Problematic Smartphone Use & Generalized Anxiety in Adults  Introduction  As companies like Apple continue to create new gadgets with the latest trends, the influence technology has on our society continues to grow. Parents today are more concerned than ever that technology, namely cell phones, will have detrimental effects on the mental health of their children (Lee et al., 2018). Fortunately for them, problematic technology use related to mental health is an emerging area of study in research today. One particular interest within this topic is the association between problematic smartphone use and generalized anxiety in adults. Generalized anxiety disorder is one of the most prevalent mental disorders in the United States, and symptoms often surface in late adolescence or early adulthood (National Institute of Mental Health [NIMH], n.d.). Therefore, as problematic smartphone use and generalized anxiety are both widespread issues amongst the young adult population, further studying the nature and causality of this relationship is critical to developing and employing preventative measures in changing the scope of the problem.Theories of Problematic Smartphone Use Many researchers do not know why problematic smartphone use and generalized anxiety are related, but many theories have attempted to explain this relationship as interest in the topic has expanded. Of theories present in the existing literature, many emphasize addiction as the main component in fueling the relationship between problematic smartphone use and generalized anxiety. For example, Elhai, Levine, Dvorak, and Hall (2017b) wanted to investigate the type of smartphone use that tends to be most problematic in its association with anxiety. When evaluating the differences between process and social use in this relationship, they chose the uses and gratifications theory (Blumler, 1979) to justify their research. This theory suggests people possess individual differences in their motivations that drive their behavior. People often seek control in interacting with others, and when they feel this control has been achieved, their smartphone use is increased to maintain this feeling of control. As a result, increased use becomes problematic use in which people attend to specific cues or aspects of the cell-phone they know will lead to their supposed control. Therefore, psychopathology is a necessary precursor to explain problematic use in this theory. Elhai et al. (2018a) also base their study on individual differences in motivation with the self-determination theory (Ryan & Deci, 2000). This theory emphasizes intrinsic motivation as driving social interaction to satisfy an individual’s emotional needs. Phone use becomes problematic with fear of missing out when emotional needs are not met, and phone use increases out of necessity. Elhai, Dvorak, Levine, and Hall (2017a) also compiled a comprehensive review examining the severity of psychopathology with problematic smartphone use and use the incentive sensitization theory (Elhai, Dvorak, Levine, & Hall, 2017a) to do so. In this theory, Robinson and Berridge (2001) also believe in the power of cues. This theory relies on positive reinforcement. For example, an individual’s mood may be enhanced when he or she hears the ring of an incoming text message. This ring may be associated with the positive social interaction that is to follow by cell-phone. In wanting social interaction, an individual may learn to crave this attention and compulsively check text messages in anticipation of this ‘reward’. Thus, compulsively checking and increased use may lead to problematic use. Other theories emphasize excessive phone use as a coping mechanism, which leads to problematic use. Long et al. (2016) study the relationships of various psychological correlates in regard to problematic smartphone use in the context of the stress-coping theory. In this theory and related to problematic smartphone use, people may turn to their phone as an escape from stress-inducing situations or aversive experiences. This theory is also explained by a phenomenon Panova and Lleras (2016) discuss in the context of their research as the “security blanket effect”. Again, the cell-phone becomes a mode for avoidance from stress-inducing stimuli. While individuals may become emotionally resilient as a result of avoiding the stressful stimuli, the overuse may become problematic because the underlying issue is not being dealt with.Objective Smartphone Use Not all smartphone use is problematic, so there is a need to measure and compare psychological correlates with both objective and problematic use. In an attempt to understand how measures of anxiety, objective smartphone use, and problematic smartphone use relate, Rozgonjuk, Levine, Hall, and Elhai (2018) used the Moment app to track participants in their number of phone screen unlocks and time using their cell-phones. The researchers found that problematic smartphone use was positively related to average minutes of screen time—e.g., scores of problematic smartphone use increased as the average number of minutes of screen time also increased. There was not sufficient evidence to conclude that anxiety measures were positively related to average minutes of screen time, but the authors did conclude anxiety measures were positively related to the number of phone screen unlocks. Thus, cell-phones may be used for different reasons. One could infer that average number of minutes of screen time reflects social use, whereas phone screen unlocks could be related to non-social use. This largely implies that the way we use our cell-phones could have different implications on problematic smartphone use and, thus, psychological correlates. As observed in Rozgonjuk and colleagues’ study (2018), problematic smartphone use is related to how much time people spend on their cell-phones, so what exactly are people doing on their cell-phones that is so time-consuming? Hussain, Griffiths, and Sheffield (2017) addressed part of the question. With an online survey examining patterns of smartphone use, the researchers determined the three most popular apps used on smartphones: social media, texting, and music apps. In relating these commonly used apps to increased time spent on smartphones, this finding could reflect the beliefs behind the uses and gratifications theory (Blumler, 1979) and the self-determination theory (Ryan & Deci, 2000) in that cell-phone use is out of necessity; there is a compulsive need to stay connected to others to boost mood.Gender Differences in Problematic Smartphone Use Putting theory into action, many studies have explored and established a relationship between problematic smartphone use and generalized anxiety. Jenaro, Flores, Gómez-Vela, González-Gil, and Caballo (2007) examine this relationship with 337 participants from a university in Spain using measures such as Beck’s Depression Inventory, Beck’s Anxiety Inventory, and the General Health Questionnaire-28. The researchers found there was a significant relationship between clinical anxiety and heavy cell-phone use, as opposed to non-clinical anxiety and light cell-phone use. Interestingly, females were almost twice as likely as males to overuse their cell-phones. While Lee et al. (2018) uses adolescents as their sample population, this study also sheds light on important gender differences. The researchers are interested in differences in use with computers compared to smartphones, and their groups of interest are the dual-problem group, problematic internet group, problematic smartphone group, and a healthy group. Although females in Jenaro and colleagues’ study (2007) were more likely to overuse their cell-phones, females in this study are less likely to be dual-users: those that overuse the internet and their smartphones. The findings also show differences in brain activation. Females showed higher activation in left frontal regions of the brain and, thus, exhibit higher cognitive control. Therefore, females may be more prone to overuse their cell-phones and exclusively their cell-phones.Mediators in Problematic Smartphone Use and Generalized Anxiety Another hot topic within the relationship between anxiety and problematic smartphone use is mediators that can act as agents of change in decreasing problematic smartphone use and, thus, anxiety levels. For example, in a study conducted by Elhai, Levine, Dvorak, and Hall (2016), behavioral activation and emotion regulation were found to be mediators in this relationship. Behavioral activation is an alternative to avoidance in which individuals participate in pleasurable activities of their choice. Instead of individuals turning to a cell-phone as an avoidance mechanism for their anxious emotions, individuals can engage in those pleasurable activities to relieve anxious feelings. Emotion regulation, on the other hand, is simply another term for emotional control. When an individual is experiencing heightened emotions, like worry with anxiety, they often calm themselves with a cell-phone. The researchers here are insinuating that with adequate emotion regulation skills, a cell-phone is unnecessary as an avoidance mechanism because emotion regulation is a learned behavior. In using these strategies and equipping individuals with these skills, both anxiety and problematic smartphone use can be alleviated. Elhai, Levine, O’Brien, and Armour (2018b) explored similar mediators: distress tolerance and mindfulness. In this study, distress tolerance functions similarly to emotion regulation in that individuals know how to tolerate negative emotions. With mindfulness, an individual attends to the negative stimuli or emotions rather than suppressing them. In this way, an individual can address his or her specific emotional needs, also similar to emotion regulation. While researchers have more insight into strategies to mediate the relationship between anxiety and problematic smartphone use, many other variables that may act as mediators in this relationship remain unknown and are in need of further exploration.Areas for Further Research Being a relatively new topic, more research is needed with the relationship between problematic smartphone use and anxiety. As stated, mediators in this relationship are largely unexplored, but mediators may hold the key in decreasing the negative effects problematic cell-phone use has on anxiety and vice versa. In a study conducted by Lepp, Barkley, and Karpinski (2014) on cell-phone use, anxiety, and satisfaction with life, high cell-phone use was associated with high anxiety and low satisfaction with life. However, satisfaction with life is such a broad term; it is not entirely clear what that variable entails. Researchers know that satisfaction with life is associated with the success of failure of a marriage and other social relationships, decreased substance abuse, and decreased suicidality. Therefore, providing evidence for a relationship between cell-phone use and satisfaction with life requires more research in understanding other mediators under the umbrella of ‘satisfaction with life’. As with Lepp and colleagues’ study (2014), Richardson and colleagues’ study (2018) on problematic smartphone use and nature connectedness demonstrates that how we use technology is important. This study concluded that problematic smartphone use, anxiety, and nature connectedness were related in that higher cell-phone use produces higher anxiety and decreased nature connectedness—e.g., connection to an individual’s environment. This relationship is, however, not unidirectional. For example, increasing nature connectedness may positively impact levels of anxiety and problematic smartphone use. On the other hand, problematic smartphone use could negatively impact an individual’s connection to his or her environment and, thus, emotional well-being. More research is vital to understanding the causal relationship between cell-phone use, anxiety, and nature connectedness in that mediators in our relationship with technology are very relevant for the future. Directional causality is also another necessary area for future research as described in Vahedi and Saiphoo’s meta-analytic review (2018) on the relationship between anxiety, stress, and problematic smartphone use. Evidence supports a relationship between these three variables, but researchers are unclear if increased stress and anxiety lead an individual to overuse his or her cell-phone or if stress and anxiety increase as a result of cell-phone overuse. In the conclusion of the review, Vahedi and Saiphoo (2018) touch on an important idea: cell-phones can be used for just about anything. People can listen to music, watch television and movies, use social networking apps, text and call, and use web browsers for all kinds of reasons; it seems as if the list is never-ending. Thus, further studying which aspects of cell-phone use are most problematic and why is crucial to understanding the root of the problem. Change and the creation of preventative measures are only made possible through this understanding.Conclusion Finally, while this review remains an initial effort to understand the relationship of problematic smartphone use and anxiety and the associated factors at play in their relationship, further research should explore the following questions, with the use of experiments. How does the multifunctionality of cell-phones impact relations with psychological constructs like generalized and social anxiety? What is the causal relationship between cell-phone use and connection to an individual’s surroundings? How do cohorts of satisfaction of life relate to both anxiety and cell-phone use?ReferencesBlumler, J. G. (1979). The Role of Theory in Uses and Gratifications Studies. Communication Research, 6(1), 9–36. doi:10.1177/009365027900600102Elhai, J. D., Dvorak, R. D., Levine, J. C., & Hall, B. J. (2017a). Problematic smartphone use: A conceptual overview and systematic review of relations with anxiety and depression psychopathology. Journal of Affective Disorders, 207, 251-259. doi:10.1016/j.jad.2016.08.030Elhai, J. D., Levine, J. C., Alghraibeh, A. M., Alafnan, A. A., Aldraiweesh, A. A., & Hall, B. J. (2018a). Fear of missing out: Testing relationships with negative affectivity, online social engagement, and problematic smartphone use. Computers in Human Behavior, 89, 289-298. doi:10.1016/j.chb.2018.08.020Elhai, J. D., Levine, J. C., Dvorak, R. D., & Hall, B. J. (2016). Fear of missing out, need for touch, anxiety and depression are related to problematic smartphone use. Computers in Human Behavior, 63, 509-516. doi:10.1016/j.chb.2016.05.079Elhai, J. D., Levine, J. C., Dvorak, R. D., & Hall, B. J. (2017b). Non-social features of smartphone use are most related to depression, anxiety and problematic smartphone use. Computers in Human Behavior, 69, 75-82. doi:10.1016/j.chb.2016.12.023Elhai, J. D., Levine, J. C., O’Brien, K. D., & Armour, C. (2018b). Distress tolerance and mindfulness mediate relations between depression and anxiety sensitivity with problematic smartphone use. Computers in Human Behavior, 84, 477-484. doi:10.1016/j.chb.2018.03.026Hussain, Z., Griffiths, M. D., & Sheffield, D. (2017). An investigation into problematic smartphone use: The role of narcissism, anxiety, and personality factors. Journal of Behavioral Addictions, 6(3), 378-386. doi:10.1556/2006.6.2017.052Jenaro, C., Flores, N., Gómez-Vela, M., González-Gil, F., & Caballo, C. (2007). Problematic internet and cell-phone use: Psychological behavioral, and health correlates. Addiction Research & Theory, 15(3), 309-320. doi:10.1080/16066350701350247Lee, S., Lee, D., Nam, C. R., Kim, D. Y., Park, S., Kwon, J., . . . Choi, J. (2018). Distinct patterns of internet and smartphone-related problems among adolescents by gender: Latent class analysis. Journal of Behavioral Addictions, 7(2), 454-465. doi:10.1556/2006.7.2018.28Lepp, A., Barkley, J. E., & Karpinski, A. C. (2014). The relationship between cell phone use, academic performance, anxiety, and satisfaction with life in college students. Computers in Human Behavior, 31, 343-350. doi:10.1016/j.chb.2013.10.049Long, J., Liu, T., Liao, Y., Qi, C., He, H., Chen, S., & Billieux, J. (2016). Prevalence and correlates of problematic smartphone use in a large random sample of Chinese undergraduates. BMC Psychiatry, 16, 12. doi:10.1186/s12888-016-1083-3National Institute of Mental Health. (n.d.). Generalized Anxiety Disorder. Retrieved from https://www.nimh.nih.gov/health/statistics/generalized-anxiety-disorder.shtmlPanova, T., & Lleras, A. (2016). Avoidance or boredom: Negative mental health outcomes associated with use of information and communication technologies depend on users’ motivations. Computers in Human Behavior, 58, 249-258. doi:10.1016/j.chb.2015.12.062Richardson, M., Hussain, Z., & Griffiths, M. D. (2018). Problematic smartphone use, nature connectedness, and anxiety. Journal of Behavioral Addictions, 7(1), 109-116. doi:10.1556/2006.7.2018.10Robinson, T. E., & Berridge, K. C. (2001). Incentive-sensitization and addiction. Addiction, 96(1), 103-114. doi:10.1046/j.1360-0443.2001.9611038.xRozgonjuk, D., Levine, J. C., Hall, B. J., & Elhai, J. D. (2018). The association between problematic smartphone use, depression and anxiety symptom severity, and objectively measured smartphone use over one week. Computers in Human Behavior, 87, 10-17. doi:10.1016/j.chb.2018.05.019Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78. doi:10.1037/0003-066X.55.1.68Vahedi, Z., Saiphoo, A. (2018). The association between smartphone use, stress, and anxiety: A meta?analytic review. Stress and Health: Journal of the International Society for the Investigation of Stress, 1–12. doi:10.1002/smi.2805