An increasingly common session opener: a client enters my office and reports that he hasn’t slept because he spent most of the previous night online watching YouTube videos, looking at Instagram, and reading Facebook posts. He didn't intend to spend so much time online. And he asks (more of himself than of me) “What am I doing?” He is tired and exasperated with himself, largely because this is not the first time he’s lost an entire night to the internet. Then he added: “I’m not getting what I want because I get distracted by what’s online.”

My response to him: “I suspect that you hoped that surfing the web would give you something, that it would do something for you. I wonder what you are being distracted from. What is it that you want to "get"? Let’s try to explore and understand what you need.”

As wonderful as online connectivity can be, the number of patients who report spending hours on their computers, tablets, or phones during unstructured time is increasing—and they’re not necessarily happy about this. Surfing the web, watching YouTube, looking at Instagram or scrolling through Facebook posts on your smartphone has become a means of spending time when you’re between tasks or when you just don’t know what to do with yourself. Apps have become a way of distracting yourself, disconnecting from feelings, filling time, and mediating relationships.

Many clients admit to losing hours to YouTube, Facebook, Instagram, Tumblr, Hulu, online pornography, and other entertainments. Most of these clients complain of feeling drained and somewhat disoriented at the end of their online sessions. Many also note that they have difficulty sleeping when they go offline. They are both tired and hyped up, depressed and agitated. Nearly all complain of failing to accomplish tasks or goals. Nearly all complain of feeling dissatisfied with the quality of their family, marital or social relationships--not enough "face time", not enough quality time, not enough meaningful connection.

As an artist friend commented, “the internet, with all its bells and whistles, has become the latest thief that robs people of time, creativity, and relationships.”

Other commentators have written extensively about the ironic loneliness that many people feel in this age of social media. Although we seem to be are more connected than ever, many people feel more isolated, lonely, and unfulfilled than ever.

Perhaps it is because we are connecting with machines instead of people.

This blog is not about the ‘perils’ of the internet. (Indeed, I’m quite aware of how I am using the internet to talk about mental health and to contribute to a larger conversation about aspects of wellness and healing.) Rather, this blog IS about the decisions you make about how you use your unstructured time and what may be driving those decisions. This blog IS about how you make the choices that energize or deplete you.

Ask yourself this: how do you feel when you unexpectedly face a block of unstructured time? Think longer and deeper: after the initial frisson of anticipation, what comes up? And then, be honest with yourself: what do you actually do with that free time? How often do you go online? How much time do you spend there?

For many, unstructured time—especially unstructured time spent alone--evokes anxiety: an open stretch of time elicits fears of the unknown and emptiness. Questions arise—often emerging from the murk of our unconscious: What am I doing with my life? With whom do I connect? What would make me happier? What do I need? How do I get my deepest needs met? Why do I feel dissatisfied? You are suddenly faced with yourself—warts and all—and feel compelled to react to whatever it is that makes you feel uncomfortable.

Unstructured time also presents you with opportunities to honestly look at yourself and ask why you do what you do. Unstructured time can bring you face to face with your vulnerabilities, your need to connect with others, and perhaps your unacknowledged ambivalence about doing so. After all, relationships are, by their very nature, experiences with vulnerability.

It seems to me that there is indeed choice to be made when you encounter a stretch of unstructured time: you can wake up, meaningfully take action to creatively connect with your deepest self and others; or you can “go to sleep” by distracting yourself with passive entertainments. Many people reach for a distraction. Many would rather check out than check in.

From my perspective, depression and anxiety seem to correlate with the number of hours people spend ‘checked out’ online. (This is my observation, and I do not have hard statistics to support this claim.) Passive entertainments tend not to engage one’s whole being. On the other hand, creative actions taken in relationship with others engage us as whole persons and tend to connect us more meaningfully with others.

There is a paradox to creative activity and connection: while it requires effort, taking creative action to connect with yourself and others is energizing. You feel good when you’ve been engaged in a meaningfully productive activity or an activity that brings you face-to-face with others. When you’re creative, you plug into a vital source of energy—indeed, a life force.

And so, the choice is yours. In the words of poet Mary Oliver: “Tell me, what is it you plan to do with your one wild and precious life?”

Patients who are experiencing strong emotional distress will often ask about taking medication. Questions about depression or anxiety medications are often accompanied by strong ambivalence: patients recognize that something is wrong and want to feel better, and at the same time express doubt that a pill will be effective. Others would rather take a pill and be done with it; they believe that talking about their problems is ineffective, that therapy is a waste of time.

Medications can help. But there are a number of questions that need to be explored before making decisions about trying a psychotropic medication.

· How long have you felt the distress?

· How intense is the distress? How is the distress impacting your ability to function?

· If the distress is arising in response to a life situation, how have you managed similar situations in the past?

· How well are you sleeping? How well are you eating?

· Are you using alcohol or other substances to cope? If so, what, how much, and how often are you using them? (Please be honest with yourself and your therapist!)

· Will medication facilitate the deeper work of psychotherapy?

It’s important to talk through these questions and share any concerns you have about medications and their possible side-effects with your doctor or therapist. A good assessment is essential before any medication is considered. How these questions and others are answered are all part of a good evaluation—an important first step toward making an informed decision.

That said, here are a few thoughts:

Acute distress clouds thinking. When you’re in distress, your attention narrows and focuses on those factors that either create or contribute to your distress. When you’re acutely uncomfortable, it’s harder to see the bigger picture. Decision-making can become impaired by acute distress: it’s harder to clearly see the issues and all the factors impacting those issues. It's harder to discern the consequences of the decisions you might have to make. Everything is experienced through the fog of distress. Depressed clients often report that their thinking slows down when their depression is acute, and one of the hallmarks of depression is the inability to make decisions. Anxious clients report that they feel unsettled, distractible, hyper-vigilant, and afraid to act.

Anti-depressant or anti-anxiety medications can take the edge off of acute emotional distress. Anti-psychotic medications are essential for managing schizophrenias or other psychotic disorders. The right medication(s), prescribed and monitored by a psychiatrist who has evaluated and understands your distress, can be very helpful. But medication alone is rarely the sole answer to psychological problems. However, medication used in conjunction with psychotherapy, especially Cognitive Therapies, has been shown to be very effective. (Indeed, there is a great deal of research literature in support of combining medications with psychotherapies.)

As a therapist, I want you to have your feelings, but I don’t want to you become flooded, overwhelmed or disabled by them. Emotional distress signals problems that need to be addressed. Therapy is about working with your thoughts and feelings. And meaningful psychotherapy asks that you be willing to experience enough of your distress (without being overwhelmed by it) so that you can work through it. Finding a medication at an effective dosage that allows you to have your feelings and think clearly can certainly support our work together.

The idea is not to avoid distress but to work through it.