Internet Addiction E-Book

Daria J. Kuss

• Herausgeber: Hogrefe Publishing
• Kategorie: Fachliteratur
• Serie: Advances in Psychotherapy - Evidence-Based Practice
• Sprache: Englisch
• Veröffentlichungsjahr: 2018

Seitenzahl: 215

Beschreibung

This book examines how you can identify, assess, and treat Internet Addiction in the most effective manner. Internet use has become an integral part of our daily lives, but at what point does Internet use become problematic? What are the different kinds of Internet Addiction? And how can professionals best help clients? Internet Addiction refers to a range of behavioral problems, including social media addiction and Internet gaming disorder. This compact, evidence-based guide written by leading experts from the field helps disentangle the debates and controversies around Internet Addiction and outlines the current assessment and treatment methods. The book presents a 12–15 session treatment plan for Internet and gaming addiction using the method and setting with the best evidence: group CBT. Printable tools in the appendix help clinicians implement therapy. This accessible book is essential reading for clinical psychologists, psychiatrists, psychotherapists, counsellors, social workers, teachers, as well as students.

Leseprobe

Advances in Psychotherapy – Evidence-Based Practice, Volume 41

Internet Addiction

Daria J. Kuss

Nottingham Trent University, Nottingham, UK

Halley M. Pontes

Nottingham Trent University, Nottingham, UK

About the Authors

Dr. Daria J. Kuss is a chartered psychologist, chartered scientist, and program leader of the new MSc Cyberpsychology at Nottingham Trent University, UK. She is an award-winning author and internationally recognized expert on Internet addiction, and is regularly invited to deliver keynotes on her research around the world. This is her third book.

Dr. Halley M. Pontes is a chartered psychologist (CPsychol) and founder of the Portuguese Society of Behavioral and Technological Addictions. He is a lecturer in psychology and his main research interest relates to the issue of psychometric assessment of behavioral addictions (e.g., Internet addiction, Internet gaming disorder, and social networking addiction). Dr. Pontes has published over 70 refereed studies, including empirical studies, book chapters, and conference presentations.

Advances in Psychotherapy – Evidence-Based Practice

Series Editor

Danny Wedding, PhD, MPH, Saybrook University, Oakland, CA

Associate Editors

Larry Beutler, PhD, Professor, Palo Alto University / Pacific Graduate School of Psychology, Palo Alto, CA

Kenneth E. Freedland, PhD, Professor of Psychiatry and Psychology, Washington University School of Medicine, St. Louis, MO

Linda C. Sobell, PhD, ABPP, Professor, Center for Psychological Studies, Nova Southeastern University, Ft. Lauderdale, FL

David A. Wolfe, PhD, ABPP, Adjunct Professor, Faculty of Education, Western University, London, ON

The basic objective of this series is to provide therapists with practical, evidence-based treatment guidance for the most common disorders seen in clinical practice – and to do so in a reader-friendly manner. Each book in the series is both a compact “how-to” reference on a particular disorder for use by professional clinicians in their daily work and an ideal educational resource for students as well as for practice-oriented continuing education.

The most important feature of the books is that they are practical and easy to use: All are structured similarly and all provide a compact and easy-to-follow guide to all aspects that are relevant in real-life practice. Tables, boxed clinical “pearls,” marginal notes, and summary boxes assist orientation, while checklists provide tools for use in daily practice.

Continuing Education Credits

Psychologists and other healthcare providers may earn five continuing education credits for reading the books in the Advances in Psychotherapy series and taking a multiple-choice exam. This continuing education program is a partnership of Hogrefe Publishing and the National Register of Health Service Psychologists. Details are available at https://us.hogrefe.com/cenatreg

The National Register of Health Service Psychologists is approved by the American Psychological Association to sponsor continuing education for psychologists. The National Register maintains responsibility for this program and its content.

Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the Library of Congress Control Number 2018954414

Library and Archives Canada Cataloguing in Publication

Kuss, Daria J., author

Internet addiction / Daria J. Kuss (Nottingham Trent University, Nottingham, UK), Halley M. Pontes (Nottingham Trent University, Nottingham, UK).

(Advances in psychotherapy--evidence-based practice ; v. 41)

Includes bibliographical references. Issued in print and electronic formats.

ISBN 978-0-88937-501-7 (softcover).--ISBN 978-1-61676-501-9 (PDF).--ISBN 978-1-61334-501-6 (EPUB)

1. Internet addiction. 2. Internet addiction--Diagnosis. 3. Internet addiction--Treatment. I. Pontes, Halley M., author II. Title. III. Series: Advances in psychotherapy--evidence-based practice ; v. 41

RC569.5.I54K87 2018

616.85’84

C2018-904753-4

C2018-904754-2

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

Registered trademarks are not noted specifically as such in this publication. The use of descriptive names, registered names, and trademarks does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.

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Format: EPUB

ISBN 978-0-88937-501-7 (print) • ISBN 978-1-61676-501-9 (PDF) • ISBN 978-1-61334-501-6 (EPUB)

http://doi.org/10.1027/00501-000

Citability: This EPUB includes page numbering between two vertical lines (Example: |1|) that corresponds to the page numbering of the print and PDF ebook versions of the title.

|v|Dedication

To Henry

D.J.K.

To Emilia

H.M.P.

|vi|Acknowledgments

We would like to thank Dr. Klaus Wölfling and Dr. Kai Müller for sharing their fantastic work on the treatment of Internet and gaming addiction. We would also like to thank Dr. Richard Graham for sharing one of his case studies.

Contents

Acknowledgments

1 Description

1.1 Terminology

1.2 Definition

1.2.1 Motives and Types of Internet Addiction

1.2.2 Addiction, Excess, and High Engagement in Internet Addiction

1.3 Epidemiology

1.4 Course and Prognosis

1.5 Differential Diagnosis

1.6 Comorbidities

1.7 Diagnostic Procedures and Documentation

2 Theories and Models of Internet Addiction

2.1 The Cognitive-Behavioral Model

2.2 The Syndrome Model of Addiction

2.3 The Components Model of Addiction

2.4 The Neuropsychology-Based Model

2.5 The Interaction of Person-Affect-Cognition-Execution Model

3 Diagnosis and Treatment Indications

4 Treatment

4.1 Methods of Treatment

4.1.1 Individual Therapy

4.1.2 Integrating Family and Significant Others in the Therapy Process

4.1.3 Group Therapy

4.2 Mechanisms of Action

4.3 Efficacy and Prognosis

4.4 Variations and Combinations of Methods

4.5 Problems in Carrying Out Treatments

4.6 Multicultural Issues

5 Case Vignette

Differential Diagnosis

Treatment Provided and Treatment Outcomes (Including Patient Satisfaction)

Follow-Up Information

Other Relevant Information

6 Further Reading

7 References

8 Appendix: Tools and Resources

Information Sheet on Internet Addiction

Internet Gaming Disorder Test (IGD-20 Test)

Scoring Information

Source

References

Internet Gaming Disorder Scale–Short Form (IGDS9-SF)

Scoring Information

Source

References

Weekly Protocol for Internet Use

|1|1Description

The concept of addiction has expanded considerably in recent years to include many types of excessive and addictive behaviors, and is now no longer restricted to behaviors related to the misuse of substances. The use of different Internet applications and videogames has become increasingly popular among people. Although there are indeed many benefits and advantages the Internet brings to all of us, there is a growing concern among several stakeholders (e.g., governments, clinicians, etc.) in relation to potential detrimental and addictive effects of the Internet for a minority of individuals. The term Internet addiction entered the medical lexicon in the mid-1990s, and since then, an increasing number of scientific reports about excessive and addictive use of this medium has been published in the literature. We discuss the nature of Internet addiction, including its terminology, definition, motivational factors, epidemiological status, potential risk factors, and methods for treatment. This book is a guide for professionals, academics and researchers working in the field, as it combines up-to-date research evidence with practical guides for how to run clinical and psychotherapeutic sessions, using an evidence-based treatment approach.

1.1 Terminology

Since the mid-1990s, a wide range of terms have been adopted to describe excessive and detrimental use of the Internet. In most cases, heterogeneity in the terminology results either from (a) the theoretical premises that the authors identify, and/or (b) the way in which Internet addiction was clinically assessed. Some of these terms used include Internet addiction disorder, pathological Internet use, compulsive Internet use, virtual addiction’, problematic Internet use, generalized pathological Internet use, and Internet use disorder, etc. In this book, the term Internet addiction will be used for the sake of consistency to describe generalized (nonspecific) addictive use of the Internet. Other specific terms such as videogame addiction, Internet gaming disorder (IGD), and social networking addiction will also be used to refer to specific types of Internet addiction.

When studying the psychological implications of excessive Internet use, the primary object of addiction is the experience that is stimulated by the contents found online and/or the interactive experience of gaining access to this material or these applications online. Research on Internet addiction has investigated a wide range of online behaviors, their potential addictive properties, and how |2|such behaviors can result in functional impairments. One example of these behaviors is online gaming and the associated detrimental effects emerging from videogame addiction. The literature on videogame addiction has adopted a broad range of terminologies to define the phenomenon, including computer game dependence, problem videogame playing, videogame addiction, Internet gaming addiction, pathological videogame use, online gaming addiction, problematic online game use, video game dependency, pathological gaming, problematic online gaming, and more recently, IGD, and gaming disorder.

Social networking addiction is also an emerging issue within the Internet addiction literature. Previous scholars have used different terms to characterize this phenomenon, such as social network addiction, online social networking site addiction, Facebook addiction, addiction to social networking sites, social network site addiction, social network disorder, social media addiction, and social media disorder. Throughout this book, the term social networking addiction will be adopted for the sake of consistency.

1.2 Definition

The definition of Internet addiction has been extensively debated and developed considerably over the past 20 years. Notwithstanding such debates, a minority of users will become addicted to the Internet; this addiction is regarded as a behavioral addiction often associated with serious health-related impairments. In broad terms, Internet addiction can be defined as a behavioral pattern of Internet use encompassing a dysfunctional craving for the use of the Internet for unregulated and excessive periods of time, with accompanying significant psychosocial and functional impairments that are not accounted for by any other disorder. Weinstein, Feder, Rosenberg, and Dannon (2014) defined Internet addiction by excessive or poorly controlled preoccupation, urges, and/or behaviors regarding Internet use that lead to impairment or distress in many life domains. Initial theoretical efforts to define Internet addiction saw it as similar to pathological gambling, further defining it as an impulse-control disorder not involving the ingestion of psychoactive intoxicants (Young, 1998b). Furthermore, Internet addiction has been defined as a compulsive-impulsive spectrum disorder involving online and/or offline computer usage patterns featuring excessive use, withdrawal symptoms, tolerance, and negative outcomes (Block, 2008). Internet addiction is also a type of technological addiction, which is conceptually operationalized as a nonchemical (behavioral) addiction involving excessive human–machine interactions (Griffiths, 1995). In this context, technological addictions, such as Internet addiction, represent a subset of behavioral addictions encompassing six key components that are common to all addictive behaviors (Griffiths, 2005; also see Section 2.3).

The lack of robust formal diagnostic criteria to assess Internet addiction represents a methodological shortcoming, as researchers tend to adopt modified criteria for pathological gambling to assess Internet addiction. Pontes, Kuss, and Griffiths (2015) argued that although Internet addiction may share some commonalities with other substance use disorders, the suitability of such criteria in the assessment of Internet addiction is questionable. A study |3|by Tonioni et al. (2014) investigated two clinical samples (31 Internet addicts and 11 pathological gamblers) and a control group of 38 healthy individuals to ascertain whether Internet addiction patients exhibited distinct psychological symptoms, temperamental traits, coping strategies, and relational patterns in comparison with pathological gamblers. This study concluded that Internet addicts presented significantly higher mental and behavioral disengagement associated with augmented interpersonal impairment. Moreover, temperamental patterns, coping strategies, and social impairments appeared to be different across both addictions. Although Internet addicts and pathological gamblers appear to share relatively similar psychological profiles, previous research found no overlap between these two groups (Dowling & Quirk, 2009), further supporting the notion that the two phenomena are separate disorders.

Given the evolving nature of Internet addiction as a psychological construct and clinical phenomenon, more recent theoretical developments have defined it within a continuum of problem severity. Researchers from a cognitive-behavioral and sociocognitive perspective often employ the term problematic Internet use to describe a more common and less severe problem than is suggested by the term Internet addiction. Accordingly, problematic Internet use is usually situated by cognitive-behavioral researchers in the middle range of the continuum of problem severity and emphasizes the mild and benign nature of related negative outcomes (truancy, foregoing social events) of unregulated Internet use. Conversely, addiction researchers place Internet addiction at the upper end of the continuum, as they view the issue as a pathology, which implies the experience of serious negative life consequences (divorce, dropping out of school, dismissal from a job; Pontes, Caplan, & Griffiths, 2016).

Further theoretical developments have defined Internet addiction as an addictive syndrome (Shaffer et al., 2004), referring to a cluster of symptoms and clinical expressions related to an abnormal underlying condition. In this case, not all symptoms or signs are present in every expression of the syndrome, and some manifestations of a syndrome may have unique signs and symptoms. In this context, Internet addiction might be a distinctive expression of the same underlying syndrome reflecting multiple opportunistic expressions (Griffiths, Kuss, Pontes, & Billieux, 2016). Despite the recent advances, other scholars have argued that Internet addiction is a misnomer that should be abandoned due to the high conceptual heterogeneity of the term and because being addicted to the Internet implies that someone is addicted to a delivery mechanism. Thus, sustaining the concept of Internet addiction might require that one ignore the fact that Internet addicts are no more addicted to the Internet than alcoholics are addicted to bottles.

With regard to the definition of videogame addiction, researchers have traditionally adopted a broad range of definitions to describe its detrimental effects. However, in May 2013, the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association (APA; APA, 2013) was published, and it proposed IGD as a tentative mental health disorder warranting further research. Accordingly, IGD is defined as a persistent and recurrent involvement with videogames that may lead to significant clinical and functional impairments of daily work and/or educational activities. IGD is indicated by endorsement of five out of nine symptoms over a 12-month period – namely (i) salience: excessive |4|preoccupation with videogames; (ii) withdrawal symptoms: the experience of unpleasant symptoms when videogaming is taken away; (iii) tolerance: spending increasing amounts of time playing videogames; (iv) loss of control: unsuccessful attempts to control online game participation; (v) giving up other activities: loss of interest in previous hobbies and entertainment as a result of, and with the exception of, playing videogames; (vi) continuation: continued excessive videogaming use despite knowledge of psychosocial problems; (vii) deception: deceiving family members, therapists, or others regarding the amount of videogaming; (viii) escape: playing videogames to escape or relieve negative moods; and (ix) negative consequences: jeopardizing or losing a significant relationship, job, or education or career opportunity because of videogaming (APA, 2013).

Although the inclusion of IGD in the DSM-5 contributed to standardizing the definition of videogame addiction, the attempt to medicalize the phenomenon has generated several debates and controversies between scholars as to whether videogame addiction should be considered an official diagnosis (Kuss, Griffiths, & Pontes, 2017). Some of these initial concerns resulted from the fact that the diagnostic criteria for IGD were largely derived from a combination of existing clinical criteria and unofficial conditions, such as pathological gambling, substance use disorder, and generalized Internet addiction (GIA). Further concerns regarding how best to define IGD at the criterion level have emerged in the literature more recently as some criteria have arguably proven controversial.

Several scholars have argued that withdrawal symptoms and tolerance are by far the most problematic criteria in the definition of IGD, even though the diagnostic accuracy of these two criteria was found to be fairly good (ranging from 84.6% to 90%, respectively; Ko et al., 2014). In a recent systematic review, evidence supporting withdrawal symptoms in IGD was found to be underdeveloped, with many studies reporting no withdrawal symptoms, and no study reporting actual physical withdrawal symptoms. Furthermore, commonly reported emotional and behavioral withdrawal symptoms are irritability and restlessness. Tolerance in IGD has been broadly defined as “the need to spend increasing amounts of time engaged in videogames,” which has been argued to be inadequate, as it implies that any increase in time spent gaming denotes tolerance when its definition does not stipulate the specific reasons for that increased engagement in gaming. Further research has shown that individuals with IGD may have different reasons not necessarily related to tolerance for spending more time gaming.

More recently, the World Health Organization (WHO) has decided to recognize videogame addiction as a mental health disorder by including gaming disorder as a disorder in the 11th revision of the International Classification of Diseases (ICD-11) based on reviews of available evidence supporting the new diagnosis. Accordingly, gaming disorder is characterized by a pattern of persistent or recurrent (online and/or offline) gaming behavior, which manifests by impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context); increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and continuation or escalation of gaming despite the occurrence of negative consequences (WHO, 2018). Moreover, the behavior pattern should be of sufficient |5|severity to cause significant impairment in personal, family, social, educational, occupational, or other important areas of functioning (WHO, 2018). Although the pattern of gaming behavior may be continuous or episodic and recurrent, the behavior and other features should normally be evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe (WHO, 2018).

Given that less research has been conducted on social networking site addiction, the definition of this phenomenon appears scattered in the literature. The definition of social networking addiction also remains to be further refined. Nevertheless, research has shown that in some cases, a minority of individuals using social networking sites can develop symptoms akin to those of other addictive disorders, leading them to experience negative outcomes due to excessive and addictive use of social networking sites (Pontes, Andreassen, & Griffiths, 2016). The definition of social networking addiction denotes individuals who are overly concerned about using social networking sites due to a strong and uncontrollable intrinsic motivation, leading them to devote so much time and effort to this activity that it impairs other important areas of life, such as social activities, academic and professional commitments, interpersonal relationships, and/or psychology health and well-being (Andreassen & Pallesen, 2014). However, social networking addiction remains an unofficial diagnosis, similar to GIA.

1.2.1 Motives and Types of Internet Addiction

There are several reasons and specific motives underpinning Internet use in general. Previous research examining why individuals use the Internet provided useful insights to help us understand the underlying psychological motivational factors for using the Internet. According to Papacharissi and Rubin (2000), individuals present different motives for using the Internet, including (1) interpersonal utility (pursuit of social contact and interaction online); (2) passing time (use of the Internet to avoid boredom); (3) information seeking (use of the Internet to seek information online); (4) convenience (ease of access to the Internet to communicate with others); and (5) entertainment (use of the Internet for entertainment). Interestingly, Papacharissi and Rubin (2000) reported that information seeking was the most salient reason for using the Internet across both genders.

Wolfradt and Doll (2001) identified key motives for adolescent Internet use, broadly corresponding to three distinct types of Internet use. According to these authors, adolescents utilize the Internet to obtain information, for entertainment, and for interpersonal communication. Moreover, they found that information and entertainment were the main motives accounting for adolescents’ Internet use, while interpersonal communication played only a minor role in explaining Internet use.

Early research also contributed to identifying factors making the Internet particularly alluring and addictive. Pornographic and sexual utilization has been explained by Cooper’s Triple A Engine (access, affordability, and anonymity; Cooper, 1998) and by the ACE model (anonymity, convenience, and |6|escape) of Young et al. (1999). Based on findings from early research, some of the key variables accounting for the acquisition and maintenance of addictive online behaviors are related to accessibility, affordability, anonymity, convenience, escape, immersion and/or dissociation, disinhibition, and social acceptability.

In addition to identifying specific motivational factors, previous research has defined specific typologies of Internet addiction to help us understand the extent of the problem and how it can manifest. Current views on Internet addiction define the phenomenon as an umbrella term encompassing several specific types of Internet addictions. This view emerged from an early study that delineated five specific types of distinct addictive online behaviors (Young et al., 1999):

Cybersexual addiction: addictive use of adult websites for sexual purposes.

Cyber-relationship addiction: addictive involvement in online relationships.

Net compulsions: addictive online gambling, shopping, or trading.

Information overload: addictive use of the Internet to search for information.

Computer addiction: addictive online gaming.

Although this early view was important to foster subsequent research and a better understanding of the addictive nature of the Internet, it also comes with a few caveats, as it has been argued that the Internet may simply be the means or “place” where the most commonly reported addictive behaviors occur. In other words, the Internet may be just a medium to fuel other online addictions. Indeed, this assertion seems to be empirically and clinically valid, as new evidence has emerged from a number of studies supporting the need to distinguish between addictions on the Internet versus addiction to the Internet (Griffiths, 1995). This distinction is particularly important in the context of videogame addiction, because Internet addiction and videogame addiction present with different underlying psychological mechanisms (reward schedules) and motivational pulls.

Another potential issue emerging from Young’s Internet addiction typology relates to the fact that videogame addiction is vaguely defined as “computer addiction.” While it is true that videogame addiction may manifest via playing computerized games, gaming is a much broader activity in and of itself, as players can choose to play using different platforms (e.g., smartphones). Thus, equating videogame addiction with computer addiction may be misleading. Irrespective of these issues, videogame addiction has been extensively researched over the past 3 decades, with the first reports dating back to the early 1980s. Previous research has concluded that videogame addiction is, as a disorder, capable of generating mental health problems for a minority of gamers. Studies investigating the role of motives in gaming found that escapism (i.e., playing to avoid real-life difficulties) not only leads to increased psychiatric distress, but is also the strongest motivational factor predicting videogame addiction. There are other equally important gaming motivations that have been consistently linked to videogame addiction, such as immersion, achievement, and/or advancement motives associated with the need for progressing and improving performance within the game. By contrast, research |7|has also identified motivational factors for gaming that are associated with more positive outcomes, such as playing to meet new gamers or to maintain existing friendships. Given that videogame addiction is particularly prevalent at early developmental stages, understanding children’s motivations for gaming is key.

Ferguson and Olson (2013) found that children’s motivations for gaming were related to seeking fun or a challenge (motivation due to the fun or excitement elements of the games), catharsis or autonomy (motivation related to releasing anger or frustration or generally escaping problems in the offline world), social relatedness (motive related to social factors), and boredom (motivation emerging from having little else better to do). Ferguson and Olson (2013