Study Points

Problematic Internet Use: Controversies and Implications for Practice

Course #76172 - $25 • 5 Hours/Credits

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. Of the following age-groups, which uses the Internet the most?

    INTERNET USAGE PATTERNS

    In order to understand the impact of the Internet on personal lives, it is important to obtain a brief glimpse of Internet usage. According to the U.S. Census Bureau, 82% of all households had Internet use and 81% had broadband access in 2016 [100]. In a 2016 study conducted by the Pew Internet Research Center of adults 18 years of age and older, 88% of men and women used the Internet. Individuals 18 to 29 years of age use the Internet the most (99%), while adults 65 years of age and older use the Internet the least (64%); Internet use also increases with income and education levels [7]. With Web 2.0, more people are using social networking sites and creating and viewing podcasts, vodcasts, and blogs. As of 2015, the top five Internet activities were sending or reading emails; texting or instant messaging; using online location-based services; using social media networks; and online shopping, travel reservations, and other consumer services [8]. Approximately 48% of all American households have a laptop or a desktop computer, a smartphone, a tablet, and broadband Internet connection as of 2018 [100]. There is no doubt that Internet technology has become a ubiquitous part of the American landscape.

    Click to Review
  2. What percentage of adults in the United States own a cell phone?

    INTERNET USAGE PATTERNS

    Cell phones, particularly smartphones (and therefore, the Internet), are an integral part of the fabric of individuals' lives. An estimated 95% of adults in the United States own any type of cell phone, and 77% specifically own a smartphone [92]. However, the phone is more than just a means to connect with other people. According to the Pew Internet and American Life Survey, 39% of adults in the United States, 70% of adolescents, and 72% of young adults (18 to 29 years of age) indicated that the phone is a way to deal with boredom [9]. Another study found that at least 63% of high school students use the Internet to escape from problems or a depressed mood [98]. In a focus group study of Australian adolescents and their use of cell phones, interesting themes emerged [10]. While it is not surprising they were attached to their cell phones, these adolescents expressed that the number of calls they received on their cell phone was associated with how valued or loved they felt. When they could not use their cell phones, they felt disconnected. This speaks to how cell phones have become entrenched in individuals' social and personal lives. At least 46% of Americans think that a smartphone is something that they could not live without [94].

    Click to Review
  3. What is the most popular social media website in the United States?

    INTERNET USAGE PATTERNS

    More individuals are using social networking sites for personal and professional purposes as well. In 2016, more than 80% of online adults in the United States used a social networking site and 56% used multiple sites, specifically Instagram, Twitter, Pinterest, and LinkedIn [14]. The most popular social networking sites are Facebook (used by 69% of adults) and YouTube (used by 73% of adults) [102]. In addition, 32% of online adults use Instagram, 31% use Pinterest, 29% use LinkedIn, and 24% have a Twitter account [14]. In a 2019 survey, 74%% of the research participants say they use Facebook on a daily basis [102]. In general, users of social networking sites are diverse in terms of race, level of education, and income. There are slight gender and larger age differences in use, especially among the various websites. An estimated 83% of online women and 75% of online men use Facebook. A total of 88% of online adults 18 to 29 years of age use the site, compared with 84% of those 30 to 49 years of age, 72% of those 50 to 64 years of age, and 62% of those 65 years of age and older [14].

    Click to Review
  4. According to a survey of mental health professionals, what is the most common presenting Internet-related problem?

    INTERNET-RELATED PROBLEMS

    Although new technologies open doors to new opportunities, they can also bring new challenges and problems, and the Internet is no exception. The Internet can be a tool used to commit various criminal activities, including child pornography, human trafficking, harassment, stalking, scams, and fraud [16]. Those with a drive to act out sexually may be more likely to take action using the Internet due to the perceived anonymity and ease. In a survey of 1,504 mental health professionals, counselors, and clinicians, participants were asked to identify Internet-related problems their clients had brought into their clinical sessions. The most common problems were [16,103,104,105,106,107,108]:

    • Overuse: By far, overuse was the most common problem, with 61% of professionals reporting having clients who excessively use the Internet. In one survey, 28% of adults reported being online "almost constantly." Certainly, this category can overlap with additional compulsions. For example, an individual may excessively use the Internet to engage in viewing online pornography. A specific amount of online activity has not been set as the threshold of what is considered excessive; rather, usage is considered problematic if it interferes with day-to-day activities.

    • Pornography: More than half (56%) of the mental health professionals surveyed regularly dealt with Internet-related pornography issues, such as overuse, family conflict, unwanted exposure, subsequent development of sexually deviant interests, and illegal pornography. It is reported that 53.3% of adults turn to the Internet to meet their sexual needs, spending at least one hour per week engaging in some form of online sexual activity. It has been estimated that 10% of the population may meet the criteria for cybersex addiction.

    • Infidelity: Internet infidelity is defined as a relationship that starts via e-mail, chatrooms, or Internet games and that has a sexual and/or romantic nature. About 20% of professionals' cases involved couples coping with sexual infidelity from Internet activities and the negative impact on the relationship.

    • Sexual abuse: Sixteen percent of professionals reported cases involving a client (often an adolescent or child) who had received unwanted sexual advances over the Internet, including inappropriate sexual and exploitive involvement. In a 2019 study, 5.8% of adolescents reported having become acquainted with someone online with the objective of engaging in online sexual activity in the past year. Nearly 33% had been pressured to engage in online sexual activity at least once.

    • Gaming, role-playing, and gambling: A number of study participants (15%) reported having clients presenting with gaming, role-playing, and gambling problems, primarily stemming from the client's own behavior. This category included persons with problematic behaviors related to online gambling, solitary gaming (e.g., solitaire), interpersonal gaming with other people online (both known and unknown), and fantasy games involving role playing. Online poker is a rapidly growing type of gambling.

    • Harassment: One in 10 professionals had clients who were either perpetrators or victims of online harassment. Online harassment was defined as experiencing defamatory postings by someone else, impersonating another person online, stalking, threatening violence, or physical and emotional abuse as a result of an online relationship. Digital polyvictimization, or a variety of technology-based harassment, was reported in 75% of a community sample of adults. These victims were at increased risk for post-traumatic stress and anxiety.

    • Isolative-avoidant use: Clients who use the Internet to such an extent that they have reduced their face-to-face encounters were reported by 10% of participants.

    Click to Review
  5. Internet infidelity is defined as a relationship that starts via e-mail, chatrooms, or Internet games and that has a sexual and/or romantic nature.

    INTERNET-RELATED PROBLEMS

    Although new technologies open doors to new opportunities, they can also bring new challenges and problems, and the Internet is no exception. The Internet can be a tool used to commit various criminal activities, including child pornography, human trafficking, harassment, stalking, scams, and fraud [16]. Those with a drive to act out sexually may be more likely to take action using the Internet due to the perceived anonymity and ease. In a survey of 1,504 mental health professionals, counselors, and clinicians, participants were asked to identify Internet-related problems their clients had brought into their clinical sessions. The most common problems were [16,103,104,105,106,107,108]:

    • Overuse: By far, overuse was the most common problem, with 61% of professionals reporting having clients who excessively use the Internet. In one survey, 28% of adults reported being online "almost constantly." Certainly, this category can overlap with additional compulsions. For example, an individual may excessively use the Internet to engage in viewing online pornography. A specific amount of online activity has not been set as the threshold of what is considered excessive; rather, usage is considered problematic if it interferes with day-to-day activities.

    • Pornography: More than half (56%) of the mental health professionals surveyed regularly dealt with Internet-related pornography issues, such as overuse, family conflict, unwanted exposure, subsequent development of sexually deviant interests, and illegal pornography. It is reported that 53.3% of adults turn to the Internet to meet their sexual needs, spending at least one hour per week engaging in some form of online sexual activity. It has been estimated that 10% of the population may meet the criteria for cybersex addiction.

    • Infidelity: Internet infidelity is defined as a relationship that starts via e-mail, chatrooms, or Internet games and that has a sexual and/or romantic nature. About 20% of professionals' cases involved couples coping with sexual infidelity from Internet activities and the negative impact on the relationship.

    • Sexual abuse: Sixteen percent of professionals reported cases involving a client (often an adolescent or child) who had received unwanted sexual advances over the Internet, including inappropriate sexual and exploitive involvement. In a 2019 study, 5.8% of adolescents reported having become acquainted with someone online with the objective of engaging in online sexual activity in the past year. Nearly 33% had been pressured to engage in online sexual activity at least once.

    • Gaming, role-playing, and gambling: A number of study participants (15%) reported having clients presenting with gaming, role-playing, and gambling problems, primarily stemming from the client's own behavior. This category included persons with problematic behaviors related to online gambling, solitary gaming (e.g., solitaire), interpersonal gaming with other people online (both known and unknown), and fantasy games involving role playing. Online poker is a rapidly growing type of gambling.

    • Harassment: One in 10 professionals had clients who were either perpetrators or victims of online harassment. Online harassment was defined as experiencing defamatory postings by someone else, impersonating another person online, stalking, threatening violence, or physical and emotional abuse as a result of an online relationship. Digital polyvictimization, or a variety of technology-based harassment, was reported in 75% of a community sample of adults. These victims were at increased risk for post-traumatic stress and anxiety.

    • Isolative-avoidant use: Clients who use the Internet to such an extent that they have reduced their face-to-face encounters were reported by 10% of participants.

    Click to Review
  6. Isolative-avoidant Internet use is defined as

    INTERNET-RELATED PROBLEMS

    Although new technologies open doors to new opportunities, they can also bring new challenges and problems, and the Internet is no exception. The Internet can be a tool used to commit various criminal activities, including child pornography, human trafficking, harassment, stalking, scams, and fraud [16]. Those with a drive to act out sexually may be more likely to take action using the Internet due to the perceived anonymity and ease. In a survey of 1,504 mental health professionals, counselors, and clinicians, participants were asked to identify Internet-related problems their clients had brought into their clinical sessions. The most common problems were [16,103,104,105,106,107,108]:

    • Overuse: By far, overuse was the most common problem, with 61% of professionals reporting having clients who excessively use the Internet. In one survey, 28% of adults reported being online "almost constantly." Certainly, this category can overlap with additional compulsions. For example, an individual may excessively use the Internet to engage in viewing online pornography. A specific amount of online activity has not been set as the threshold of what is considered excessive; rather, usage is considered problematic if it interferes with day-to-day activities.

    • Pornography: More than half (56%) of the mental health professionals surveyed regularly dealt with Internet-related pornography issues, such as overuse, family conflict, unwanted exposure, subsequent development of sexually deviant interests, and illegal pornography. It is reported that 53.3% of adults turn to the Internet to meet their sexual needs, spending at least one hour per week engaging in some form of online sexual activity. It has been estimated that 10% of the population may meet the criteria for cybersex addiction.

    • Infidelity: Internet infidelity is defined as a relationship that starts via e-mail, chatrooms, or Internet games and that has a sexual and/or romantic nature. About 20% of professionals' cases involved couples coping with sexual infidelity from Internet activities and the negative impact on the relationship.

    • Sexual abuse: Sixteen percent of professionals reported cases involving a client (often an adolescent or child) who had received unwanted sexual advances over the Internet, including inappropriate sexual and exploitive involvement. In a 2019 study, 5.8% of adolescents reported having become acquainted with someone online with the objective of engaging in online sexual activity in the past year. Nearly 33% had been pressured to engage in online sexual activity at least once.

    • Gaming, role-playing, and gambling: A number of study participants (15%) reported having clients presenting with gaming, role-playing, and gambling problems, primarily stemming from the client's own behavior. This category included persons with problematic behaviors related to online gambling, solitary gaming (e.g., solitaire), interpersonal gaming with other people online (both known and unknown), and fantasy games involving role playing. Online poker is a rapidly growing type of gambling.

    • Harassment: One in 10 professionals had clients who were either perpetrators or victims of online harassment. Online harassment was defined as experiencing defamatory postings by someone else, impersonating another person online, stalking, threatening violence, or physical and emotional abuse as a result of an online relationship. Digital polyvictimization, or a variety of technology-based harassment, was reported in 75% of a community sample of adults. These victims were at increased risk for post-traumatic stress and anxiety.

    • Isolative-avoidant use: Clients who use the Internet to such an extent that they have reduced their face-to-face encounters were reported by 10% of participants.

    Click to Review
  7. Behavioral addictions are distinct from substance use disorders in their progression, consequences, and relapsing patterns.

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    Indeed, many persons with Internet misuse or compulsion can be categorized into an existing psychiatric disorder, indicating that it may be a symptom rather than a unique disorder. Some have suggested that problematic Internet use could fall under the category of behavioral addictions. Behavioral addictions, also referred to as process addictions, refer to compulsive behaviors related to sex, gambling, gaming, and shopping [18]. A behavior moves away from being "normal" and to being pathologic when it produces positive emotions while being performed, but results in negative impact on mood and outlook when the individual cannot stop or reduce the behavior despite the negative consequences [18]. Behavioral addictions are characterized by feelings of tension prior to engaging in the act, and subsequent feelings of gratification or pleasure during and immediately after engaging in the act until the process begins again [19]. It parallels substance use disorders in its progression, consequences, and relapsing patterns.

    Click to Review
  8. In what way does problematic Internet use parallel impulse control disorders?

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    Others have suggested that Internet use disorder may be an impulse control disorder. Problematic Internet use appears similar to impulse control disorders such as pathologic gambling or kleptomania because the behaviors are pleasurable and one cannot resist the impulse to engage in the behavior(s) despite negative consequences [21]. Because use of the Internet can activate reward circuits in the brain, it shares common symptoms/consequences with other impulse control disorders [22]. Like dependence disorders, different types of Internet misuse share four common features: excessive use, withdrawal, tolerance, and negative repercussions [23].

    Click to Review
  9. An activity that involves employing the Internet to locate specific information that pertains to day-to-day activities is referred to as

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    It has also been proposed that the type of online activity and the purposes it ultimately serves will act to further categorize those with problematic Internet use. For example, some have organized compulsive online activities under three headings: excessive gaming, sexual preoccupations, and social media/e-mail/text messaging [23,27]. Still others have distinguished online activities based on the type of gratification individuals can derive [28]. For example, an activity that involves employing the Internet to locate specific information that pertains to day-to-day activities is referred to as content gratification. In other cases, online activity may produce process gratification, which involves satisfaction stemming from the technology itself and the prolonged activity that distracts an individual from fulfilling other responsibilities [28].

    Click to Review
  10. Cybersexual addiction is defined as pathologic abuse of online relationships.

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    Problematic Internet use is a broad term that can encompass different types of behavioral problems [29,30]. Some subtypes include:

    • Cybersexual addiction: Compulsive use of pornographic websites and electronic materials

    • Cyber-relationship addiction: Pathologic abuse of online relationships

    • Online gambling compulsions: Pathologic gambling behaviors facilitated by online gambling websites

    • Information overload: Overuse of the Internet to seek information and read blogs

    • Online gaming compulsions: Joining online groups to play virtual fantasy world games (e.g., Fortnite, FarmVille) and to engage socially with other players.

    Click to Review
  11. Which of the following is NOT a barrier affecting Internet misuse research?

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    Although the topic of problematic Internet use has become of increased interest for researchers and empirical studies in this area have been completed, there are still many research challenges that have yet to be resolved. It is important to keep these in mind when reviewing the findings of studies presented in this course. Some barriers affecting Internet misuse research include [5,26,38,119]:

    • Lack of consensus on the definition of Internet addiction/misuse

    • Variability of assessment instruments. Difficulty agreeing on Internet misuse terminology and criteria has led to the development of a wide range of diagnostic instruments. When researchers use different instruments, it is difficult to compare findings across studies.

    • Self-reported data. Many studies rely on self-reports, which raises questions about the reliability of the data.

    • Small sample sizes. Cross-sectional samples (i.e., recruitment of respondents at one point in time, usually with small sample sizes) are common, which raises the issue of generalizability.

    • Adolescent samples. The majority of studies have focused on adolescents and young adults in school settings, which again can affect the generalizability of findings.

    • Lack of causal inference. Many studies are cross-sectional and correlational in nature. As a result, it is not possible to make causal inferences regarding what factors precede and precipitate Internet addiction. More experimental and longitudinal studies are required.

    Click to Review
  12. Which of the following attributes of the Internet contribute to misuse?

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    The Internet has certain characteristics that promote disinhibition, which can encourage greater disclosure, less restraint, and greater expressiveness [32]. These attributes can make the Internet attractive for users, but they also contribute to problematic behaviors. One such attribute is the relative anonymity of online interactions. There is a perceived safety in being unknown that allows one to take on different personas or say or do things one might otherwise not. For the most part, the Internet, particularly websites, blogs, and other text-based platforms, lends itself to invisibility. In online communication, there is often no concern about nonverbal cues and messages sent. Feeling free of oversight can result in problematic use.

    Online, people can interact and communicate with each other in non-real-time. This asynchronicity provides no feedback loop to discourage negative behavior [32]. Because there are no immediate social and nonverbal cues online, Internet users are able to assign a voice and/or image to another user (consciously or unconsciously) [32]. This projection of real and imagined characteristics onto others' online personas, called solipsistic introjection, can result in false bonding and trust. All of these factors combine to make it easier for a person to dissociate online fiction from offline fact (i.e., dissociative imagination).

    Click to Review
  13. The projection of real and imagined characteristics onto others' online personas

    PROBLEMATIC INTERNET USE: DEFINITIONS AND CONTROVERSIES

    Online, people can interact and communicate with each other in non-real-time. This asynchronicity provides no feedback loop to discourage negative behavior [32]. Because there are no immediate social and nonverbal cues online, Internet users are able to assign a voice and/or image to another user (consciously or unconsciously) [32]. This projection of real and imagined characteristics onto others' online personas, called solipsistic introjection, can result in false bonding and trust. All of these factors combine to make it easier for a person to dissociate online fiction from offline fact (i.e., dissociative imagination).

    Click to Review
  14. Which of the following is NOT one of the most commonly cited reasons for Internet use by children and adolescents?

    SCOPE OF PROBLEMATIC INTERNET USE

    Higher rates of Internet use have been reported in students with average or poor academic performance [121]. The prevalence of problematic Internet use among youths may be lower than adult or college-age individuals because adolescents' Internet usage is typically restricted during school hours. In a study of 7,292 adolescents 12 to 18 years of age, 4.6% boys and 4.7% girls were considered addicted to the Internet, with criteria analogous to those established for pathologic gambling [34]. In a Norwegian telephone study with 3,237 youths 12 to 18 years of age, 2% were addicted to the Internet and almost 9% were considered at risk according to the Young Diagnostic Questionnaire [35]. In a study of 1,618 adolescents 13 to 18 years of age in China, 10.2% were considered moderately addicted and 0.6% were considered severely addicted to the Internet according to the Internet Addiction Test (IAT) [36]. A 2017 Italian study of 224 high school students used the IAT and the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) to assess Internet addiction and problematic Internet use [96]. According to IAT scores, 1.6% had Internet addiction and 24.6% of the students had problematic Internet use. MMPI-A score analysis found that problematic Internet use was strongly associated with "schizophrenia and bizarre mentation" [96]. Entertainment, searching for information, and communicating with friends were the most commonly cited reason for use in all studies.

    Click to Review
  15. In general, men tend to seek online activities that are characterized by

    SCOPE OF PROBLEMATIC INTERNET USE

    Some have speculated that these gender differences may be explained by differences in how men and women use the Internet. In general, men tend to seek online activities that are characterized by dominance, control, or power, and women are more likely to seek online activities that promote relationships and connection with others [1,39]. This difference could explain gender variations between studies, particularly if diagnostic criteria are skewed toward one type of behavior. If time spent on synchronous or real-time Internet communication platforms (e.g., social media) for pleasure-seeking or for avoidance is a criterion, women may score higher [45].

    Click to Review
  16. According to interpersonal theory, problematic Internet use is the result of

    THEORETICAL EXPLANATIONS FOR PROBLEMATIC INTERNET USE

    According to interpersonal theory, individuals' relationships are focal points to understanding behaviors. Early interpersonal relationships, particularly the parent-child relationship, provide the foundation for an individual's well-being and sense of self. This theory also posits that social anxiety results from poor early interpersonal relationships, with children responding to anxiety from the caregiver to form an internalized negative self-image [47]. For these people, the Internet may help to build a social connectedness and sense of belonging to compensate for poor early social relationships [47]. Studies indicate that poor or challenging interpersonal relationships increase levels of social anxiety, which then influences problematic Internet use [47].

    Click to Review
  17. The diathesis stress model adopts some components of cognitive-behavioral theory, but it also focuses on the social context and the individual's pre-existing vulnerabilities.

    THEORETICAL EXPLANATIONS FOR PROBLEMATIC INTERNET USE

    The diathesis stress model adopts some components of cognitive-behavioral theory, but it also focuses on the social context and the individual's pre-existing vulnerabilities. According to this model, there must first be a predisposing vulnerability and an acute stressor in order for the unhealthy behavior to arise [51]. This predisposing vulnerability may be present in the form of an existing psychopathology. For example, an individual with pre-existing symptoms of anxiety or depression may turn to the Internet in response to a stressful life event [51]. Through use of the Internet and its various applications, the behaviors are reinforced, and the pleasurable responses from spending time on the Internet may result in continual and excessive use. An individual's maladaptive cognitions (e.g., distorted view of oneself) perpetuate the misuse of the Internet [51].

    Click to Review
  18. According to Grohol's Model of Pathological Internet Use, the first stage of Internet use is

    THEORETICAL EXPLANATIONS FOR PROBLEMATIC INTERNET USE

    Grohol maintains that individuals, particularly newcomers to the Internet or to a specific Internet use (e.g., social media), go through phases in terms of how they engage and interact with online technology [52]. Stage 1 is the enchantment phase, in which the individual learns to navigate the virtual environment and immerses him/herself into it. Some people have difficulty moving beyond this phase, finding themselves spending more and more time online. Others progress to stage 2, or the disillusionment (avoidance) phase. In this stage, individuals are no longer enchanted with the different features of the Internet and may abandon or avoid use when possible. The final step is stage 3, the balance (normal) phase. Persons in this phase find a balance in incorporating the use of the Internet with their other daily activities.

    Click to Review
  19. In a study of different personality traits as possible predictors of problematic Internet use in adolescents, the strongest predictor was

    RISK FACTORS

    Novelty seeking, or the proclivity to pursue intense novel stimuli in order to obtain excitement and exhilaration, has been linked to substance abuse and impulse control disorders [119]. In a study of different personality traits as possible predictors of problematic Internet use in adolescents, novelty seeking was the strongest predictor for problematic Internet use [53].

    Click to Review
  20. More time spent on Internet applications with an interactive component decreases the risk of developing problematic Internet behaviors.

    RISK FACTORS

    More time spent on Internet applications with an interactive component, such as chat rooms or role-playing simulation such as Second Life or Sims, increases the risk of developing problematic Internet behaviors [33]. In a study of Turkish pre-teens, researchers found that as Internet use transitioned from primarily gaming to chatting over time, the amount of time spent online increased, with some reporting spending more than 10 hours per day online [54]. Another study found that the use of Internet chat applications was a key variable that was correlated with the transition from intermittent problematic Internet use to full addiction [44]. Similarly, in another study with adolescents, excessive use of synchronous or real-time communication applications (e.g., instant messaging, texting, chatting) predicted compulsive use of the Internet within six months; this was not true of e-mail applications [55]. There may be a component of real-time applications that evokes compulsive patterns, preoccupation, and loss of control. However, it is still not completely clear whether Internet applications that have an interactive feature are more "addictive" or if these features attract more individuals who are lonely, isolated, and/or lack social skills.

    Click to Review
  21. Which of the following family life experiences is a risk factor for adolescent Internet misuse?

    RISK FACTORS

    For adolescents, dissatisfaction with family life may predict problematic Internet use. Research indicates that adolescents who disclose being very dissatisfied with their family or who have dysfunctional families are more likely to be addicted to the Internet compared to their satisfied counterparts [36,119]. In a study of 903 Korean adolescents, researchers found that family environment was a strong predictor of problematic Internet use [58]. In a study of 180 male adolescents, authoritarian parenting style predicted problematic Internet use [128]. Adolescents who were exposed to parental marital violence and/or were victims of abuse were at greater risk of being addicted to the Internet than those with non-violent home lives.

    Click to Review
  22. The progression from daily Internet use to compulsive Internet usage is related to low levels of extraversion, agreeableness, and emotional stability.

    RISK FACTORS

    Individuals' personality traits may influence how they use the Internet and how misuse manifests. The progression from daily Internet use to compulsive Internet usage is related to low levels of extraversion, agreeableness, and emotional stability [63]. In a three-year longitudinal study with 1,365 adolescents, the personality traits of low agreeableness, low conscientiousness, high openness, and high neuroticism were correlated with initial problematic Internet use [129].

    Click to Review
  23. It has been posited that problematic Internet use is not a separate diagnostic category, but instead problematic or excessive Internet use is a symptom of another pre-existing mental health condition.

    DIAGNOSIS

    Alternatively, it has been posited that problematic Internet use is not a separate diagnostic category, but instead problematic or excessive Internet use is a symptom of another pre-existing mental health condition, such as depression, anxiety, or obsessive-compulsive disorder [67]. Some believe that the Internet may become a medium for the manifestation of other addictions [68]. For example, a pathologic shopper may use the Internet as a vehicle to make purchases. Studies indicate that individuals with problematic Internet use also tend to have personality disorders, including borderline personality disorder, avoidant personality disorder, and obsessive-compulsive disorder. Persons with poor impulse control and addictive disorders may be more vulnerable to problematic Internet behaviors [66]. One of the main arguments against problematic Internet use being considered a distinct psychiatric condition is that the majority of those displaying problematic Internet behaviors already have a diagnosis of a least one psychiatric disorder [69].

    Click to Review
  24. Which of the following is NOT a sign/symptom of problematic Internet use?

    DIAGNOSIS

    The following symptoms and signs have been associated with problematic Internet use [29,30,33,71]:

    • Preoccupation with online activities and continuing to think about being online while not on the Internet

    • A need to spend more time online in order to feel satisfied

    • Euphoria when online

    • Inability to control Internet usage

    • Irritability or anxiety when Internet usage is reduced or ceased

    • Being online longer than anticipated or scheduled

    • Using the Internet to escape problems or to feel better

    • Lying to family and/or friends about how much time is spent on the Internet

    • Decreasing the amount of time spent on physical or off-line activities

    • Repetitive motion and carpal tunnel syndrome, including numbness and pain in the wrists, fingers, neck, shoulder, or hands

    • Amount of Internet usage begins to be a detriment to work, family, and/or social life

    • Continuing on the Internet even when spending too much on fees for various online activities

    • Minimizing or justifying the negative effects of Internet use

    • Blaming other factors for overusing the Internet

    • Excusing the behavior

    Click to Review
  25. Possibly the most widely used instrument to assess problematic Internet use is Young's Internet Addiction Test.

    ASSESSING PROBLEMATIC INTERNET USE

    Possibly the most widely used instrument, the IAT was developed in 1998 and consists of 20 questions focusing on various types and frequency of Internet-related behaviors [33]. Points are assigned based on the frequency of behaviors, with 0 points for not applicable behaviors, and 5 points for activities that the user "always" engages in. A score of 80 or more indicates problematic Internet use. A copy of the IAT is available at https://www.stoeltingco.com/media/wysiwyg/IAT_web_sample.pdf.

    Click to Review
  26. The Chen Internet Addiction Scale (CIAS) consists of

    ASSESSING PROBLEMATIC INTERNET USE

    The CIAS consists of 26 questions answered using a four-point Likert scale to indicate frequency of behaviors. It assesses the domains of compulsive use, tolerance, negative consequences with interpersonal relationships, and time management after withdrawal [131]. The clinical cutoff point is 64, with higher scores indicative of problematic Internet use [73,131].

    Click to Review
  27. A more in-depth clinical assessment is always necessary to fully understand the context of an individual's Internet use.

    ASSESSING PROBLEMATIC INTERNET USE

    Screening instruments can be very helpful to rapidly assess clients at risk for Internet abuse. However, in some cases, a more in-depth clinical assessment is necessary to fully understand the context. One way of approaching this is to ask about environmental factors, usage frequency and content, and dual diagnosis issues [76].

    Click to Review
  28. Which of the following has been identified as a psychosocial consequence of excessive Internet use?

    CONSEQUENCES OF PROBLEMATIC INTERNET USE

    Many studies have linked excessive Internet use to negative psychologic well-being, particularly increases in depressive symptoms. A study of Spanish college students found that individuals who were considered Internet and cell phone over-users were more likely to experience symptoms of insomnia, anxiety, and depression than those who used the Internet less [79]. Other studies have supported these findings. Not only are depression and other psychologic disorders often present in persons with excessive Internet use in general, rates of psychologic disorders (e.g., depression, obsessive-compulsive disorder) increase with the amount of time spent online [44]. Problematic Internet use is also associated with an increased risk for suicide [135].

    Click to Review
  29. Which of the following is a cognitive-behavioral intervention for problematic Internet use?

    INTERVENTIONS FOR PROBLEMATIC INTERNET USE

    Cognitive-behavioral therapy (CBT) is based on the premise that cognitions or belief systems dictate behavior. Individuals with problematic Internet use tend to display signs of overgeneralizations, rigid thinking, cognitive distortions, and other maladaptive thought processes that contribute to using the Internet to cope or escape [84,85]. Cognitive restructuring and specific activities to monitor and limit Internet use may therefore be effective. This would consist of identifying the client's maladaptive beliefs, challenging them, and developing self-talks to restructure the existing belief systems. Concrete, structured, and measurable techniques are required to help diminish the negative behavior (i.e., overuse of the Internet). These interventions include [85,136]:

    • Implementing external stoppers (e.g., timing Internet usage and setting limits)

    • Identifying specific tasks for Internet use

    • Posting physical reminders regarding the negative effects of Internet overuse and the benefits of reducing Internet use (e.g., notes on the computer)

    • Identifying alternative activities to substitute for Internet activities

    • Implementing behaviors that would disrupt normally scheduled Internet activities to assist in establishing new patterns and habits. For example, if a client checks e-mail upon waking, instruct him/her to eat breakfast first, after which he/she can check e-mail.

    • Moving the computer or using a device or tablet only in the presence of other people to develop accountability.

    • Keeping a diary documenting Internet use.

    Click to Review
  30. Because the family environment plays a role in problematic Internet use, family-based interventions should be a component of the treatment.

    INTERVENTIONS FOR PROBLEMATIC INTERNET USE

    Studies indicate that individuals who are dissatisfied with their family life are more likely to engage in problematic use of the Internet. Because the family environment plays a role in problematic Internet use, family-based interventions should be a component of the treatment [89]. This would include parent training to assist in helping improve communication between them and their children (for younger abusers), developing skills to promote healthy family interactions, family therapy, and a focus on developing positive self-esteem and identity.

    Click to Review

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.