The development and treatment of problematic internet use in adolescents
Global Internet usage has grown exponentially over the last decade1,2. Numerous benefits have been associated with the proliferation of Internet use, including increased access to information, the facilitation of interpersonal relationships, access to virtual activities that induce a sense of accomplishment for users, amongst others3. It is however increasingly evident that Internet use in some cases may lead to Internet addiction (IA), which is associated with various detrimental effects for users4,5,6. Accordingly, IA is becoming increasingly relevant in clinical settings, as reflected by the recent addition of Internet Gaming Disorder in the DSM-5. Classification of IA however remains controversial, as no gold standard of IA assessment has emerged2. Notwithstanding, it is of clinical importance to demarcate potentially pathological (i.e., addictive) behaviours from high-engagement Internet use due to the detrimental impacts specific to IA. Many countries have accordingly come to see IA as a potential threat to public health, particularly in young people2,7. Adolescence can be a time of turmoil, with high levels of stressful circumstances, developmental issues, as well as the development of psychopathology1. This is further compounded by the fact that adolescence is a critical developmental period where vulnerability to addiction may develop8. The pervasive availability and mobility of new media has accordingly emerged as a problem in young people, due to its potentially negative impact on identity formation, cognitive functioning, academic performance, dietary behaviour, interpersonal relationships, involvement in risky activities, self-injury tendencies, and brain development3,9. Online disinhibition, as a consequence of online anonymity may be particularly problematic for adolescents as their cognitive control capabilities may not be adequately developed2. Low self-esteem, insufficient academic achievement, and poor family function are reported to increase risk of IA developing in adolescents, as does the presence of premorbid psychiatric symptoms8. Excessive Internet use and gaming additionally provides a forum by which individuals can escape real-life problems, with such escape-avoidance behaviours increasing vulnerability to the development of psychopathology. Accordingly, comorbidity between mental disorders and addiction is high, with IA in adolescents reflecting high levels of depression and insomnia, suicidal ideation, attention-deficit hyperactivity disorder, social phobia, and hostility, schizophrenia, obsessive–compulsive disorder, aggression, drug and problematic alcohol use5,6,7,8. Adolescents presenting with IA have been reported to experience intense preoccupation with thoughts of internet use, cravings to go online when offline, and lack of control over their use, subsequently leading to significant functional impairments including neglect of school and academic work and prioritisation of internet use over associating with friends. This in turn reduces participation in enjoyable offline activities, cyclically perpetuating increased internet use6.
Clinical Implications If comorbid conditions are present in individuals presenting with IA, clinicians and consumers alike would benefit from targeting both problems in treatment. Current research has indicated that a treatment approach including cognitivebehavioural learning and the application of conscientiousness facets, such as order, dutifulness, and regular day structure, may prove beneficial in reducing symptom severity and increasing perceived control over one’s life and mental health, particularly if treatment is initiated before the age of 16 years. Group-based therapy may also be effective over individual therapy due to the establishment of a support network of individuals who experience similar problems and are faced with similar difficulties. Research has further indicated that the use of psychopharmacological treatment may be indicated to alleviate Internet and gaming addiction symptomatology, as well as symptoms of comorbid psychopathologies6. Family therapy furthermore
a crucial component of treatment of IA in adolescents, as families are critical in supporting the young persons’ development, particularly as parents play a critical role in limit setting and modeling appropriate boundaries, specifically in relation to their own use of technology5,9.
Ami Raman Clinical Psychology Registrar | COPMI Clinician
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