Smartphone Addiction in Adolescents: Developing a Psychotherapy Protocol Based on Cognitive-Behavioral Approach and Its Effectiveness on Emotion Regulation and Loneliness

Document Type : Original Article

Authors

1 PhD Student in Psychology, Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran

2 Professor, Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran

Abstract

Background: Increased use of smartphones is an emerging crisis. So, the present study focused on the developing a psychotherapy protocol based on cognitive-behavioral approach and its effectiveness on treatment of smartphone addiction loneliness and emotional regulation.
Method: The first section of the present study is allocated to designing a therapeutic protocol based on cognitive-behavioral approach. Then, according to a quasi-experimental research design, 30 girl adolescents who were diagnosed with smartphone addiction were selected by a convenience sampling method and randomly divided into experimental and control groups. Experimental group received 8 sessions of psychotherapy. Smartphone Addiction Scale-Short Form (SAS-SV(, Emotional Regulation Questionnaire (ERQ( and UCLA Revised Loneliness Scale were applied as research tools. Analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA) were used to analyze the data.
Results: The findings showed that cognitive-behavioral therapy in addition to the treatment of smartphone addiction has led to a significant decrease in loneliness and improved emotional regulation skills.
Conclusion: The therapeutic intervention based on cognitive-behavioral approach can be considered as an effective treatment strategy in treatment of smartphone addiction and also is able to reduce loneliness and increase emotion regulation.

Keywords


 
1. Haug S, Castro RP, Kwon M, Filler A, Kowatsch T, Schaub MP. Smartphone use and smartphone addiction among young people in Switzerland. Journal of behavioral addictions. 2015;4(4):299-307.
2. Buctot DB, Kim N, Kim JJ. Factors associated with smartphone addiction prevalence and its predictive capacity for health-related quality of life among Filipino adolescents. Children and Youth Services Review. 2020;110:104758.
3. Lin Y-H, Chiang C-L, Lin P-H, Chang L-R, Ko C-H, Lee Y-H, et al. Proposed diagnostic criteria for smartphone addiction. PloS one. 2016;11(11):e0163010.
4. Kim J, LaRose R, Peng W. Loneliness as the cause and the effect of problematic Internet use: The relationship between Internet use and psychological well-being. Cyberpsychology & behavior. 2009;12(4):451-5.
5. Amalya ID, Rizqi A, Fadjri FA. The Relationship Between Smartphone Addiction and Loneliness Among Students. Proceeding of The ICECRS. 2020;8.
6. Sönmez M, Gürlek Kısacık Ö, Eraydın C. Correlation between smartphone addiction and loneliness levels in nursing students. Perspectives in Psychiatric Care. 2020.
7. Panicker J, Sachdev R. Relations among loneliness, depression, anxiety, stress and problematic internet use. International Journal of Research in Applied, Natural and Social Sciences. 2014;2(9):1-10.
8. Douglas AC, Mills JE, Niang M, Stepchenkova S, Byun S, Ruffini C, et al. Internet addiction: Meta-synthesis of qualitative research for the decade 1996–2006. Computers in human behavior. 2008;24(6):3027-44.
9. Kim E, Cho I, Kim EJ. Structural equation model of smartphone addiction based on adult attachment theory: Mediating effects of loneliness and depression. Asian Nursing Research. 2017;11(2):92-7.
10. Spada MM, Marino C. METACOGNITIONS AND EMOTION REGULATION AS PREDICTORS OF PROBLEMATIC INTERNET USE IN ADOLESCENTS. Clinical Neuropsychiatry. 2017;14(1).
11. Rozgonjuk D, Elhai J. Problematic smartphone usage, emotion regulation, and social and non-social smartphone use. Proceedings of the Technology, Mind, and Society. 2018;35:1-.
12. Gross JJ. The emerging field of emotion regulation: An integrative review. Review of general psychology. 1998;2(3):271-99.
13. Gross JJ, Levenson RW. Emotional suppression: physiology, self-report, and expressive behavior. Journal of personality and social psychology. 1993;64(6):970.
14. Hormes JM, Kearns B, Timko CA. Craving F acebook? Behavioral addiction to online social networking and its association with emotion regulation deficits. Addiction. 2014;109(12):2079-88.
15. Extremera N, Quintana-Orts C, Sánchez-Álvarez N, Rey L. The Role of Cognitive Emotion Regulation Strategies on Problematic Smartphone Use: Comparison between Problematic and Non-Problematic Adolescent Users. International journal of environmental research and public health. 2019;16(17):3142.
16. Fu L, Wang P, Zhao M, Xie X, Chen Y, Nie J, et al. Can emotion regulation difficulty lead to adolescent problematic smartphone use? A moderated mediation model of depression and perceived social support. Children and Youth Services Review. 2020;108:104660.
17. Horwood S, Anglim J. Emotion Regulation Difficulties, Personality, and Problematic Smartphone Use. Cyberpsychology, Behavior, and Social Networking. 2020.
18. Lemos IL, Abreu CNd, Sougey EB. Internet and video game addictions: a cognitive behavioral approach. Archives of Clinical Psychiatry (São Paulo). 2014;41(3):82-8.
19. Lindenberg K, Halasy K, Schoenmaekers S. A randomized efficacy trial of a cognitive-behavioral group intervention to prevent Internet Use Disorder onset in adolescents: The PROTECT study protocol. Contemporary clinical trials communications. 2017;6:64-71.
20. Young KS. Cognitive behavior therapy with Internet addicts: treatment outcomes and implications. Cyberpsychology & behavior. 2007;10(5):671-9.
21. Young KS. CBT-IA: The first treatment model for internet addiction. Journal of Cognitive Psychotherapy. 2011;25(4):304-12.
22. Young KS. Treatment outcomes using CBT-IA with Internet-addicted patients. Journal of behavioral addictions. 2013;2(4):209-15.
23. Beck AT. Thinking and depression: I. Idiosyncratic content and cognitive distortions. Archives of general psychiatry. 1963;9(4):324-33.
24. Beck AT. Cognitive therapy: Nature and relation to behavior therapy. Behavior therapy. 1970;1(2):184-200.
25. Beck AT. Cognitive therapy as the integrative therapy. 1991.
26. Beck AT. Cognitive therapy: past, present, and future. Journal of consulting and clinical psychology. 1993;61(2):194.
27. Kwon M, Lee J-Y, Won W-Y, Park J-W, Min J-A, Hahn C, et al. Development and validation of a smartphone addiction scale (SAS). PloS one. 2013;8(2):e56936.
28. Kwon M, Kim D-J, Cho H, Yang S. The smartphone addiction scale: development and validation of a short version for adolescents. PloS one. 2013;8(12):e83558.
29. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology. 2003;85(2):348.
30. Balzarotti S, John OP, Gross JJ. An Italian adaptation of the emotion regulation questionnaire. European Journal of Psychological Assessment. 2010;26:61-7.
31. Qasempour A, Ilbeigi R, Hassanzadeh S, editors. Psychometric properties of Gross and John emotional regulation questionnaire in an Iranian sample. Sixth Conference on Student Mental Health 2012; University of Guilan.
32. Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence. Journal of personality and social psychology. 1980;39(3):472.
33. Mirdorikvand F. A study of loneliness with academic performance, anxiety, depression and self-esteem in male students of Poldakhtar middle school.. Ahvaz: Shahid Chamran University of Ahvaz; 1999.
34. Rapee RM, Oar EL, Johnco CJ, Forbes MK, Fardouly J, Magson NR, et al. Adolescent development and risk for the onset of social-emotional disorders: A review and conceptual model. Behaviour research and therapy. 2019;123:103501.
35. Dayan J, Bernard A, Olliac B, Mailhes A-S, Kermarrec S. Adolescent brain development, risk-taking and vulnerability to addiction. Journal of Physiology-Paris. 2010;104(5):279-86.
36. Lin YH, Lin SH, Yang CC, Kuo TB. Psychopathology of everyday life in the 21st century: smartphone addictionpp. In: Montag C, Reuter M, editors. Internet Addiction. Cham: Springer; 2017. p. 339-58.
37. Extremera N, Quintana-Orts C, Sánchez-Álvarez N, Rey L. The Role of Cognitive Emotion Regulation Strategies on Problematic Smartphone Use: Comparison between Problematic and Non-Problematic Adolescent Users.. International journal of environmental research and public health. 2019; 16(17):3142.
38. Oh YJ, Kim HD. The Relationship between Perceived Smartphone Addiction and Physical and Mental Health in Female College Students.. Journal of the Korean Society of School Health. 2020;33(1):48-57.
39. Selçuk KT, Ayhan D. The relationship between smartphone addiction risk and sleep duration and psychosocial comorbidities in health professional candidates. Perspectives in Psychiatric Care. 2020;56(3):541-6.
40. Zhang MX, Wu AM. Effects of smartphone addiction on sleep quality among Chinese university students: The mediating role of self-regulation and bedtime procrastination. Addictive behaviors. 2020;111:106552.
41. Park N, Lee H. Nature of youth smartphone addiction in Korea. Journal of Communication Research. 2014;51:100-32.
42. Jiang Q, Li, Y, Shypenka V. Loneliness, individualism, and smartphone addiction among international students in China. Cyberpsychology, Behavior, and Social Networking. 2018;21(11):711-8.
43. Sönmez M, Gürlek Kısacık Ö, Eraydın C. Correlation between smartphone addiction and loneliness levels in nursing students. Perspectives in Psychiatric Care. 2020:1-6.
44. Aktaş H, Yılmaz N. Smartphone addiction in terms of the elements of loneliness and shyness of university youth. International Journal of Social Sciences and Education Research. 2017;3(1):85-100.
45. Dikeç G, Yalnız T, Bektaş B, Turhan A, Çevik S. Relationship between smartphone addiction and loneliness among adolescents. Journal Of Dependence. 2017;18(4):103-11.
46. Gao Y, Li, A, Zhu T, Liu X, Liu X. How smartphone usage correlates with social anxiety and loneliness. PeerJ. 2016;4:e2197.
47. Estevez A, Jáuregui P, Sanchez-Marcos I, López-González H, Griffiths MD. Attachment and emotion regulation in substance addictions and behavioral addictions. Journal of behavioral addictions. 2017;6(4):534-44.
48. Shadur JM, Lejuez CW. Adolescent substance use and comorbid psychopathology: Emotion regulation deficits as a transdiagnostic risk factor. Current addiction reports. 2015;2(4):354-63.
49. Yildiz MA. Emotion regulation strategies as predictors of internet addiction and smartphone addiction in adolescents. Journal of Educational Sciences and Psychology. 2017;7(1):66-78.
50. Trumello C, Babore A, Candelori C, Morelli M, Bianchi D. Relationship with parents, emotion regulation, and callous-unemotional traits in adolescents’ Internet addiction. BioMed research international. 2018;2018.
51. Squires LR, Hollett KB, Hesson J, Harris N. Psychological Distress, Emotion Dysregulation, and Coping Behaviour: a Theoretical Perspective of Problematic Smartphone Use. International Journal of Mental Health and Addiction. 2020:1-16.
52. Nufus N, editor Literature Review: Cognitive behavioural therapy (CBT) to lower smartphone addiction of adolescent. International Conference on Community Psychology, Humanization and Religio-Culture: Critical and Decolonial Voices; 2019; Yogyakarta–Indonesia: Faculty of Psychology Universitas Ahmad Dahlan.
53. Lan Y, Ding J-E, Li W, Li J, Zhang Y, Liu M, et al. A pilot study of a group mindfulness-based cognitive-behavioral intervention for smartphone addiction among university students. Journal of Behavioral Addictions. 2018;7(4):1171-6.
54. Yu H-G, Son C. Effects of ACT on smartphone addiction level, self-control, and anxiety of college students with smartphone addiction. Journal of Digital Convergence. 2016;14(2):415-26.
55. Davis RA. A cognitive-behavioral model of pathological Internet use. Computers in human behavior. 2001;17(2):187-95.
56. Beck AT. A 60-year evolution of cognitive theory and therapy. Perspectives on Psychological Science. 2019;14(1):16-20.
57. Dattilio FM, Hanna MA. Collaboration in cognitive‐behavioral therapy. Journal of Clinical Psychology. 2012;68(2):146-58.
58. Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. British journal of general practice. 2005;55(513):305-12.
59. Puls HC, Schmidt R, Hilbert A. Therapist adherence and therapeutic alliance in individual cognitive‐behavioural therapy for adolescent binge‐eating disorder. European Eating Disorders Review. 2019;27(2):182-94.
60. Kauer SD, Reid SC, Crooke AHD, Khor A, Hearps SJC, Jorm AF, et al. Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial. Journal of medical Internet research. 2012;14(3):e67.
61. Berking M, Ebert D, Cuijpers P, Hofmann SG. Emotion regulation skills training enhances the efficacy of inpatient cognitive behavioral therapy for major depressive disorder: a randomized controlled trial. Psychotherapy and psychosomatics. 2013;82(4):234-45.
62. Khalily MT, Bhatti MM, Ahmad I, Saleem T, Hallahan B, Ali SA-e-Z, et al. Indigenously adapted cognitive–behavioral therapy for excessive smartphone use (IACBT-ESU): A randomized controlled trial. Psychology of Addictive Behaviors. 2020.
63. Malinauskas R, Malinauskiene V. A meta-analysis of psychological interventions for Internet/smartphone addiction among adolescents. Journal of behavioral addictions. 2019;8(4):613-24.
64. Cheever NA, Moreno MA, Rosen LD. When Does Internet and Smartphone Use Become a Problem? In: M M, A R, editors. Technology and adolescent mental health. Cham: Springer; 2018. p. 121-31.