Putting It into Practice
Being aware of the risk factors for problem technology use and encouraging healthy use of technology as early as possible is important, especially for young people, as their brains are still developing. Screening young people and their families formally or informally and intervening early—particularly when risk factors such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), depression and anxiety are present—can help prevent a problem from developing or worsening.
The prevention of problem technology use has not been extensively researched to date. However, a systematic review by Vondráčková & Gabrhelík (2016) looked at the studies that have been published on this topic and provided recommendations based on the current research. This study first identified four target groups for universal prevention interventions, including:
- children and adolescents
- college students
- parents and people closely linked to the person
- employees that regularly access the Internet.
It was recommended that the primary target group for prevention be children and adolescents—with college students being the secondary target group—where implementation occurs within school settings. Interventions should also take into consideration the students’ surroundings, including their family, peers, environment and extracurricular activities.
Looking at selective and indicated prevention of problem technology use, the research emphasized tailoring interventions to people at higher risk, focusing on risk factors such as pre-existing conditions, personality traits, physiology, patterns of Internet use and sociodemographic factors as well as the person’s current situation.
It was recommended that counsellors, teachers and employers focus on prevention interventions that improve life skills for (1) the person at risk and (2) their parents, teachers and peers. Interventions for the at-risk person should include skills development with respect to Internet use, coping with stress and emotions, dealing with interpersonal situations and use of free time. Prevention interventions tailored for parents, teachers and peers should focus on encouraging closer relationships and monitoring of Internet use.
This research is in agreement with other reviews that provide brief insights on prevention. These reviews highlight the importance of providing comprehensive education to youth at an early age about the benefits and consequences of the Internet as well as education to adolescents about controlled, safe Internet use. It was recommended that these topics be incorporated into overall life-skills training, which should also highlight the topics of impulsivity, different motivations for Internet use, cyberbullying, false information online and other risky behaviours. Suggestions were also made to involve peer leaders, who can provide real-life experience, and family members, who can provide emotional support, oversee Internet use and monitor for co-occurring disorders.
Providing information to youth and parents can be done through community presentations, information nights, written materials and psychoeducational groups. Building partnerships with local schools, youth mental health services, hospitals and family health teams can also help to build knowedge and capacity about problem technology use. Based on the available research on preventing problem technology use and other risky behaviours, it is recommended that interventions go beyond just providing information on negative consequences. Interventions must also provide support for developing life skills, facilitate behaviour change for problem technology use and other risky behaviours and target the family, peer, school, community and environmental levels.
Learn more about prevention with the
video game tip sheet and
youth, family and interactive technology brochure.
Soul Crush Story
Soul Crush Story: A video game to teach about healthy and harmful video gaming
was designed to be an engaging way to deliver health promotion messages related to video gaming.
It is an interactive tool for health educators who would like to facilitate a workshop for youth/young adults around video gaming. The goals are to build the player’s awareness of some of the ways that games manipulate behaviour, while encouraging open conversation about video gaming and risks.
Learn more about Soul Crush Story from the
Screening tools can provide valuable information on which treatment/services may be appropriate and whether further assessments are needed. They can also help create an informed and holistic treatment plan that addresses underlying or co-occurring issues that may impact recovery.
Screening for problem technology use can be done informally or formally. Questions about gaming and Internet use may be asked as part of a larger assessment interview, or screening tools may be used to determine whether a problem may exist. A number of research-validated screening tools for problem technology use are available. Some validated and self-administered screening tools are:
If someone has already identified problem technology use as the reason for seeking treatment, then a screening tool may be used to assess severity, raise the person’s awareness and monitor any changes over time.
Given the high rate of co-occurring issues in this population, using other screening tools to identify mood concerns as well as other functional difficulties can be helpful. Learn more about
commonly used screeners for global functioning and concurrent disorders. In addition, a validated screener for ASD is listed below:
Please note that these tools are not meant to diagnose or to replace a clinical evaluation. Also, some screening tools may require permission and/or have a fee for use.
Assessment is an ongoing process of understanding the bio-psycho-social, spiritual and cultural factors that underlie and maintain problem technology use. Assessment is often conducted as a structured interview with screening tools and questions about the various domains in a person’s life, including mental health, learning abilities/challenges, family of origin, current family situation, trauma, bullying, substance use and religious and cultural affiliations, to name a few. A comprehensive assessment would also include specific details about problem technology use, including length of time it has been a problem, how much time the person spends online, what specific activities he or she is involved in and what the impact has been.
Family involvement is a critical component of a thorough assessment because loved ones can provide key collateral information. For instance, youth may not remember or be aware of their early childhood history, including testing for developmental issues and/or feedback from teachers. Parents and family members can offer important information about their loved one’s history and behaviour in relation to disorders like ASD, ADHD and learning disabilities. Families are often deeply impacted by their loved one’s problem technology use and may benefit from their own assessment and support.
Learn more about how to involve families below.
The benefit of a thorough assessment is that it can guide a comprehensive treatment plan that will impact recovery outcomes. A treatment plan should be collaborative and based on the person’s goals. It should also be staged and geared toward the person’s readiness for change.
A comprehensive treatment plan may include external referrals—such as case management, psychiatry, psychometric testing, community groups and family therapy—to support the person’s stated goals and the treatment provider’s recommendations. It would also incorporate collaborative information from the person’s current supports, including family, physicians, case managers and counsellors in the community. Given the high prevalence of co-occurring issues with problem technology use, referrals to external providers may also be required in order to meet the person’s complex needs.
Responding to co-occurring issues
Given the prevalence of ADHD, ASD, learning disabilities, depression and anxiety among people with problem technology use, referring for a psychiatry assessment, providing concurrent treatment and prioritizing issues within the treatment plan may be necessary. Prioritization will depend on what aspect is most severe, what the client is willing to work on and what is available within your organization and/or community.
Another way of responding to common co-occurring concerns is to tailor treatment to concurrent issues. For example, cognitive-behavioural therapy (CBT) for mood and gaming issues may be offered. People with social anxiety may be meeting their social needs in a less stressful way by being online. If they do not receive support for their social anxiety, it will be difficult for them to cut down or stop their online activities. Another example is ASD, where people who are diagnosed find it difficult to read social cues and relate to their peers. Responding to their needs may involve offering support for learning social skills.
Negative consequences resulting from problem technology use also need to be addressed in order to facilitate recovery. For example, if a lot of family conflict has resulted from problem technology use, this may prevent people from seeking family support and/or cause stress that leads them to go online as a coping strategy. Treating co-existing concerns—whether through individual or family counselling, medications or other talk therapies—can positively impact recovery by addressing factors that may be contributing to the problem.
How to involve families
Parents commonly initiate treatment for their youth, often requesting if they can be seen by a counsellor to help them with their “video game addiction.” It is important to explain to parents that family involvement improves outcomes, as they can provide support for their loved one’s treatment goals outside of therapy. Most of the youth in treatment are living with their parents, who pay for the Internet and sometimes the devices they use to access the Internet and video games. Given the developmental stage of the youth (youth often being more impulsive and less able to foresee negative long-term consequences), limits and consequences set by parents can provide much needed support for reducing gaming- and Internet-related harms.
Providing psychoeducation for parents and loved ones about the risks and common co-occuring issues, including mental health diagnoses, can be very helpful in fostering understanding and empathy for their child. Young people have never known a world without technology. Therefore, their values may be different from their parents, teachers and counsellors about how to use technology and when it is appropriate to use it as well as their preferences for certain types of digital communication over face-to-face contact. It is important to identify and explore differences in values, as this can impact judgment and communication between adults and youth about online activities. For example, parents may feel that their child’s online friendships are not “real” friendships. Not only do youth consider online friendships real and supportive, they often feel more comfortable sharing things with people they have met online.
It can be helpful to invite parents/family into a session(s) with their child to get collateral information and to provide them with information about the treatment goals and plan. Psychoeducation can be very beneficial for parents when offered in groups, where they can meet other parents dealing with the same concerns and share ideas about how to cope. If loved ones have an opportunity to discuss their own concerns, get support and learn more about problem technology use, this will positively impact their loved one’s recovery and improve their own mental health and well-being.
In the event that the person with problem technology use is an adult, it would be helpful to invite anyone impacted by the problem into the session(s).
Skills to use in treatment
CBT is the therapeutic modality that is proving to be the most effective in research for problem technology use. A core aspect of CBT is the process of cognitive restructuring, where clients (1) recognize and challenge unhelpful thinking styles such as rationalizations that result in negative consequences and (2) develop new, more balanced ways of thinking.
- CBT aims to help people identify the thoughts that negatively affect their mood and influence their behaviours. For example, if someone believes that surfing the Internet and watching videos are the only ways to relax and that relaxing after a hard day at work is a deserved reward, this can lead them to go online. If being online has negative consequences, such as increased conflict at home, becoming aware of that can help bolster motivation and provide an opportunity to choose an alternative way of thinking the next time the thought occurs.
- CBT involves strategies to help people create alternative, more helpful and accurate thoughts. For example, the next time that person is stressed out after a hard day, they can respond by thinking, “I have had a hard day, and I need a break. But when I go online, I end up staying up too late, and I am tired the next day. Maybe I can let my spouse know that I’ve had a rough day, that I’m going for a walk and that I’ll do my tasks when I get back in 30 minutes.” This will address the need for a break by using a coping strategy without the negative consequences.
CBT often involves having clients keep a record or diary to monitor their online activities, including when they went online, what they did, how much time they spent and how they felt before and after the activity. Capturing what was going on when they were having urges to go online—including what the situation was and how they were feeling—can also be informative. They can rate their mood from zero to 10 or zero to 100 and rate their urges to go online. They would also rate their mood after they went online. Regardless of whether they want to quit, cut down or just create awareness about their online behaviours, tracking can be a valuable tool to help with readiness for change and relapse prevention. The act of monitoring and tracking activities alone facilitates behaviour change.
When tracking urges, challenging unhelpful thoughts and using an alternate coping strategy like the one just described, it can be helpful for people to rate not only their mood before and after an urge but also the strength of their urge. This can help reveal that urges may occur but that they do not have to be acted on. It can also show that other coping strategies can work without having any negative consequences.
It is important to start with a goal that the person is willing to work on and explore how the goal may be impacted by problem technology use. For example, if the person wants to get into university but has low grades because of too much time spent online rather than doing homework or attending class, then reaching that goal would require changes to the person’s online behaviour. Targeting problem technology use directly and/or prematurely when the client has not identified it as the primary issue can impede or disrupt the therapeutic alliance.
Working with families
The relationship between parents and their children is a key element in recovery. Since parents and youth may have a different definition of the problem and different goal(s) for treatment, focusing on communication and improving/strengthening the relationship is an important place to start. Problem technology use has likely caused conflict within the home and even become the focus of most communications within the family. It is not uncommon for the child to be labelled as the problem and the parents to think, “If they would only stop gaming, everything would be fine.” This view undoubtedly creates reluctance on the part of the youth to engage in treatment. One strategy to get the youth to approach treatment while supporting the whole family is to have them all come to a session together and create a safe environment by:
- being non-judgmental and empathetic
- listening to and validating their concerns
- providing psychoeducation
- working collaboratively
- looking for and pointing out strengths
- slowing down and containing conflict
- providing transparency and clarity.
Families may also benefit from creating a contract with their youth about treatment goals and what will happen when these goals are met or unmet. When youth are asked for their input in creating a contract around their problem technology use, creating “buy in” in the process can go a long way. Parents and youth may benefit from coaching around effective communication strategies when discussing sensitive topics with one another—including using “I” statements, choosing a good time to talk and keeping conversations brief. Parents also need to provide positive role modelling regarding their own technology use.
Parenting in the digital age can be very challenging, particularly when a problem exists and parents have other competing priorities. An emphasis on self-care for parents of youth with problematic technology use is integral for their well-being and that of their children. They may have their own mental health issues that need to be addressed and may benefit from the same techniques that can be helpful for their children, such as CBT and mindfulness.
Adults with problem technology use may be experiencing difficulties in their relationships with friends and families due to the amount of time and attention they devote to technology. They may need support around rebuilding relationships, including learning effective communication techniques, resolving conflict and addressing any issues of avoiding intimacy by being online.
For any addiction, relapse is often part of the recovery process. The ubiquity of technology in society and the 24-hour access people have to their online devices can increase temptation and the risk for relapse. Relapse prevention should happen from the moment treatment begins and should involve identifying the person’s high-risk situations/triggers to going online and developing some early coping strategies. CBT can be used by performing a functional analysis of problem technology use behaviours. Learn more about
functional analysis using CBT.
Sometimes technology can also be used to support recovery goals, providing ways to track or reduce access to online activities. Based on clinical observation and recommendations from health professionals, the following are some suggested tools that can be used to help clients reduce or stop certain online behaviours and/or time spent online:
- Use software to block certain websites.
- Shut Internet access down at a certain time/specific times of the day.
- Remove data plan from Smartphone.
- Keep technology out of the bedroom.
- Keep technology in a shared space in the home.
- Sign out of certain websites so they do not load automatically.
- Turn off alerts on devices.
- Block certain applications from Smartphone.
Working with clients through a health equity lens
Health equity helps ensure that factors such as gender, race, ethnic background, ability to speak English, sexual orientation, immigration status, income and education do not affect a person's access to or the outcomes of timely, appropriate and high-quality care. The
Health Equity Impact Assessment tool developed by the Ministry of Health and Long-Term Care (2012) recommends that all health care decision-making include evaluation of the unintended positive and negative impacts for various population groups, including:
- Indigenous peoples (e.g., First Nations and Métis peoples and Inuit)
- age-related groups (e.g., children, youth, seniors, etc.)
- people with disabilities (e.g., physical, D/deaf, deafened or hard of hearing, visual, intellectual/developmental, learning, mental illness, addictions/substance use, etc.)
- ethnoracial communities (e.g., racial/racialized or cultural minorities, immigrants and refugees, etc.)
- Francophones (e.g., new-immigrant Francophones, deaf communities using LSQ/LSF, etc.)
- people experiencing homelessness (e.g., marginally or underhoused, etc.)
- linguistic communities (e.g., uncomfortable using English or French, communication affected by literacy, etc.)
- people receiving low income (e.g., unemployed, underemployed, etc.)
- religious/faith communities (e.g., Buddhist, Muslim, Christian, etc.)
- rural, remote or inner-urban populations (e.g., geographic/social isolation, underserviced areas, etc.)
- groups defined by sex/gender (e.g., male, female, women, men, trans, transsexual, transgendered, non-binary, two-spirited, etc.)
- groups defined by sexual orientation (e.g., lesbian, gay, bisexual, etc.).
Please note that this list is not exhaustive, may not be fully inclusive and/or may not reflect the preferred terminology within the listed population groups. Clients may also identify with more than one of the above. It is important that your problem technology use programs/services incorporate the
Health Equity Impact Assessment tool in planning and service delivery. This website will endeavor to provide more evidence-informed content for specific population groups in the future.
In the spirit of reconciliation, the Problem Gambling Institute of Ontario at the Centre for Addiction and Mental Health recognizes the need for culturally responsive clinical support and treatment for First Nations and Métis peoples and Inuit. Within these communities, there are diverse peoples, cultures, languages, histories and experiences. Although research on problem technology use in Indigenous communities within Canada is currently lacking, the research that does exist shows increasing use of information and communication technologies. For instance, Fiser (2010) found that about 50.8% of First Nations people surveyed in Canada had access to residential broadband or high-speed Internet services. As Indigenous peoples’ access to technology becomes more widespread and they continue to face the effects of colonization, trauma and oppression, increased prevalence of problem technology use may emerge. To address problem technology concerns that do arise, it is essential that all prevention strategies, assessments and supports are trauma-informed, integrate traditional knowledge and wisdom and are considerate of the diversity within Indigenous communities.
Age-related groups: Youth of transitional age (16 to 25 years old)
Given that most of the people presenting for treatment are male youth of transitional age, likely directed toward treatment by their parents, you will need skills to engage youth who may have a high level of ambivalence about making changes to their online behaviour. Knowing something about games and gaming culture, including the types of games available, the names of games and some of the gaming lexicon, can be very effective. You can also elicit information about the games from the client, which can help build an alliance. Most youth presenting for treatment still live with their parents and often rely on them emotionally and financially, so involving families in the treatment process is integral.
In both males and females, the brain is still developing until the age of 25, which affects executive functioning essential to one’s organizing and planning abilities and impulsivity. Youth is also characterized by increasing independence from family, increasing connection to peer groups and emotional lability. The need for novelty that problem technology use effectively provides is also higher in youth. Fortunately, this stage is also characterized by an increased capacity to learn and grow. The developmental stage, including brain development, needs to be considered when treating youth with problem technology use. Coping strategies aimed at impulsivity, emotional regulation, organization and planning can help with recovery goals. Contextualizing the need for growing independence can help normalize certain behaviours, increase empathy and reduce conflict within families.
People with disabilities
In addition to being young and sometimes reluctant, clients may also be living with co-occurring issues like depression and anxiety that make it difficult to engage in treatment. These issues need to be identified early so that support can be offered to decrease barriers to treatment and recovery. Depending on the co-occurring issue, expecting people to change their online behaviours if they are meeting important psychological and social needs that way may not be realistic. For example, if someone has social anxiety or lacks social skills, he or she would need to learn how to cope and get those needs met offline in order to successfully reduce time spent online. Gaming and connecting online are highly normative in many young people’s peer groups and they may fear losing friends or being disconnected if they are not online.
It is important to consider culture when assessing risk factors, protective factors, the impacts of problem technology use and appropriate treatments for your clients. Much of the research to date has focused on problem technology use in youth from Asian cultures, looking at variables such as family dynamics that may play a role in the development of problem technology use. As more studies are published from regions all over the world, there will be a greater focus on different cultural factors that influence problem technology use, including access, amount and type of technology used.
Newcomers to Canada may face adjustment issues that could put them at risk for mental health issues and addictions. Refugees dealing with financial concerns, adjustment issues, trauma, social isolation and other stressors may also face impacts to their well-being as they settle in Canada. Being online can provide a way to connect with others and a way to spend free time, meaning less time is available for cultivating offline activities and supports and a higher risk for developing problem technology use. More research on the effects of acculturation and its link to problem technology use is still needed.
Finding meaningful activities
“I don’t know what else to do” is a common refrain from people who are trying to reduce or stop problem technology use. Parents may say, “He has no other hobbies” or “She doesn’t want to do anything else.” Young people who have grown up entertaining themselves with technology may not have cultivated other interests. Boredom is associated with problem technology use, so identifying meaningful activities offline is a crucial part of recovery. Most offline activities do not provide young people with as much stimulation or short-term benefit, but they will likely provide more satisfaction and meaning in the long term without the negative consequences of problem technology use. It can be helpful for you to spend time on this issue with clients. Parents can also play an integral role by engaging in activities with their children and helping them identify and experiment with new activities until they find something that is meaningful to them.
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