Contrary to our expectation, the magnitude of the correlations between relational ability and quality, parental relationships and family functionality, and IA were found to be small.
The strength of the association between IA and the risk and protective factors was found to be higher in younger age groups. Conclusion The findings highlight a need for closer examination of psychosocial factors, especially intrapersonal variables when assessing high-risk individuals and designing intervention strategies for both general IA and Internet game addiction. Thus, there is an urgent need to gain a comprehensive understanding of this phenomenon and to develop effective strategies for both prevention and intervention.
Effective prevention and intervention requires a conceptual model that connects risk and protection factors, mediating processes, and maladaptive behaviors. To date, a number of risk and protective factors that contribute to the development and maintenance of Internet addiction have been identified. Despite a growing number of empirical investigations, theoretical models of Internet addiction have been slow to develop.
Some attempts 3 , 4 , 5 , 6 have been made to explain Internet addiction by appealing to either intrapersonal or interpersonal perspectives: the intrapersonal perspective focuses on the individual's internal characteristics, such as temperament, self-esteem, negative emotions, etc. There has also been a focus on intrapersonal characteristics e.
For example, several studies 9 , 10 , 11 , 12 , 13 , 14 have argued that people who experience low self-esteem or identity problems may become addicted to the Internet because they use it as a means to compensate for deficits in those areas. There is strong evidence that symptoms of depression are strongly associated with Internet addiction, and that individuals who have increased levels of depression are more susceptible to becoming addicted to the Internet.
Control problems related to attention problem 24 , 30 and self-regulation 31 may be important variables as well. By contrast, other researchers have explained Internet addiction in terms of interpersonal difficulties. From this perspective, the online space functions as a substitute for an unmet need for an actual relationship.
In other words, the online space provides a rewarding sense of belonging, warmth, and well-being. In fact, Internet addicts exhibit higher rates of conflict with their parents, 35 report dysfunctional communication with their parents, and experience higher levels of familial conflict 1 , 36 than non-addicts.
Thus, the interpersonal perspective highlights the roles of family dynamics, interpersonal factors, and developmental factors in the explanation of an adolescent's Internet addiction. Although a number of studies have examined the features that make participants more vulnerable to developing an Internet addiction, these studies have not included a comprehensive list of the characteristics that could contribute to Internet addiction.
In addition, not all of the potentially relevant psychosocial characteristics can be identified or incorporated into a single study. The establishment of a basic theoretical framework for the examination of the relative contributions of the psychosocial antecedent factors that predict Internet addiction requires an empirical synthesis of the literature.
Thus, the present study aimed to document the relative strengths of the associations between Internet addition and various psychosocial variables via meta-analytic techniques. In particular, given the high volume of research that has been conducted on this topic in Korea, it will be valuable to have more broad-based quantitative estimates of the effect sizes associated with the various possible risks and protective factors of Internet addiction.
It may be particularly worthwhile to analyze the results of empirical studies that have been conducted in Korea and have not had exposure in international journals. The present study also addressed the extent that intrapersonal and interpersonal variables contribute to Internet addiction. In the field of substance abuse, researchers have already used an integrated framework that includes both of these variables to explain substance-use behaviors.
Thus, the present study aimed to investigate the magnitude of the effect sizes of intrapersonal and interpersonal variables therein. The final purpose of this study was to examine the effects of a moderator on associations between psychosocial variables related to Internet addition. With respect to psychosocial factors, there are several sources of variability: one example is related to the individual's age; research has not yet determined whether differences between psychosocial variables are related to age.
However, there is some evidence that under similar levels of Internet usage in terms of exposure, intensity, or duration , younger individuals may be more vulnerable to the negative consequences of Internet addiction than adults. Thus, in the current study, we examined whether there is a similar effect of age on the associations between psychosocial variables and Internet addiction.
Next, we examined whether the overall associations differ according to subtype of Internet addiction, specifically general Internet addiction versus Internet-game addiction. While Internet addiction is a broad concept that includes Internet chatting, shopping, and information searching, Internet-game addiction is associated with the compulsive playing of online games. In addition, Internet addiction measures including those for Internet-game addiction are sometimes organized to suit a specific purpose or a specific population.
The primary aim of this meta-analysis is to evaluate the risk and protective factors associated with Internet addiction and to determine which of these factors are the most strongly correlated with Internet addiction in Korean subjects. Comparison between the intrapersonal and interpersonal variables on the magnitude of the effect size is also of major interest. The results of this analysis may promote better understanding of the characteristics of Internet addiction and may contribute to the development of effective treatment strategies.
Second, potential moderators of the relationship between these psychosocial variables and Internet addiction are considered. Age was chosen as a sample-level moderator because of the implications for younger individuals and suggestions in the literature that there may be important differences in psychosocial factors related to age.
Differences in the strength of the associations according to age or the subtype of Internet addiction will have implications for understanding the age-specific e. An increased understanding of these variables will enable interventions to be tailored to the needs of a specific population. The year was chosen as the starting year for the search because that is when active empirical inquiry into the psychological factors affecting Internet addiction first began.
Although the clinical features of the behavioral problems related to Internet use have been described using diverse terminology e. Therefore, the following key words were entered into the search databases separately and in combination: Internet addiction, game addiction, pathological Internet use, problematic Internet use, excessive Internet use, and Internet game addiction.
Second, the references of the retrieved articles and book chapters were manually searched. Additional searches for unpublished studies were not conducted.
Whatever the application general surfing, pornography, chat rooms, message boards, social networking sites, video games, email, texting, cloud applications and games, etc. Examples of this would be pornography sexual stimulation , video games e.
To increase pleasure, these individuals are more likely to seek greater than average engagement in behaviors that stimulate an increase in dopamine, effectively giving them more reward but placing them at higher risk for addiction. There is debate about which came first, the addiction or the co-occurring disorder [ 18 , 40 ].
The study by Dong et al. But due to the limitations of the study further research is necessary. The following paragraphs illustrate the various treatment options for IAD that exist today. Unless studies examining the efficacy of the illustrated treatments are not available, findings on the efficacy of the presented treatments are also provided.
Unfortunately, most of the treatment studies were of low methodological quality and used an intra-group design. The general lack of treatment studies notwithstanding, there are treatment guidelines reported by clinicians working in the field of IAD. Unfortunately, clinical evidence for the efficacy of these strategies is not mentioned. Non-psychological Approaches Some authors examine pharmacological interventions for IAD, perhaps due to the fact that clinicians use psychopharmacology to treat IAD despite the lack of treatment studies addressing the efficacy of pharmacological treatments.
Internet usage decreased significantly from a mean of In another study Han, Hwang, and Renshaw [ 48 ] used bupropion a non-tricyclic antidepressant and found a decrease of craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex after a six week period of bupropion sustained release treatment.
Methylphenidate a psycho stimulant drug was used by Han et al. After eight weeks of treatment, the YIAS-K scores and Internet usage times were significantly reduced and the authors cautiously suggest that methylphenidate might be evaluated as a potential treatment of IAD. According to a study by Shapira et al. In addition to these studies, there are some case reports of patients treated with escitalopram [ 45 ], citalopram SSRI - quetiapine antipsychotic combination [ 43 ] and naltrexone an opioid receptor antagonist [ 51 ].
A few authors mentioned that physical exercise could compensate the decrease of the dopamine level due to decreased online usage [ 52 ].
In addition, sports exercise prescriptions used in the course of cognitive behavioral group therapy may enhance the effect of the intervention for IAD [ 53 ]. Psychological Approaches Motivational interviewing MI is a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence [ 54 ].
It was developed to help individuals give up addictive behaviors and learn new behavioral skills, using techniques such as open-ended questions, reflective listening, affirmation, and summarization to help individuals express their concerns about change [ 55 ].
Peukert et al. Reality therapy RT is supposed to encourage individuals to choose to improve their lives by committing to change their behavior. It includes sessions to show clients that addiction is a choice and to give them training in time management; it also introduces alternative activities to the problematic behavior [ 58 ]. According to Kim [ 58 ], RT is a core addiction recovery tool that offers a wide variety of uses as a treatment for addictive disorders such as drugs, sex, food, and works as well for the Internet.
In his RT group counseling program treatment study, Kim [ 59 ] found that the treatment program effectively reduced addiction level and improved self-esteem of 25 Internet-addicted university students in Korea. Widyanto and Griffith [ 8 ] report that most of the treatments employed so far had utilized a cognitive-behavioral approach.
In her study, Young [ 62 ] used CBT to treat clients suffering from IAD and found that participants were better able to manage their presenting problems post-treatment, showing improved motivation to stop abusing the Internet, improved ability to control their computer use, improved ability to function in offline relationships, improved ability to abstain from sexually explicit online material, improved ability to engage in offline activities, and improved ability to achieve sobriety from problematic applications.
Cao, Su and Gao [ 63 ] investigated the effect of group CBT on 29 middle school students with IAD and found that IAD scores of the experimental group were lower than of the control group after treatment. The authors also reported improvement in psychological function.
In the experimental group the scores of depression, anxiety, compulsiveness, self-blame, illusion, and retreat were significantly decreased after treatment. The authors found that CBT alone or combined with EA can significantly reduce the score of IAD and anxiety on a self-rating scale and improve self-conscious health status in patients with IAD, but the effect obtained by the combined therapy was better. Multimodal Treatments A multimodal treatment approach is characterized by the implementation of several different types of treatment in some cases even from different disciplines such as pharmacology, psychotherapy and family counseling simultaneously or sequentially.
Orzack et al. In this group treatment, the quality of life increased and the level of depressive symptoms decreased after 16 weekly treatment sessions, but the level of problematic Internet use failed to decrease significantly [ 69 ]. Internet addiction related symptom scores significantly decreased after a group of 23 middle school students with IAD were treated with Behavioral Therapy BT or CT, detoxification treatment, psychosocial rehabilitation, personality modeling and parent training [ 70 ].
Therefore, the authors concluded that psychotherapy, in particular CT and BT were effective in treating middle school students with IAD.
Shek, Tang, and Lo [ 71 ] described a multi-level counseling program designed for young people with IAD based on the responses of 59 clients. Findings of this study suggest this multi-level counseling program including counseling, MI, family perspective, case work and group work is promising to help young people with IAD.
Internet addiction symptom scores significantly decreased, but the program failed to increase psychological well-being significantly. A six-week group counseling program including CBT, social competence training, training of self-control strategies and training of communication skills was shown to be effective on 24 Internet-addicted college students in China [ 72 ]. The authors reported that the adapted CIAS-R scores of the experimental group were significantly lower than those of the control group post-treatment.Comparison between the intrapersonal and interpersonal variables on the magnitude of the effect size is also of major interest. Master's theses and doctoral dissertations were not included unless they were published in academic journals and underwent peer review. Some attempts 3 , 4 , 5 , 6 have been made to explain Internet addiction by appealing to either intrapersonal or interpersonal perspectives: the intrapersonal perspective focuses on the individual's internal characteristics, such as temperament, self-esteem, negative emotions, etc. The substantial associations found between the Internet addiction measures used by our included studies suggest that the current study's dependent variables are likely to be reliable. The establishment of a basic theoretical framework for the examination of the relative contributions of the psychosocial antecedent factors that predict Internet addiction requires an empirical synthesis of the literature. Additional searches for unpublished studies were not conducted.
Beard [ 2 ] recommends that the following five diagnostic criteria are required for a diagnosis of Internet addiction: 1 Is preoccupied with the Internet thinks about previous online activity or anticipate next online session ; 2 Needs to use the Internet with increased amounts of time in order to achieve satisfaction; 3 Has made unsuccessful efforts to control, cut back, or stop Internet use; 4 Is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use; 5 Has stayed online longer than originally intended. In total, 95 studies met the criteria for inclusion in the meta-analysis, of which 54
The strength of the association between IA and the risk and protective factors was found to be higher in younger age groups. A coding frame was used to categorize these variables into nine key variables that were based on the categorization of previous studies.
From this perspective, the online space functions as a substitute for an unmet need for an actual relationship. To date, a number of risk and protective factors that contribute to the development and maintenance of Internet addiction have been identified. The authors reported that the adapted CIAS-R scores of the experimental group were significantly lower than those of the control group post-treatment. Control problems related to attention problem 24 , 30 and self-regulation 31 may be important variables as well. When any of this information was missing, the study was excluded. Among the studies originally identified from the literature search, 68 were excluded due to failure to meet the inclusion criteria.