Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before-After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy

Background The growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient’s life. Objective This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT). Methods Of the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction. Results Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724. Conclusions This study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the treatment from a behavioral perspective, and gave patients the confidence to continue to manage Internet use in their lives.

[1]  T. Zhu,et al.  [Clinical effect of electroacupuncture combined with psychologic interference on patient with Internet addiction disorder]. , 2009, Zhongguo Zhong xi yi jie he za zhi Zhongguo Zhongxiyi jiehe zazhi = Chinese journal of integrated traditional and Western medicine.

[2]  M. Beutel,et al.  AS32-02 - Treating Internet Addiction: First Results on Efficacy of a Standardized Cognitiv-behavioral Therapeutic Approach , 2012, European Psychiatry.

[3]  C. Ko,et al.  The comorbid psychiatric symptoms of Internet addiction: attention deficit and hyperactivity disorder (ADHD), depression, social phobia, and hostility. , 2007, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[4]  Griffiths,et al.  Clinical psychology of Internet addiction: a review of its conceptualization, prevalence, neuronal processes, and implications for treatment , 2015 .

[5]  Catriona M. Morrison,et al.  The Relationship between Excessive Internet Use and Depression: A Questionnaire-Based Study of 1,319 Young People and Adults , 2010, Psychopathology.

[6]  Keith W. Beard,et al.  Modification in the Proposed Diagnostic Criteria for Internet Addiction , 2001, Cyberpsychology Behav. Soc. Netw..

[7]  Y Liu,et al.  Is there a relationship between Internet dependence and eating disorders? A comparison study of Internet dependents and non-Internet dependents , 2009, Eating and weight disorders : EWD.

[8]  Sriram Ramaswamy,et al.  Internet Gaming Addiction , 2004, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[9]  P. Keck,et al.  Olanzapine in the treatment of pathological gambling: a negative randomized placebo-controlled trial. , 2008, The Journal of clinical psychiatry.

[10]  Zsolt Demetrovics,et al.  The three-factor model of Internet addiction: The development of the Problematic Internet Use Questionnaire , 2008, Behavior research methods.

[11]  Daniel L. King,et al.  Assessing clinical trials of Internet addiction treatment: a systematic review and CONSORT evaluation. , 2011, Clinical Psychology Review.

[12]  Ana María Contreras,et al.  Description of Internet Addiction among Chilean Medical Students: A Cross-Sectional Study , 2014, Academic Psychiatry.

[13]  Daeyoung Oh,et al.  A Case of Withdrawal Psychosis from Internet Addiction Disorder , 2014, Psychiatry investigation.

[14]  M. Brown,et al.  Commonalities in the Psychological Factors Associated with Problem Gambling and Internet Dependence , 2010, Cyberpsychology Behav. Soc. Netw..

[15]  Silvia Kratzer,et al.  Ist „Internetsucht” eine eigenständige Erkrankung? , 2007 .

[16]  Ya-song Du,et al.  Longer Term Effect of Randomized, Controlled Group Cognitive Behavioural Therapy for Internet Addiction in Adolescent Students in Shanghai , 2010, The Australian and New Zealand journal of psychiatry.

[17]  I. Lyoo,et al.  Depression and Internet Addiction in Adolescents , 2007, Psychopathology.

[18]  Agata Blachnio,et al.  Clinical approaches to treatment of Internet addiction , 2014, Pharmacological reports : PR.

[19]  M. Atmaca.  A case of problematic internet use successfully treated with an SSRI-antipsychotic combination , 2007, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[20]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[21]  조영미,et al.  Development of Internet Addiction Proneness Scale-Short Form(KS scale) , 2008 .

[22]  Jing Luo,et al.  The effect of Internet use on adolescents' lifestyles: A national survey , 2012, Comput. Hum. Behav..

[23]  Standardization Study of Internet Addiction Improvement Motivation Scale , 2012, Psychiatry investigation.

[24]  P. Keck,et al.  Psychiatric features of individuals with problematic internet use. , 2000, Journal of affective disorders.

[25]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[26]  Kimberly S. Young,et al.  CBT-IA: The First Treatment Model for Internet Addiction , 2011, Journal of Cognitive Psychotherapy.

[27]  Özgül Örsal,et al.  Evaluation of Internet Addiction and Depression among University Students , 2013 .

[28]  P. Renshaw,et al.  Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. , 2010, Experimental and clinical psychopharmacology.

[29]  Nicholas Tarrier,et al.  Positive Clinical Psychology: a new vision and strategy for integrated research and practice. , 2010, Clinical psychology review.

[30]  Manuel Gámez-Guadix,et al.  Analysis of the Indicators of Pathological Internet Use in Spanish University Students , 2010, The Spanish journal of psychology.

[31]  C. Ko,et al.  Psychiatric Comorbidity of Internet Addiction in College Students: An Interview Study , 2008, CNS Spectrums.

[33]  Kong,et al.  P300 change and cognitive behavioral therapy in subjects with Internet addiction disorder: A 3-month follow-up study , 2011 .

[34]  Huanhuan Li,et al.  The role of cognitive distortion in online game addiction among Chinese adolescents , 2013 .

[35]  S. Pallanti,et al.  Internet addiction: a descriptive clinical study focusing on comorbidities and dissociative symptoms. , 2009, Comprehensive psychiatry.

[36]  M. Di Nicola,et al.  A Role for Pharmacotherapy in the Treatment of “Internet Addiction” , 2012, Clinical neuropharmacology.

[37]  Eric Hollander,et al.  Escitalopram in the treatment of impulsive-compulsive internet usage disorder: an open-label trial followed by a double-blind discontinuation phase. , 2008, The Journal of clinical psychiatry.

[38]  C. Yen,et al.  The association of Internet addiction symptoms with anxiety, depression and self-esteem among adolescents with attention-deficit/hyperactivity disorder. , 2014, Comprehensive psychiatry.

[39]  J Michael Bostwick,et al.  Internet sex addiction treated with naltrexone. , 2008, Mayo Clinic proceedings.

[40]  K. Young.  Internet Addiction , 2004 .

[41]  Daniel T L Shek,et al.  Evaluation of an Internet addiction treatment program for Chinese adolescents in Hong Kong. , 2009, Adolescence.

[42]  Regina J. J. M. van den Eijnden,et al.  The Compulsive Internet Use Scale (CIUS): Some Psychometric Properties , 2009, Cyberpsychology Behav. Soc. Netw..

[43]  M. Griffiths.  A ‘components’ model of addiction within a biopsychosocial framework , 2005 .

[44]  Kimberly Young,et al.  The Relationship Between Depression and Internet Addiction , 1998, Cyberpsychology Behav. Soc. Netw..

[45]  F. Kaneez,et al.  Is Cognitive Behavioral Therapy an Intervention for Possible Internet Addiction Disorder , 2013 .

[46]  Jerald J. Block.  Issues for DSM-V: internet addiction. , 2008, The American journal of psychiatry.

[47]  M. Kaess,et al.  The Association between Pathological Internet Use and Comorbid Psychopathology: A Systematic Review , 2012, Psychopathology.

[48]  R. A. Davis,et al.  A cognitive-behavioral model of pathological Internet use , 2001, Comput. Hum. Behav..

[49]  Jennifer B. Unger,et al.  Concurrent and Predictive Relationships Between Compulsive Internet Use and Substance Use: Findings from Vocational High School Students in China and the USA , 2012, International journal of environmental research and public health.

[50]  Chih-Hung Ko,et al.  The Association between Adult ADHD Symptoms and Internet Addiction among College Students: The Gender Difference , 2009, Cyberpsychology Behav. Soc. Netw..

[51]  Tjibeng Jap,et al.  The Development of Indonesian Online Game Addiction Questionnaire , 2013, PloS one.

[52]  C. Ko,et al.  Tridimensional Personality of Adolescents with Internet Addiction and Substance Use Experience , 2006, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[53]  Karl Mann,et al.  Effects of a manualized short-term treatment of internet and computer game addiction (STICA): study protocol for a randomized controlled trial , 2012, Trials.

[54]  T. Schoenmakers,et al.  Treating Internet Addiction With Cognitive-Behavioral Therapy: A Thematic Analysis of the Experiences of Therapists , 2012, International Journal of Mental Health and Addiction.

[55]  Hui Li,et al.  Effects of electroacupuncture combined psycho-intervention on cognitive function and event-related potentials P300 and mismatch negativity in patients with internet addiction , 2012, Chinese Journal of Integrative Medicine.

[56]  Kimberly S. Young,et al.  Treatment outcomes using CBT-IA with Internet-addicted patients , 2013, Journal of behavioral addictions.

[57]  Alexander Winkler,et al.  Send Orders of Reprints at Reprints@benthamscience.org Internet Addiction: a Brief Summary of Research and Practice , 2022 .

[58]  Christina Brezing,et al.  Non-substance-addictive behaviors in youth: pathological gambling and problematic Internet use. , 2010, Child and adolescent psychiatric clinics of North America.

[59]  S. Mythily,et al.  Prevalence and correlates of excessive Internet use among youth in Singapore. , 2008, Annals of the Academy of Medicine, Singapore.

[60]  P. Renshaw,et al.  The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. , 2009, Comprehensive psychiatry.

[61]  Ronald Pies,et al.  Should DSM-V Designate "Internet Addiction" a Mental Disorder? , 2009, Psychiatry (Edgmont (Pa. : Township)).

[62]  Doug Hyun Han,et al.  Bupropion in the treatment of problematic online game play in patients with major depressive disorder , 2012, Journal of psychopharmacology.

[63]  A. Nardi,et al.  Treatment of internet addiction in patient with panic disorder and obsessive compulsive disorder: a case report. , 2015, CNS & neurological disorders drug targets.

[64]  LEE M. Cheung,et al.  The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: an exploratory cross‐sectional analysis , 2011, Journal of sleep research.

[65]  C. Ko,et al.  Internet addiction: ongoing research in Asia , 2010, World psychiatry : official journal of the World Psychiatric Association.

[66]  M. Hamilton.  The assessment of anxiety states by rating. , 1959, The British journal of medical psychology.

[67]  A. Johansson,et al.  Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years). , 2004, Scandinavian journal of psychology.

[68]  Dan J Stein,et al.  Problematic internet use: Proposed classification and diagnostic criteria , 2003, Depression and anxiety.

[69]  Elias Aboujaoude,et al.  Potential Markers for Problematic Internet Use: A Telephone Survey of 2,513 Adults , 2006, CNS Spectrums.