The primary goal of this interventional study is to explore whether 3 months of arts-based digital interventions can change the way in which teenagers (13-16 years of age) use social media and are affected by them. The main questions it aims to answer are: * Can we give teenagers new, stimulating, and more goal-oriented ways of using social media through arts-based digital trainings and active discussions around social media? * Can these arts-based digital interventions also help teenagers to overcome the negative consequences of social media overuse (such as depression, anxiety, and reduced attention and cognitive performance)? Secondarily, this study also aims to explore the brain and behavioral traits associated with these arts-based interventions to better understand how they work. Researchers will compare a music composition intervention with two other interventions: an active control intervention based on visual-arts instead of music (i.e., photography), and a passive approach to control for the mere pass of time. Participants will: * Complete a baseline and a post-intervention evaluation where researchers will obtain measures of cognitive performance (attention and executive functions, mainly), mood, mental health, brain structure and function, and social media usage and attitudes towards these platforms. * Complete weekly measures regarding their use of social media platforms and their mood. * Complete 3-month arts-based composition / edition intervention (based on music or visual-arts/photography), or the equivalent time with no intervention (passive control group). The motivation of this study was driven by the observation that, in recent years, there has been an increasing use of social media and digital devices in teenagers, while the scientific community still does not fully understand the effects of the overuse of these digital means and platforms. Moreover, some of the negative effects described to be associated with the passive overuse of social media tap on the same brain structures that are benefited by musical and artistic trainings. Hence, we thought it could be worth trying to use arts-based training to help teenagers compensate for or overcome the negative effects of social media at the neural, cognitive, mood and mental health levels. This study introduces novelty through three main aspects. Firstly, it employs a digital art creation approach that requires no classical art training, making it more accessible and less intimidating. Secondly, it incorporates commonly used digital devices (e.g., phones/tablets) and motivating environments into the learning process, integrating the development of new digital skills and the practice of critical thinking around the use of SM into normal classroom activities. Finally, the study employs a multi-methodological approach to explore the brain mechanisms underlying mental-health and cognitive changes resulting from arts-based interventions. Finally, we believe that conclusions from SMART will: * set the basis for developing preventive and therapeutic interventions for depression and anxiety in teenagers, * promote educational programs that provide optimal tools for adolescents to navigate social media in a healthy manner, and * inspire educational policy.
1. Project Description Smart devices and social media (SM) have become prevalent among teenagers, raising questions about their effects on mental health and cognition. Most recent research has focused on the negative effects of SM overuse, including an increased risk of developing depression and anxiety, and alterations in cognitive functions, mainly attention. However, SM have also proven to have positive influences, such as promoting social interaction, creativity, and wellness, among others. Hence, the issue does not seem to be the time spent on SM per se, but the type of activity, content, and engagement the adolescents carry out on these platforms. As the U.S. Surgeon General recently warned, with the increasing use of smart devices and SM in youth, more resources must be dedicated to assessing which SM activities are beneficial or detrimental for the developing brain of adolescents. On the other hand, prior research suggests that art-based interventions, such as those based on music, improve mental health, and promote plastic changes in brain networks related to executive function and emotional regulation. Interestingly, these same brain areas and functions are known to be affected by SM passive overuse. Thus, here, the investigators use music and visual arts interventions to transform adolescent usage of SM, with the aim of mitigating the negative effects of excessive passive use of these platforms. The research team hypothesizes that both music and visual art interventions will improve mental health and enhance cognition. Further, researchers expect this cognitive and mental-health improvement to be paired with structural changes in brain centers related to emotional processing and executive function. 2. Research Question The main motivation and research question behind SMART is whether art appreciation and practice can change the way teenagers interact on SM, overcoming the negative influence of smart devices and social media platforms, and ultimately leading to beneficial cognitive and emotional effects. The first specific goal is to transform the use of social media in teenagers by providing them with digital (i.e., using software solutions) arts-based training, tools, and goal-oriented activities that they can implement in SM, while stimulating their critical thinking about these platforms. The investigators hypothesize that these tools and reflections will help the participants have a healthier relationship with SM, aiding them, for instance, to be critical about the content shared online, to look for healthier and more respectful online interactions, and/or to look for more stimulating activities to do online. The second specific goal would be to elucidate the behavioral and brain mechanisms behind the potential effects of music and visual-arts interventions on cognitive and emotional processing. Researchers expect the digital arts-based interventions to have positive effects on executive functions, specifically in the realm of attention, and on emotional and mental health markers. Investigators hypothesize that improvements in mental health will correlate with plastic changes in emotional and reward-related centers such as ventral striatum and ventromedial prefrontal cortex. Furthermore, the research team predicts that cognitive improvements will be related to plastic changes in prefrontal regions related to attention and executive functions. As secondary goals, SMART aims to develop art-related training programs that are useful, motivating, and applicable in educational contexts. Investigators would also like them to be applicable to preventive and therapeutic approaches aiming to improve the wellbeing and mental health of patients living with chronic conditions (such as diabetes, cancer, or major depression). Ultimately, the researchers aim to raise awareness of the benefits and importance that art-related activities, especially musical ones, have during development. 3. Research Applications Although some recent and currently ongoing investigations are also working on improving attention and executive functions in children and adolescents through cognitive training, even by using music and visual-arts interventions, the proposed project is the first of its kind in exploring the effects of arts-based training in transforming adolescents' use of SM. If predicted benefits from digital artistic interventions are confirmed, conclusions from SMART will have a ground-breaking impact in policy making regarding adolescents' mental health and education. Moreover, the conclusions and materials developed within this project have the potential to be applied in clinical contexts (e.g., health education, therapeutic purposes) in a wide array of physical and mental health conditions. For instance, arts-based interventions like the ones proposed here could be developed for the management of stress, depression, and anxiety symptoms associated with chronic health conditions such as diabetes or cancer. 4. Methodology High school students (9th graders; ages 13-16) will be recruited and divided into two intervention groups/arms: one focused on music composition/edition and another on photography composition/edition. An additional group that will not complete any intervention will be part of the study as a passive control. Participants will be recruited from Fort Hamilton High School (a public school in Brooklyn, NYC), and other public high schools in the NYC area with which collaboration agreements are being set nowadays. A pre-post longitudinal experimental design will be implemented. A sample size analysis determined that to have 80% of power to detect a large effect in a 2 (Pre/Post) x 3 (Group: Music, Visual Art, Control) mixed between-within repeated measures ANOVA, 18 participants per group are required. Investigators will recruit 30 participants per group to account for attrition. Individual experience in music and visual arts will be taken into account, mostly targeting non-experts but not excluding by that factor. Interventions will be administered in 1-hour sessions twice a week for 3 months (24 sessions; 3-month art-based interventions have been previously optimal at inducing mental health/cognitive improvements and brain plasticity. Interventions will include basic structural concepts from each discipline (musical, visual) so that participants are able to appreciate, edit, and create from scratch their own digital pieces, while maintaining a parallel structure and exigency between both types of interventions. Participants will create their artistic pieces using software such as SoundTrap/GarageBand (Music group) and LightRoom/Photoshop (Visual Art group). The classes will also include concepts related to the creative process, exploration of curiosity and identity within artistic activities, teamwork, and collaboration. SM will be used or included in discussions with the students every week to explore inspiration, reflect on what artists share online, be critical about how people comment online, and how to react to criticisms/feedback. The control group will not receive any musical or visual art training initially but will be able to complete the intervention of their choice once the study is over. The interventions will be taught by experienced instructors from the American Composers Orchestra (Music) and NYU's department of Integrated Design and Media (Visual Art). All participants will complete a baseline and a post-intervention 3-month follow-up evaluation that will include: (i) measures of mental health (via validated self-reports of depression, anxiety, general mood, and self-esteem); (ii) cognitive function (attention, measured via a flanker and a foraging inattentional blindness task); and (iii) brain plasticity, via the assessment of gray (GM) and white matter (WM) structure (MRI). Regarding the latter, researchers will collect high resolution T1-weighted images (1x1x1 mm3) for GM analysis and a diffusion-weighted MRI sequence for WM (1.5x1.5x1.5 mm3; 128 diffusion weighted volumes; b-value of 1500 s/mm2). The investigators will also collect information regarding participant's attitudes, opinions and usage of SM, and their sensitivity to general and artistic rewards. Continuous measures will include weekly input regarding: (i) progression of abilities and engagement in the arts classes (by instructors and main research, intervention groups); (ii) mood and motivation states (PANAS); and (iii) self-reported SM usage by filling the number of hours spent on their smartphones and the list and hours spent on their most-used apps (via their smartphone built-in screen-time function). Longitudinal changes in mental health and cognition will be assessed using JASP and a mixed within-between repeated measures 3x2 ANOVA. Post-hoc tests with Tukey correction for multiple comparisons will be used for significant main effects and interactions. Brain changes will be assessed via Voxel Based Morphometry as implemented in SPM12 and CAT12. FWE-correction will be used to control for multiple comparisons. For WM, researchers will use Tract-Based Spatial Statistics (TBSS) and will perform tractography of the main white matter pathways (e.g., arcuate, inferior longitudinal, uncinate, and inferior fronto-occipital fasciculi, corpus callosum, etc.) using Automatic Fiber Quantification. The investigators will assess markers of microstructural WM integrity previously related to cognitive and mental health status (Fractional Anisotropy, Axial, Radial, and Mean Diffusivity). FWE-correction using non-parametric permutations will be used to control for multiple comparisons. Spearman correlations will be used to assess the relationship between significant changes in mental health, cognitive, and brain plasticity. Regarding recruitment timelines, the researchers expect to have active groups recruited, completing the interventions during both the Fall 2024 and the Spring 2025 semesters, and take the Fall 2025 semester to work on finding matching controls and adjusting recruitment to compensate for the expected attrition rate of 20-30% of recruited participants. 5. Access and Dissemination Dissemination actions will target both the scientific community and the general public. All publications will be released as open access articles in international peer-reviewed scientific journals. All data and teaching materials from both interventions will be released as open-access resources. Also, to raise awareness about the issues that could be improved by exploiting SMART results, white papers directed to education/culture policy makers will also be published. Oral and poster presentations at renowned international conferences, such as Human Brain Mapping and Society for Neuroscience, are also planned. Actually, this protocol has been accepted to be presented as a poster at the "Music and Neuroscience VIII" conference that will be held in Helsinki in June 2024 (this is the most important event for the neuroscience of music research, held every 3 years). Also, SMART 1-day workshops at local schools will be held targeting parents, teachers and educators, as well as policy makers. These workshops will explain the rationale and the project characteristics and results obtained up to that moment and will be used to hold open discussions with attendants to solve doubts and fully understand stakeholders' interests and concerns. These discussions could also motivate future work and an expansion of the current intervention protocol/study. The research team is currently working on the setup of the SMART website and Social Media accounts, aiming to inform and keep up to date both the scientific community and the general population regarding the development of the project. Finally, participation on national and international science outreach activities, such as science fairs and conferences at public and private schools and science popularization articles published in online dedicated platforms (i.e., The Conversation, Naukas), are ensured thanks to the ongoing involvement of Dr. Vaquero in these types of activities.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
61
Participants in this group will complete two 1-hour music composition training intervention sessions per week over the course of 3 months (24 sessions total). These sessions will take place in the participating schools\' premises, during normal hours corresponding to their advisory period class; or in participating centers during extracurricular activities' periods. The curriculum for these music composition lessons has been developed specifically for this project, in collaboration and based on the educational music composition programs from the American Composers Orchestra (ACO). Lessons review basic structural musical concepts, practicing active listening and music appreciation skills, teaching about the use of music-composition specific software (i.e., Soundtrap), and helping the students in expressing themselves / their identity through music, learning about musical story-telling through the creation of their own musical pieces from scratch.
Participants in this group will complete two 1-hour photography/visual-arts composition/edition intervention sessions per week over the course of 3 months (24 sessions total). These sessions will take place in the participating schools\' premises, during normal hours corresponding to their advisory period class; or in participating centers during extracurricular activities' periods. The curriculum for these photography composition lessons has been developed specifically for this project, in collaboration and based on educational photography/film programs from Downtown Community TV Center (DCTV). Lessons review basic structural photography/visual-arts concepts, practicing visual-arts appreciation skills, teaching about the use of photography edition specific software (i.e., Photoshop), and helping the students in expressing themselves/their identity through photography, learning about visual story-telling through the creation of their own photographical projects from scratch.
Fort Hamilton High School
Brooklyn, New York, United States
Faculty of Arts & Science, Psychology Department - New York University
New York, New York, United States
Post - Pre changes in attitudes and importance given to social media
qualitative differences in attitudes and importance of SM self-reported by participants before and after the intervention. Researchers will use a questionnaire specifically developed for this purpose ('Usage, Attitudes \& Opinions about Social Media Questionnaire').
Time frame: From enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in social media profiles followed in social media
qualitative differences in the kind of profiles followed by participants before and after the intervention. Researchers will use a questionnaire specifically developed for this purpose ('Usage, Attitudes \& Opinions about Social Media Questionnaire').
Time frame: From enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in mood and emotional reaction while being online
qualitative differences in participants' mood and emotional reaction while using social media before and after the intervention. Researchers will use a questionnaire specifically developed for this purpose ('Usage, Attitudes \& Opinions about Social Media Questionnaire').
Time frame: From enrollment to the end of the post-intervention evaluation (roughly at week 14).
Weekly evolution of screentime
measures of actual smartphone usage will be collected every week during the intervention period (or the 3-month period, in the case of the passive Control group) via self-report questionnaires in which participants will fill the objective smartphone screentime usage data measured by the screentime function on their device. The higher the value input here by participants, the greater the amount of hours spent on their phone.
Time frame: From week 1 to week 12 of the intervention (or 3-month no intervention period for the control group).
Weekly evolution of mood
measures of weekly mood will be gathered by making participants fill the Positive and Negative Affect Scale (PANAS) once a week. This scale ranges from 10 to 50 for Positive Affect, with greater values meaning greater presence of positive mood; and from 10 to 50 for Negative Affect, with greater values meaning greater presence of negative mood.
Time frame: From week 1 to week 12 of the intervention (or 3-month no intervention period for the control group).
Post - Pre changes in self-esteem
the investigators will use the standard test Rosenberg Self-Esteem Questionnaire, ranging from 0 to 30, with scores between 15 and 25 pertaining to a normal range and scores below 15 suggesting low self-esteem.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Depression (CDI)
measured via the Children Depression Inventory (CDI), a 27-item scale ranging from 0 to 54. The higher the CDI score, the higher the depressive state.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Anxiety (SCARED)
measured via the Screen for Child Anxiety Related Disorders (SCARED), a scale ranging from 0 to 82 with values greater than 25 in the total score indicating the presence of anxiety disorder. It is divided in subscales for Panic Disorder (cut-off=7), Generalized Anxiety Disorder (cut-off=9), Separation Anxiety Disorder (cut-off=5), Social Anxiety Disorder (cut-off=8), and School Avoidance (cut-off=3).
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Mood
measures of mood will be acquired by using the Positive and Negative Affective Scale (PANAS). This scale ranges from 10 to 50 for Positive Affect, with greater values meaning greater presence of positive mood; and from 10 to 50 for Negative Affect, with greater values meaning greater presence of negative mood.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Attention
measured via an Attentional Flanker task, a specifically developed task for this purpose measuring accuracy and reaction times for congruent, incongruent, and neutral trials.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in verbal learning and memory
researchers will apply the Rey's Auditory Verbal Learning test (AVLT), a standard test counting number of remembered words in each immediate trial and after a delay of 20 minutes. The higher the number in each trial, the better the participant's verbal and learning functions
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in auditory working memory
measured via the WAIS-V Letter Number Sequencing. Score ranges from 0 to 21, with higher scores indicating better auditory working memory.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in functional connectivity at rest
measured using functional MRI (fMRI). Summary beta values representing the level of brain activity will be calculated in functional networks of interest.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in neurophysiological correlates of pre-attentive auditory detection
the Mismatch Negativity (MMN) component would be characterized for each melodic and rhythmic violation of the presented stimuli. The amplitude of the MMN would be calculated and compared between timepoints.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in brain morphology / anatomy
Using structural Magnetic Resonance Imaging, researchers will obtain T1-weighted images that will allow for the study of participants' cortical and subcortical gray matter. Applying analyses such as Voxel-Based Morphometry or Cortical Thickness values of gray matter will be obtained, compared between groups and correlated with other types of measures (i.e., cognitive, mental health, behavioral).
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in brain structural connectivity
Using structural Magnetic Resonance Imaging, researchers will obtain diffusion-weighted images that will allow for the study of participants' white matter structural connectivity between areas of interest. Applying analyses such Tract-Based Spatial Statistics or Tractographical reconstruction of white-matter pathways, macro- and microstructural measures of tracts of interest will be calculated, compared between groups and correlated with other types of measures (i.e., cognitive, mental health, behavioral).
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Treatment Fidelity
Treatment fidelity will be annotated for every week and session as a percentage that represents the accuracy and fit between the actual lessons carried out and the original planned lesson for each intervention session. This percentage will be estimated by the research team present at each intervention session.
Time frame: From beginning of the intervention to end of intervention (at week 12)
Students' Engagement during Interventions
Attendance and engagement during every lesson will be recorded and valued using a 1-7 Likert scale. These observations and ratings will be annotated by the research team present at each intervention session.
Time frame: From beginning of the intervention to end of intervention (at week 12)
Post - Pre changes in self-reported screentime
the investigators will use a questionnaire specifically developed for this purpose ('Usage, Attitudes \& Opinions about Social Media Questionnaire'). The higher the value input here by participants, the greater the amount of hours spent on their phone.
Time frame: From enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in social media platforms used
qualitative change in students' top 10 self-reported most-used apps in a questionnaire specifically developed for this purpose ('Usage, Attitudes \& Opinions about Social Media Questionnaire').
Time frame: From enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in types of posts shared online
qualitative differences in the types of posts shared by participants in the social media profiles before and after the intervention. Researchers will use a questionnaire specifically developed for this purpose ('Usage, Attitudes \& Opinions about Social Media Questionnaire').
Time frame: From enrollment to the end of the post-intervention evaluation (roughly at week 14).
Weekly evolution of apps most used during weekday
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measures of actual most-used apps during a given weekday will be collected every week during the intervention period (or the 3-month period, in the case of the passive Control group) via self-report questionnaires in which participants will fill the objective list of most-used app days during the given weekday and for how long has each of them been used, measured by the screentime function on participants' device.
Time frame: From week 1 to week 12 of the intervention (or 3-month no intervention period for the control group).
Weekly evolution of apps most used during weekend day
measures of actual most-used apps during a given weekend day will be collected every week during the intervention period (or the 3-month period, in the case of the passive Control group) via self-report questionnaires in which participants will fill the objective list of most-used app days during the given weekend day and for how long has each of them been used, measured by the screentime function on participants' device.
Time frame: From week 1 to week 12 of the intervention (or 3-month no intervention period for the control group).
Post - Pre changes in Depression (DASS21)
measured via the Depression, Anxiety and Stress Scale 21 (DASS-21), with 7 items dedicated to measure Depression. Scores range from 0 to 42, with higher scores indicating greater depressive symptoms (scores 14-20 suggest moderate depression, scores greater than 28 suggest extremely severe depression)
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Anxiety (DASS21)
measured via the Depression, Anxiety and Stress Scale 21 (DASS-21), with 7 items dedicated to measure Anxiety. Scores range from 0 to 42, with higher scores indicating greater anxiety symptoms (scores 10-14 suggest moderate anxiety, scores greater than 20 suggest extremely severe anxiety).
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Stress (DASS21)
measured via the Depression, Anxiety and Stress Scale 21 (DASS-21), with 7 items dedicated to measure Stress. Scores range from 0 to 42, with higher scores indicating greater stress symptoms (scores 19-25 suggest moderate stress, scores greater than 34 suggest extremely severe stress).
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in the Total Mood Disturbance (POMS)
researchers will use the Profile of Mood and States Scale (POMS) with a total mood disturbance measure calculated out of summing up the negative-mood subscales (Anger-Hostility: 0- 20; Confusion-Bewilderment: 0 - 20; Depression-Dejection: 0 - 28; Fatigue-Inertia: 0 - 20; Tension-Anxiety: 0 - 24) and subtract the positive mood subscale (Vigor-Activity: 0 - 24). The higher the scores the greater the probability of having a mood-related issue.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Social Anxiety
researchers will use the Social Anxiety Scale for Adolescents (SAS-A), a 18-item scale whose scores range from 18 to 90 in the total SAS-A score (but that also counts with subscales in Fear of Negative Evaluation: 8-40; Social Avoidance and Distress - New: 6-30; and Social Avoidance and Distress - General: 4-20). The higher the scores, the greater the social anxiety symptoms (recommended cut-off=50).
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in Focused Attention and Executive Functions
researchers have specifically developed the Foraging Inattentional Blindness task for this purpose. Visual targets and distractors move around the screen, and participants have to find the targets as quickly as possible until reaching a total score of 200 points. Reaction times and search strategy within the screen are recorded.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).
Post - Pre changes in functional connectivity at rest within different frequency bands
measured using Magnetoencephalography (MEG), connectivity at rest between brain sources of interest will be calculated within different frequency bands.
Time frame: Difference from enrollment to the end of the post-intervention evaluation (roughly at week 14).