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Problem Technology Use

Problem technology use is characterized by excessive behaviours of gaming or watching gaming, social networking, streaming videos, browsing, reading, chatting or texting. Problem technology use leads to a variety of negative consequences in one’s life.

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Gambling, Gaming & Technology Use
Knowledge Exchange

Problem Technology Use

  
  
  
  
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Technology is embedded in our daily lives, and for some, it can negatively impact school/work, relationships and overall health. It is often not possible to avoid using technology altogether, but it is possible for your client to reduce or stop certain activities that are causing harm and affecting life balance. As people increasingly seek help for this issue, treatment providers have had to respond in the absence of a large body of research. In this section, we will provide an evidence-informed overview of problem technology use, including terminology, diagnostic criteria, risk factors, common co-occurring issues, screening, assessment, current research and commonly used treatment approaches.

Key Concepts​

Technology has become a constant presence in our daily lives. Since it is a relatively new phenomenon, however, its impact on children’s development and on adults throughout their lifespan is unclear. Current research has started to uncover more about the consequences of problem technology use. For instance, there is evidence to suggest that problem technology use can negatively impact relationships, emotional well-being and day-to-day functioning as well as school and/or job productivity. A number of mental health and neurodevelopmental issues can also co-occur with problem technology use, presenting as a risk factor and/or comorbidity.

To date, most research on problem technology use has focused on adolescents. Research is still ongoing to better understand the causes and consequences of problem technology use for all people throughout their lifespan and the best practices for healthy, productive and balanced technology use.


How much screen time is too much?

Accessing Technology
Accessing Technology

Screen time includes the use of any electronic screens, including televisions, laptops, desktops, tablets and Smartphones. It is common for people to use more than one device at a time. In addition to recreational uses, computers and other digital technologies are being used for work. They are also increasingly being used within classrooms, both for homework and as a way for school administrators to communicate with students.

According to the 2015 Ontario Student Drug Use and Health Survey, about 63% of Ontario high school students spend at least three hours per day on recreational screen time. In the 2015 Centre for Addiction and Mental Health Monitor study, Ontario adults reported spending an average of 11.5 hours per week on electronic devices for e‑mail, social media, browsing and chatting purposes, demonstrating how much technology is embedded in our daily lives.

The Canadian Paediatric Society offers guidelines for screen time in children, discouraging screen-based activities for children less than two years of age and limiting recreational screen time to less than one hour per day for children two to five years old. Although these time limits may be difficult to implement today, it is important to consider what people are doing online and when they are doing it rather than just the amount of time they spend online.


Risk factors and impacts

It is important to consider biological, psychological, social and cultural factors when assessing the risk factors and impacts of problem technology use. Biological factors can include gender, heredity and physical health. Psychological factors may be self-esteem, personality and mental health. Social and cultural factors can include family relationships, peer groups and values. Some specific examples of risk factors for problem technology use, based on clinical experience and current scientific evidence, include:

  • developmental stage (younger people are more at risk)
  • low self-esteem
  • bullying
  • family conflict
  • access to technology
  • perfectionism (neuroticism)
  • poor social adjustment
  • difficulty bouncing back
  • learning difficulties or exceptionalities (high IQ)
  • depression and anxiety
  • attention-deficit/hyperactivity disorder (ADHD)
  • autism spectrum disorder (ASD)
  • obsessive-compulsive disorder (OCD).

Impacts of problem technology use may include:

  • family and relationship conflict
  • difficulty relating to or empathizing with others
  • poor work and/or academic performance
  • sleep disturbances
  • psychological distress
  • poorer physical and mental health
  • suicidal ideation
  • brain changes (distractibility, concentration and memory issues, depression, anxiety).

Important to note is that this is not an exhaustive list and that many conditions may be classified as both a risk factor and an impact.


Who is impacted by problem technology use?

Transitional-age youth—people between 16 and 25 years of age—make up the highest proportion of people with problem technology use. It is not uncommon for parents to become concerned about their child’s behaviour when they notice increasing hours spent online, poor sleep habits and lower academic performance. Parents often relay that their child remains isolated in his or her room and no longer spends time doing other activities. This can prompt parents to seek treatment for their child’s problem technology use.

One or both parents may come to treatment with their child. Youth commonly do well in high school while they are living with their parents. However, when they leave for post-secondary education—where they have less structure and accountability, and the work is harder—they can fall behind, especially if they are not able to limit time spent gaming or using the Internet. Youth may not see their gaming or Internet use as an issue and may be reluctant to cut down or stop certain online behaviours.

Although most of the research to date has focused on youth, adults can also be affected by problem technology use and may be reluctant to enter treatment. Much in the same way as youth, adults can benefit from having loved ones involved in their treatment.


Differences between adults and youth with problem technology use

Adults may not be impacted by problem technology use in the same ways as youth, since adults likely have already established their social, educational and work lives. For adults, some of the negative impacts of problem technology use include:

  • loss of relationships
  • marital or family problems
  • job loss or decreased productivity.

For young people, problem technology use can interrupt their ability to become independent from their parents and build a life offline.

 


What makes online games so addictive?

Online games are not a benign medium. Although not everyone who plays them will develop a problem, many games contain features that make the activity highly rewarding. These properties include:

  • opportunity for achievement
  • opportunity to socialize
  • infinite levels
  • in-game currency
  • intermittent rewards
  • virtual worlds that are still active when the player is offline.

Games have structural differences that impact how addictive they can be. For example, Massively Multiplayer Online Role-Playing Games (MMORPGs) are highly immersive worlds where players can build their characters over time, play and socialize with others in team-based activities, and accumulate status in the game. Other examples include Real-Time Strategy (RTS) and First-Person Shooter (FPS) games.

There are many similarities between gaming and gambling. This includes the structural design of the video games, which offer intermittent reinforcement and opportunities to spend money for a chance to win a particular power. The growing popularity of e-sports—where competitors play in gaming competitions for a cash prize—also provides additional incentives to game in a manner similar to professional poker players, once again blurring the lines between gaming and gambling.


Common co-occurring mental health issues

Research indicates that people with problem technology use are more likely to have certain co-occurring mental health issues. It is not clear whether some of these disorders underlie the problematic use or result from it, namely depression and anxiety. However, it is common for pre-existing issues to be exacerbated by problematic technology use. Some common co-occuring mental health and neurodevelopmental disorders are:

  • ADHD
  • anxiety (generalized and social phobia)
  • ASD
  • depression
  • OCD.

Is there a diagnosis for problem technology use?

Although there is no formal diagnosis for problem technology use in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5)—the reference manual most widely used in Canada—Internet Gaming Disorder is currently being considered for inclusion pending further research. Even though Internet Gaming Disorder is not currently an official diagnosis, clinicians are seeing people with this issue and observing the impacts it can have on their lives. Much like the other addictive disorders in the DSM‑5—which range from mild to moderate to severe—problem gaming can also fall within a spectrum/continuum of severity. The criteria for Internet Gaming Disorder are similar to other addictive disorders, with some nuanced differences.

According to the DSM-5, five or more of the following criteria must be met within one year for a diagnosis of Internet Gaming Disorder:

  1. Preoccupation or obsession with Internet games.
  2. Withdrawal symptoms (e.g., irritability, anxiety, sadness) when not playing Internet games.
  3. A build up of tolerance (i.e., more time needs to be spent playing the games to get the same level of excitement).
  4. Unsuccessful attempts to stop or curb playing of Internet games.
  5. Loss of interest in other life activities, such as hobbies.
  6. Continued overuse of Internet games even with the knowledge of how much they impact a person’s life.
  7. Misrepresentation to others about Internet game usage.
  8. Use of Internet games to relieve anxiety, guilt or other negative moods (i.e., it is a way to escape).
  9. Loss of or putting at risk a vocational opportunity or relationship because of Internet games.

"Should I just unplug the computer?"

Many parents and loved ones will ask professionals this question when they are highly stressed and worried about their child, observing negative consequences as a result of problem technology use. There is no “one size fits all” answer to this question, as it depends on the severity of the impact, the age of the child, the values and relationship of the family, the tasks they may still need the computer to perform and the impact of taking it away. For example, if a child is severely depressed and socially isolated, and the only relief he or she gets is online, taking it away without putting proper supports in place may create safety issues.


How is problem technology use treated?

Cognitive-behavioural therapy (CBT)

Research indicates that CBT is an effective treatment modality for problem technology use. It involves tracking online activity, triggers and urges. People learn to shift the behaviours, thoughts and emotions that are linked to problem technology use, thereby understanding and responding to their urges in a different way.

Learn more about CBT.

Motivational interviewing

Motivational interviewing is frequently used in health care settings to facilitate behavioural change. It is a person-centered counselling style for addressing the common problem of ambivalence about change.

Narrative therapy

There has been some evidence in support of narrative therapy for problem technology use. Narrative therapy helps people to reframe their perceptions of themselves and their behaviours and focus on their strengths.

Group therapy

Often, therapy is delivered in groups because it is resource efficient, provides social supports and normalizes the person’s experience by meeting others who are dealing with the same issue(s). Group therapy may be used as a core mode of treatment or as an adjunct to individual therapy.

Family involvement/family therapy

It is crucial for family members to be involved in their loved one’s treatment. This is especially true when treating youth, because they are often still emotionally and financially reliant on their parents. Research on mental illness and substance use disorders shows that having family involved in treatment improves recovery outcomes. Family plays an important role in teaching values, offering emotional support, modelling behaviours, setting limits and helping youth to find meaningful activities. Involvement of loved ones may take the form of family therapy, parent support and coaching or parent participation in some of their child’s sessions to talk about treatment goals.

Psychoeducation for both the parents/families and the person with problem technology use can be an important component of recovery, in particular helping them to understand mental health issues, the link between co-occurring concerns (such as a mental health diagnosis and the behaviour) and the importance of positive role modelling with technology. Other family factors, such as supervision, communication and conflict, may also need to be addressed.

Family involvement can also be helpful for adults who have problem technology use, including support for loved ones such as spouses/partners and children if it is age and situation appropriate.

Mindfulness

Mindfulness is an evidence-based practice of learning to focus one’s attention in the present moment, without judgment. Mindfulness has been used to help with chronic pain, depression, anxiety, stress and substance use. More recently, gambling problems have also been addressed using mindfulness-based approaches. It can help people become more aware of their thoughts and feelings and delay their impulses.

Learn more about mindfulness.

Harm reduction approach

Harm reduction is an approach that aims to reduce the negative consequences resulting from a problematic behaviour. Given the ubiquity of technology today, it would be impossible for people to be completely abstinent. They can choose to be abstinent from an online activity that is unproductive for them, such as gaming or watching videos, but they will likely still need to use technology and be online to do work/school assignments or connect with people. Many people may not be ready to quit or stop an activity but are willing to engage in treatment to gain more control over their behaviour. Harm reduction allows people at different stages of readiness with different goals to engage in treatment and make improvements in their lives.

Learn more about harm reduction.

Medication

Medication to treat common co-occuring mental health issues that impact or are impacted by problem technology use can be helpful. For instance, there is some evidence to support the use of the antidepressant bupropion (i.e., Wellbutrin) in reducing symptoms of depression as well as the severity of game-playing cravings and problematic Internet use.


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Research Snapshot

Internet Use Statistics
Internet Use Statistics

The Internet plays a significant role in the lives of North Americans, with roughly 88% of adults in the United States using the Internet (Pew Research Center, 2017) and 83% of Canadian households having access to the Internet (Statistics Canada, 2014). The Internet is available 24 hours a day, seven days a week using Smartphones, tablets, computers and gaming consoles, with people often accessing the Internet on multiple devices at a time.

Although the Internet—and technology in general—has improved our lives in many ways, it can also lead to excessive behaviours that cause harm in people’s lives. Problem technology use is growing in prevalence worldwide, with Pontes and colleagues (2015) reporting national prevalence rates between 1 and 18%, with an average of 7.5%. In Ontario, roughly 7.1% of adults have moderate to severe problematic use of electronic devices (Ialomiteanu, 2015).

Although research in this area is still in its infancy (Kuss & Lopez-Fernandez, 2016), and fundamental differences exist in the operational definitions used by researchers (Lam, 2014), problem technology use is starting to be recognized as a mental health concern. For instance, one component of problem technology use—Internet Gaming Disorder—has been added as a "condition for further study" in section III of the Diagnostic and Statistical Manual of Mental Disorders V. However, Internet Gaming Disorder, as well as other behaviours encompassed within problem technology use, requires further research prior to its official inclusion in the manual.


Is problem technology use an addiction disorder or impulse control disorder?

There has been a long-standing debate among researchers regarding the perspectives and origins of problem technology use. Some have conceptualized problem technology use as a disorder akin to substance dependence while others view it as an impulse control disorder like problem gambling.​​​


VS.

Is problem technology use akin to substance dependence?

Problem technology use may be similar to a chemical addiction characterized by mood alterations, tolerance, withdrawal, relapse and psychosocial difficulties (Kuss & Griffiths, 2015). Similar to substance dependence, it can encompass excessive or poorly controlled urges and cravings for Internet use as well as a maladaptive obsession with the Internet despite attempts to curb its use (Tokunaga & Rains, 2016). In addition, the brain regions involved in gaming urges and cravings were found to be similar to those involved in substance dependence (Ko et al., 2009).

Is problem technology use akin to impulse control disorders?

Problem technology use may be a product of inadequate control over impulsive thoughts or feelings (Ioannidis et al., 2016; Tokunaga & Rains, 2016; Young, 1996). The two main elements of impulse control disorders are cognitive preoccupation and uncontrolled behaviours (Grant et al., 2010). Therefore, impulse control in the context of problem technology use can be characterized by preoccupation with Internet use and engaging in online activities to escape negative mood states despite the damaging consequences associated with continued use (Tokunaga & Rains, 2016).


A third conceptualization, "relational resources deficit," appears briefly within the literature as another perspective on problem technology use. This conceptualization views problem technology use as the result of deficits in the ability to form and maintain interpersonal relationships. Some people prefer to communicate in an online environment, an inclination fueled by psychosocial problems (e.g., loneliness and depression) that impede social competence and make communicating online a socially rewarding experience (Tokunaga & Rains, 2016).


Relationship between problem technology use and co-occurring conditions

The literature cites a number of theories to explain the relationship between problem technology use and co-occurring conditions.

  • Problem technology use is secondary to psychiatric problems as a means of escaping one’s issues or as a dysfunctional coping strategy (Ferguson & Ceranoglu, 2014; Kardefelt-Winther, 2014).
  • Problem technology use is an addiction in and of itself, and psychiatric problems develop because of Internet and gaming issues (Gentile et al., 2011; Király et al., 2015).
  • A reciprocal relationship exists between problem technology use and psychiatric problems (mutual vulnerabilities) (Király et al., 2015; Kuss, 2013).

What theory is correct? Problem technology use encompasses a variety of online activities and games, making comparisons between research studies difficult and problematic (Vadlin et al., 2016). In order to better understand the disorder and make these essential comparisons, more consistent conceptual and operational definitions of problem technology use must be established (Anderson et al., 2016). Only then can we determine which theoretical framework(s) can be used to best explain problem technology use and its prognosis.


Barriers to treatment: Large number of conceptual and operational definitions of problem technology use

A recent review by Pontes and colleagues (2015) reported national prevalence rates for problematic Internet use between 1 and 18%. This variability is in part due to a large number of terms and definitions for problem technology use. For example, some of the various terminologies used include: "compulsive computer use"; "Internet dependency"; "pathological Internet use"; "Internet addiction"; "Internet gaming disorder"; "Internet gaming addiction"; and "cybersex addiction" (Lam, 2014). This lack of consistency creates difficulties for researchers and clinicians alike in properly identifying and assessing people with problem technology use.


Emerging research: Personality and problem technology use

Although a number of factors can contribute to the development of problem technology use, personality factors are emerging as a research area of interest. Many studies published to date (some of which are listed below) have looked at how personality traits can put adolescents and adults at risk for problem technology use.

  • Zhou et al., 2017
  • Munno et al., 2017
  • Kayiş et al., 2016

Despite the studies that have already been published, this research area is relatively new, and we are only beginning to understand how this may play a role in the clinical setting.


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Putting It into Practice

Prevention

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:

  1. children and adolescents
  2. college students
  3. parents and people closely linked to the person
  4. 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 game screen capture
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 ga​ming and risks.

Learn more about Soul Crush Story from the facilitator's manual​.


Screening

Screening for Problem Technology Use
Screening for Problem Technology Use

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

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.


Treatment planning

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 elements

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.

  1. 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.
  2. 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.

Formulating goals

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.

Relapse prevention

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.

Indigenous peoples

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.

Ethnoracial communities

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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Handouts for clients​​​​

  
  
Youth, family and interactive technologybrochure-youth-family-interactive-tech-accessible-2017
Les jeunes, leur famille et les technologies interactivesbrochure-youth-family-interactive-tech-fr
Changing your Thinkingproblem-tech-use-changing-your-thinking
Modifier vos penséesproblem-tech-use-changing-your-thinking-fr
Coping with Triggers and Urgesproblem-tech-use-coping-with-triggers-and-urges
Gérer les déclencheurs et les enviesproblem-tech-use-coping-with-triggers-and-urges-fr
Learning from Slips and Relapsesproblem-tech-use-learning-from-slips-and-relapses
Tirer les leçons des dérapages et des rechutesproblem-tech-use-learning-from-slips-and-relapses-fr
Planning Aheadproblem-tech-use-planning-ahead
Planifierproblem-tech-use-planning-ahead-fr
Video Gaming: How to Make Healthy Choicesproblem-tech-use-video-gaming-healthy-choices
Jeux vidéo : comment faire des choix éclairésproblem-tech-use-video-gaming-healthy-choices-fr
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Clinical simulation vid​eo

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Download video transcript

This video clip shows a fictitious therapist and client session for teaching purposes.

The scenario shows a typical cognitive-behavioural therapy session with a client (Bart) who is trying to maintain his changes related to problem gaming. The client and his therapist are discussing a recent lapse. The therapist works collaboratively with him to complete the Learning from Slips and Relapses handout and find alternate activities and coping strategies for triggers that may lead to excessive video gaming.​​