Module 2 Internet Addiction: Symptoms, Risks and Intervention Methods by AKETH

IO2 Training Material THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Log-on Back to Life / 2017-1-1TR01KA201-046632 The Internet and the Virtual Social Environment

Log on Back to Life is an Erasmus+ KA201 project co-funded by the Turkish national agency that received funding for 2 years starting in 2017. The aims of the project are to support project partners in dealing with a horizontal effect for all countries, the Internet Addiction Disorder (IAD). The main priority arises from the contribution of the project to support trainers in tackling the phenomenon of internet addiction. By creating a more attractive career guidance perspective we are promoting educational quality in teaching in favor of the main actors who are the students. In parallel, we emphasize on the integration of ICT tools in teaching to understand the usefulness of new technologies by the students in a rational way. The objectives and results of the Log on Back to Life are in line with the priority of the EU for effective investment in quality education and training. In conclusion, Log on Back to Life will support the early treatment of symptoms that lead to long-term dependence of the internet through prevention and early intervention. Through the material and methodologies will be produced during theprojectthenaddressingoftheschool drop outs phenomenon will be possible by demonstrating to students the positive impact of the Internet and methods to avoid the consequences arising from this.

THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

2017-1-1TR01-KA201-046632 / Log-on Back to Life Internet Addiction: Symptoms, Risks and Intervention Methods

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Module 2 Internet Addiction: Symptoms, Risks and Intervention Methods contents keywords 2.1 Defining Addiction, Addiction-Prone personality and Internet Addiction

4 5

Internet Addiction: subtypes

Comorbidity

Personality Trait and Internet addiction

2.2 Symptoms of Internet Addiction

2.3 Psychosocial Consequences of Internet Addiction

Prevention and Treatment strategies for pathological Internet use 28 2.4 Practical Applications

Assessment quiz

Resources

Partners

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M. 2 Log-on Back to Life / 2017-1-1TR01KA201-046632 The Internet and the Virtual Social Environment

Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Duration

5 hours

[ 2h theory / 3h practical applications ]

Aims of the module  To help secondary school teachers understand Internet addiction, its symptoms, risks and intervention methods,  To provide school teachers with comprehensive information about internet addiction and its psychosocial consequences.

Knowledge

Skills

Competences

Teachers will be able to

define the Internet Addiction

classify the symptoms of Internet Addiction

list main prevention and treatment strategies for pathological Internet use

discuss psychosocial categorize symptoms consequences of Internet of Internet addiction Addiction and addiction-prone personality apply different teaching outline and summarize strategies to help young psychosocial internet addicts consequences of Internet addiction employ different practical suggest strategies for applications in helping prevention and treatment students’ internet for pathological Internet addiction issues use

identify roles in preventing and mitigating Internet Addiction among students. Teaching/Training Methods

Lecture, group discussion, task groups, individual work, etc.

Materials

Projector, flipchart, markers, post-its ad

keywords  Entertainment/ information

 "Rituals" of everyday life

 disorders

 physical dependence

 risk factor

 Internet dependence

 space of knowledge

 computer dependence

 addictive potential

 mental dependence

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Internet Addiction: Symptoms, Risks and Intervention Methods 2.1 Defining Addiction, AddictionProne personality and Internet Addiction Along with new technologies, the Internet has reshaped and improved many aspects of our lives by being integrated in the daily experience. Internet has become more available, offers more services and its usage is growing in every age group. Approximately 46% of the world population is on the Internet today, compared to less than 1% in 1995 (Internet Live Stats). The world’s most developed countries already have an Internet penetration level over 90%, for example Iceland, 100%, Norway, 98%, Denmark, 96.3%, UK, 92.6%, or Japan, 91.1%, while the highest growth rates are recorded on the African continent in developing countries like Mali, 18.6%, Cameroon, 16.5%, or Côte d’Ivoire, 14.3%. The overall rate in Europe is 73. 5%. The evolution in communication is linked to the growth of the social networks over the years. On the one hand, general-interest social networks have become more and more popular. On the other hand, some services, aimed at peculiar groups of people, were born (e.g. LinkedIn). Furthermore, thanks to the tools and functionalities they deliver, the social networks -and, more globally, general-interest platforms delivering vertical services- have been gradually transfor-

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Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Log-on Back to Life / 2017-1-1TR01- ming into web horizontal services. This is to say, they are able to meet KA201-046632 numerous web browsing needs. For these reasons, the social network has The Internet and the Virtual Social become the prevalent choice for Internet access, in an increasingly growing Environment

proportion of the population.

Nowadays, Facebook is the prevailing social network (source: Alexa 2018). It has over two billion users per month and it is available in over 90% of the territories of the world. Instagram is pervasive but less popular, with almost 800 million users. The Chinese social networks Qzone and Weibo (a website for microblogging), account for 568 million users and for 376 million users respectively. Twitter, Google+, Snapchat and Pinterest have 200 to 300 million users each. Finally, LinkedIn displays the lowest number of active users: notwithstanding this, it is the most popular social network for professionals, gathering almost 106 million of users. The prevalence of Internet Addiction ranges from 0.8% to 26.7%. In Europe the prevalence of Internet dependence among children aged 8 to 11 ranged from 1% to 18.3%. In the United States, the prevalence of Internet dependence was of 26.3%. Most studies carried out in Asia found higher rates of prevalence when compared to Europe (Mak, et al., 2014). A crosssectional study with 1,708 teens aged between 17 to 19 from four schools of the two largest cities in Taiwan found a prevalence of 13.8% of Internet Addiction, with a higher prevalence in the male gender, with significant losses in the relationship of the addicted teen with parents, teachers and poor school performance when compared to non-addicted teens (Yang, 2007). Up until 2017 in Romania, 72,50% of the 16 to 74 old had at least once use a computer. However, computer users in urban areas outnumber those in rural areas by almost 1,7 times. The number of computer users decreases with the age group, insomuch that 91,50% of the 16-34 age group as compared to 44,8% of the 55-74 age group have used a computer. In Italy, over the time, we have seen a proliferation of web-access devices, tools and technologies. In particular, the mobile device connection is now very popular. In 2016, 78.3% of the regular Internet users aged 15 or more THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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used a smartphone to connect to the Internet in Italy, 49.6% used a PC,

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31.1%, a laptop or a netbook, 28.8% used a tablet, and 5.8% used other mobile devices such as e-books, smartwatches, etc. Another dimension of the research concerns the population’s Internet access, with two thirds of the Romanian households having an Internet connection. A region-based analysis reveals that the Bucharest-Ilfov region has better access, with 4 out of 5 households connected to the Internet, followed by the West and North-West regions. The South and the North-East regions have the lowest levels of Internet access. These proportions, however, are not relevant by themselves. At their core stands the alarm signal triggered by specialists, according to whom “the people who play games on the Internet are as prone to becoming addicted as poker or lottery players.” 1. In Italy, throughout ten years (2006-2016), the proportion of population that has never used the Internet has sharply reduced, with percentages reducing from 63.0% to 32.7%. At the same time, the regular users have progressively

https://www.baboon. ro/statisticiinteresante-despreinternet-2017penetrareainternetului-lumea-iii/

grown (+28.9%), as well as the heavy users (+29.9%) – See ISTAT, 2018. A study by Simona Ştefănescu (The Romanian Sociology Magazine, Bucharest, 2008) reveals surprising statistics regarding the time teenagers spend using the Internet. According to the data provided by deep interviews, most teenagers (29 out of 30 subjects of deep interviews and 75,8% of the 1008 survey subjects) use the Internet daily. The amount of time they spend on the Internet varies from 1hour to 10 or even 13 hours daily. Some of the subjects who were interviewed stated that their Internet connection is on all day long. Thus, the cumulated percentage of those who spend more than 6 hours, 4-6 hours and 3-4 hours a day on the Internet reaches 52% on weekdays. One of this study’s conclusions is that the Internet is more than a means of communication for teenagers, it is also a source of entertainment and information that no other form of mass media can provide. For example, network gaming both feeds the young THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01- population’s need to play, as well as their competitive drive, enabling them KA201-046632 to test their skills and intelligence (with strategy games) or their The Internet and the Virtual Social knowledge, memory, logic and intuition (with general knowledge games). Environment

On the other hand, the Internet is an access gate to music and films, two

of teenagers’ major interests. The television and the radio also offer these, but the main advantage of the Internet is that almost anything is readily available not only to watch but also to download. Furthermore, while radio and television come with constraints as to the choice of multimedia content, the Internet is especially appreciated by teenagers for the freedom it offers in this respect, considering their tendency to deny the values, preferences and interests that are different from their own. The freedom the Internet provides its users with also applies to information. As a result, this is the main environment teenagers get their information from. In Italy, a study (Tonioni et al., 2012) investigated the psychopathological symptoms, behaviors and hours spent online in patients with internet addiction disorder (IAD). The weekly amount of time spent online in the clinical IAD group was relevant (47.8±27.5). Findings suggest that a misuse of the Internet, characterized by many hours spent online avoiding interpersonal relationships with real and known people, could be an important criterion in the clinical interview in order to diagnose the IAD.

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It should also be noted that Griffiths (2010) asserts that excessive use of an

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activity (e.g., social networking) does not necessarily equate with addiction, as he has published case studies of excessive Internet users (i.e., up to 14 hours a day) who have few negative consequences in their lives (i.e., the time spent engaged in an activity does not always mean that it is problematic and/or addictive). In some, but not all cases of very excessive Internet use, Griffiths (2000) claimed that the participants had used the Internet as a way to cope with and counteract other inadequacies (e.g. lack of social support in real life, low self-esteem, physical disability, etc.). Griffiths also observed that it was interesting to note that all of the participants seemed to be using the Internet mainly for social contact and he postulated that it was because the Internet could be an alternative, text-based reality where users are able to immerse themselves by taking on another social persona and identity to make them feel better about themselves, which in itself would be highly rewarding psychologically. It is important in this way to assess the existence of other six criteria, alongside with the time spent online. More specifically, these are: salience (the way the Web dominates a personâ&#x20AC;&#x2122;s life, with worries, craving, deterioration in daily living activities, etc.), mood changes, tolerance (increased online activity, also involving increasingly intense contents), symptoms of withdrawal (such as irritability), conflicts (interpersonal, intrapsychic, with other activities), and relapses. Nonetheless, a number of studies have highlighted the danger that excessive Internet use may pose to students as a population group. This population is deemed to be vulnerable and at risk given the accessibility of the Internet and the flexibility of their schedules (Moore, 1995).

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Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Log-on Back to Life / 2017-1-1TR01- We might say that the Internet is part and parcel of teenagers’ day-to-day KA201-046632 life, and, as one female student put it, “life without the Internet cannot be The Internet and the Virtual Social conceived.” It is especially interesting that teenagers almost exclusively Environment

think that the Internet comes with no harm: it is not their “new” means of

communication, but inherent to their lives and with positive sides only. Many adults, however, consider the dangerous side of this means of communication, lacking restriction and censorship, a space where boundless liberty is dangerously misunderstood, an environment of moral decay, an illusory, parallel and harmful reality, a source of stress and of time wasting, of driving people apart from one another, promoting ignorance and destroying people’s will to learn etc. Research by sociologists and communication specialists points that teenagers link none of these features with the Internet. On the contrary, they associate it with utility and leisure, with liberty as a fundamental right that is exclusively positive. The Internet is for them a realm of knowledge and not of ignorance, of relaxation and not of stress, while the reality the Internet offers is an integral part of their life, and not at all “parallel” or illusory.

Image 1 Terms describing Internet and their popularity

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11 Dependence-Addiction Being dependent may be considered as the basic status of a human being. In fact, human babies enter the world dependent. They are in need of care for a given period of time, before being autonomously able to satisfy their own primary needs and before acquiring social competencies. Throughout the various stages of their evolutionary development, individuals switch from a state of total dependence from parental caring to a state of relative or selective dependence, which is defined as autonomy or independence. This ontogenetic development, leading from dependence in the child to autonomy in the adult, is called “Separation–individuation”. It defines the psychological process of detachment from parental care, in order to achieve one’s personal and relational identity. Adolescence is seen as the highlight of this individuation process. Adolescence is a period within the life span characterized by fundamental development of the Ego, intended as a psychic need which functions as mediator between the inner world and the external world. The Ego builds itself up and matures over time, thus allowing for the individual to become increasingly capable of caring for themselves, which means to be less and less dependent. Dependence phenomena are to be placed in a continuum – ranging from normal to pathological conditions. At one extreme, there are sensory and motivational statuses which have nothing to do with the need for alleviating suffering. Then come the dependence statuses, which involve objects or intentional behaviors but do not influence cognition, affective life, or will. At the other extreme, there are statuses of irrepressible, morbid dependence characterized by carving and abstinence.

When we talk about addiction, alcohol, nicotine and drugs usually come to mind, although, as surprising as it might seem, almost all human activity – THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01- work, food, sexual activity, material gain, record setting etc. – can become KA201-046632 addictive. The term “addiction” is defined by literature as a compulsive The Internet and the Virtual Social ritual that has surpassed the option stage, a physiological or physical Environment

engagement in rewarding stimuli which, when retreated, results in withdrawal symptoms. At a certain point, addictive behaviour becomes an ever-increasing problem for the individual and for those around them, and yet the subject will not give up on it. There is a certain resemblance with other compulsive behaviours that can be harmful to human dignity. Some personality traits might change, but this transformation can pass unnoticed for quite some time. Medicine operates with the concept of “substance dependence” instead of “addiction”. A number of American professional organizations (American Pain Society, American of Family Physicians, American Society of Addiction Medicine şi Federation of State Medical Boards) operate with the concept of “addiction”, however, to distinguish between compulsive behaviour and physical dependence (Gabriela Elena Chele, 2010). In 1957, the WHO experts introduced the concepts of “physical dependence” and “psychiatric dependence”. The latter is reflected by the abstinence syndrome.

► Physical dependence takes the form of pathological states induced by one’s organic need of consuming alcohol / drugs to avoid the symptoms that occur once the substance ceases to be used. It does not occur with all drugs, but is more frequently associated with alcohol, heroine and morphine. Certain disturbing physical symptoms take place, known as withdrawal symptoms.

► Psychiatric dependence manifests through behavioural changes and through a particular mental state which is associated with the compelling

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need to consume alcohol / drugs periodically or continuously in order to

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alleviate psychiatric discomfort. Dependence is associated with alcohol and all drug types, but with computer use also. Some people use their computers to obtain pleasure, to avoid the distress, anxiety, irritability, insomnia and depression often associated with withdrawal. The International Classification of Diseases (ICD 10) uses the term â&#x20AC;&#x153;dependence syndromeâ&#x20AC;?, while providing the clinical diagnosis criteria. Three or more of the following manifestations should have occurred together for at least 1 month or, if persisting for periods of less than 1 month, should have occurred together repeatedly within a 12-month period: 1. Impaired capacity to control substance-taking behaviour in terms of its onset, termination, or levels of use, as evidenced by the substance being often taken in larger amounts or over a longer period than intended, or by a persistent desire or unsuccessful efforts to reduce or control substance use; 2. A physiological withdrawal state when substance use is reduced or ceased, as evidenced by the characteristic withdrawal syndrome for the substance, or by use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms; 3. Evidence of tolerance to the effects of the substance, such that there is a need for significantly increased amounts of the substance to achieve intoxication or the desired effect, or a markedly diminished effect with continued use of the same amount of the substance; 4. Preoccupation with substance use, as manifested by important alternative pleasures or interests being given up or reduced because of substance use; or a great deal of time being spent in activities necessary to obtain, take or recover from the effects of the substance; 5. Persistent substance use despite clear evidence of harmful consequences as evidenced by continued use when the individual is actually aware, or may be expected to be aware, of the nature and extent of harm.

According to Kuss, Shorter, van Rooij, van de Mheen, Griffiths (2014), Internet addiction can be operationally defined as a consistent and potentially pathological behavioural pattern, characterized by salience THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Log-on Back to Life / 2017-1-1TR01- (preoccupation with online activities), tolerance (the need to spend KA201-046632 increasing amounts of time engaged in the activity), withdrawal symptoms The Internet and the Virtual Social (when unable to use the Internet), using online activities to modify mood, Environment

conflict (within oneself, in relationships, or with academic/occupational

activities because of online engagement) and relapse (unsuccessful attempts to control the behaviour). ► Internet Addiction has been defined as any online-related, compulsive behaviour which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. Internet Addiction has been called Internet dependency and Internet compulsivity. By any name, it is a compulsive behaviour that completely dominates the addict’s life. Internet Addicts make the Internet a priority more important than family, friends, and work. The Internet becomes the organizing principle of addicts’ lives. While engaged in this network, the individual will not feel alone and will find gratification from whatever there is on the Internet that interests him. ► Computer addiction strictly refers to one’s interaction with computers. While lacking the need to engage with other individuals, the addict will resort to the programs / games that he finds interest in. An analysis of the mechanism that determines addictive behaviour, in one form or another, implies the following hypotheses: ► The hypothesis of the mechanism resembling substance addiction ► The hypothesis of the mechanism resembling impulse control disorder ► The hypothesis of the mechanism resembling a disorder that is “secondary” to a “primary” disorder.

Internet Addiction: subtypes The labels Internet Addiction, Internet Addiction Disorder, Pathological Internet Use, Problematic Internet Use, Excessive Internet Use and THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Compulsive Internet Use have all been used to describe more or less the same

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concept, i.e., that an individual could be so involved in their online use as to neglect other areas of their life. Young (1999 a, b) claims Internet Addiction is a broad term that covers a wide variety of behaviours and impulse control problems. She claims this is categorized by five specific subtypes: ► ► ► ►

Cyber-relationship addiction: Over-involvement in online relationships. Net compulsions: Obsessive online gambling, shopping or day-trading. Information overload: Compulsive web surfing or database searches. Cybersexual addiction: compulsive use of adult websites for cybersex and cyberporn. ► Computer addiction: Obsessive computer game playing (e.g., Doom, Myst, Solitaire etc.). According to some researchers, such as Dr. Kimberley Young, “cyberrelationship addictions”, “cyber-sexual addictions”, “net compulsions” (gambling, day trading) and so on are all Internet Addictions. However, many would argue that these – if they are addictions – are addictions ON the Internet, not TO it (Griffiths, 2000a). The Internet is a medium and it is a situational characteristic. The fact that the medium might enhance addictiveness or problematic behavior does not necessarily make it a sub-type of Internet Addiction. The Internet is just a channel through which individuals may access whatever content they want (e.g., gambling, shopping, chatting, sex). On the other hand, online games differ from traditional standalone games, such as offline video games, in important aspects such as the social dimension or the role-playing dimension that allow interaction with other real players.

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Log-on Back to Life / 2017-1-1TR01- Finally, it is also worth mentioning that there are some problematic online KA201-046632 behaviors that could be called Internet addictions as they can only take The Internet and the Virtual Social place online. The most obvious activity that fulfills this criterion is social Environment

networking as it is a “pure” online activity and does not and cannot take place offline. As regards the addiction to the Internet, there are some case studies that seem to report an addiction to the Internet itself (e.g., Young, 1996b; Griffiths, 2000). Most of these individuals use functions of the Internet that are not available in any other medium, such as chat rooms or various role play games. These are people addicted to the Internet. However, despite these differences, there seem to be some common findings, most notably reports of the negative consequences of excessive Internet use (neglect of work and social life, relationship breakdowns, loss of control, etc.), which are comparable to those experienced with other, more established addictions. In this connection, Davis’ model of Pathological Internet Use (PIU) was the first to differentiate between Generalized Pathological Internet Use (GPIU) and Specific Pathological Internet Use (SPIU). Davis considers SPIU as a type of IA where people pathologically engage in a specific function or application of the Internet (e.g., gambling, gaming, shopping), whereas GPIU is a more general, multi-dimensional pathological use of the Internet. Davis introduced concepts such as distal and proximal contributory causes of PIU. On the one hand, distal causes may include pre-existing psychopathology (e.g., social anxiety, depression, substance dependence) and behavioral reinforcement (i.e., provided by the Internet itself throughout the experience of new functions and situational cues that contribute to conditioned responses). On the other hand, proximal causes may involve maladaptive cognitions that are seen as a sufficient condition with the potential to lead to both GPIU and SPIU and also cause symptoms associated with PIU (Griffiths et al., 2016).

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Regardless of ‘ON’ or ‘TO’, it is always a matter of Addiction and, therefore,

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we are talking about a Web usage pattern that causes significant uneasiness. Pending further conceptual elaborations which will make the definitional aspects less puzzling, addressing the issue both through preventive actions and treatment options is of primary importance.

Comorbidity In general, the comorbidity between mental disorders and addiction is high, with individuals suffering from mental health problems three times more likely to be addicted relative to healthy populations. Comorbidities complicate treatment. Comorbidity with psychiatric diseases is observed in patients with Internet Addiction, with a rate between 13.3% and 26.3%. The Internet dependent presents various psychiatric comorbidities, especially anxiety, mood disorders, Attention Deficit Disorder and Hyperactivity (ADHD), social phobia, obsessive–compulsive disorder, and substance abuse. To conclude, the severity of IA correlates with the intensity of dissociative symptoms. Comorbid mood and anxiety disorders appear to be particularly common, for adolescents as for adults. A possible explanation for this strong and frequent link may be the fact that as Internet use increases, online activities take up gradually more time in the lives of Internet users. This reduces the time available to participate in alternative enjoyable pastime activities and to engage with real-life family and friendship circles, which may lead to increased loneliness and stress. Alternatively, Internet use and gaming may serve as a method to escape real life problems, effectively resulting in avoidance coping, which may exacerbate stress and negative feelings, and lead to negative consequences, including addiction and depression. Research including Internet Addiction treatment experts from six countries indicated a large percentage of individuals with Internet addiction at both

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Log-on Back to Life / 2017-1-1TR01- in-patient and out-patient treatment facilities suffer from comorbid KA201-046632 anxiety disorders, most commonly social anxiety and social phobia (Kuss & The Internet and the Virtual Social Griffiths, 2015). This may be explained through the mechanism of Environment

compensation, suggesting individuals who have difficulties engaging and

bonding with their peers in real life may instead use the Internet for social interaction, as the online space removes the embodied (and potentially anxiety-provoking) elements from the interaction. These elements include the individualâ&#x20AC;&#x2122;s outward appearance and the exclusion of (often feared) face-to-face contact in favour of virtual (and often text-based) interaction. Similarly, the cause-effect relationships between ADHD, social phobia, and IA depression and Internet Addiction are not exactly known. There is some evidence that Internet Addiction may be related to an increased susceptibility to developing psychiatric disorders, in particular: anxiety, insomnia, somatoform disorders, social functioning-alterations, severe depression. The higher the IAD level, the greater the risk of developing a psychopathology. The impacts on the mood, as well as on narcissism, anxiety and impulsiveness, shall be discussed in section II.3.

Personality Trait and Internet addiction Alongside with the existence of psychological difficulties and the comorbidity with psychiatric disorders, personality disorders may also constitute risk factors.

The percentage of psychiatric disorders among the people with IAD is twice as high as among the general population. This suggests that having some

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pathological personality traits could contribute to the onset of Internet

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Addiction. The most vulnerable personalities to IAD are characterised by obsessivecompulsive personality traits and/or are prone to social withdrawal, with inhibitory aspects in relationships with people. In respect of the personological profiles prone to social withdrawal and to inhibition, IAD is a type of avoidance behaviour. Through this, the individual does not tackle their existential concerns. The same goes for loneliness and IAD. People with Internet Addiction problems without previous pathology are often individuals displaying narcissistic personality traits, and quite often they are adolescents. The schizoid personality trait can be observed in many individuals assessed as Internet addicted. The schizoid personality is characterized by difficulties to develop steady social relationships. These individuals are considered as cut off from society, solitary, and with little inclination to integrate into groups. They appear distant, due to the fact that their personal interests typically contribute to increase their isolation from other people â&#x20AC;&#x201C; they are, in fact, particularly attracted to inanimate elements and objects. Other possible underlying factors of Internet Addiction may be constant novelty seeking, intended as a personality trait which reflects the personâ&#x20AC;&#x2122;s openness to seek new stimulation. Harm avoidance, low reward dependence, low emotional stability, low agreeableness, low conscientiousness, low self-control, and resourcefulness could also be predisposing factors.

A correlation seems also to emerge between self-esteem and Internet Addiction. In such cases, this may justify a finding of an immature emotional-affective development. Adolescents seem to prefer being alone to taking part in clubs or parties, and, because of their low self-esteem, THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Log-on Back to Life / 2017-1-1TR01- they experience embarrassment, discomfort or anxiety in social situations, KA201-046632 to which they react with avoidance. Their thoughts are pervaded by The Internet and the Virtual Social brooding, sense of guilt, and self-depreciation (Young, 1996b). Environment

Similarly, some difficulties in the family, and impaired social and scholastic performance may increase the risk for Internet Addiction and suggest that surfing the Internet serves as escape for individuals trying to cope with life’s situations that they cannot control. There are at-higher-risk individuals because of the presence of specific biopsychosocial factors and factors related to Internet use patterns (Vondrácková & Gabrhelἱk, 2016). The risk factors relate to: ► psychopathological factors: ADHD, depressive and anxiety disorders, and social phobia, substance use, or obsessive compulsive symptoms; ► personality characteristics: hyperactivity and impulsivity, high novelty seeking and low reward dependence, introversion, low conscientiousness and agreeableness and high neuroticism/low emotional stability, hostility, low level of self-control and selfregulation; ► physiological characteristics: stronger blood volume pulse and respiratory response and a weaker peripheral temperature; ► patterns of Internet use: a large number of hours spent online, engagement in different video games, or excessive weekend Internet use; ► sociodemographic factors such as gender or family economic disadvantage; and ► the current situation: loneliness and stress or affiliation with peers who have lower levels of social acceptance or young people situated in a class with higher levels of Internet addiction.

Internet Addiction: Symptoms, Risks and Intervention Methods THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION

2.2 Symptoms of Internet Addiction

CONTAINED THEREIN

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The symptoms of Internet Addiction are visible when an individual feels better while engaging with virtual friends, when email checking becomes an obsession, when the individual comes to identify himself with the virtual individual, when social roles are replaced by virtual personas, when the virtual world is prioritized over family, work, food, health and sleep. The Internet addicted individuals experience gratification when they go online and become anxious and distressed when offline, they navigate the Web to escape from worries, they lose sense of time. The overpowering urge to use the Internet and the feeling of comfort associated with being online are symptoms of addiction. The increasing amount of time people spend on the Internet, as well as the level of their involvement in online activities to derive satisfaction are signs of addiction. On the other hand, offline time will result in anxiety, irritability and lack of concentration. Worse still, although the individual realises that excessive Internet use is damaging his physical and psychological wellbeing, the individual cannot give up In his book, Virtual Addiction, Dr. David Greenfield (apud Gabriela Elena Chele, 2010) suggests that the unique traits of the Internet can contribute to addiction development.

These include: ► Easy access – at the press of a button, the users can access any website in the world – 24 hours a day, 7 days a week. There is no limit to the available information, there is always something new to explore. ► Sensory stimulation – bright colours, high speed, ease of use and the interactive format has turned the Internet into an inciting experience. THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01-KA201-046632 Internet Addiction: Symptoms, Risks and Intervention Methods

Log-on Back to Life / The users can perform social and intellectual interactions as participants 2017-1-1TR01KA201-046632 or as observers. The Internet and ► Anonymity – real-life inhibitions melt away when users do not know one the Virtual Social another. They can be anything they choose to be. If their real life is Environment

unhappy, the users can create an ideal virtual world. ► Losing track of time – most Internet users confessed to losing track of time in this environment. 3D game graphics allows individuals to interact with other users in the virtual world. The excessive addictive potential of these “massively multiplayer online games” (MMOG) has made some users to state that their effect is similar to heroine. Dr. Kimberly Young (1996a) developed the first survey to diagnose Internet Addiction. The brief eight-item questionnaire modified criteria for pathological gambling to provide a screening instrument for addictive Internet use: 1. Do you feel preoccupied with the Internet (think about previous on-line activity or anticipate next on-line session)? 2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction? 3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use? 4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop Internet use? 5. Do you stay on-line longer than originally intended? 6. Have you jeopardized or risked the loss of significant relationship, job, educational or career opportunity because of the Internet? 7. Have you lied to family members, therapist, or others to conceal the extent of involvement with the Internet? 8. Do you uses the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

Patients were considered “addicted” when answering “yes” to five (or more) of the questions and when their behavior could not be better accounted for by a Manic Episode. Young stated that the cut off score of “five” was consistent with the number of criteria used for Pathological Gambling and was seen as an adequate number of criteria to differentiate normal from pathological addictive Internet use. THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Internet Addiction: Symptoms, Risks and Intervention Methods 2.3 Psychosocial Consequences of Internet Addiction Using the Internet to the degree of pathological attraction can have serious adverse consequences that negatively affect many vital activities of the individual: social, professional, psychological, physical, as well as interpersonal relationships. ► Effects on physical development Prolonged use of the computer is an important risk factor for obesity. Prolonged use leads to discomfort / tension in the back muscles, vicious positions of the spine (scoliosis, kyphosis), tendinitis, called even “nintendonitis”, characterized by severe pain in the extensor tendon due to repeated pushing of the buttons during the game, it favors epileptic seizures (photosensitive epilepsy is determined by “frequent blinking” or bright flashing). You may also experience hypnic disorders: sleep reduction, nightmares. One in five children, of those who have a computer, spend less time sleeping than their own parents at the same age. ► Effects on psycho-cognitive development Prolonged use of the computer may cause emotional disturbances: anxiety, irritability, low tolerance to frustration, and depression. Young (1997) concludes that those with psychological problems may be most attracted to anonymous interaction on the Internet. Kimberly Young and THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01- Robert Rogers watched the possible link between depression and Internet KA201-046632 use. The Internet and the Virtual Social People who use the computer overwhelmingly are irritable, have a low Environment

tolerance to frustration, are in constant internal tension, while dominated by anxiety. Computers channel these inner states but at the same time they potentiate them due to the negative health effects. These people are shy, show physical inconvenience, insecurity, vulnerability, irritation. On the other hand, 38.9% of those who spend time talking to friends or acquiring knowledge through computers show the complex of self-assertion and 41.2% manifest the insecurity complex. Thus, due to shyness, for fear of being rejected and of not being able to assert themselves, of being disregarded or of being wounded, ridiculed, because of lack of self-trust, individuals sometimes hide behind a computer screen. They want to communicate and establish relationships with other people, but their complexes prevent them from acting properly when faced with those people. The non-verbal displays through the computer are extremely advanced, so users can express emotion towards a certain situation without the conversation partner perceiving the real intensity of their feelings or the difference between graphically displayed emotion and reallife emotion. Computer communication enables people who interact to put on the mask they want through the graphical possibility of expressing emotions. ► Effects on social skill development Longitudinal studies reveal how personality traits, family dynamics, communication with children and adolescents are influenced. M. Weinstein (1995), Professor of Political Science at Purdue University, points out that technology has damaged the value system and social functioning in adolescents. Prolonged use of computers leads to

behavioral disturbances: social withdrawal, introversion, verbal or physical aggression, irritating explosive behavior when asked to do something else. By finding so much satisfaction while engaged with computers, teenagers begin to give up on social activities and avoid the interaction that is necessary for their social skills development. There has been an increase in the number of “electronic friends” in computer users with a diminishing friendship relationship involving social interaction. A moderate level of use has a minor

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social impact but excessive use (over 30 hour / week) and violent games can

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lead to increased aggressive behavior, hostility in children. ► Effects of computer use on reality perception The virtual world created by computers (games, the internet) takes children away from the real world. Through games, the child interacts with simulated characters and different creatures. Through the Internet, adolescents assume different identities in interacting with others. These make the real – virtual limit no longer clear to children and adolescents. Internet games reinforce this integration of virtual life. In MUD, for example, the computer generates characters that interact with the characters coordinated by people, and some children even think that the other characters are all people. These mix between real and virtual life. While playing on the Internet with their favorite cartoon characters, children learn to recognize letters and, in the meantime, computers become part of their lives. ► Effects of computer use on mood, anxiety, impulsivity, and on some personality trait As discussed above, there is certainly a correlation among mood, anxiety, impulsivity and some personality traits and Internet Addiction. It can be reasonably assumed that these psychopathological ad psychological aspects are predisposing factors that contribute to the development of Internet Addiction.

In addition to this, it should be noted that studies have measured the immediate impact of Internet exposure on mood and psychological traits, i.e., they have looked at examples of what happens to problematic internet users when they disconnect. In a first research (Romano et al., 2013) participants with Internet Addiction showed a sharp decrease in mood, immediately after being disconnected from Internet.

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Log-on Back to Life / 2017-1-1TR01- The figure below illustrated the changes in the scores in the PANAS Test KA201-046632 (Panas+ = positive affect score, Panas- = negative affect score) after being The Internet and disconnected from Internet. The positive affect (Panas+) is significantly the Virtual Social Environment lower in the group with Internet addiction (High group), while this is not

the case of the group without Internet Addiction (Low group).

Image 2. The change between post- and pre-internet use in positive mood (PANAS+), and negative mood (PANAS-) for both the low internet-using (Low) and high internet-using (High) groups

This suggests that the immediate negative effect of online interruption on mood could contribute to an increased re-use of the Internet, in an effort to improve mood. The Internet, therefore – by acting almost as an antidepressant – favours the creation of a vicious circle. This also appears to be the mechanism of anxiety. It almost seems that the Internet is used as a tranquilliser. The impact of internet exposure on impulsivity was also explored. Interestingly, individuals with Internet Addiction problems become more impulsive when they are online. The participants were ‘withdrawn’ from Internet, their smartphones, etc. for 4 hours. After this (Reed et al., 2015), the participants were exposed to a Computerised choice assessment, before and after an Internet session. Their choices could be inhibited (self-controlled), optimal (optimal) or impulsive.

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The graph below shows the participants’ answers before the exposure to the

2017-1-1TR01-KA201-046632 / Log-on Back to Life Internet Addiction: Symptoms, Risks and Intervention Methods

Internet. The answers are essentially the same for the two groups.

Image 3 Percentage of impulsive, optimal, and self-controlled choiches in Computerised choice assessment, for both the low internet-using (Low) and high internet-using (High) groups.

As shown in the graph below, for participants reporting Internet Addiction problems (High level users), in the second choice test the inhibited choices decrease, almost as much as the impulsive choices increase.

Image 4 the change in the impulsive, optimal and self-controlled choices in Computerized choice assessment, between post- and pre-internet use, for both the low internet-using (Low) and high internet-using (High) groups.

An explanation may be found in the learning theory: the exposure to an environment characterized by highly variable reinforcement – such as the Internet – produces the tendency to make impulsive choices.

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Log-on Back to Life / 2017-1-1TR01- These impulsive behaviors may predict a further use of the Internet, thus KA201-046632 creating a circle of dependence. This suggests that the individuals reporting The Internet and addiction problems are at a greater risk of developing problematic the Virtual Social Environment behaviors related to impulsive choices (such as gambling, and

pornography) when they are online. As regards personality traits, there is evidence that they may be exacerbated by a particular use of the social networks. For example, some researchers studied personality changes over a fourmonth period. They also assessed the participants’ usage of social media during that same period (Reed et al., 2018). The results established the more that people used social media, involving the posting of images (i.e. Facebook or Instagram) the more they subsequently displayed narcissistic traits (+ 25%). The use of visual social media may therefore emphasize the perception of narcissistic individuals that they are the main focus of attention. The lack of immediate ‘direct’ social censure, may offer them the opportunity to inflict aspects of their narcissistic personality, present themselves in a grandiose manner, and realize fantasies of omnipotence.

Prevention and Treatment strategies for pathological Internet use ► Prevention According to Throuvala, Griffiths, Rennoldson, Kuss (2018) a distinction can be made among several types of prevention: primary (prevent onset of a disease), secondary (reduce the incidence of a disease) and tertiary prevention (reduce the impact of a persistent health issue) prevention, emphasizing a public health perspective; as well as among universal (targeting a wide population), selective (targeting subpopulations) and indicated prevention (targeting at risk or vulnerable individuals). Yeun and Han (2016), who conducted a meta-analytic review on psychosocial treatment interventions that included prevention initiatives, found large effects for reducing IA and improving self-control and self-esteem. The effectiveness of prevention programs to be implemented at school had been emphasized also by Wells, Barlow, Stewart- Brown (2003).

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The prevention programs should enhance protective (individual) factors and

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minimize risk variables of IA, reduce comorbid symptoms and negative psychosocial consequences related to IA. Protective factors relate to skill enhancement, knowledge imparting and attitude changing, and reducing symptoms of comorbidities. It is important to improve the knowledge of IA risks and impacts, together with the development of psychosocial competencies: critical evaluation skills, social skills, problem solving skills, emotion regulation skills, cognitive restructuring skills, reduction of impulsiveness, self-concept, self-management, promotion of awareness of subjective relationship with technologies. Several authors (Ackson, Henderson, Frank, Haw, 2012; Tsitsika, Janikian, Greydanus, 2013; Vondráčková, Gabrhelík, 2016) recommend including family involvement and school relations, within their prevention programs. ► Treatment Kimberly Young (1998) put forward a series of intervention strategies for Internet addiction. Practice the Opposite – A reorganization of how one’s time is managed is a major element in the treatment of the Internet addict. Therefore, the clinician should take a few minutes with the patient to consider current habits of using the Internet. The clinician should ask the patient, (a) What days of the week do you typically log on-line? (b) What time of day do you usually begin? (c) How long do you stay on during a typical session? and (d) Where do you usually use the computer? Once the clinician has evaluated the specific nature of the patient’s Internet use, it is necessary to construct a new schedule with the client. Which means practicing the opposite. The goal of this exercise is to have patients disrupt their normal routine and re-adapt new time patterns of use in an effort to break the on-line habit.

External Stoppers – Another simple technique is to use concrete things as prompters for the Internet Addict to log off (alarm clocks, egg timers etc.) THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Log-on Back to Life / 2017-1-1TR01- Setting Goals – Many attempts to limit Internet usage fail because the user KA201-046632 relies on an ambiguous plan to trim the hours without determining when The Internet and those remaining on-line slots will come. In order to avoid relapse, the Virtual Social Environment structured sessions should be programmed for the Internet addict by

setting reasonable goals, perhaps 20 hours instead of a current 40. Then, those twenty hours should be scheduled in specific time slots and written onto a calendar or weekly planner. The patient should keep the Internet sessions brief but frequent. This will help avoid cravings and withdrawal. Abstinence – If a specific application has been identified and moderation of it has failed, then abstinence from that application is the next appropriate intervention. The Internet addict must stop all activity surrounding that application. This does not mean that the individual can not engage in other applications which they find to be less appealing or those with a legitimate use. A patient who finds chat rooms addictive, may need to abstain from them. However, this same patient may use e-mail or surf the World Wide Web to make airline reservations or shop for a new car. Another example may be a patient who finds the World Wide Web addictive and may need to abstain from it. However, this same patient may be able to scan news groups related to topics of interest about politics, religion, or current events. Reminder Cards – To help patients stay focused on the goal of either reduced use or abstinence from a particular application, they should write down a list of the, (a) five major problems caused by addiction to the Internet, and (b) five major benefits for cutting down Internet use or abstaining from a particular application. Next, the patient will transfer the two lists onto a 3x5 index card and have them within close reach. The patients will be instructed to take out the index card as a reminder of what they want to avoid and what they want to do for themselves when they hit a choice point when they would be tempted to use the Internet instead of doing something more productive or healthy.

Personal Inventory –The patient will be instructed to make a list of every activity or practice that has been neglected or curtailed since the on-line habit emerged, using the following scale: 1 - Very Important, 2 - Important, or 3 Not Very Important. In rating this lost activity, the patient should genuinely THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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reflect how life was before the Internet. This exercise will help the patient

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become more aware of the choices he or she has made regarding the Internet and rekindle lost activities once enjoyed. This will be particularly helpful for patients who feel euphoric when engaged in on-line activity by cultivating pleasant feelings about real life activities and reduce their need to find emotional fulfillment on-line. ► Other methods of treatment Support groups. The 12 Step recovery program, aimed at the treatment of alcohol and substance use, has also proved effective in the Internet addiction recovery programmes. Self-help groups consist of people affected by the same problem. These groups are useful for sharing experiences, establishing rules for regulating the usage of the Internet and for reacquiring control of one’s life. The group setting allows for the participants to slightly reduce their sense of shame, guilt and isolation – often caused by the persons’ abuse conduct. The group is a supporting, non-judgmental environment: via the group, the patients may discuss about their symptoms and sufferings with the other members and share similar experiences and emotions. Family therapy: Family relationships are disrupted and negatively influenced by Internet Addiction. However, a strong sense of family support may enable the patient to recover. Intervention with the family should focus on several main areas: ► educate the family on how addictive the Internet can be, ► reduce blame on the addict for behaviors,

► ► improve open communication about the pre-morbid problems in the family which drove the addict to seek out psychological fulfillment of emotional needs on-line, and

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Log-on Back to Life / 2017-1-1TR01- ► encourage the family to assist with the addict’s recovery such as finding KA201-046632 new hobbies, taking a long over-do vacation, or listening to the addict’s The Internet andfeelings. the Virtual Social Environment

Cognitive Therapy: Cognitive therapy is used to deal with maladaptive thoughts often associated with addictive or compulsive behavior. These thoughts are “reframed” in order to enable the individual to develop adaptive cognitive behaviour. For this purpose, the first European therapy camp to treat Internet Addiction was established in Germany, while in France, the “Two days without a screen” programme encouraged the young participants to discover other joys of life.

Cognitive Behavior Therapy (CBT). CBT is a form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional behaviors, thoughts and emotions. CBT focuses on solutions, encouraging patients to change destructive patterns of behavior. In addition to cognitive restructuring, it provides for the use of behavior modification techniques (i.e., contingency management). It may be applied in groups (Lindenberg, Halasy, Schoenmaekers, 2017). The therapy requires approximately 12 weekly sessions where the early stages are focused on the behavioral aspects of the patient, while in subsequent stages the treatment is gradually shifted towards confronting the cognitive assumptions and distortions that encourage the problematic behavior. During treatment Internet addicts identify affective and situational triggers associated with their addictive online behavior and learn how to modify them into more adaptive ones. In addition, CBT encourages the stimulation of activities which do not involve the use of the Internet in order to treat specific comorbidities. For example, the decreased use of the Internet decreases the dopamine levels in the individual. Participation in physical activities would compensate for this decrease in dopamine and enhance the effectiveness of the intervention (Cash et al. 2012).

Multimodal

therapy.

Multimodal

therapy

encompasses

several

psychotherapeutic approaches: group therapy, individual therapy, family therapy and interventions at school level. Since the different approaches are complementary, they should be applied in an integrated manner, with the aim THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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of addressing also any other co-existing psychiatric symptoms. The idea is to

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combine some elements of the multimodal therapy with motivational interviews and to use them simultaneously, both during individual therapy and in the group setting, as well as during family therapy. Counselling in addiction treatment. Counselling is one of the necessary ingredients of a therapeutic intervention program in addictions. It starts from the assumption that a person suffering from addictions or in situations of risk needs external support to be able to solve multiple problems caused by addictive or preexisting behavior. Counselling is a more general therapeutic intervention that builds on a therapeutic relationship, the therapeutic cooperation that creates a trustworthy framework to advise or develop recovery strategies. The results of counseling programs depend among other things on learning new approaches to solving old problems by using more counselling, encouragement and continuous rewarding techniques for the client in their difficult efforts, as well as the positive emotional involvement of the therapist in reducing feelings of helplessness. Counselling may also be addressed to the parents of young people, in order to support them in the recovery process of their kids. It can also be aimed at suggesting the appropriate relationship patterns, according to the kidsâ&#x20AC;&#x2122; age. Modulating control, sharing, and negotiating rules on Internet use with children may be a strategy to promote a more conscientious use of the Internet itself.

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Log-on Back to Life / 2017-1-1TR01KA201-046632 The Internet and the Virtual Social Environment

The Internet and the Virtual Social Environment 2.4 Practical Applications

1. Measurement Scale of Internet Addiction Use the Internet Addiction Test with your class. The 20-item studentsâ&#x20AC;&#x2122; test was developed by Dr. Kimberly Young to measure Internet addiction. You can access the questionnaire by following this link: (JOTFORM link / please provide it in your language) Analyse your class profile and identify some intervention strategies.

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35 2. Describe the profile of an Internet Addict

considering the following dimensions:



cognitive



relational



emotional

3. The “Millennial” or the “digital generation” lives in a world of electronic devices where the Internet plays a special part. Identify the “positive” effects of Internet use.

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Log-on Back to Life / 2017-1-1TR01KA201-046632 The Internet and the Virtual Social 4. Many families face their children’s Internet Addiction problem. Environment

Spending excessive time amount in front of the screen takes its toll on their behaviour and overall health. Even the Internet can be harmful if the parents do not monitor their kids’ behavior. It is therefore recommended to set some rules. These rules should not depriving the children from the benefits coming from Internet use.

Propose a set of rules to prevent Internet addiction, without depriving the child of

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37 5. Discussing a case study

Objectives

analyzing real life situations where IA is detected; Sharing views about the case presented; Identifying the appropriate actions to be implemented to contribute to the resolution of the problem.

Target audience

Duration

Method

teachers

from 1 to 3 hours

group discussion

Case example The parents of a 16-year old high school student contact the Teaching staff supervisor about their child. Brian (fantasy name) is spending over 30 hours a week playing the online game ‘Minecraft’ and has stopped taking part in family life. He is skipping meals. His school performances are becoming poor. The parents have many arguments with him about gaming. They tried to cut his game playing time to two hours a day. This didn’t work. Brian had always been very interested in IT. Since the age of 12, he has had a PC available. The parents agree with the teacher upon a meeting. Brian is invited to take part to the meeting too. They talk about the issue. During the interview with the teacher, Brian complains about not being understood. His parents say the gaming has had a disturbing effect on the family. They also say Brian has had an aggressive argument with his mother: once, Brian pushed away her mother when she tried to block his access to the Internet. As a teacher, what do you think about the potential level of IA? What other areas could you investigate further? Identify the appropriate actions to be implemented to contribute to the resolution of the problem. This case example is inspired by a case example reported on ‘Internet Addiction: A Handbook and Guide to Evaluation and Treatment’ by Kimberly S. Young & Cristiano Nabuco de Abreu (Editors).

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Log-on Back to Life / 2017-1-1TR01KA201-046632 6. Glossary matching The Internet and the Virtual Social Environment Familiarising with any new words; Learning the

Objectives

appropriate terminology to talk about IA at school

Target audience

Duration

teachers

from 1 to 3 hours

Method

Tools needed flashcards with terms and definitions (to be created)

Scramble flashcards. Have teachers working in pairs. Ask them to match the glossary terms with the appropriate definition. Once finished, each pair shares their work with the group. Please note all pairs should work on the same set of terms. This will allow for productively sharing the outcomes and opinions at the end of the session. Time for discussing any unclear words shall be also taken into account.

The words in the glossary may include: Depression – Anxiety – Sleep deprivation – Narcissism Compensatory Usage of the Internet – Excitatory Usage of the Internet - Pathological gambling – Dating – Email harassment – online safety - Problematic Internet User – Cognitive Behavioural Therapy – Counseling, etc.

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39 7. Role play

Objectives

train the teachers toward recognizing issues related to Internet Addiction. Practice how to manage any requests for help arising within the classroom

Target audience

Duration

Tools needed

teachers

from 2 to 4 hours

flashcards with the descriptions of the roles

Method

Teachers, in pairs, are given the flashcards. They roleplay situations where IA-related issues are reported. They present their work to the group. After, they switch roles. After, they switch pair

ROLE A: Student, aged 15. S/He tells the teacher, he/she is spending quite a lot of time online. In the last month, he/she probably spent more than 7 hours per day surfing the web. He/She does not directly ask about Internet Addiction. ROLE B: Teacher. S/He tries to investigate further. Is the student having sleeping problems? Are his/her relationships with classmates and the family impacted? Does the student know about IA? (etc.) The teacher tries to provide support to the student.

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Log-on Back to Life / 2017-1-1TR01- Assessment quiz KA201-046632 The Internet and the Virtual Social Environment 1. Which are the clinical signs associated with the Internet addiction

disorder?

2. Internet Addiction has multiple psycho-social consequences. Which of these influence students the most?

3. Name an intervention strategy to prevent Internet addiction that can be applied with your students. 4. 5. 6. 7. 8. 9. THE EUROPEAN COMMISSION SUPPORT FOR THE PRODUCTION OF THIS PUBLICATION DOES NOT CONSTITUTE AN ENDORSEMENT OF THE CONTENTS WHICH REFLECTS THE VIEWS ONLY OF THE AUTHORS, AND THE COMMISSION CANNOT BE HELD RESPONSIBLE FOR ANY USE WHICH MAY BE MADE OF THE INFORMATION CONTAINED THEREIN

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Resources Cash H, D. Rae C, H. Steel A & Winkler A. Internet Addiction: A Brief Summary of Research and Practice. Curr Psychiatry Rev 2012; 8:292–298. Davis, R. A. (2001) A сognitive–behavioural model of pathologiсal internet use. Сomputers in Human Behavior, 17, 187–195. Griffiths, M. D. (2010). The role of context in online gaming excess and addiction: Some case study evidence. International Journal of Mental Health and Addiction, 8, 119–125. Griffiths, M. D. (2000) Does internet and computer “addiction” exist? Some case study evidence. CyberPsychology and Behavior, 3, 211–218. Griffiths,

M.D.

(2000a).

Internet

addiction

Time

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