*2.3.2. Internet Addiction Diagnostic Questionnaire (IADQ)*

This questionnaire was developed by Young [7]. It is a self-report measure which consists of eight items dichotomously. It is based on the diagnostic symptoms of pathological gambling [40]. This questionnaire utilized the following criteria: preoccupation, tolerance, loss of control, withdrawal, negative consequences, denial, and escapism. If the scores were five or more of the criteria, it indicates Internet addiction.

### *2.3.3. Chen's Internet Addiction Scale (CIAS)*

This scale was developed by Chen et al. [27] and was the most frequently used scale in the empirical research papers studying Internet addiction. The CIAS is a self-report measurement consists of 26 items on a 4-point Likert scale. It assesses the main symptoms of Internet addiction, tolerance, compulsive use, and withdrawal, as well as related problems in terms of negative impact on social activities, interpersonal relationships, physical condition, and time management. Furthermore, it assesses the weekly online hours and Internet use experience. The scores of 67/68 indicate Internet addiction. It has good internal consistency of the scale, with Cronbach's alpha values between 0.79 and 0.93 for the subscales [27].

#### **2.4. Risk factors**

Several risk factors have been identified as associated factors for Internet addiction especially among adolescents and adults. Some of these factors are related to socio-demographic variables such as age (being younger adolescents and younger adults [31, 41, 42]), gender (being male) [3, 11, 17, 24, 25, 27, 30–34, 41–46], female gender [22], higher family income levels [17, 44], living in rural areas (for adolescents) [47], living in urban areas (for adults) [34], single parent (for adults) [24, 33], marital status (for adults) (being single) [24], income (for adults) (financial difficulties), unemployment (for adults) [11], university year level (being in lower-year levels) (e.g., first or second year) [31, 42] and lower school grade levels (for adolescents) [3, 22, 27], and ethnic group (Asian ethnicity) [38].

**2.3. Assessment tools of Internet addiction**

186 Cognitive Behavioral Therapy and Clinical Applications

*2.3.1. Young's Internet Addiction Test (YIAT)*

with a Cronbach's alpha of 0.93 [23].

(IADQ), and (3) Chen's Internet Addiction Scale (CIAS).

*2.3.2. Internet Addiction Diagnostic Questionnaire (IADQ)*

of the criteria, it indicates Internet addiction.

*2.3.3. Chen's Internet Addiction Scale (CIAS)*

subscales [27].

**2.4. Risk factors**

Many tools have been developed to investigate Internet addiction or similar concepts. However, the main diagnostic assessment instruments used widely in empirical studies involve (1) Young's Internet Addiction Test (YIAT), (2) Internet Addiction Diagnostic Questionnaire

It was developed by Young [10] by adapting Diagnostic and Statistical Manual IV (DSM-IV) criteria for substance dependence and pathological gambling [40], and it is a modification of the previous 8-item scale. The criteria include loss of control, neglecting everyday life, relationships and alternative recreation activities, behavioral and cognitive salience, negative consequences, escapism/mood modification, and deception. It is a self-report scale and consists of a 20 items; each item is scored using a 5-point Likert scale ranging from 1("not at all") to 5 ("always"). The score of the total scale ranges from 20 to 100. The Internet users are categorized as follows: a score 70–100 reflects significant problems due to Internet use and 40–69 reflects frequent problems when scoring [13]. It has shown to be reliable and valid [13]. The internal consistency of the Internet Addiction Test (IAT) has been reported as excellent,

This questionnaire was developed by Young [7]. It is a self-report measure which consists of eight items dichotomously. It is based on the diagnostic symptoms of pathological gambling [40]. This questionnaire utilized the following criteria: preoccupation, tolerance, loss of control, withdrawal, negative consequences, denial, and escapism. If the scores were five or more

This scale was developed by Chen et al. [27] and was the most frequently used scale in the empirical research papers studying Internet addiction. The CIAS is a self-report measurement consists of 26 items on a 4-point Likert scale. It assesses the main symptoms of Internet addiction, tolerance, compulsive use, and withdrawal, as well as related problems in terms of negative impact on social activities, interpersonal relationships, physical condition, and time management. Furthermore, it assesses the weekly online hours and Internet use experience. The scores of 67/68 indicate Internet addiction. It has good internal consistency of the scale, with Cronbach's alpha values between 0.79 and 0.93 for the

Several risk factors have been identified as associated factors for Internet addiction especially among adolescents and adults. Some of these factors are related to socio-demographic variables Moreover, there are factors related to Internet use and patterns of Internet use, which are also recognized as risk factors for developing Internet addiction. Age of using Internet for the first time (being so young or earlier adolescence age) [11, 17, 33], frequency [17], and duration (more than 10 hours daily) of Internet use [17, 22, 27, 31, 35, 36], Internet access at home [12], Internet use at an Internet café [25, 27], purposes of Internet use (e.g., for noneducational purposes [e.g., downloading programs, music or movies, playing online games or chatting, and social networking] [17, 22, 32, 35], online activities and practices [e.g., communicating, playing online games, listening to music, making new friends, and online chatting] [25, 35], Internet use for mood regulation [47], and having a hobby such as reading books [18]), positive outcome expectancy from Internet use, and low self-efficacy toward using Internet [36] have relationships with the development of Internet addiction. In addition to this, parental involvement and guidance regarding Internet behaviors were reported to be correlated with Internet addiction, specifically little parental communication about Internet use and lack of rules about Internet times and use [48]. It is suggested that social factors including poor academic performance (for adolescents) [8] and dissatisfaction with academic performance (for adults) [32, 36], poor relations with school [43, 49], inadequate social adaptation [17], stress [43], leisure boredom [50], presence of peers and siblings consuming alcohol [49], and lack of social support [8, 34, 38, 42] are associated with Internet addiction.

It is reported that family variables were associated with Internet addiction such as family conflict and dissatisfaction [43, 49], an insecure attachment style [36], child maltreatment experiences [32], poor parental relationship [25, 46], poor family love [32], homesickness [33], low parental involvement and supervision [50], and showing positive attitude to adolescent substance use by parents [49].

Health-risk factors such as consuming alcohol, substance use, and smoking have been suggested as risk-factors for Internet addiction. Previous studies have documented a relationship between alcohol, substance use, and Internet addiction [43]. Onen et al. [45] revealed that there was a relationship between Internet addiction and smoking. In addition, a behavioral factor such as a habit of skipping breakfast [34] was correlated with Internet addiction.

It is necessary to recognize that psychological and psychiatric problems and symptoms are also associated with Internet addiction. Several studies have reported a relationship between Internet addiction, depression, anxiety, attention deficit and hyperactivity disorder, social phobia, neurosis, solitude, hostility, aggressive behaviors, suicide, psychological dysfunction, and emotional and behavioral problems [8, 10, 11, 17, 22, 27, 41, 42, 51, 52]. It is also reported that negative personality characteristics including depressive thoughts, low self-esteem, poor self-perception and concept [38, 53], novelty seeking, harm avoidance, low reward dependence [38], impulsivity [36, 49], introversion, low agreeableness, and emotional instability [54], escapism and fantasy [30], could lead to the development of Internet addiction. Furthermore, the following internal characteristics were documented as risk factors: low life satisfaction [17], low well-being [54], loneliness, lack of confidence [17, 30], preference for online social interaction, negative life outcomes [47], and seeking for enjoyment and entertainment [49].

behavioral therapy is not a discrete treatment technique, but it is a general term refers to a group of therapies [57]. Through treatment by CBT, the therapists use many techniques including relaxation, social, physical, and thought exercises to raise a client's awareness of his or her emotional and behavioral patterns, challenging beliefs, mindfulness-based interventions [57]**,** journal writing therapy or writing therapy [58], and time management

Internet Addiction and Cognitive Behavioral Therapy http://dx.doi.org/10.5772/intechopen.71277 189

• **Interpersonal therapy** is a type of treatment concentrating on enhancing interpersonal connections and actual social relationships with friends, parents, and others. Therefore, this therapy purposes to find new methods of interaction and includes the following interventions: encouraging influence, developing communication techniques and strategies, mod-

• **Support groups** may be helpful in the treatment of Internet addiction. These support groups should be applied to help addicts in attaining appropriate support that facilitate recovery. Moreover, couples counseling could be a necessary part of recovery among Internet addicts, whose marital and familial relationships have been negatively affected by

This is the first model of its kind and the most effective type of therapy for Internet addiction that is focusing on cognitive behavioral therapy (CBT). Researchers have documented that using cognitive behavioral therapy (CBT) is an effective treatment for Internet addiction [53]. The CBT in general helps addicts to realize addictive feelings and actions, while learning new coping skills and methods to prevent a relapse. The CBT usually takes 3 months of treatment or approximately 12 weekly sessions. The focus of this therapy is to assess the client's patterns of use and then develop new schedule to change the past formed patterns. External influences such as activities that demand the addict to leave Internet could be applied. There are also treatment programs that help the client in identifying goals about the time needed for using

The CBT-IA model is a comprehensive approach which can be divided into phases, including (1) behavior modification, (2) cognitive restructuring, and (3) harm reduction therapy (HRT). The first phase or the early stage of therapy is behavior modification that is focusing on specific behaviors and situations where the impulse control disorder causes the significant difficulty and is used to control compulsive Internet use and reduce the time spend online by addict. The second phase is a cognitive restructuring that is applied to identify, challenge, and adjust cognitive disruptions and negative beliefs that cause a compulsive usage of Internet and effect on this behavior of addiction [53]. The third phase is harm reduction therapy (HRT) that is a new and untested therapy, which is used for continuation of recovery and prevention of relapse. The HRT is used to recognize and cure psychiatric problems related to Internet addiction and treat social problems in relationships with families, peers, and friends. We will

**2.7. Cognitive Behavioral therapy for Internet addiction (CBT-IA)**

methods [59].

eling, and role-playing.

Internet addiction.

the Internet.

discuss each in turn.

#### **2.5. Negative consequences of Internet addiction**

Internet addiction results in experiencing physical, social, and mental or psychological problems. It has been linked to physical problems like sleep disturbance, eating problems, limited physical activity, back strain, eyestrain, and others [52]. Research literature has been demonstrated that Internet addiction leads to a poor health condition, excessive daytime sleepiness, insomnia, nightmares, difficulty in falling asleep and night awakenings [2], loss of energy, physiological dysfunction, weakened immunity [17], overweight and obesity, and impaired vision [55].

The Internet addicts transfer their social lives into the Internet world. Internet addiction leads to many social issues such as disturbing family, social, and workplace relations, where it isolates the persons from family and society and keeping them away from social interactions [27]. It has a negative effect on interaction with peers and friends, family life, academic life, and social life [41].

It is important to understand that Internet addiction may lead to negative effects on psychological development for population. The worst effects are Internet anxiety [38, 46], depression [30, 32, 33, 36, 51], suicidal ideation [51], social phobia and phobic anxiety [41], schizophrenia, obsessive-compulsive disorder [30], antisocial/aggressive behaviors [49], self-injurious behavior [56], harmful alcohol use [46], and sleeping disorders [31]. In a Chinese study conducted among school students, the results indicated that the scores for comorbid disease and impulsivity were higher among students experienced Internet addiction [52].

#### **2.6. Treatment for Internet addiction**

Treatment for Internet addiction is similar to treating any other types of addiction. It involves cognitive behavioral therapy, interpersonal psychotherapy, and support groups.

• **Cognitive behavioral therapy (CBT)** is a short-term and problem-focused type of behavioral treatment. It focuses on helping clients consider the relationship between beliefs, thoughts, and feelings and following behavior patterns and actions. During CBT, clients learn that their perceptions influence directly on responses to specific situations. In particular, a client's thought process guides his or her behaviors and actions. Cognitive behavioral therapy is not a discrete treatment technique, but it is a general term refers to a group of therapies [57]. Through treatment by CBT, the therapists use many techniques including relaxation, social, physical, and thought exercises to raise a client's awareness of his or her emotional and behavioral patterns, challenging beliefs, mindfulness-based interventions [57]**,** journal writing therapy or writing therapy [58], and time management methods [59].

