Treatment of Internet Addiction

The initial and perhaps most crucial component of treatment protocols for children and adolescents with addictive behaviour is establishing a therapeutic alliance. Young people with “Internet addiction” are often reluctant to attend consultations and may be highly irritable or angry with their parents, whom they see as overreacting. 

To establish a good relationship, the therapist uses motivational interviewing techniques and should be warm, approachable, honest and respectful toward the young person; seeking to understand and help address problems that are often related to parental relationships, peer interactions or academic performance. Many of these children and adolescents are withdrawn, show cognitive rigidity, lack empathy and have difficulties with social understanding. As a result, they may display inadequate, defiant or challenging behaviour, to which the therapist must respond calmly with composure. Working with these boys requires patience, frustration tolerance, flexibility, enthusiasm and confidence in their potential.

To help control addictive behaviour, it is advisable to suggest a period of abstinence (at least temporarily) from certain video games or technological applications for the adolescent. However, as technology today is necessary for daily functioning, it may not be realistic to propose total screen abstinence for patients. Adolescents are unlikely to accept this as an initial option, and, moreover, the recreational or social activities they engage in through video games or the Internet have today become part of a healthy development when practised in moderation. 

Therefore, new treatment strategies have been proposed to support controlled use of video games, social networks and other Internet-based social or leisure activities. The specific therapy objectives must be agreed with the young man and his family, as well as the treatment plan to achieve them. It is useful to establish “therapeutic contracts” or “family agreements” that specify the rules for using the devices involved. 

Treatment should also address underlying difficulties, as screens may be used as an escape or defence mechanism against personal difficulties. Therefore, most therapeutic programmes incorporate cognitive-behavioural techniques for problem-solving, emotion and stress management, impulse control, restructuring of obsessive thoughts, frustration tolerance, social skills and relapse prevention. It is often necessary to introduce techniques to foster empathy, address cognitive rigidity and enhance social and moral reasoning.

In recent years, the treatment of addictions has increasingly incorporated so-called third-generation psychotherapeutic techniques, including the aforementioned motivational interviewing techniques, dialectical behaviour therapy, acceptance and commitment therapy and mindfulness. Finally, it is also important to help the youngster create a new lifestyle, which includes different leisure alternatives among his daily obligations of going to school or performing domestic tasks, for example. This may involve training in time management and organisation, enhancing social support networks and facilitating engagement with community resources.

Family-based intervention also represents a key component in the prevention and treatment of adolescent addictions. Psycho-educational groups for parents are recommended. This helps them understand the nature of addictions; learning to maintain authority in the home, by combining firmness with affection and respect for the adolescent; as well as supporting his development towards autonomy, responsibility and healthy leisure pursuits. Family therapy can also be performed to recover the bond between family members, re-define roles, work through guilt and facilitate emotional communication and empathy. 

In some cases, psychotropic treatment is also necessary; for example, when the patient has severe or persistent symptoms of anxiety or depression, obsessive-compulsive behaviour, delusional thoughts or a high level of impulsiveness or hostility, leading to aggressive responses, when family members attempt to set limits on screen use.

According to clinical experience with children and adolescents, outpatient treatment is always preferable, but in some cases partial or full hospitalisation may be necessary. In some cases, when addiction is severe or there are comorbid disorders or serious family difficulties, intensive treatment may be required in a day hospital; or full hospital admission may be necessary - both to provide containment and treatment in a situation of acute crisis - and to conduct a psychiatric assessment.  In the day hospital, conflicts arising from attempts at family control are addressed. Reintegration into school can also be facilitated for young people who have dropped out. 

In severe cases, treatment may need to take place in residential therapeutic centres or through short hospital stays if little progress has been made in outpatient care.