INTERNET ADDICTION:

THE COUNSELOR’S EYEVIEW

PhD GC 608
Counseling and Psychotherapy II

-DESIREE O. LABIO
OVERVIEW :
Myths of Internet Addiction
Understanding IA
Subtypes of IA
The Triggers
Signs and Symptoms of IA
Co-Morbidity
Prevalence
Guidance Counselor’s Role
Assessment Tools
Interventions
Other Approaches
Therapeutic Techniques and Strategies
MYTHS OF
INTERNET
ADDICTION
Myth 1:

INTERNET ADDICTION
DOESN’T CAUSE
WITHDRAWAL
Myth 2:

TECHNOLOGY ADDICTION
IS RARE
Myth 3:

INTERNET ADDICTION IS
NOT A BIG PROBLEM
Myth 4:

INTERNET ADDICTION ONLY

AFFECTS TEENS
Myth 5:

INTERNET ADDICTION IS
HARMLESS
Myth 6:

MOST PEOPLE COULD

FUNCTION WITHOUT THE
INTERNET
UNDERSTANDING
INTERNET
ADDICTION
INTERNET ADDICTION

defined as the inability to control Internet use, that may results
to impaired relationships; brings about family, work, or
interpersonal difficulties; and impacts daily function in a
negative way.


described as an impulse control disorder that does not involve
use of an intoxicating drug and is very similar to pathological
gambling (Young, 1996).


is also sometimes referred to as Internet Addiction Disorder
(IAD), Technology Addiction, Pathological Internet Use,
Excessive Internet Use, Problematic Internet Use and
Compulsive Internet Use
INTERNET ADDICTION
Internet Addiction is not an official disorder, and many
mental health professionals are not certain if it ever
should be considered a real disorder. Nevertheless,
compulsive Internet use is a serious problem thus it is
recognized as a mental health concern.
The APA’s DSM-5 Substance Use Disorders workgroup
found less evidence to support the inclusion of Internet
addiction more generally and cautions that, until more
systematic data are collected, gaming and other excessive
uses of the Internet should be considered separately.
Internet Addiction is a “Process Addiction” – disorder of
behavior, not abuse of a substance.
SUBTYPES OF
INTERNET
ADDICTION
SUBTYPES OF INTERNET ADDICTION
1.Cyber-sexual addiction
2.Cyber-relationship addiction
3.Net compulsions
4.Information overload
5.Computer addiction
SUBTYPES OF INTERNET ADDICTION
1.CYBER-SEXUAL ADDICTION
Cybersex addiction is one of the more self-explanatory internet addictions. It
involves online pornography, adult websites, sexual fantasy/adult chat rooms, and
XXX web-cam services among others.
An obsession with any of these services can be harmful to one’s ability to form real-
world sexual, romantic, or intimate relationships.
compulsive use of adult chat rooms or cyber-porn
Individuals who suffer from this are typically engaged in viewing, downloading, and
trading online pornography or involved in adult fantasy role-play chat rooms, social
media, and sexting.
Sexting and Pornography Addiction is a specific sub-type of Internet addiction that
requires counseling and inpatient treatment.
People who suffer from low self-esteem, a distorted body image,
untreated sexual dysfunction, or a prior sexual addiction are
more at risk to develop sexting and pornography
addiction problems.
SUBTYPES OF INTERNET ADDICTION
2.CYBER-RELATIONSHIP ADDICTION
Typically, online relationships are formed in chat rooms or different social
networking sites but can occur anywhere you can interact with people online.
Often, people who pursue online relationships do so while concealing their
real identity and appearance – this modern phenomena led to the creation of
the term “catfish.”
After being consumed by an online social life and persona, a person may be
left with limited social skills and unrealistic expectations concerning in-person
interactions. Many times, this leads to an inability to make real-world
connections, in turn, making them more dependent on their cyber
relationships.
Counseling or therapy is typically required to treat this addiction and ensure
lasting behavioral changes.
Individuals who suffer from an addiction to chat rooms, social networking, or
texting become over-involved in online relationships or may engage in virtual
adultery.
SUBTYPES OF INTERNET ADDICTION

3.NET COMPULSIONS
Net compulsions concern interactive activities online that can be extremely
harmful, such as online gambling, trading stocks, online auctions (such as E-
bay), and compulsive online shopping(such as shopee, lazada, zalora).

These habits can have a detrimental impact on one’s financial stability and
disrupt job-related duties. Spending or losing excessive amounts of money
can also cause stress in one’s relationships. With instant and easy access to
online casinos and stores, it is easy for those who are already susceptible to
a gambling or spending addiction to get hooked online.

These focus on winning and often cause financial problems, relationship

problems, and work-related problems among addicts.
problem gamblers often withdraw from their loved ones, sneak around, and
lie about where they’ve been and what they’ve been up to. The same can be
said for compulsive shoppers.
SUBTYPES OF INTERNET ADDICTION
4. INFORMATION OVERLOAD /
COMPULSIVE INFORMATION SEEKING
The wealth of data available has created
a new type of compulsive behavior
regarding excessive Internet and database
searches.

Screen addiction in this case results in spending greater amounts of time

searching and collecting data from the web and organizing information.

Obsessive compulsive tendencies and reduced work productivity are

associated with this behavior. Depending on the severity of the addiction,
treatment options can range from different therapy modalities – which
target changing compulsive behavior and developing coping strategies –
to medication.
SUBTYPES OF INTERNET ADDICTION
5.COMPUTER GAMING ADDICTION
Computer gaming addiction involves on- and
offline activities that can be done with a computer.
Researchers quickly found that obsessive computer
game playing was become a problem in certain
settings. Office employees would spend excessive
amounts of time playing these games
causing a notable decrease in productivity.
Today, there are thousands of new addicting games
(Mobile Legends, Rules of Survival).
Computer addiction is the oldest type of internet/computer addiction, and it is
still prevalent and harmful today.
Although gaming addiction is not yet officially recognized as a diagnosable
disorder by the American Medical Association, there is increasing evidence that
people of all ages, especially teens and pre-teens, are facing very real,
sometimes severe consequences associated with compulsive use of video and
computer games.
other type INTERNET ADDICTION
SOCIAL MEDIA ADDICTION
Problematic social media use, also known as
social media addiction or social media overuse, is a
proposed form of psychological or behavioral
dependence on social media platforms, also known
as Internet addiction disorder, and other
forms of digital media overuse.
Social media is just as addictive as drugs, alcohol, or
gambling. Being addicted to Facebook and
Instagram may seem harmless at first, but it
can have significant unforeseen
consequences. Suddenly you feel
depressed, unproductive and
downright irritable, all because of the
world within your phone.
THE TRIGGERS
FOUR TYPES OF TRIGGERS THAT ACT AS THE
INITIATION OF EXCESSIVE INTERNET USE:
1.APPLICATIONS—a particular online function is
particularly problematic for the addict;
2.EMOTIONS—being online is gratifying and
calming, while blocking pain, uncertainty, or
discomfort;
3.COGNITION—the internet acts as relief from
maladaptive thoughts and catastrophic thinking;
4.LIFE EVENTS—dissatisfaction with one or
multiple areas of life including absence of
meaningful or intimate relationships.
https://www.counseling.org/Resources/Library/VISTAS/2010-V-Online/Article_61.pdf
SIGNS AND
SYMPTOMS OF
INTERNET
ADDICTION
SIGNS and SYMPTOMS OF IA
Problematic internet use can be harmful because it often has a significant impact on one’s daily life. Some of
the key indicators to be aware of are:


Losing track of time - Many people find that they lose themselves when they are online and, as
a result, consistently spend longer online than initially intended.


Social isolation - Cracks in your real-life relationships may indicate that you are spending so much
time focusing on online relationships. Some individuals may also find that they feel their online friends
'understand' them in a way that no one in real life can.


Temporary high - As with any addiction, individuals keep returning for their next 'fix' because it
gives them the feeling of euphoria and excitement. If you tend to rely heavily on the Internet for stress relief
purposes as a pick-me-up or for sexual gratification, then it could be a sign of a deeper underlying issue.


Feelings of guilt and defensiveness - If you are feeling guilty and constantly trying to
justify the amount of time spent on the Internet, or if you are lying about or trying to hide what you do
online then this could be an indicator of Internet addiction.


Physical symptoms - Aside from the emotional aspects, excessive use of technology can cause
some physical side effects and discomfort including strained vision, backache, neck ache, headaches, sleep
difficulties and carpal tunnel syndrome.
other SIGNS AND SYMPTOMS OF IA:
Increasing preoccupation with, Neglecting friends and family
and investment of resources Neglecting sleep to stay online
(e.g., time, money, energy) on
Being dishonest with others
Internet-related activities
Unpleasant feelings (e.g., Feeling guilty, ashamed,
depression, anxiety, loneliness, anxious, or depressed as a
emptiness) when not online result of online behavior
Negative impact on Weight gain or loss, backaches,
work/school performance headaches, carpal tunnel
Problems develop in existing syndrome
relationships Withdrawing from other
Difficulty in forming new pleasurable activities
offline relationships
Tolerance can develop
Denial http://netaddiction.com/
CO-MORBIDITY
There are other psychological conditions that
may need to be addressed before or in concert
with IA (Block, 2008).

Social anxiety, sexual disorders, pathological

gambling, other addictions, and depression may
all be related to IA; therefore, these possibilities
should be considered when choosing an
appropriate approach to treatment.

IA has also been linked with a number of

psychopathologies and social deficits.
Young and Rodgers (1998) found that there was an association
between depression and Internet use. Their findings implied that
low self-esteem, poor motivation, fear of rejection, and the need
for approval associated with depression contribute to internet
use.
Particularly, the anonymity and less threatening social interaction
possible when online are attractive to users. A correlation has
been established between level of shyness (discomfort and
inhibition in the presence of others) and IA in ―net generation
participants (Chak & Leung, 2004).
Furthermore, participants who can be categorized as having IA
tended to have a more external locus of control. Significant
associations between Attention Deficit Hyperactivity Disorder
(both Inattentive and Hyperactivity- Impulsivity domain) and IA
have been established, indicating ADHD may be a risk factor in
developing pathological Internet use (Yoo et al., 2004).
PREVALENCE
 PREVALENCE:
Though the lack of standardized definitions and terminology make IA
statistics somewhat unreliable, some research has been conducted
regarding its prevalence.
Statistics reported from The Center for Internet Addiction’s website
(2006) show that approximately 5-10% of the population using the
Internet suffer from IA. In South Korea, prevalence of IA is reported at
2.1% of the population (210,000 children may have IA) and are in need
of treatment including psychotropic medications and/or hospitalization
(Block, 2008).
Research conducted by Kaltiala-Heino, Lintonen, and Rimplea (2004)
found that about 2% of adolescents ages 12-18 were displaying multiple
symptoms of IA.
Though this prevalence represents a small portion of the population,
the researchers believed that this figure will increase dramatically as
adolescents’ daily use of the Internet increases.
PREVALENCE:
ADOLESCENTS
• 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 .
• 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 4.0 to 25.3% among school students. In USA, the
rate was reported between 0 and 26.3% , and 0.8 and 13.5% in the
European Union. In Asia regions, the prevalence of Internet addiction is
reported between 2 and 25.3%. In Middle Eastern, the prevalence was
between 1 and 28.4% and the high prevalence was among Turkish
students (11.6–28.4%).
PREVALENCE:
ADULTS
• Moreover, many studies regarding Internet addiction were conducted
among adults in various countries.
• The prevalence rates in studies have used Young’s Internet Addiction
Test ranged from 1.2% in the UK to 40% of the Jordanian university
students. On the contrary, the prevalence of Internet addiction by
using Chen’s Internet Addiction Scale reported 12.3% to 17.9%
among Taiwanese adults. However, the prevalence rates of Internet
addiction by using the Internet Addiction Diagnostic Questionnaire
demonstrated 1.0% among Norwegian adults while 22.8% among
Iranian Internet users.
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.
GUIDANCE COUNSELOR’S ROLE:

1.EQUIP YOURSELF
2.IDENTIFY THE PROBLEM
3.ASSESSMENT
3.THERAPEUTIC
INTERVENTION PROGRAM
GUIDANCE COUNSELOR’S ROLE:
GUIDANCE COUNSELOR’S ROLE:
Kim (2007) recommends that school counselors provide small
group and/or individual counseling for students with IA if they
receive referrals from teachers, parents, and students.
Structured Reality Therapy-based individual and group
counseling has shown to be effective in working with students as
part of the Comprehensive Developmental School Counseling
Programs responsive services (Kim, 2007).

Collaboration with parents and local mental health agencies may

be necessary for effectively treating IA. As the concern for IA
continues to grow, school counselors need o be prepared to take
preventative steps that reach all students. This involves working
collaboratively within the school and within the community to
meet the needs of students who are struggling with problematic
Internet use.
Assessment
Tools
Many tools have been developed to investigate Internet addiction or similar concepts.
However, the main diagnostic assessment instruments used widely in empirical studies
involve (1) Young’s Internet Addiction Test (YIAT), (2) Internet Addiction Diagnostic
Questionnaire (IADQ), and (3) Chen’s Internet Addiction Scale (CIAS)

1. Young’s Internet Addiction Test

(YIAT)
2. Internet Addiction Diagnostic
Questionnaire (IADQ)
3. Chen’s Internet Addiction Scale
(CIAS)
Young’s Internet Addiction Test (YIAT)
• It was developed by Young by adapting Diagnostic and Statistical Manual
IV (DSM-IV) criteria for substance dependence and pathological gambling
, and it is a modification of the previous 8-item scale.
• The criteria include loss of control, neglecting everyday life, relationships
and alternative recreation activities, behavioral and cognitive salience,
negative consequences, escapism/mood modification, and deception.
• It is a self-report scale and consists of a 20 items; each item is scored
using a 5-point Likert scale ranging from 1(“not at all”) to 5 (“always”).
• The score of the total scale ranges from 20 to 100. The Internet users are
categorized as follows: a score 70–100 reflects significant problems due
to Internet use and 40–69 reflects frequent problems when scoring.
• It has shown to be reliable and valid. The internal consistency of the
Internet Addiction Test (IAT) has been reported as excellent, with a
Cronbach’s alpha of 0.93
Internet Addiction Test (YIAT)
1. Do you feel that you stay online longer than you intend?
2. Do you neglect household chores to spend more time online?
3. Do you prefer the excitement of the Internet to intimacy with your partner?
4. Do you form new relationships with fellow online users?
5. Do others in your life complain to you about the amount of time you spend online?
6. Does your work suffer because of the amount of time you spend online?
7. Do you check your email before something else that you need to do?
8. Does your job performance or productivity suffer because of the Internet?
9. Do you become defensive or secretive when someone asks what you do online?
10. Do you block disturbing thoughts about your life with soothing thoughts of the Internet?
11. Do you find yourself anticipating when you go online again?
12. Do you feel that life without the Internet would be boring, empty, and joyless?
13. Do you snap, yell, or act annoyed if someone bothers you while you are online?
14. Do you lose sleep due to late night log-ins?.760.650
15. Do you feel preoccupied with the Internet when offline or fantasize about being online?
16. Do you find yourself saying “just a few more minutes” when online?
17. Do you try to cut down the amount of time you spend online and fail?
18. Do you try to hide how long you’ve been online?
19. Do you choose to spend more time online over going out with others?
20. Do you feel depressed, moody, or nervous when you are offline, which goes away once you
are back online
Internet Addiction Diagnostic
Questionnaire (IADQ)
• This questionnaire was developed by Young . It is a
self-report measure which consists of eight items
dichotomously.
• It is based on the diagnostic symptoms of
pathological gambling.
• 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
Internet Addiction Diagnostic Questionnaire
(IADQ):
1.Do you feel preoccupied with the Internet (think about previous online activity or
anticipate next online 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 use the Internet as a way of escaping from problems or of relieving a
dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?
Answering “yes” to five or more questions is required to diagnose Screen addiction,
although some research suggests meeting three of the criteria is enough to diagnose.
/
Chen’s Internet Addiction Scale
(CIAS)
• this scale was developed by Chen et al. and was the most
frequently used scale in the empirical research papers studying
Internet addiction.
• The CIAS is a self-report measurement consists of 26 items on a
4-point Likert scale.
• 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. The scores of 67/68 indicate Internet addiction.
It has good internal consistency of the scale, with Cronbach’s
alpha values between 0.79 and 0.93 for the subscales.
TREATMENT
AND
INTERVENTIONS
• Treatment for Internet addiction is available, but only a few
specialized Internet addiction services exist.

• There is no one specific treatment that should be used to

address an internet addiction. Depending on the severity of the
addiction and the behaviors of the individual, different types of
treatment would be effective.
• Therapy is generally incorporated into the treatment of
addiction along with any co-occurring disorders that may be
present such as anxiety, depression, and/or obsessive-
compulsive disorder.
• The goal of treatment is usually not complete abstinence.
However, when a person is addicted to online porn, for example,
treatment goals may involve using the internet without
attempting to seek out pornography.
Hurr (2006) strongly advocates for using a multimodal
intervention approach that considers individual, social, and
environmental factors. He also points out that single
interventions (such as parental or in school) will most likely
not succeed.

Cognitive Behavioral Therapy and Reality Therapy were

indicated as preferred intervention modalities because of
their empirically-supported effectiveness, flexibility, brief
nature, and generalizability to various cultures and
populations (Kim, 2007). They also are developmentally
appropriate for the typical student who may have IA that
would be most often referred to school counselors for help.
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.

In particular, a client’s thought process guides

his or her behaviors and actions. Cognitive
behavioral therapy is not a discrete treatment
technique, but it is a general term refers to a
group of therapies.
• Researchers have documented that using cognitive
behavioral therapy (CBT) is an effective treatment for
Internet addiction .
• 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.
• The focus of this therapy is to assess the client’s patterns
of use and then develop new schedule to change the past
formed patterns. External influences such as activities that
demand the addict to leave Internet could be applied.
Cognitive behavioral therapy-
Internet Addiction (CBT-IA)
The CBT-IA model is a comprehensive approach which
can be divided into phases.
Phase 1- Behavior Modification
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.

This phase of the CBT-IA, behavior therapy is applied to examine

both computer behavior and non-computer 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.
Non-computer 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 .
Phase 1- continuation…
TIME MANAGEMENT for Internet addicts is
the primary aim of CBT-IA.
It is always important to be aware of the
main goal in this phase, which is modifying
unhealthful computer behavior to healthful
one.
In the beginning of implementation of this
phase, the therapist should assess the
client’s present use of the Internet.
Phase 1- continuation…
A DAILY INTERNET ACTIVITY DAIRY could
be adopted to evaluate client’s behavior
and develop a plan for treatment. This
diary should include date and time of each
session, event, Internet activities (e.g., mailing,
chatting, Web surfing, and shopping), situations,
duration, feelings that trigger excessive
online usage, and outcome of the Internet
session (what activities were achieved, what activities were stopped
while online).
Phase 1- continuation…
The recovery success among Internet addicts could be
measured through REDUCED ONLINE HOURS AND
ABSTAINS from any contact with problematic online
applications.
According the results of the daily dairy, therapist could
review the duration and favorite times of online. It is
necessary for the clients to get rid of any problematic
online behavior.
This could be achieved by using computer
restructuring or reorganization strategy. The clients
should remove bookmarks or favorite files and sites
that lead to the problem online.
Phase 1- continuation…
Then, the therapist puts time management goals with
the addicts and uses many methods to help them
interrupt old patterns of addictive online behavior such
as
1)TAKING ROUTINE COMPUTER BREAKS
2)USING ALARM OR TIMER as reminder to do another
activity (e.g., walking through the office or garden or
home, or see what family is doing in the living room) and
3)USING FILTERING SOFTWARE that could be used to
block access to some online sites and can help clients to
self-regulate online use.
Phase 2- Cognitive Restructuring
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
In application of this phase of treatment, many
methods are used including assessment of the 1)type
of disturbance, 2)problem solving methods, 3)coping
techniques, 4)modeling, 5)support group, and 6)self-
thought monitoring.
Phase 2- continuation
The therapy classifies the maladaptive cognitions that are
employed as triggers for excessive use of the Internet.
The Internet addicts experience distorted thoughts regarding
their world, for example, “We do not like the people because
nobody appreciate us” and “the Internet world is the only site
where we are respected and appreciated.”
These extreme thoughts are distinguished by all or nothing
thinking that intensifying and preserving the clients’ online
addiction.
In Internet games, the addicts who carry out their goals in these
games will result in psychological dependence on using the online
to enhance their self-esteem.
Phase 2- continuation
Online addicts have a cognitive bias that they are
treated with respect in their virtual world, but they
feel unhappiness and lack of satisfaction with real
lives. These thoughts encourage them to engage in
the online.
Cognitive restructuring is used to breach this pattern
of behavior. In this stage, the therapist puts the
addict's thoughts “under the microscope,” and the
addict is challenged by rewriting the negative thinking
related to him/her.
Cognitive restructuring will help addicts reevaluate the
rationality and validity of these interpretations.
Phase 2- continuation…
For example, addict who uses Internet games to build
self-esteem will begin to understand that using
Internet is for the satisfaction of the unfulfilled needs
in his or her real life.
When the addicts have awareness of their patterns of
mistaken thinking, they start to challenge these
thoughts more independently of therapy.
In this way, they will have difficulty to reason or justify
their online usage and to break the cycle of connecting
online usage with the best life.
Phase 2- continuation…
Through faults in addicts thinking, they feel worsted because they
overestimated difficulties and lessen the potential of corrective
actions.
The CBT-IA assists addicts to determine the main problems or
consequences caused by Internet addiction in order to help them
stay concentrated on treatment goals.
In addition, the therapist asks the addict to make a list of the five
main problems result from Internet addiction and a list of the five
main advantages for lowering or avoiding online use in order to
identify consequences.
Clients’ reassurance is very important because it is making their
decision list broad and all comprising, and it should be honest as
possible.
Phase 2- continuation…
The therapist should learn the worthy skill of clear-
minded assessment of consequences for any
recovery from online addiction and relapse
prevention.
This phase is used to deal with denial that frequently
exists among Internet addicts and to resist the defense
mechanism of rationalization that clarifies excessive
Internet use.
Online addicts have ambivalence feelings toward
treatment. They may enter the treatment sessions with
mixed feelings because they are not taking
responsibility for their behavior and are not certain
from their desire to quit their online use.
Phase 2- continuation…
The addict considers Internet as a healthy outlet just to
rationalize his behavior:
“This behavior does not cause any harm to
anybody else”
“This is not a big deal”
“The Internet is not a problem in my life, it is the
stress.”
They also lower from the hurt that causes to loved ones:
“It is a device,”
“It is not a sexual relation outside marriage,”
“It is only words on the screen. ”
Phase 2- continuation…
In this therapy, the addicts are faced when they conflict
themselves. At the first session, they admit to have an
addiction. The next session, they lower the same behavior
of addiction.
In this stage, the treatment assists addicts to take the
responsibility of the problem.
The addicts recognize that they will stick to a structured
online time management plan, if they admit their
addiction, which is the important focus in this stage of
therapy because it remains addicts that they take a daily
commitment, and if they are not ready to take this
appointment for themselves, and someone else, then
abstaining will be difficult to preserve.
Phase 3- Harm Reduction Therapy
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.
During this stage, the therapist identifies and addresses
the factors related to development of Internet addiction
including personal, situational, social, psychological, or
occupational issues .
Phase 3- continuation…
Full or complete recovery means examining the
fundamental issues lead to the compelling behavior
and finding solutions to these issues in a healthy way;
on the contrary, relapse is probable to happen.

As a part of recovery, the HRT is considered as an

important method for the addict to indicate the main
issues leading to the addiction . It is necessary to
explain that addicts begin to be dependent on the
Internet because it provides an urgent and acceptable
means of temporarily avoiding psychological or
situational problems.
Phase 3- continuation…
The harm reduction therapy (HRT) is
used to identify the coexisting issues in
the online addicts’ lives. Internet
becomes a fantasy world that can
take them away from their
problems. Through using the Internet,
people recognize a safe and easily
accessible way to escape.
Phase 3- continuation…
The HRT stresses on identifying and treating underlying
psychiatric problems coexisting with compulsive online
usage by administering, when indicated, appropriate
medications.

It focuses on treating dual diagnosis with depression,

anxiety, or obsessive-compulsive disorder that is
common among Internet addicts, as well as comorbid
addiction to alcohol or drugs.

Harm reduction focuses on the client’s strengths and

capacity to change as the starting point.
Phase 3- continuation…
In this phase, the main focus of the treatment sessions is
raising awareness toward the issues leading to compulsive
online use. Addicts are encouraged to participate in setting-
up the treatment and selecting the useful goals and
strategies. The addicts work to find healthy ways to deal with
feelings of low self-esteem without Internet use.
In addition, the addicts learn more effective stress
management methods to assist them to relax instead of
depending on the Internet in order to control job stress. The
addicts are helped to find new jobs or career opportunities if
they suffer from work difficulties. This thing minimizes the
harmful consequences of Internet abuse and helps the
recovered addicts develop new and healthy coping strategies
Reality Therapy
At its core, reality therapy is a form of therapy that aims to help people with
unmet needs, set goals, problem solve, and create more meaningful
connections with others.

It recognizes five basic human needs that must be met to allow for healthy
functioning and life satisfaction (Good Therapy, 2015a):

SURVIVAL (food, water, shelter, sexual fulfillment)

LOVE AND BELONGING (via family, friendships, community, etc.)
POWER (sense of accomplishment, self-confidence, self-esteem)
FREEDOM (independence, sufficient personal space, autonomy)
FUN (satisfaction, pleasure, and enjoyment)

Reality therapy is intended to help clients identify their unmet needs and
guide them through making plans and setting goals to fulfill these unmet
needs. It aims to anchor clients in the reality of their world and help them
navigate that world through making responsible decisions that bring them
closer to their goals (Arnold, n.d.).
Reality Therapy continuation
Reality therapy has been used widely as a treatment for
addictive disorder (e.g.,drugs, sex, food, work).
Glasser (1985) has used Choice Theory to explain
addiction.
Howatt (2003) developed a core addiction recovery tool
based on Choice Theory figuring out that Choice Theory
can serve as a core addiction recovery tool.
Reality therapy is designed to help individuals control
their behavior and make new and difficult choices, in
their lives. It is based on choice theory, which assumes
that people are responsible for their lives and for what
they do, feel, and think.
Reality Therapy continuation…
Reality therapy (RT) is supposed to encourage individuals to
choose to improve their lives by committing to change their
behavior.
It includes sessions to show clients that addiction is a choice and
to give them training in time management; it also introduces
alternative activities to the problematic behavior (Kim, 2007).
According to Kim, RT is a core addiction recovery tool that offers
a wide variety of uses as a treatment for addictive disorders such
as drugs, sex, food, and works as well for the Internet.
In his RT group counseling program treatment study, Kim found
that the treatment program effectively reduced addiction level
and improved self-esteem
Reality Therapy continuation…
Reality therapy teaches decision-making
and planning to achieve specific goals. The
three guiding principles of reality therapy
are realism, responsibility, and right-and-
wrong. If you choose reality therapy, be
prepared to discuss solutions to your
problems realistically.
OTHER
APPROACHES
Other Therapy/Approaches
1. Miller’s (1983) Motivational Interviewing Approach
2. Young’s (1999) Time Management and Family
Therapy Approaches
3. Rosenthal’s (2008) Psychodynamic Psychotherapy
4. Larose’s (2011) UGs Paradigm (Uses and Gratification)
5. De Abreu and Goes’ (2011) Structured Cognitive
Psychotherapy Model – 18-Week Program
6. Delmonico and Griffin’s (2011) Three Approaches
7. Eidenbenz’ (2011) Phase Model
8. Chrismore, Betzelberger, Bier, & Camacho’s (2011)
12- Step Recovery in Inpatient Treatment
9. Young’s (2007, 2011, 2015) Cognitive Behavior
Therapy (CBT)
10.Griffiths’ (2015) Combination Approaches
11.Breslau, Aharoni, Pedersen, and Miller’s (2015)
Combination Approaches
12.Cash, Rae, Steel, & Winkler’s (2012) Multimodal
Treatments
13.Kuss & Lopez-Fernandez’ (2016)
Psychopharmacotherapy, Psychological Therapy,
and Combined Treatment
Miller’s (1983) Motivational
Interviewing Approach
Motivational interviewing was developed by Miller (1983) and
Miller and Rollnick (1991) in which “a goal-directed style of
counseling for eliciting behavior change by helping clients to
explore and resolve ambivalence” by “asking open-ended
questions, giving affirmations, and reflective listening” (Young,
2015, p.11).

“Motivational interviewing is an approach based upon principles

of experimental social psychology, applying process such as
attribution, cognitive dissonance, and self-efficacy” (Miller, 1983,
p.147).
Young’s (1999) Time Management
and Family Therapy Approaches
Young (1999) believed that the
traditional abstinence models
with banned Internet use are
not practical interventions, and
the treatment should be focused
on moderation and controlled
use.
Rosenthal’s (2008)
Psychodynamic Psychotherapy
The psychodynamic model, psychoanalysis, and psychodynamic therapy came
from Sigmund Freud (1856-1939) who asserted that our subconscious mind
and innate impulses contributed to our abnormal behaviors and the mental
issues we suffered.

Psychodynamic psychotherapy (PDPT) consists of seven types of interventions

or techniques:
(a) focus on affect and expression of the patient’s emotions;
(b) exploration of the patient’s attempts to avoid topics or engage in activities
that hinder the progress of therapy;
(c) identification of patterns in the patient’s actions, thoughts, feelings,
experiences, and relationships;
(d) an emphasis on past relationships;
(e) focus on interpersonal experiences;
(f) an emphasis on the therapeutic relationship; and
(g) an exploration of wishes, fantasies, and dreams (Rosenthal, 2008).
Rosenthal’s (2008)
Psychodynamic Psychotherapy
 In psychodynamic psychotherapy, it is assumed that what
people say and do has meaning, although it may be outside of
conscious awareness; that there are patterns to one’s behavior,
and these repetitive patterns can be discerned from the
individual’s life narrative, and observed in the therapeutic
relationship; and that although these behaviors become fixed,
they can change with insight and understanding.
Psychodynamic psychotherapy is effective for a variety of
disorders; thus, it is sufficient to justify a clinical trial for
pathological gambling.
 However, it was argued that psychodynamic theory ignored our
ability to use our own free will to control our behavior and
ignored external factors (e.g., biological influences of genetics
on our predisposition) to some mental problems (Waude, 2016).
Larose’s (2011) UGs
Effective self-regulation to moderate the controlled online behavior;
“restoring self-regulation to one form of media consumption (e.g.,
television) or even in completely different behavior domains (e.g.,
eating or exercise habits) might enhance the ability to regulate
Internet behavior.”
LaRose (2011) also mentioned the uses and gratifications (UGs)
paradigm. “Gratifications are assessed through responses to verbal
statements about respondents’ reasons for media consumption
(e.g., enjoyment, social interaction), typically assessed on a
multipoint rating scale”
 “The relationship of uses and gratifications (UGs) of Internet use to
self-regulation of online behavior is thus crucial in the development
of Internet habits that disrupt lives and also in the prevention of
problematic forms of use”
De Abreu and Goes’ (2011) Structured Cognitive
Psychotherapy Model – 18-Week Program
De Abreu and Goes (2011) developed a structured cognitive program for the therapy of
Internet addicts. In their Structured Cognitive Psychotherapy Model for the treatment of
Internet addiction, there were topics for an 18-week program:

Week 1 - APPLICATION OF INVENTORIES,

Week 2 - PROGRAM PRESENTATION,
Week 3 - ANALYSIS OF THE INTERNET’S POSITIVE ASPECTS,
Week 4-5 DO I LIKE TO OR NEED TO NAVIGATE THE WEB?
Week 6-7 WHAT THE EXPERIENCE OF NEEDING IS LIKE,
Week 8 - ANALYSIS OF THE MOST OFTEN VISITED WEB SITE AND THE SUBJECTIVE
SENSATIONS EXPERIENCES,
Week 9 - UNDERSTANDING THE TRIGGERING MECHANISM,
Week 10- LIFE LINE TECHNIQUE,
Week 11- DEEPENING INTO DEFICIENT ASPECTS,
Week 12-14 WORKING ON EMERGING TOPICS,
Week 15-16 ALTERNATIVE ACTIONS COPING PROCESS,
Week 17 PREPARATION FOR TERMINATION, AND
Week 18 TERMINATION AND APPLICATION OF INVENTORIES
Delmonico and Griffin’s (2011) Three
Approaches
Delmonico and Griffin (2011) proposed three approaches to manage
problematic cybersex behavior:
(a) computer and environment management,
(b) electronic management, and
(c) acceptable use policies.

Strategies in computer and environmental management consisted of using

the computer in high-traffic areas, limiting the days and times of use, avoid
using computer alone at home, specifying where the Internet can or cannot
be used, making sure the monitor is visible to others, and installing screen
savers or backgrounds of family or partner (Delmonico & Griffin, 2011).
Electronic management included filtering and blocking, and computer
monitoring (Delmonico & Griffin, 2011). Acceptable use policies involved
helping clients establish clear boundaries to use the Internet, such as setting
the time of day, number of hours online, off-limit technologies, and use of
filtering or monitoring software between the client and clinicians (Delmonico
& Griffin, 2011).
Eidenbenz’ (2011) Phase Model
Eidenbenz (2011) proposed a therapy process called Phase Model. In the Phase Model, there
were
1) START-UP PHASE (ONE TO THREE SESSIONS),
The goal for the start-up phase was to “create a cooperative working relationship and to
obtain information for conducting an individual and systemic analysis of the problem
(diagnostics) and for forming hypothesis”

2) MOTIVATION PHASE (THREE TO FIVE SESSIONS),

The purpose of the motivation phase was to understand the circumstances (e.g., lack of say,
lack of respect, no sense of achievement) that cause and maintain addiction.

3) EXPLORATORY PHASE (THREE TO EIGHT SESSIONS),

The exploratory phase focused on promoting “an in-depth exploration of the causes of
online addiction as well as active discussions and respect within the family and alliances at
parental and sibling level”

4) STABILIZATION AND FINAL PHASE (ONE TO THREE SESSIONS).

Finally, the client will reach a level of satisfactory when he controls online times effectively,
improves his academic performance, takes up other recreational activities, deals more
constructively with conflicts, etc.
Chrismore, Betzelberger, Bier, & Camacho’s
(2011) 12- Step Recovery in Inpatient Treatment
The first step in this treatment is to spend fathering information
through psychological screenings, a bio-psychosocial interview,
medical history, and a concerned person questionnaire (CPQ).

“Treating Internet and computer addiction is explained within the first

day of treatment along with the 12-step concept and Third Tradition of
Alcoholics Anonymous.

All patients are expected to abstain from alcohol, drugs, and other
addictive behaviors while in treatment. The client is given a copy of
the Emotions Anonymous book, as well as copies of the Alcoholics
Anonymous (AA) and Narcotics Anonymous (NA) texts to provide the
origin and background of the 12-step philosophy”
Young’s (2007, 2011, 2015) Cognitive Behavior Therapy (CBT)

COGNITIVE-BEHAVIORAL THERAPY was

developed by Young (2007, 2011) which
consisted of three approaches:
1)behavioral modification to control Internet
use;
2)cognitive restricting to challenge and
3) modify cognitive distortions;

HARM REDUCTION THERAPY to address co-

morbid issues.
Griffiths’ (2015) Combination Approaches
Griffiths (2015) pointed out that the treatment of behavioral addictions
employed programs and approaches that were used in the treatment of
chemical addictions, such as pharmacotherapy, cognitive-behavioral
therapy, psychotherapy, and self-help therapy in the past decade.
In Pharmacological intervention, the addicts were given a drug to help
overcome their addiction, such as the use of opioid antagonists
(Griffiths, 2015).
In cognitive-behavioral therapy, rational emotional therapy,
motivational interviewing, and relapse prevention were used
(Griffiths, 2015).
Psychotherapy included Freudian psychoanalysis, transactional
analysis, drama therapy, family therapy, and minimalist intervention
strategies (Griffiths, 2015).
Self-help therapy involved the Minnesota Model 12-step program
(Griffiths, 2015).
Breslau, Aharoni, Pedersen, and Miller’s
(2015) Combination Approaches
The treatment strategies mentioned by Breslau, Aharoni, Pedersen, and
Miller (2015) included psychological interventions (e.g., cognitive-
behavioral therapy), Pharmacological interventions, support groups,
specialized outpatient and inpatient treatment centers, trainings and
continuing education courses for providers in PIU treatment strategies,
and applicability of Internet-based treatment approaches.

Prevention is better than cure. Breslau et al. (2015) proposed the

following prevention strategies for problematic Internet use: self-
regulation (e.g., self-monitoring use, committing to self or others to
limit use, rewarding oneself for meeting goals of limited use), workplace
Internet policies (e.g., limit, block, or monitor employee Internet use),
and cyber-wellness prevention programs (e.g., teach and train
employees the safe and appropriate use of the Internet).
Cash, Rae, Steel, & Winkler’s (2012)
Multimodal Treatments
Cash, Rae, Steel, and Winkler (2012) divided the treatment
of Internet addiction to non-psychological approaches,
psychological approaches and multimodal treatments
In non-psychological approaches, pharmacological
interventions for IAD have been used, such as serotonin-
reuptake inhibitors for depression and anxiety, bupropion
for decreasing the crave of Internet video game play, mood
stabilizers for improving the symptoms, etc. (Cash, Rae,
Steel, & Winkler, 2012).
In Psychological approaches, motivational interviewing,
community reinforcement and family training, reality
therapy, acceptance and commitment therapy, and
cognitive-behavioral approach were used.
Kuss & Lopez-Fernandez’ (2016)
Psychopharmacotherapy, Psychological Therapy, and
Combined Treatment
Kuss and Lopez-Fernandez (2016) analyzed 46 studies on Internet
addiction and classified them into four major categories:

1.TREATMENT SEEKER
CHARACTERISTICS,
2. PSYCHO-PHARMACOTHERAPY,
3.PSYCHOLOGICAL THERAPY,
4.AND COMBINED TREATMENT.
THERAPEUTIC
STRATEGIES
AND
TECHNIQUES
CBT TREATMENT STRATEGIES
1. PRACTICE THE OPPOSITE
2. EXTERNAL STOPPERS
3. SETTING GOALS
4. ABSTINENCE
5. REMINDER CARDS
6. PERSONAL INVENTORY
7. SUPPORT GROUPS
8. FAMILY THERAPY
1.PRACTICE THE OPPOSITE:
Discover clients' patterns of internet use and
disrupt these patterns by suggesting new
schedules.

For example, if the patient goes online as soon as

he or she arrives home from work and remains
online until it is time to go to bed, the clinician
may suggest that he or she take a break for
dinner, watch the news, and only then go back to
the computer.
2.EXTERNAL STOPPERS:
Clients can use real events or activities to
prompt themselves to log off of the internet.

For example, the use of an alarm clock to

function as a warning for the patient that it is
time to turn off the computer and carry out
some other offline activity, such as going to work
or school.
3.SETTING GOALS:
Help clients to come up with specific, achievable
goals with regard to the amount of time spent
online.

For example, if the patient remains online all day

long on Saturdays and Sundays, a schedule with
brief sessions of use followed by brief, although
frequent, discontinuations could be designed.
4.ABSTINENCE FROM
CERTAIN APPLICATIONS:
Encourage abstinence to only those applications that the
client is unable to control. (Cybersex/cyberporn)

This means that patients should stop navigating particular

web sites or even certain applications (e.g. MSN, Facebook,
online games) that are most attractive for them,
discontinuing the use from time to time, shifting to
alternative forms such as sending and receiving e-mails,
news search, bibliographical sources for their school work,
and so forth.
5.REMINDER CARDS:
Use visible cues that remind the clients of the
costs of their internet addiction and the benefits
of breaking the addiction.

For example, a card containing the five major

problems caused by internet addiction, as well
as the five major benefits from reducing the use
(or ultimately refraining from using a given
application) should be listed.
6.PERSONAL INVENTORY:

Help the clients to recognize the benefits of

breaking their habit by showing them all
the activities that they used to engage in or
cannot find the time for because of
internet addiction.
7.SUPPORT GROUPS:
These are useful because many
Internet addicts are said to use
the Internet to compensate for a
lack of social support.
8.FAMILY THERAPY:
Family interventions are necessary to address relational problems that
may have contributed to or resulted from internet addictions.

Some people with internet addiction who develop financial problems

may benefit from financial counseling.

Marriage (or couples) counseling may be helpful when internet

addiction in one member of the dyad has disrupted the relationship.

Young especially recommended couples therapy for cyber-sexual

addiction.
Likewise, family therapy may be helpful when problematic behaviours
have disrupted the family unit.
WASTE TIME INTERVIEW
TECHNIQUES
1. WITHDRAWAL
2. ADVERSE CONSEQUENCES
3. INABILITY TO STOP
4. TOLERANCE AND INTENSITY
5. ESCAPE
WASTE TIME INTERVIEW

WITHDRAWAL
"How do you feel/what happens to you when you are
unable to engage in online gaming like ML/in facebook
chatting

Responses may include irritability, anxiety, depression,

anger, and/or other negative mood states. Clients may
also reveal using other behaviors or chemicals to
supplement their addictive behaviors as a means to
avoid withdrawal symptoms.
WASTE TIME INTERVIEW
ADVERSE CONSEQUENCES
"Have you experienced any negative (or adverse)
consequences as a result of your behaviors?"
Responses may include broken relationships,
being grounded at home, lowered grades, lack of
sleep, financial difficulties, physical injury, being
kicked off a sports team, and/or psychological
trauma (e.g., suicidal ideations). This can lead to
further discussions about the cost of continuing
the addictive behaviors.
WASTE TIME INTERVIEW

INABILITY TO STOP
"Have you attempted to cut back, control, or
stop your behaviors without success, even when
you know that continuing will cause you harm?"
Responses may include multiple attempts at
stopping or controlling the addictive behaviors
without success, even when faced with the
knowledge that continuing poses a physical or
psychological problem.
WASTE TIME INTERVIEW
TOLERANCE OR INTENSITY
"Have you found it necessary to increase the
amount or intensity of your behaviors to achieve
the same high (or whatever reaction occurs
whenever the behavior is used)?"
Responses may mirror the tolerance that one
would feel towards alcohol: whereas one
alcoholic beverage used to provide an alteration
in mood, tolerance would be evidenced by it
taking six drinks to produce a similar effect.
WASTE TIME INTERVIEW

ESCAPE
"Do you find yourself engaging in the activity
whenever you feel such things as stress, anxiety,
depression, sadness, loneliness, or anger?“
Responses here may include any negative mood
state and discussion can easily move into co-
morbid emotional concerns (e.g., depression,
anxiety, etc.).
REALITY THERAPY GROUP
COUNSELING PROGRAM
WDEP SYSTEM
WDEP framework refers to a cluster of strategies designed to promote change:

W=wants;
D= direction and doing;
E= evaluation; and
P= planning.
WEDP Questions
What is the WDEP model?

This is a really straightforward model which helps us clarify changes we want to

make in our lives, using a short sequence of questions:

W = What do you Want?

D = What are you Doing to get what you want?

E = How well is this going (the Evaluation stage)? And:

P = Let’s re-Plan, or produce an explicit Plan linked to what you Want. Is there a
more effective way to get what I want?

Out of this questioning process normally comes some fragments of story, or some
insights, which may or may not fit well together; and with which you can work to
make sense of the situation.
Myth 1:

INTERNET ADDICTION DOESN’T

CAUSE WITHDRAWAL

Fact:
Withdrawal symptoms are a core
feature of internet addiction.
Myth 2:

TECHNOLOGY ADDICTION IS
RARE

Fact:
Technology addiction is prevalent
and becoming more common.
Myth 3:

INTERNET ADDICTION IS NOT A

BIG PROBLEM

Fact:
Internet addiction is a global
problem, and it’s on the rise.
Myth 4:

INTERNET ADDICTION ONLY

AFFECTS TEENS

Fact:
Internet addiction may affect pre-
teens to adults
Myth 5:

INTERNET ADDICTION IS HARMLESS

Fact:
Internet addiction is associated with a
serious reduction in quality of life,
developmental concerns, functional
impairments, and other mental health
disorders.
Myth 6:

MOST PEOPLE COULD FUNCTION

WITHOUT THE INTERNET

Fact:
Abstaining from internet use may
not be feasible for most people
References
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determinants of internet addiction disorder: An empirical study of Korean
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Kim, J. (2007). Reality Therapy group counseling program as an internet

addiction recovery method for college students in Korea. International
Journal of Reality Therapy, 26(2), 3- 9.

Thompson K. Therapeutic Journal Writing: An Introduction for

Professionals. London, England: Jessica Kingsley Publishers; 2010

Young, K. (1996). Internet addiction: The emergence of a new clinical

disorder. Cyber Psychology and Behavior, 3, Til-IAA

Young KS. Treatment outcomes using CBT-IA with Internet-addicted

patients. Journal of Behavioral Addictions. 2013;2(4):209-215
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www.goodtherapy.org/learn-about-therapy/issues/internet-addiction

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