Avatar to Addiction

Engaging adolescents with Internet Addiction: 

Why it’s crucial to understand their world.

Like it or not, computer and internet use is firmly cemented in our social structure. There are many advantages to these technological advancements including the revolution of how our children are educated, accessing information, learning and communicating. Unfortunately with these advantages comes unknown risks one of which has been identified as the excessive use or even obsession with the use of the internet applications and online games.

Since the prospect of Internet Addiction was identified, a small group of dedicated researchers has been scrambling to answer a plethora of questions including possible diagnostic criteria for such a disorder, how to assess this group of symptoms, and perhaps the biggest question is how to develop an effective treatment model. Without delving into the statistics, from a clinical perspective it is evident research is playing catchup to an increasing presentation rate faced by our public and private mental health services.

While I will divert many questions such as the development of diagnostic criteria for possible inclusion in the DSM-V, to the expert researchers in the field, I would like to discuss recent advances in treatment for Internet Addiction. More specifically, I will refer to an aspect of treatment that to my knowledge has been neglected in current literature.

What do we mean by engaging?

I am referring to a process that communicates empathy for the young person’s online world and the important needs that it meets. In my experience this can be done by making a concerted effort to understand their game or social media platform of choice (may be multiple) to combat the inevitable “you wouldn’t understand” adolescent resistance. Every therapist should ask themselves, do I understand the game or social network they play? How it operates? How the reinforcement is administered? And ultimately how the game or play is supporting the online self-concept (ie why is their online persona so appealing?).

Why do we need to emphasise engagement?

There are three main benefits to establishing strong rapport when treating children and adolescents with I.A.:

1. The Assessment Process: Murali & George (2007) suggest some key points and aspects that are crucial to assessing IA. Their assessment places emphasis on gathering information around history (onset, progression, favourite applications of use), impact on functioning, co-morbid psychiatric disorders, and the need to obtain corroborative information. Theoretically, these are all valuable aspects in assessing IA, however, how often do teenagers suffering from IA readily volunteer this information? In my experience, very rarely. It is therefore crucial to establish engagement and build rapport to conduct an accurate assessment of the symptoms.

2. The Treatment of Internet Addiction: Young’s (2007; 2011) Cognitive Behavioural Therapy (CBT) model is the first treatment model that has shown some very encouraging outcomes. She suggests that treatment would require targeting the behavioural component first, followed by challenging the unhelpful cognitions (thoughts) and then a period of ‘harm reduction” strategies. I am excited by the prospect of this treatment and for the most part agree with its theoretical grounding. However, we appear to be missing a crucial step in the model: engagement and rapport building. Without engagement, rapport and motivation most treatment modes will fail. I can appreciate this may not have been a major consideration for Young as she may be referring to an adult population which in most cases possess at minimum the motivation to attend a treatment program. Children and adolescents are often “forced” by their parents or responsible adult to seek treatment and regularly don’t acknowledge their internet use as problematic.

As a psychologist working predominantly with children and adolescents, there are two main areas of Internet Addiction I have found challenging in my clinical work: online gaming (role player and strategic games) and social media. Both areas have been linked to the idea of extreme self-concepts (Davis 2001; Young 2011). This means the “real world” self has often encountered low self-esteem due to bullying or trauma, making way for a second “online” self-concept to be created. This “online” self-concept is based on negative cognitions such as “my online friends think I am great, all my friends at school hate me”. It is therefore not hard to see how a young person can become immersed in their online persona or avatar. With this in mind, we can hypothesis that the behavioural treatment proposal to reduce internet use and thus damage their online social world will be met with resistance. It is for this reason that I propose that any treatment mode would benefit from significant attempts to engage the child or adolescent on their level.

3. The Treatment of Co-Morbid Disorders: Developing a strong rapport also enables the therapist to treat co-morbid disorders that may be present either prior to or have developed since the onset of IA. Recent research suggests that clients suffering from IA have elevated rates of other psychiatric diagnosis including Depression, Social Anxiety, Attention Deficit Hyperactivity Disorder (ADHD), and Drug and Alcohol use (C.-H. Ko, J.-Y.Yen, C.-F. Yen, C.-S. Chen, C.-C. Chen; 2012).

Furthermore, past research has indicated that 29% of people suffering from IA report using it to alter their mood or escape reality (Greenfield 1999). I would suggest this psychological escape is a significant underlying factor for children and adolescents who often turn to the comfort of their social online world to combat social difficulties in their real world. Future research may benefit from establishing if children and adolescents with IA are using the online world as a coping mechanism and any possible similarities to how this age group use other maladaptive coping mechanisms such as Deliberate Self-Harm and Drug and Alcohol use.

Case Study: Brian

Brian is a 14 year old boy presenting with IA symptoms due to his constant use or obsession with a Harry Potter website. On first assessment it appeared the use was a special interest not unlike that commonly found in clients with Asperger’s Syndrome. After some brief research and further sessions that focused purely on engagement and trying to understand Brian’s world, it became evident that his internet use was an online virtual world where you create an Avatar and interact in a virtual “Harry Potter” scenario. He would spend anywhere from 6-12 hours a day online, often playing in the early hours of the morning so he could be online at the same time as others in Asia and North America.

Brian had created a preferred “online” self in which he was a well respected professor at Hogwarts, conducting lectures to other Avatars on certain topics. This was a stark contrast to his “real world” self where he was socially isolated and a victim of physical and emotional bullying at school. Brian had become very defensive and avoided talking about his internet use, firstly out of fear he would be judged by others, and secondly, due to the prospect it would be taken away.

Hints for Engaging Adolescents with I.A.

  • Understand how the game or online application works.
  • Avoid judgmental statements. Instead focus on understanding what reinforcement is being provided and/or what needs are being met by the “online world”
  • Make a concerted effort to understand the game or media platform of interest.

Food for Thought: Other Practical Challenges

As we see rapid advances in technology, we will inevitably be faced with increasing challenges in treatment. The most obvious of these may be the development of smart phones. These “mobile mini computers” have truly revolutionized our society changing how we do business, organise our lives and access the internet.

This provides a generation of children and adolescents already struggling with excessive use of computer applications and the internet an opportunity to go viral. Computer games that were traditionally limited to the home computer are now accessible to young people around the clock. Could we see a generation of “more functional” (harder to detect and diagnose) gamers that don’t follow the agoraphobic house bound stereotypical adolescent with IA? Surely if this is occurring the diagnostic indicators would need to focus on under developed social skills as they may be “going out” but not actually engaging in social relationships.


To be complete

Brad Marshall