|
| A) | Individuals 18 to 29 years of age | ||
| B) | Individuals 30 to 39 years of age | ||
| C) | Individuals 40 to 59 years of age | ||
| D) | Individuals 65 years of age and older |
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, 92% of all households had Internet use and 85% had broadband access in 2018 [100]. 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 (75%); Internet use also increases with income and education levels [52]. With Web 2.0, more people are using social networking sites and creating and viewing podcasts, vodcasts, and blogs. As of 2021, the top five Internet activities were texting or instant messaging, e-mail, using social networking sites, engaging with online financial services, shopping, making travel reservations, and other online consumer services [91].
| A) | 35% | ||
| B) | 65% | ||
| C) | 85% | ||
| D) | 97% |
Cell phones, particularly smartphones (and therefore, the Internet), are an integral part of the fabric of individuals' lives. In 2021, an estimated 97% of adults in the United States own any type of cell phone, and 85% 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].
| A) | |||
| B) | Myspace | ||
| C) | YouTube | ||
| D) |
More individuals are using social networking sites for personal and professional purposes as well. The most popular social networking sites are YouTube (used by 81% of adults), Facebook (used by 69% of adults), and Instagram (used by 40% of adults) [102]. In a 2019 survey, 74% of the research participants reported using 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 77% of online women and 61% of online men use Facebook. A total of 70% of online adults 18 to 29 years of age use the site, compared with 77% of those 30 to 49 years of age, 73% of those 50 to 64 years of age, and 50% of those 65 years of age and older [14]. With the COVID-19 pandemic and related individuals spent much more time alone, moving to online classes and shopping. Experts have speculated that addictive or problematic behaviors on the Internet may have been exacerbated [140].
| A) | experiencing defamatory postings for someone else. | ||
| B) | engaging in online gaming for extensive periods of time. | ||
| C) | impersonating another person or a fictional person online. | ||
| D) | using the Internet to such an extent that face-to-face encounters are reduced. |
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 overuse, pornography, infidelity, sexual abuse, and harassment [16,103,104,105,106,107,108]. Psychiatric mental health nurses identified these same types of problematic Internet exposures in a 2015 survey, indicating that the problems over the past decade have remained constant [15]. Further, isolative-avoidant use is a concern. Clients who use the Internet to such an extent that they have reduced their face-to-face encounters were reported by 10% of participants.
| A) | Overuse | ||
| B) | Pornography | ||
| C) | Isolative-avoidant use | ||
| D) | Gaming, role-playing, and gambling |
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.
| A) | True | ||
| B) | False |
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. Forming relationships online may be easier because people feel safer self-disclosing because of the physical distance [143]. About 20% of professionals' cases involved couples coping with sexual infidelity from Internet activities and the negative impact on the relationship.
| A) | True | ||
| B) | False |
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.
| A) | Both involve some level of withdrawal. | ||
| B) | The development of tolerance is evident. | ||
| C) | The behaviors are pleasurable and one cannot resist the impulse to engage despite negative consequences. | ||
| D) | There are feelings of tension prior to engaging in the act and subsequent feelings of gratification during and immediately after. |
Others have suggested that Internet use disorder may be an impulse control disorder [147]. 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].
| A) | process gratification. | ||
| B) | content gratification. | ||
| C) | excessive online gaming. | ||
| D) | search engine gratification. |
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].
| A) | True | ||
| B) | False |
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.
| A) | Self-reported data | ||
| B) | Older adult samples | ||
| C) | Lack of consensus on definition | ||
| D) | Variability of assessment instruments |
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 [5,12,26,38,119]:
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.
Failure to control for other variables. A range of variables might explain the negative effects of problematic or excessive misuse of the Internet.
| A) | Asynchronous communication | ||
| B) | Lack of nonverbal cues or messages | ||
| C) | Relative anonymity of online interactions | ||
| D) | All of the above |
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.
| A) | is only a conscious decision. | ||
| B) | can result in false bonding and trust. | ||
| C) | is referred to as totalitarian interjection. | ||
| D) | make it easier to separate online fiction and offline fact. |
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).
| A) | Shopping | ||
| B) | Entertainment | ||
| C) | Searching for information | ||
| D) | Communicating with friends |
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]. In Japan, researchers found a prevalence rate of 4.6% elementary-aged children [148]. 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.
| A) | connection with others. | ||
| B) | promotion of relationships. | ||
| C) | avoidance of real-life issues. | ||
| D) | dominance, control, or power. |
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].
| A) | a lack of social skills. | ||
| B) | differences in brain structure. | ||
| C) | cognitive distortions and negative self-talk. | ||
| D) | poor or challenging relationships increasing levels of social anxiety. |
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].
| A) | True | ||
| B) | False |
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].
| A) | the balance phase. | ||
| B) | the avoidance phase. | ||
| C) | the enchantment phase. | ||
| D) | the disillusionment phase. |
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 [154]. 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.
| A) | novelty seeking. | ||
| B) | harm avoidance. | ||
| C) | self-directedness. | ||
| D) | conscientiousness. |
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].
| A) | True | ||
| B) | False |
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.
| A) | Being a victim of abuse | ||
| B) | Exposure to parental discord | ||
| C) | Satisfaction with family relationships | ||
| D) | Having multiple siblings or a large family |
In studies of high school students in Taiwan, the level of boredom in an individual's leisure time predicted risk of problematic Internet use [56]. In a study of 564 junior high school students, a positive relationship was noted between attention deficit hyperactivity disorder (ADHD) and problematic Internet use [156]. Similarly, another study found that attention deficit was related to problematic Internet use among college students in Taiwan, with stronger correlation in women than in men [57]. This was more so the case for women than men. It is plausible that the Internet offers a vehicle for an individual to be engaged in activities that require quick responses, which then offsets the feeling of boredom, particularly in persons with ADHD.
| A) | True | ||
| B) | False |
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].
| A) | True | ||
| B) | False |
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 [69,161]. Furthermore, the question of causality remains [161].
| A) | Minimizing the positive effects of Internet use | ||
| B) | Blaming other factors for overusing the Internet | ||
| C) | Lying to friends or family about time spent on the Internet | ||
| D) | A need to spend more time online in order to feel satisfied |
The following symptoms and signs have been associated with problematic Internet use [29,30,33,71,154,162]:
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
Depressive symptoms
Being online longer than anticipated or scheduled
Using the Internet to escape problems or to feel better
The Internet gets in the way of other activities
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
Feeling bored and that life is empty
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
| A) | True | ||
| B) | False |
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 [33,160]. 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. The IAT has been the most widely utilized instrument in empirical studies, having been validated in the United States and other countries [163]. In a review of empirical studies conducted between 1991 and 2016, 30% used the IAT [164]. A copy of the IAT is available at https://www.iitk.ac.in/counsel/resources/IATManual.pdf.
| A) | 14 questions. | ||
| B) | 26 questions. | ||
| C) | 55 questions. | ||
| D) | 200 questions. |
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].
| A) | True | ||
| B) | False |
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].
| A) | Improved self-esteem | ||
| B) | Decreased online bonds | ||
| C) | Increased depressive symptoms | ||
| D) | Increased social isolation but decreases in rates of psychological disorders |
Many studies have linked excessive Internet use to negative psychological well-being, particularly increases in depressive symptoms. A quantitative study with 673 young adults (18 to 25 years of age) found that psychological well-being decreased as Internet addiction levels increased [167]. 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 psychological disorders often present in persons with excessive Internet use in general, rates of psychological 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 and substance use and addiction (including opioids, club drugs, and hallucinogens) [135; 168].
| A) | Using external stoppers | ||
| B) | Implementing behaviors that disrupt normally scheduled Internet activities | ||
| C) | Posting physical reminders regarding the negative effects of Internet overuse | ||
| D) | All of the above |
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.
| A) | True | ||
| B) | False |
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, psychosocial support, and a focus on developing positive self-esteem and identity [171].