Clinical Practices and SummaryThe f

Clinical Practices and Summary
The following clinical techniques with empirically supported utility may be drawn from treatment
studies for adolescent Internet addiction:
An activity-monitoring schedule may be useful for a clinician and client to gain a shared
understanding of what types of online activities occur (i.e., in a typical week), at baseline
and over the course of therapy. It may also be useful for the client to document thoughts
and emotional states before, during, and after online activities to understand the functional
purpose of Internet use. Cognitions, emotions, and behavioral activity that occur in response
and in tandem to the online behavior should also be recorded. For example, John should keep
a log of those times when he fights with his parents about his computer use or urinates in a
bottle at his computer. This information may be helpful for John to understand the negative
effect of his excessive computer use, and motivate positive change. Treatment goals should be realistic given the pervasiveness of the Internet in school and home
life. For example, abstinence from the Internet may not be possible, given its role in homework
assignments, social life, and so on. Controlled or regulated Internet use is often the target
goal in clinical studies (Shek, Tang, & Lo, 2009). John’s initial goal in therapy, therefore, may
be to not use the Internet when doing his homework. Young (2007) suggests that behavior therapy (i.e., conditioning) may be used to relearn how
to use the Internet to achieve specific outcomes, such as moderated online usage and, more
specifically, abstinence from problematic online applications and controlled use for legitimate
purposes. Behavior-based strategies to reduce prolonged Internet use may be useful in the beginning
stages. For example, using an alarm clock to set a maximum limit of 45 minutes of Internet
use, and then having to do something else for 15 minutes. Similarly, having the client wait for
5 minutes at the computer with the screen turned off before initiating use. Behavioral experiments to test problematic cognitions associated with Internet use (e.g., “I
have no control over my Internet use”) or reduced online behavior (e.g., “I am worthless
without the Internet in the life”) may help to build a client’s self-confidence. An example experiment
may involve testing a belief about “uncontrollability” by having the client repeatedly
open and close a favorite website without interacting with the website. Psychoeducation is an effective adjunct to CBT, particularly for an adolescent’s parental
authorities. Many parents have limited knowledge of the Internet, its functions, and issues of
cyber safety. Parents should also be informed that simply removing the computer from a heavy
adolescent user’s life can be a significant shock and may be counterproductive to developing
a trusting and supportive parent-child relationship (Dini, 2008). John’s parents’ attempts to
reduce John’s Internet use by removing and restoring Internet access in the bedroom were
not effective and created significant relationship discord. It would be helpful if they provided
John with support and encouragement for his efforts in reaching his therapeutic goals. Working collaboratively with adolescent clients and their parents has been shown to improve
parent-child communication and consolidate CBT practice. In most cases, an adolescent’s
habitual Internet use is likely to have resulted in a breakdown in family communication and
cause significant stress and conflict. Family relationships may be repaired by collaboratively
reaching a shared understanding about what Internet addiction is and what it is not, having
common goals for therapy, and setting time for bonding as a family.