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The effect of a family-based intervention model on Internet-addicted Chinese adolescents.

The Internet has become an important tool in everyday life. As an essential media channel, it is routinely used for personal communication, academic research, information exchange, and entertainment (Davis, Flett, & Besser, 2002). Data from the China Internet Network Information Center (2010) showed that, by December 31, 2009, the number of Chinese Internet users had reached 384 million, and, of these, the proportion of users aged 10-19 comprised 31.8%. With this soaring number, the negative impacts of Internet use should be kept in mind, especially the problem of Internet addiction (Bricolo, Gentile, Smelser, & Serpelloni, 2007; Iskender & Akin, 2010). The term Internet Addiction Disorder was first used by Young (1998), who described Internet addiction as a wide variety of behaviors and an impulse-control disorder which does not involve an intoxicant. Young listed diagnostic criteria for Internet addiction similar to those for chemical substance dependence and pointed out that Internet addiction adversely affected physical health, family life, and academic performance (Young, 1999a). Previous researchers found that 1.4% to 17.9% of adolescents have Internet addiction in both Western and Eastern societies (Cao & Su, 2007; Jang, Hwang, & Choi, 2008; Kaltiala-Heino, Lintonen, & Rimpela, 2004; Mythily, Qiu, & Winslow, 2008). The latest official investigation reports of Internet addiction in Chinese adolescents indicated that, by 2010, the proportion of Chinese urban youth Internet users addicted to the Internet will be 14.1% (Chinese Youth Internet Association, 2010).

From the perspective of the family system theory, Stanton (1977) describes the addict or alcoholic as the family member with the least amount of power within the family and who develops an illness that unifies the remainder of the family. As family anxiety rises, the symptoms of addictive behavior become worse. Increases in such "ill" behavior unify the family to support the afflicted one. The addict thus serves the function of maintaining and preserving the family. So, not only attempting to simply treat the adolescent but also addressing the family once again will increase the potential for the recovery of a young life (Cook, 2001).

Over the past several years, relationships have been demonstrated between Internet addiction and individual, environmental, and familial factors. According to Young and Rogers (1999), excessive time spent online might increase the risk of Internet addiction. Social-psychological or personality variables, such as sensation seeking, loneliness, depression, poor motivation, fear of rejection, and the need for approval have been reportedly associated with this addictive behavior (Lin & Tsai, 2002; Whang, Lee, & Chang, 2003; Yen, Ko, Yen, Wu, & Yang, 2007). In addition, significant positive correlations were found between interpersonal problems and Internet addiction in adolescents (Seo, Kang, & Yom, 2009).

In this field, some attention was given also to the relationship between family factors and Internet addiction. Previous researchers have documented that an adolescent's family environment is highly predictive for adolescent Internet addiction (Nam, 2002; Young, 1999a). According to Davis (2001), adolescents whose parents provide insufficient attention and support are more likely to be psychologically unstable, which leads to overusing the Internet in order to escape their home situations. In a South Korean study it was found that not only protective factors (e.g., parenting attitudes, family communication, and family cohesion) but also risk factors of family violence (e.g., marital violence and parent-to-child violence) are strongly associated with Internet addiction (Park, Kim, & Cho, 2008). And in China, due to the one-child family policy, most urban adolescents come from one-child families. In the current climate of fierce academic competition, there are particular concerns that with all parental expectations and aspirations focused on just one child, these pressures are leading to high rates of anxiety and depression, and behavioral problems in Chinese adolescents (Liu, Ma, Kurita, & Tang, 1999; Wan, Fan, Lin, & Jing, 1994). According to the recent investigation using Egna Minnen av Bardndosnauppforstran (EMBU; a Swedish inventory of parental rearing practices) profiles of adolescents with IAD in China, parental methods of education within the family and family functioning were closely associated with Internet addiction in adolescents. The parental behavioral patterns for adolescents with IAD tend to be more overinvolved, more punitive, and involve more rejection and less emotional warmth (Tao, Huang, Wang, & Zhang, 2009).

On the basis of studies concerning related factors of Internet addiction, many researchers have offered their suggestions with regard to Internet addiction intervention. And many of them have listed improving family functioning as one of the intervention focuses (Ko, Yen, Yen, Lin, & Yang, 2007; Young, 1999b). Chinese scientist Ran Tao suggested that family-based prevention of IAD may be necessary. Unfortunately, a survey of the literature shows that little research emphasizing promoting family function for Internet addiction exists. Most treatments were aimed at changing the addictive behavior only; such treatments include behavioral or cognitive therapy (Davis, 2001; Young, 1999b), reality therapy group counseling programs (Kim, 2007), as well as group therapy with a combination of readiness to change, cognitive behavioral therapy, and motivational interviewing interventions (Orzack, Voluse, Wolf, & Hennen, 2006). Some researchers investigated the effect of intervention integrated with family therapy, but only stayed at the level of individual counseling (Yang & Hao, 2005).

Based on a thorough review of the literature on intervention strategies and treatment techniques used in the fields of substance abuse, addictive behavior, family counseling, and group psychotherapy, combined with features commonly associated with Chinese families and many years of previous work experience on Internet addiction, in this study we aimed to develop a half-structural (i.e., part designed in advanced, part impromptu as needed during therapy) family-based group intervention model to cure Internet addiction in adolescents. We hypothesized that, when family functioning was improved through the application of this model, the addictive behavior would be improved as a result.

METHOD

DESIGN AND SAMPLE

Participants were recruited between March 1st and July 31st, 2008, from among the inpatients at the Addiction Medical Treatment Center of the Beijing Military Zone General Hospital. All patients were identified as Internet addicts according to Ran Tao's diagnostic criteria as described below (Tao, Huang, Wang, Zhang, Zhang, & Li, 2009). None of participants had serious physical, psychological, or mental disorders. Ethical approval was obtained from the Beijing Military Zone General Hospital Ethics Committee. All participants gave closed hospitalization consent and informed consent for both the trial and the subsequent study.

A total of 57 participants formed the sample for this study. All were aged between 14 and 25 and agreed to complete 1-month and 3-month follow-ups. Trained research assistants who were blind to individual participants' group status conducted a baseline assessment. Participant's took an average of 30-40 minutes to complete the assessment. Randomization was independently achieved by the last author, using a computer-generated allocation schedule. The experimental group comprised 28 participants, and the remaining 29 served as the control group. The experimental group included 3 females and 25 males (24 middle-school students and 4 college students) with an average age of 17.88 [+ or -] 3; the control group included 4 females and 25 males (26 middle-school students and 3 college students) with an average age of 18.32 [+ or -] 2. The differences between the two groups in terms of age, gender, and education background were not statistically significant.

The members in the control group received conventional therapy in the treatment center, which included military training, consisting of long-distance running, weightlifting, formation drill, and swimming, and group therapy focused on treating addictive behaviors only. The experimental group members and their parents completed a family-based half-structural group therapy program. Some members in both groups received pharmacological treatments and individual counseling. Pretest and posttest scores based on the same assessment tools as described below were collected from members of both experimental and control groups. Apart from the baseline assessment, research assistants independently carried out three posttests, which occurred immediately after the intervention and at 1-month and 3-month follow-ups. These research assistants did not take part in the intervention, nor did they know the purpose of this study; they were responsible only for the distribution and collection of questionnaires.

Because all the participants signed closed hospitalization consent, no one dropped out during the intervention. However, two participants in the control group dropped out prior to the 3-month follow-up. As both of them left Beijing, we were unable to contact them.

INSTRUMENTS

Internet addiction diagnostic criteria These criteria were proposed by Tao et al. (2009b).

Symptom criterion All the following must be present: Preoccupation with the Internet (thinks about previous online activity or anticipates next online session); Withdrawal, as manifested by a dysphoric mood, anxiety, irritability, and boredom after several days without Internet activity.

At least one (or more) of the following:

Tolerance, or a marked increase in Internet use required to achieve satisfaction; Persistent desire and/or unsuccessful attempts to control, reduce, or discontinue Internet use; Continued excessive use of Internet despite knowledge of having a persistent or recurrent physical or psychological problem likely to have been caused or exacerbated by Internet use; Loss of interest in previous hobbies or forms of entertainment as a direct result of, and with the exception of, Internet use; Uses the Internet to escape or relieve a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety).

Exclusion criterion Excessive Internet use is not better accounted for by psychotic disorders or bipolar I disorder.

Clinically significant impairment criterion Functional impairments (reduced social, academic, working ability), including loss of a significant relationship, job, educational, or career opportunities.

Course criterion Duration of Internet addiction must have lasted for a minimum of 3 months, with at least 6 hours of Internet usage (not related to business or academic work) per day.

Online Cognition Scale (OCS) The OCS was developed by Davis (2001) and contains four subscales aimed at measuring social comfort, loneliness/ depression, diminished impulse control, and distraction, with a total of 36 items. It is a 7-level self-rating inventory; a higher score represents stronger Internet addiction. This scale has high internal consistency ([alpha] = .94).

Family Assessment Device (FAD) This instrument was designed by Epstein and Baldwin (1983) with guidance from the McMaster household function model and is used to evaluate the ability of a family to fulfill basic tasks and achieve basic functions. This scale includes 60 items, used to evaluate seven aspects of family functioning: problem solving (PS), communication (CM), roles (RL), affective responsiveness (AR), affective involvement (AI), behavior control (BC), and general functioning (GF). Half of the items are used for the detection of unhealthy family functioning, while the other half address healthy family functioning. The higher the score on each subscale, the worse the family functioning. The reliability coefficient of the FAD ranges from .72-.92, and Cronbach's a ranges from .78-.86 (Epstein & Baldwin, 1983).

Perceived Social Support Scale (PSSS) This instrument was developed by Blumenthal and colleagues (1987) for use in evaluating social support based on self-understanding and self-perception. The scale includes 12 self-rated items, with each item scored on a 7-point Likert scale ranging from 1 = strongly disagree to 7 = strongly agree. The internal uniformity coefficient of this scale is .88 and the test-retest reliability is .85.

Mach Scale IV Version 1 This scale was developed to assess to Machiavellianism (Christie & Geis, 1970), that is, a tendency to deceive or manipulate others for personal gain. By measuring the general strategy participants use to get along with other people, this 7-point Likert self-rating scale ranging from 1 = strongly disagree to 7 = strongly agree can evaluate the interpersonal trust of the participants. The uniformity between the items in the Mach Scale IV Version 1 is around .38, the split reliability is .79; and as for convergent validity, the Mach Scale IV is highly related with the trustworthiness subscale of the Philosophies of Human Nature Scale (Wrightsman, 1964) (r = -.70-.80).

INTERVENTION

This family-based half-structural group therapy was developed with five goals in mind: promoting a supportive environment; studying how to correctly perceive and use the Internet; changing cognition of themselves and establishing self-confidence; improving family functioning; and fostering hope for future recovery. The 28 patients in the experimental group were divided into three groups. Groups 1 and 2 had 10 people, and Group 3 had eight people. Groups met with two therapists (one always a woman) for 14 weekly sessions, each lasting 90-120 minutes

Therapists Professionals were a 52-year-old male psychologist, a 34-year-old male occupational therapist, and two female therapist assistants (ages 28 and 29). All have extensive experience in practicing group therapy (18, 5, 4, and 4 years of experience, respectively). Of the three subgroups of the experimental group, the psychologist conducted one group and the occupational therapist conducted the other two groups; the two assistants took part in the therapy implementation of all groups. The occupational therapist has been trained in cognitive behavioral therapy (CBT), family therapy, and psychodrama therapy, by licensed trainers.

Group sessions In this research, group interventions were arranged 14 times in total, seven times for Internet-addicted adolescents, four times for their parents, and the remaining three times for both Internet addicted adolescents and their parents. Strategies and techniques used in this group intervention are summarized in Table 1.

STATISTICAL ANALYSIS

Statistical analysis was carried out using SPSS version 11.5. The intervention effects of the experimental group and the control group were compared using two-way analysis of variance (ANOVA) and least significant difference (LSD). Due to ethics and occupational policy, a direct comparison of the control and experimental groups could not be carried out. For the OCS and other scales scores of the two groups three months after the intervention, comparative analysis of the intervention effects was established using independent t tests, where p < .05 is considered statistically significant.

RESULTS

COMPARISON OF THE EXPERIMENTAL GROUP BEFORE AND AFTER THE INTERVENTION

The variations within the experimental group in all dimensions and total scores of OCS, communication, roles, affective responsiveness, general functioning scales in FAD, PSSS total score, and Mach Scale IV total score before and after the intervention were all found to be statistically significant, along with their comparative variations between different time points before and after the intervention (see Table 2).

COMPARISON OF THE CONTROL GROUP BEFORE AND AFTER THE INTERVENTION

The variations of the dimensions and total scores within the control group in OCS before and after the intervention were statistically significant, and their comparative variations before and after the intervention were also found to be statistically significant (see Table 3).

COMPARISON OF DIFFERENT EFFECTS BETWEEN EXPERIMENTAL AND CONTROL GROUPS 3 MONTHS AFTER THE INTERVENTION

The variations between experimental and control groups in terms of age, gender, educational background, average time spent online daily, and OCS total score before intervention were not statistically significant (p > .05), so a comparison of intervention effects is feasible. The scoring variations between the experimental and control groups in terms of total scores and social comfort of OCS, roles, general functioning scales in FAD, and PSSS total score 3 months after the intervention were statistically significant (Table 4).

DISCUSSION

In our primary investigation, we found that total OSC scores are positively correlated with emotion involvement subscale scores in relation to family functioning, and this indicates that the more serious the negative affective involvement in the family, the more severe the degree of Internet addiction experienced by the adolescents (Xin, Ran, & Sha, 2009). As such, this study was designed to examine the effectiveness of a family-based group intervention model for young people with Internet addiction. The most prominent characteristic of this intervention model was that we did not intend to directly interfere with the addictive behavior, but rather to focus on how to enhance family functioning in that the group intervention we designed was not only for young people, but also for their parents. In addition, our study was carried out using a sample of in-patients, which reduced drop-out rates in the intervention process.

The results showed that, in the experimental group, the scores on the subscale of communication, roles, affective responsiveness, general functioning, the comprehension of social support, and interpersonal trust for FAD improved significantly. Moreover, scores on the subscales of social comfort, loneliness/ depression, diminished impulse control, and distraction for OCS and the total score for OCS improved significantly. Therefore, with improving family functioning, Internet addiction is also reduced. These results provided support for the examination of family environment, which serves as a predictor of adolescent Internet addiction (Nam, 2002; Young, 1999a). Results also suggested the importance of improving family functioning in the intervention programs for treating Internet addiction.

A family is a relatively independent unit and system in society. The interactions and interrelations among individuals in this system have a huge influence on adolescents, who are in a crucial phase of physiological maturation and mental growth. When family functioning is poor, for example in the case of a bad marital relationship or poor parent-child communication, young people may seek love and relationships in the virtual world. Via the Internet, they may establish many virtual relationships, gain a temporary sense of affection, inclusion, and belonging (Kim & Haridakis, 2009). All of these behaviors and positive feelings contribute to the danger of Internet addiction.

In the control group, social comfort and loneliness/depression diminish impulse control and increase distraction, and the overall situation in individual online cognition significantly improved. However, possible influencing factors, such as family function, social support, and interpersonal trust, were not improved. Because in conventional treatment most interventions were focused on treating only the addictive behavior, in the control group there was no significant difference in scores for functions before and after the intervention. Although our study design did not include a longer follow-up, we predict that the intervention effect will be more difficult to maintain and the possibility of addiction recurrence is relatively high.

In this study, according to the results of the 3-month follow-up, the differences between the experimental and the control groups in terms of the scores on the social comfort subscale for OCS and OCS total, FAD total, and PSSS total are statistically significant. This further indicated that the effects of family-based intervention on the experimental group are more likely to persist and may be related to a better recovery of family functioning and more obvious improvement of social support. The former change reduces one of the most important risk factors of Internet addiction and can provide a better family environment for adolescents. The latter change enhances a protective factor of Internet addiction and improves the ability of Internet-addicted adolescents to build relationships. Overall, these two improvements provide powerful support for maintaining intervention effects and reducing the possibility of reoccurrence after the young people complete treatment and return to the family and society.

Nevertheless, there are limitations to this study. First, the sample size was small; it would be desirable if a larger sample could be recruited for future studies. Second, because many patients came from all over the country, toward the end of treatment, many of them left the hospital. That increased the difficulties of long-term follow-up, so the time period we allowed ourselves was short and the after-effects of this intervention model could not be sufficiently measured.

Despite these limitations, the results clearly suggest that participants in the family-based intervention program displayed positive changes as far as Internet use and family functioning are concerned. These findings suggest the importance of improving family functioning in the intervention programs for adolescents. Therefore, it is our hope that this study can help not only Internet-addicted young people, but can also provide a reference for any intervention regarding the mental health and growth of young people in China.

doi.org/10.2224/sbp.2011.39.8.1021

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Xin Zhong, Si Zu, Sha Sha, Ran Tao, Chongsi Zhao, and Fengchi Yang

Capital Medical University, Beijing, People's Republic of China

Mei Li

Beijing University of Civil Engineering and Architecture, Beijing, People's Republic of China

Peng Sha

University of Bonn, Bonn, Germany

Xin Zhong, School of Health Administration and Education, Capital Medical University, Beijing, People's Republic of China, and Psychology Department, Dongguan Kanghua Hospital, Dongguan, People's Republic of China; Si Zu, Sha Sha, Ran Tao, Chongsi Zhao, and Fengchi Yang, School of Health Administration and Education, Capital Medical University, Beijing, People's Republic of China; Mei Li, Psychology Consulting Center, Beijing University of Civil Engineering and Architecture, Beijing, People's Republic of China; Peng Sha, Institute of Psychology, University of Bonn, Bonn, Germany.

The authors would like to thank the patients who participated and their parents, along with the staff from the Addiction Medical Treatment Center of the Beijing Military Zone General Hospital. This project was supported in 2008 by the General Program of Social Sciences of the Beijing Municipal Education Committee (Grant SM200810025002). Appreciation is due to anonymous reviewers.

Please address correspondence and reprint requests to: Fengchi Yang, Room 316, No. 1 Teaching Building, School of Health Administration and Education, Capital Medical University, No. 10 Xitoutian Road, You An Men, Beijing 100069, People's Republic of China. Email: yangfc316@163.com
TABLE 1

STRATEGIES AND TECHNIQUES USED IN GROUP INTERVENTION

Sessions for Internet addicted adolescents

  Discussing positive and negative effects of Internet.

  Discussing and handling resistance to efforts made to change
  Internet addictive behavior.

  Exploring and understanding themselves through dream interpretation
  and sandplay.

  Enhancing interpersonal communication skills through role play and
  discussion.

  Expressing affection and disappointment to parents through
  psychodrama and role play.

  Practicing understanding parents through psychodrama and role play.

Sessions for the parents of internet addicted adolescents

  Discussing the impact of the child's Internet addiction on their
  parents' lives.

  Discussing how to correctly deal with the child's Internet addiction.

  Expressing affection and disappointment to children through
  psychodrama and role play.

  Practicing understanding children through psychodrama and role
  play.

Sessions for both internet addicted adolescents and their parents

  Releasing pent-up emotions and expressing affection to each other.

  Resolving conflicts and facilitating congruent communication
  between parents and children.

  Dealing with unbalanced family power and improving family
  functioning.

TABLE 2

THE EXPERIMENTAL GROUP'S SCORES IN ALL SCALES BEFORE AND AFTER
INTERVENTION (M [+ or -] SD)

                Index                            Pre-intervention

OCS             Social comfort                 47.75 [+ or -] 13.56
                Loneliness/depression          16.96 [+ or -] 7.05
                Diminished impulse control      4.54 [+ or -] 12.50
                Distraction                    31.21 [+ or -] 6.64
                OCS total                     136.46 [+ or -] 34.72
FAD             FAD problem solving            13.43 [+ or -] 2.64
                Communication                  21.11 [+ or -] 3.06
                Roles                          25.75 [+ or -] 3.85
                Affective responsiveness       14.61 [+ or -] 2.99
                Affective involvement          16.04 [+ or -] 2.82
                Behavior control               19.61 [+ or -] 3.26
                General functioning            26.61 [+ or -] 5.11
PSSS                                           55.07 [+ or -] 12.20
Mach Scale IV                                  88.93 [+ or -] 16.95

                Index                                Baseline

OCS             Social comfort                36.14 [+ or -] 11.10 ***
                Loneliness/depression         13.43 [+ or -] 4.14 ***
                Diminished impulse control    26.29 [+ or -] 8.91 ***
                Distraction                   21.57 [+ or -] 7.13 ***
                OCS total                     97.43 [+ or -] 27.28 ***
FAD             FAD problem solving           12.64 [+ or -] 2.11 *
                Communication                 19.25 [+ or -] 3.74 **
                Roles                         24.11 [+ or -] 3.45 **
                Affective responsiveness      13.18 [+ or -] 2.58 **
                Affective involvement         15.89 [+ or -] 2.62
                Behavior control              19.68 [+ or -] 3.24
                General functioning           23.50 [+ or -] 4.96 **
PSSS                                          68.04 [+ or -] 8.44 ***
Mach Scale IV                                 83.82 [+ or -] 13.63 **

                Index                        Post-intervention 1 month

OCS             Social comfort                34.57 [+ or -] 9.96 ***
                Loneliness/depression         13.18 [+ or -] 4.03 ***
                Diminished impulse control    25.29 [+ or -] 8.25 ***
                Distraction                    2.61 [+ or -] 6.71 ***
                OCS total                     93.64 [+ or -] 25.09 ***
FAD             FAD problem solving           12.61 [+ or -] 2.13 *
                Communication                 19.07 [+ or -] 3.64 **
                Roles                         23.93 [+ or -] 3.39 **
                Affective responsiveness      13.18 [+ or -] 2.63 **
                Affective involvement         15.71 [+ or -] 2.64
                Behavior control              19.54 [+ or -] 3.17
                General functioning           23.29 [+ or -] 4.87 ***
PSSS                                          68.21 [+ or -] 8.43 ***
Mach Scale IV                                 83.82 [+ or -] 13.63 **

                Index                                3 month

OCS             Social comfort                33.96 [+ or -] 9.69 ***
                Loneliness/depression         13.07 [+ or -] 3.92 ***
                Diminished impulse control    24.61 [+ or -] 7.78 ***
                Distraction                   19.93 [+ or -] 6.64 ***
                OCS total                     91.57 [+ or -] 24.29 ***
FAD             FAD problem solving           12.61 [+ or -] 2.13 *
                Communication                 19.04 [+ or -] 3.62 **
                Roles                         23.86 [+ or -] 3.40 **
                Affective responsiveness      13.18 [+ or -] 2.63 **
                Affective involvement         15.71 [+ or -] 2.64
                Behavior control              19.57 [+ or -] 3.18
                General functioning           23.39 [+ or -] 4.94 **
PSSS                                          68.21 [+ or -] 8.43 ***
Mach Scale IV                                 83.82 [+ or -]13.63 **

                Index                                   F

OCS             Social comfort                        17.779
                Loneliness/depression                  6.644
                Diminished impulse control            31.179
                Distraction                           32.851
                OCS total                             27.781
FAD             FAD problem solving                    2.274
                Communication                          5.842
                Roles                                  4.867
                Affective responsiveness               3.981
                Affective involvement                   .179
                Behavior control                        .033
                General functioning                    6.53
PSSS                                                  26.22
Mach Scale IV                                          3.94

                Index                                   p

OCS             Social comfort                         .000
                Loneliness/depression                  .001
                Diminished impulse control             .000
                Distraction                            .000
                OCS total                              .000
FAD             FAD problem solving                    .086
                Communication                          .001
                Roles                                  .004
                Affective responsiveness               .011
                Affective involvement                  .911
                Behavior control                       .992
                General functioning                    .001
PSSS                                                   .000
Mach Scale IV                                          .011

Notes: * p < .05, ** p < .01, *** p < .001 versus preintervention.

TABLE 3

THE CONTROL GROUP'S SCORES BEFORE AND AFTER INTERVENTION
(M [+ or -] SD)

                 Index                            Pre-intervention

OCS              Social comfort                  45.70 [+ or -] 11.16
                 Loneliness/depression           17.39 [+ or -] 4.86
                 Diminished impulse control      36.70 [+ or -] 1.07
                 Distraction                     31.74 [+ or -] 7.78
                 OCS total                      131.52 [+ or -] 27.90
FAD              FAD problem solving             13.30 [+ or -] 2.29
                 Communication                   21.52 [+ or -] 4.07
                 Roles                           24.91 [+ or -] 3.95
                 Affective responsiveness        14.22 [+ or -] 2.92
                 Affective involvement           16.61 [+ or -] 2.81
                 Behavior control                19.91 [+ or -] 3.01
                 General functioning             26.30 [+ or -] 4.99
PSSS                                             55.91 [+ or -] 1.71
Mach Scale IV                                     9.39 [+ or -] 14.95

                 Index                                Baseline

OCS              Social comfort                 39.04 [+ or -] 8.28 ***
                 Loneliness/depression          13.70 [+ or -] 4.58 ***
                 Diminished impulse control     29.22 [+ or -] 9.40 ***
                 Distraction                    23.61 [+ or -] 6.75 ***
                 OCS total                     105.57 [+ or -] 21.65 ***
FAD              FAD problem solving            13.22 [+ or -] 1.68
                 Communication                   2.74 [+ or -] 3.18
                 Roles                          25.74 [+ or -] 2.96
                 Affective responsiveness       14.09 [+ or -] 2.57
                 Affective involvement          16.83 [+ or -] 2.82
                 Behavior control                2.30 [+ or -] 2.62
                 General functioning            27.48 [+ or -] 5.66
PSSS                                            59.61 [+ or -] 1.08*
Mach Scale IV                                   86.65 [+ or -] 15.44

                 Index                        Post-intervention 1 month

OCS              Social comfort                 39.00 [+ or -] 8.23 ***
                 Loneliness/depression          13.70 [+ or -] 4.34 ***
                 Diminished impulse control     29.61 [+ or -] 9.19 **
                 Distraction                    23.74 [+ or -] 6.63 ***
                 OCS total                     106.04 [+ or -] 2.99 ***
FAD              FAD problem solving            13.26 [+ or -] 1.74
                 Communication                   2.74 [+ or -] 3.19
                 Roles                          25.74 [+ or -] 2.86
                 Affective responsiveness       14.09 [+ or -] 2.50
                 Affective involvement          16.78 [+ or -] 2.88
                 Behavior control                2.39 [+ or -] 2.31
                 General functioning            27.70 [+ or -] 5.72
PSSS                                            59.35 [+ or -] 9.84*
Mach Scale IV                                   86.61 [+ or -] 15.54

                 Index                                 3 month

OCS              Social comfort                 39.09 [+ or -] 8.02 ***
                 Loneliness/depression          14.04 [+ or -] 4.45 ***
                 Diminished impulse control     29.22 [+ or -] 9.25 ***
                 Distraction                    23.48 [+ or -] 6.76 ***
                 OCS total                     105.82 [+ or -] 2.84 ***
FAD              FAD problem solving            13.35 [+ or -] 1.90
                 Communication                   2.74 [+ or -] 3.12
                 Roles                          25.78 [+ or -] 2.94
                 Affective responsiveness       14.26 [+ or -] 2.60
                 Affective involvement          16.87 [+ or -] 2.65
                 Behavior control                2.35 [+ or -] 2.27
                 General functioning            27.65 [+ or -] 5.41
PSSS                                            59.57 [+ or -] 9.97*
Mach Scale IV                                   86.78 [+ or -] 15.18

                 Index                                    F

OCS              Social comfort                         6.826
                 Loneliness/depression                  8.775
                 Diminished impulse control             6.843
                 Distraction                           12.761
                 OCS total                             11.461
FAD              FAD problem solving                     .038
                 Communication                           .917
                 Roles                                  1.428
                 Affective responsiveness                .211
                 Affective involvement                   .099
                 Behavior control                        .424
                 General functioning                    1.643
PSSS                                                    2.551
Mach Scale IV                                            .866

                 Index                                    p

OCS              Social comfort                          .000
                 Loneliness/depression                   .000
                 Diminished impulse control              .000
                 Distraction                             .000
                 OCS total                               .000
FAD              FAD problem solving                     .99
                 Communication                           .438
                 Roles                                   .243
                 Affective responsiveness                .888
                 Affective involvement                   .960
                 Behavior control                        .736
                 General functioning                     .188
PSSS                                                     .063
Mach Scale IV                                            .011

Notes: * p < .05, ** p < .01, *** p < .001 versus preintervention.

TABLE 4

COMPARISON OF SCORES IN ALL SCALES BETWEEN EXPERIMENTAL AND CONTROL
GROUPS 3 MONTHS AFTER INTERVENTION (M [+ OR -] SD)

                Scale                        Experimental (n = 28)

OCS             Social comfort               33.96 [+ or -] 9.69 *
                Loneliness/depression        13.07 [+ or -] 3.92
                Diminished impulse control   24.61 [+ or -] 7.78
                Distraction                  19.93 [+ or -] 6.64
                OCS total                    91.57 [+ or -] 24.29 *

FAD             FAD problem solving          12.61 [+ or -] 2.13
                Communication                19.04 [+ or -] 3.62
                Roles                        23.86 [+ or -] 3.40 *
                Affective responsiveness     13.18 [+ or -] 2.63
                Affective involvement        15.71 [+ or -] 2.64
                Behavior control             19.57 [+ or -] 3.18
                General functioning          23.39 [+ or -] 4.94 **

PSSS                                         68.21 [+ or -] 8.43 **

Mach Scale IV                                83.82 [+ or -] 13.63

                Scale                        Control (n = 23)

OCS             Social comfort               39.09 [+ or -] 8.02
                Loneliness/depression        14.04 [+ or -] 4.45
                Diminished impulse control   29.22 [+ or -] 9.25
                Distraction                  23.48 [+ or -] 6.76
                OCS total                    105.82 [+ or -] 2.84

FAD             FAD problem solving          13.35 [+ or -] 1.90
                Communication                 2.74 [+ or -] 3.12
                Roles                        25.78 [+ or -] 2.94
                Affective responsiveness     14.26 [+ or -] 2.60
                Affective involvement        16.87 [+ or -] 2.65
                Behavior control              2.35 [+ or -] 2.27
                General functioning          27.65 [+ or -] 5.41

PSSS                                         59.57 [+ or -] 9.97

Mach Scale IV                                86.78 [+ or -] 15.18

                Scale                        t

OCS             Social comfort               -2.03 *
                Loneliness/depression         -.83
                Diminished impulse control   -1.93
                Distraction                  -1.88
                OCS total                    -2.22 *

FAD             FAD problem solving          -1.30
                Communication                -1.78
                Roles                        -2.13 *
                Affective responsiveness     -1.47
                Affective involvement        -1.55
                Behavior control              -.98
                General functioning          -2.94 **

PSSS                                          3.36 **

Mach Scale IV                                 -.73

Notes: * p < .05, ** p < .01 versus control.
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Article Details
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Author:Zhong, Xin; Zu, Si; Sha, Sha; Tao, Ran; Zhao, Chongsi; Yang, Fengchi; Li, Mei; Sha, Peng
Publication:Social Behavior and Personality: An International Journal
Article Type:Report
Geographic Code:9CHIN
Date:Sep 1, 2011
Words:5866
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