This widespread leads to the problem of Internet addiction especially among teenagers. Of course, the problem of Internet addiction IA has become more widespread and considered as a social and public health problem. It is known that adolescents and young adults are the high-risk groups and more vulnerable for Internet addiction [ 2 ].
Both groups especially adolescents suffer from emotional and social stress, in addition to lack of behavioral control due to incomplete psychological maturity, which motivate them to engage in risk-related factors such as Internet addiction [ 3 ]. A number of literature have been written, which identified many risk factors for Internet addiction and several negative consequences resulting from this problem.
Psychotherapy for Children, Individuals and Families
Such risk factors include socio-demographic, social, psychological and mental factors, and Internet use practices. It produces physical, social, and psychological problems, in addition to academic performance and career difficulties [ 5 , 6 ]. Therefore, this problem needs immediate action and treatment. Thus, there are different ways to treat Internet addiction; however, cognitive behavioral therapy CBT has been proposed as an effective treatment.
Managing Addictions: Cognitive, Emotive, and Behavioral Techniques -
There is a specialized type or model to treat this disorder called cognitive behavioral therapy for Internet addiction CBT-IA. This chapter presents the data associated with the prevalence of Internet addiction and the risk factors to gather a sense of the scope of the problem. The chapter also provides the cognitive behavioral therapy model for treatment of Internet addiction.
This chapter could help in developing two perspectives, the academic and the mental health. From the academic perspective, this chapter helps to identify future areas of research, as new studies in the field continue to emerge. From the mental health perspective, the chapter assists clinicians in developing more empirically sound methods to assess and potentially treat Internet-addicted clients by applying CBT-IA.
There are many definitions of Internet addiction. This variation is related to lack of agreement in definitions among studies that investigated the different symptoms and characteristics of IA. In his second definition that based on the Diagnostic and Statistical Manual IV DSM-IV pathological gambling diagnosis criteria to Internet use, Young [ 13 ] defined Internet addiction as an impulse-control disorder and made a definition that consists of eight criteria and requires the fulfillment of five out of eight for the identification of an individual to be addicted.
This criteria are 1 excessive mental effort with the Internet, 2 the need for longer time online, 3 repeated attempts to decrease Internet use, 4 withdrawal symptoms when decreasing Internet use, 5 issues in time management, 6 environmental distress family, friends, school, and work , 7 lying about time spent online, and 8 mood modification through Internet use.
Goldberg [ 14 ] defined Internet addiction on the basis of the DSM-IV substance addiction criteria as a behavioral addiction functions as a coping mechanism. There are many studies focused on studying the prevalence of Internet addiction among adolescents and others focused on adults. The adolescents are considered as a high-risk group for the behavior of Internet addiction. They undergo many developmental changes and stressful events, which result in using Internet that is considered a rich and attractive environment to reduce these stressors [ 18 ].
There are many studies concerned to determine the prevalence of this problem among this target group. The prevalence of Internet addiction varies widely. It is documented that the recent prevalence in different countries ranges from 4. In USA, the rate was reported between 0 and In Asia regions, the prevalence of Internet addiction is reported between 2 and In Middle Eastern, the prevalence was between 1 and Moreover, many studies regarding Internet addiction were conducted among adults in various countries [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].
However, the prevalence rates of Internet addiction by using the Internet Addiction Diagnostic Questionnaire [ 13 ] demonstrated 1. From the results, there are differences in prevalence of Internet addiction, which may be related to differences in the definition of possible and serious addiction, using various instruments in the evaluation and sociocultural factors. Many tools have been developed to investigate Internet addiction or similar concepts. It was developed by Young [ 10 ] by adapting Diagnostic and Statistical Manual IV DSM-IV criteria for substance dependence and pathological gambling [ 40 ], and it is a modification of the previous 8-item scale.
The score of the total scale ranges from 20 to The Internet users are categorized as follows: a score 70— reflects significant problems due to Internet use and 40—69 reflects frequent problems when scoring [ 13 ]. It has shown to be reliable and valid [ 13 ]. This questionnaire was developed by Young [ 7 ]. It is a self-report measure which consists of eight items dichotomously. It is based on the diagnostic symptoms of pathological gambling [ 40 ].
This questionnaire utilized the following criteria: preoccupation, tolerance, loss of control, withdrawal, negative consequences, denial, and escapism.
If the scores were five or more of the criteria, it indicates Internet addiction. It assesses the main symptoms of Internet addiction, tolerance, compulsive use, and withdrawal, as well as related problems in terms of negative impact on social activities, interpersonal relationships, physical condition, and time management. Furthermore, it assesses the weekly online hours and Internet use experience. Several risk factors have been identified as associated factors for Internet addiction especially among adolescents and adults.
Some of these factors are related to socio-demographic variables such as age being younger adolescents and younger adults [ 31 , 41 , 42 ] , gender being male [ 3 , 11 , 17 , 24 , 25 , 27 , 30 , 31 , 32 , 33 , 34 , 41 , 42 , 43 , 44 , 45 , 46 ], female gender [ 22 ], higher family income levels [ 17 , 44 ], living in rural areas for adolescents [ 47 ], living in urban areas for adults [ 34 ], single parent for adults [ 24 , 33 ], marital status for adults being single [ 24 ], income for adults financial difficulties , unemployment for adults [ 11 ], university year level being in lower-year levels e.
Moreover, there are factors related to Internet use and patterns of Internet use, which are also recognized as risk factors for developing Internet addiction. In addition to this, parental involvement and guidance regarding Internet behaviors were reported to be correlated with Internet addiction, specifically little parental communication about Internet use and lack of rules about Internet times and use [ 48 ].
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It is suggested that social factors including poor academic performance for adolescents [ 8 ] and dissatisfaction with academic performance for adults [ 32 , 36 ], poor relations with school [ 43 , 49 ], inadequate social adaptation [ 17 ], stress [ 43 ], leisure boredom [ 50 ], presence of peers and siblings consuming alcohol [ 49 ], and lack of social support [ 8 , 34 , 38 , 42 ] are associated with Internet addiction. It is reported that family variables were associated with Internet addiction such as family conflict and dissatisfaction [ 43 , 49 ], an insecure attachment style [ 36 ], child maltreatment experiences [ 32 ], poor parental relationship [ 25 , 46 ], poor family love [ 32 ], homesickness [ 33 ], low parental involvement and supervision [ 50 ], and showing positive attitude to adolescent substance use by parents [ 49 ].
Health-risk factors such as consuming alcohol, substance use, and smoking have been suggested as risk-factors for Internet addiction. Previous studies have documented a relationship between alcohol, substance use, and Internet addiction [ 43 ]. In addition, a behavioral factor such as a habit of skipping breakfast [ 34 ] was correlated with Internet addiction. It is necessary to recognize that psychological and psychiatric problems and symptoms are also associated with Internet addiction.
Several studies have reported a relationship between Internet addiction, depression, anxiety, attention deficit and hyperactivity disorder, social phobia, neurosis, solitude, hostility, aggressive behaviors, suicide, psychological dysfunction, and emotional and behavioral problems [ 8 , 10 , 11 , 17 , 22 , 27 , 41 , 42 , 51 , 52 ]. It is also reported that negative personality characteristics including depressive thoughts, low self-esteem, poor self-perception and concept [ 38 , 53 ], novelty seeking, harm avoidance, low reward dependence [ 38 ], impulsivity [ 36 , 49 ], introversion, low agreeableness, and emotional instability [ 54 ], escapism and fantasy [ 30 ], could lead to the development of Internet addiction.
Furthermore, the following internal characteristics were documented as risk factors: low life satisfaction [ 17 ], low well-being [ 54 ], loneliness, lack of confidence [ 17 , 30 ], preference for online social interaction, negative life outcomes [ 47 ], and seeking for enjoyment and entertainment [ 49 ]. Internet addiction results in experiencing physical, social, and mental or psychological problems.
It has been linked to physical problems like sleep disturbance, eating problems, limited physical activity, back strain, eyestrain, and others [ 52 ]. Research literature has been demonstrated that Internet addiction leads to a poor health condition, excessive daytime sleepiness, insomnia, nightmares, difficulty in falling asleep and night awakenings [ 2 ], loss of energy, physiological dysfunction, weakened immunity [ 17 ], overweight and obesity, and impaired vision [ 55 ].
Role Of Cognitive Behavioral Therapy In Addiction Treatment
The Internet addicts transfer their social lives into the Internet world. Internet addiction leads to many social issues such as disturbing family, social, and workplace relations, where it isolates the persons from family and society and keeping them away from social interactions [ 27 ]. It has a negative effect on interaction with peers and friends, family life, academic life, and social life [ 41 ]. It is important to understand that Internet addiction may lead to negative effects on psychological development for population.
In a Chinese study conducted among school students, the results indicated that the scores for comorbid disease and impulsivity were higher among students experienced Internet addiction [ 52 ]. Treatment for Internet addiction is similar to treating any other types of addiction.
It involves cognitive behavioral therapy, interpersonal psychotherapy, and support groups. Cognitive behavioral therapy CBT is a short-term and problem-focused type of behavioral treatment. It focuses on helping clients consider the relationship between beliefs, thoughts, and feelings and following behavior patterns and actions.
During CBT, clients learn that their perceptions influence directly on responses to specific situations. Cognitive behavioral therapy is not a discrete treatment technique, but it is a general term refers to a group of therapies [ 57 ]. Interpersonal therapy is a type of treatment concentrating on enhancing interpersonal connections and actual social relationships with friends, parents, and others. Therefore, this therapy purposes to find new methods of interaction and includes the following interventions: encouraging influence, developing communication techniques and strategies, modeling, and role-playing.
Support groups may be helpful in the treatment of Internet addiction. These support groups should be applied to help addicts in attaining appropriate support that facilitate recovery. Moreover, couples counseling could be a necessary part of recovery among Internet addicts, whose marital and familial relationships have been negatively affected by Internet addiction.
This is the first model of its kind and the most effective type of therapy for Internet addiction that is focusing on cognitive behavioral therapy CBT. Researchers have documented that using cognitive behavioral therapy CBT is an effective treatment for Internet addiction [ 53 ]. The CBT in general helps addicts to realize addictive feelings and actions, while learning new coping skills and methods to prevent a relapse.
The CBT usually takes 3 months of treatment or approximately 12 weekly sessions. External influences such as activities that demand the addict to leave Internet could be applied. There are also treatment programs that help the client in identifying goals about the time needed for using the Internet.
The CBT-IA model is a comprehensive approach which can be divided into phases, including 1 behavior modification, 2 cognitive restructuring, and 3 harm reduction therapy HRT. The first phase or the early stage of therapy is behavior modification that is focusing on specific behaviors and situations where the impulse control disorder causes the significant difficulty and is used to control compulsive Internet use and reduce the time spend online by addict.
The second phase is a cognitive restructuring that is applied to identify, challenge, and adjust cognitive disruptions and negative beliefs that cause a compulsive usage of Internet and effect on this behavior of addiction [ 53 ]. The third phase is harm reduction therapy HRT that is a new and untested therapy, which is used for continuation of recovery and prevention of relapse. The HRT is used to recognize and cure psychiatric problems related to Internet addiction and treat social problems in relationships with families, peers, and friends.
We will discuss each in turn. In this phase of the CBT-IA, behavior therapy is applied to examine both computer behavior and noncomputer behavior. Computer behavior deals with actual online use, with a main purpose of abstaining from questionable applications while maintaining controlled usage of the computer for legal purposes [ 53 ]. This could be explained by the example of a university student who was addicted to Internet porn movies would need to learn to refrain from these movie Websites while still being able to use Internet for academic activities, social networking, and conducting e-mails to his contacts.
Noncomputer behavior concentrates on assisting clients to promote favorable life style activities without the Internet.
The activities that do not encompass the computer usage are examined and may involve activities related to social or job-related functioning [ 53 ]. A previous study [ 60 ] found that Internet addicts felt a sense of displacement when online and were incapable to handle the main aspects of their lives due to increasing preoccupation with Internet usage, which affect their work e. As Internet addiction progressed, addicts become expanded with their online activities such as Internet games, chatting, and gambling, which lead to ignorance of social life instead of being alone in front of the computer [ 61 ].