Assessing and Treating Internet Addiction

Transcription

1 Assessing and Treating Internet Addiction Creative Strategies for an Emerging Disorder Joshua C. Watson, Ph.D. Texas A&M University-Corpus Christi

2 What Will We Cover? Brief history of the internet Introduction to internet addiction Prevalence statistics Diagnostic criteria used to identify internet addiction Internet addiction subtypes Assessment strategies Treatment strategies Additional resources to consult and reference

3 Evolution of the Internet

4 The Internet Today We are all now connected by the internet like neurons in a giant brain -- Stephen Hawking

5 Prevalence of Internet Usage Globally, 42.3% of the world population ( 3.27 billion people) have access to, and regularly use, the internet. Represents 806% increase in number of worldwide users ( ). In the United States, 87.4% of the population ( million people) have access to, and regularly use, the internet.

6 Is Internet Addiction Real? Dr. Ivan Goldberg (1996) Dr. Kimberly Young (1996) DSM-5 working groups and omission in publication

7 Addiction or Compulsion? An addiction is a persistent need to consume a substance or commit a particular act. A compulsion is an overwhelming and irresistible impulse to act in a certain manner or engage in a specific behavior. Compulsions typically preceded by intrusive thoughts or obsessions. This is not always the case for addictions.

8 Four C s of Addiction CRAVING COMPULSION CONTINUED USE LOSS OF CONTROL

9 Internet Addiction Disorder Impulse Control Disorder Substance-Use Disorders Obsessive Compulsive Disorder

10 Different Names, Same Issue Internet addiction disorder Internet-addicted disorder Net addiction Online addiction Cyberspace addiction High internet dependency Problematic internet usage

11 Scope of the Problem Young (2011) estimates 6-15% of general population exhibit signs of internet addiction potentially warranting the need for clinical attention. In a survey of 2,500 adults across the U.S., 1 in 8 participants reported one or more warning signs associated with internet addiction. Among a college-aged population prevalence rates are estimated to be higher, with ranges between 10% and 20%.

12 Diagnostic Criteria Used to Assess IA Preoccupation Withdrawal Tolerance Difficult to control Impaired social skills/interests Alleviation of negative emotions Deceptive behaviors

13 Internet Addiction Subtypes Cybersexual Behavior Cyber-Affairs and Online Relationships Online Gambling Online Gaming Information Overload

14 Cybersexual Addiction An estimated 20% of internet addicts are engaged in some form of online sexual activity. Includes viewing pornography and engaging in online-based sexual relationships (cybersex and hot chatting). Prevalence influenced by Access, Affordability, and Anonymity.

15 Online Pornography Statistics 25 million websites (12%) feature pornographic content. 40 million Americans visit pornographic websites on a daily basis. 2.5 billion s featuring pornographic content are sent daily. 25% of all internet search queries are pornography-related. 35% of all internet downloads are pornographic imaged and videos.

16 Cybersex Statistics 25 million Americans visit sex chat rooms and other sexuallyrelated sites between 1-10 hours per week. 40% of cybersex addicts report losing their spouse, 58% suffer considerable financial losses, and 32% report losing their jobs. Marital infidelity is 300% more likely for those who engage in this type of behavior.

17 Cyber-Affair/Relational Addiction The most frequent presenting problem reported at internet addiction treatment centers. Infidelity does not apply to online affairs. Individuals engaging in online relationships that become romantic in nature often change their behaviors and become more secretive about their internet usage.

18 Cyber-Affair Statistics 68% of all divorce cases involve one party meeting a new romantic partner online. In a 2005 study of persons between year of age, 24% of men reported being involved in an online relationship compared to 37% of same-aged women. 50% consider online-only intimate relationships to be cheating.

19 Online Gambling

20 Online Gambling Statistics In 2010, online gambling revenues topped 29 billion dollars. 40% of all internet gamblers are between ages of 21 and % of all internet gamblers are female. A significant percentage of online gamblers meet DSM criteria for pathological gambling disorder.

21 Online Gaming More than 500 million individuals worldwide (183 million in the U.S.) engage in online gaming for at least one hour per day. An estimated 50 million individuals play online games for more than 40 hours per week (equivalent of a full-time job). A growing number of online-gaming related deaths have been reported in recent years.

22 Surprising Trends in Online Gaming 47% of online gamers are now female. 29% of online gamers are over the age of 50. Online gaming revenue in 2014 surpassed 24 billion dollars Broadcast television (ABC, CBS, Fox, NBC) revenue 13 billion dollars Movie box office revenue 10 billion dollars

23 Information Overload Also referred to as Internet surfing Surfing behaviors can be structured or unstructured. Social media, viral content, web browsing, search engine utility.

24 Search Engine Utilization Statistics 82% of internet users utilize search engines. 93% of all internet activity begins with a search engine. Every month, over 100 billion global searches occur.

25 Rapid Expansion of Social Media Usage 1.36 billion (2004) 800 million (2009) 343 million (2011) 310 million (2010) 300 million (2011) 284 million (2006) 70 million (2010)

26 Assessment Strategies Assessment is challenged by client perceptions of their usage patterns and attempts to conceal behavior. No standard interview protocol exists to assess for internet addiction. Screening instruments have been developed and may be a good place to start the conversation surrounding potentially problematic behavior. Non-standardized assessment strategies also exist.

27 Internet Addiction Diagnostic Questionnaire IADQ was developed in Used as a screening tool to determine the existence of a problem. Includes 8 items to which clients provide a yes or no response. Multiple scoring methods have been proposed.

28 IADQ (Items 1-4) Do you feel preoccupied with the internet? Do you feel the need to use the internet with increasing amounts of time in order to achieve satisfaction? Have you repeatedly made unsuccessful efforts to control, cut back, or stop internet use? Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop internet use?

29 IADQ (Items 5-8) Do you stay online longer than originally intended? Have you jeopardized or risked the loss of a significant relationship, job, or educational/career opportunity because of the internet? Have you lied to family members, therapists, or others to conceal the extent of your involvement with the internet? Do you use the internet as a way of escaping from your problems or relieving a dysphoric mood?

30 Generalized Problematic Internet Usage Scale-2 GPIUS-2 was developed in Consists of 15 items to which clients rate their level of agreement using a 8-point Likert type response set. Higher scores indicate greater problems associated with internet use. One of the few theory-driven instruments.

31 GPIUS-2 (Items 1-5) I prefer online social interaction over face-to-face communication Online social interaction is more comfortable for me than face-to-face interaction I prefer communicating with people online rather than faceto-face I have used the Internet to talk with others when I was feeling isolated I have used the Internet to make myself feel better when I was down

32 GPIUS-2 (Items 6-10) I have used the Internet to make myself feel better when I ve been upset When I haven t been online for some time, I become preoccupied with the thought of going online I would feel lost if I was unable to go online I think obsessively about going online when I am offline I have difficulty controlling the amount of time I spend online

33 GPIUS-2 (Items 11-15) I find it difficult to control my Internet use When offline, I have a hard time trying to resist the urge to go online My Internet use has made it difficult for me to manage my life I have missed social engagements or activities because of my Internet use My Internet use has created problems for me in my life

34 Non-Standardized Assessment Strategies Unstructured interviews discussing client triggers for use. Four types of trigger categories identified: Applications Feelings Cognitions Life Events

35 Treatment Strategies Cognitive Behavioral Therapies Motivational Enhancement Therapy Family Therapies Cognitive Behavioral Therapy for Internet Addictions (CBT- IA)

36 CBT-IA Combines elements of CBT and harm-reduction therapy (HRT). Addresses the unique nature of internet addiction and challenges posed by the ubiquitous nature of the internet in society today. Treatment progresses through a 3-stage model.

37 Phase 1: Behavioral Modification Counselor and client work collaboratively to identify the scope of the problem to be addressed. Establish mutually agreed upon goals. Teaching clients to be self-reporters and keep journals. Work to eliminate or minimize usage triggers.

38 Phase 2: Cognitive Restructuring Address the maladaptive cognitions and perceptual distortions used by clients to justify their internet usage. Acknowledge denial and accept that problem exists Recognize cognitive distortions used Instill hope that change is possible (create a positive mindset)

39 Phase 3: Harm Reduction Therapy Goal of this phase is to identify and address any coexisting factors associated with the development of the addiction. Address the personal, relational, social, occupational, or situational stressors precipitating problematic usage. Identify new coping strategies and build these skills.

40 Specific Techniques and Interventions Practice the opposite Use external stoppers Set goals Place reminder cards Take a personal inventory Develop social support network Rebuild fractured relationships Regulate sleep patterns

41 Case Study Michael 20-year old college sophomore living alone in off-campus apartment. Lifelong battle with low self-esteem; called loser in school. Becomes quiet and introverted. Spends more and more time online in various chatrooms. Considers people he meets online to be close friends.

42 Case Study Michael Michael has begun spending hours per day online. Spends time thinking about getting back online and logs on as soon as classes end and he can get back home. Often loses track of time and spends all night awake and online. Health problems arise and academics become a concern as he is placed on probation for his low GPA.

43 Case Study Michael Instructors show concern but Michael makes up excuses for his poor academic performance. Although tired from lack of sleep, Michael reports feeling energized by his online relationships and uses this to justify his extended amount of time spent online. Does not see himself as having a problem nor does he believe anyone is being harmed by his behaviors.

44 Additional Resources Center for Internet Addiction ReSTART The Center for Internet and Technology Addiction