when all sorts of distractions were restricted, which enabled people to, finally – I would argue – pay attention to the gruesome and graphic murder of George Floyd. Those images were easily accessible via the media. And I think that set of ongoing crises, I would say, almost set us up for paying attention to an event that, sadly, is all too frequent, as many people are now coming to realize how common and how tragic it is that Black men and women have been murdered. But now I believe more people are paying attention; I think because they had nothing else to do but pay attention. And it was also becoming very clear, certainly by mid-May, that COVID-19 was disproportionally impacting underrepresented minorities, Blacks in particular, were more likely to get seriously ill and die as a result of contracting COVID-19. So it was, I think, starting to be a recognition of paying attention more to racism in the healthcare system, or the disparities in the health – the economic and ethnic disparities – in the healthcare system. And that all compounded, I think, to make us pay more attention to George Floyd’s murder.
Dr. Wendy Slusser 38:39
Thank you. That’s a very strong reflection on where we are today. And I wonder with your vast knowledge and background – what might keep you up at night?
Dr. Roxane Cohen Silver 38:51
I’m personally very concerned about the anti-science focus right now. And it seems so obvious to the epidemiologists, the public health specialists, the virologists, that there are ways in which we can protect ourselves and our loved ones from contracting COVID. And that science message is being countered by an anti-science message that as a scientist, I find almost impossible to cope with, myself. This anti-science movement is very frustrating to me, and I’m very concerned about increased cases – all the ways in which we were worried about the healthcare system being overwhelmed by cases of many individuals coming to emergency rooms with COVID symptoms. I’m very concerned about that, and I’m very concerned that we’re going to see a second wave that is worse than the first. I say that not because I’m an epidemiologist and not because I’m a virologist, but because I’m reading the science, and the science seems very worrying to me. And I hope I’m wrong. I hope that we have a vaccine quickly, and I hope that people embrace the vaccine, take the vaccine and help us move beyond this terrible experience that we’re going through right now. But I’m not all that optimistic. And again, I hope I’m wrong.
Dr. Wendy Slusser 40:30
No, that’s a real worry. I have the same worry. And I also sort of have a mental block on how to make people understand science. I’m not sure what the solution is for that.
Dr. Roxane Cohen Silver 40:43
Well, I think podcasts are helpful. You know, I think that we have a lot of work to do, however, in making sure that people recognize that the science is not – that the scientific message is not conspiracy theory. That the science is real, and that the scientists are not motivated for anything other than to protect themselves and their own loved ones. And that we have to protect the students that come to our campus and the faculty and the staff who work on our campus, as well as in our communities. Therefore, if the scientists are encouraging certain behaviors, we should pay attention to them.
Dr. Wendy Slusser 41:26
That’s right. So building knowledge and sharing it and making people believe in knowledge, I think that’s our goal and our hope. Well, thank you so much, Dr. Silver, you’re amazing. Such a pleasure to talk to you, to learn from you, and I hope we can carry this conversation on at a later date when your paper’s published. Thank you for tuning into “6-feet-apart,” a special series, the LiveWell podcast. Today’s episode was brought to you by UCLA’s Semel Healthy Campus Initiative Center. To stay up-to-date with the rest of the episodes in this special series, and to get more information on maintaining your mental, social, and physical well-being during COVID-19, please visit our website @healthy.ucla.edu/livewellpodcasts. Thank you and stay remote.