Unit 13: Clinical Psychology on the Internet

Therapy is beginning to be available online, and numerous studies have shown it is just as effective as in person therapy. Online therapy has many benefits, including that it can be more cost effective, it can help prevent the stigma that comes with treating mental health issues, and it can be provided to people in rural areas that might have limited access otherwise.

One study by Albertson et al. that I read called “Self-compassion and Body Dissatisfaction in Women: A Randomized Controlled Trial of a Brief Meditation Intervention” looked at how podcasts teaching self compassion would affect women’s self compassion, body dissatisfaction, body shame, body appreciation, and contingent self worth based on appearance. The study was conducted over three weeks. Participants were instructed to listen to a self-compassion podcast every day for three weeks, with a new podcast used each week. The participants were women ages 18-60, recruited from internet advertisements, snowball sampling, Facebook, and referrals from friends and therapists. There were 98 women total who listened to the podcasts. There was also a control group of 130 women who were told they were on the waitlist to receive the podcasts. The study was also controlled for age and prior meditation experience.

The study found that the group that listened to podcasts demonstrated significantly greater gains in self-compassion compared to the control group, as well as greater reductions in body dissatisfaction, body shame, and contingent self-worth based on appearance. The gains made were also still maintained 3 months later, showing that even an intervention as short as 3 weeks can have lasting effects. What impressed me most about this study was that it was a short program completely online, yet it was still successful and even had lasting affects months later. This study is one of many that shows the potential the internet has for psychological treatment online.

Cognitive behavioral therapy (CBT) is a common type of psychotherapy typically offered in person, but today even computerized cognitive behavioral therapy (cCBT) is being developed and offered. In CBT, the client works with a mental health counselor in a structured way, attending a set amount of sessions. The counselor helps the client to notice inaccurate or negative thinking, so that the client can view situations more accurately and respond to them in a more acceptable way. It has been very effective in the treatment of anxiety and depression, or treating anyone wanting to learn how to better manage stressful situations.

A study by Adelmen et al. looked at the effectiveness of cCBT in treating anxiety. According to the study, anxiety is a significant public health concern; 21% of adults and 25% of adolescents have an anxiety disorder. If these anxiety disorders are left untreated, they may persist for years or worse, develop into other psychological problems like depression or substance abuse. cCBT has the potential to be delivered to individuals living in remote regions, it doesn’t rely on the availability of clinicians locally, its cheaper, and it can also help prevent stigma. It has the potential to solve a lot of issues found with in person CBT, which is why it’s important to figure out if it’s as effective.

The study found that compared to the wait list control group, there was a significant benefit to cCBT with an effect size of .92. When cCBT was compared to in-person CBT, no significant difference was found with an effect size of just .05. Basically what this is saying is that cCBT is much better than no treatment at all, and it is equally effective as traditional in-person CBT.

With the increase of internet usage in our everyday lives, some worry that internet addiction is a new problem created as a result.  According to a survey by the Pew Research Center, 20% of Americans report being online ‘almost constantly’. But is internet addiction a real thing? Maria Konnikova wrote an article on the topic. Here are her arguments comparing how internet addiction is similar and dissimilar from substance addiction:

Similar:

  • Both behavioral and substance addictions are characterized by an inability to control how often or how intensely you engage in an activity, even when you feel the negative consequences.
  • Both come with urges and cravings, you feel a sudden and debilitating need to check your news feed or to take a hit in the middle of a meal.
  • Both are marked by an inability to stop.
  • Both seem to have some genetic basis, and genetics seem to share many common characteristics.

Dissimilar:

  • A substance affects a person physically in a way that a behavior (like internet addiction) can’t. No matter how much you use the internet, you’re not introducing something new into your blood stream.
  • It’s obvious that substance abuse has many negative effects on the person, but it’s hard to pin down a quantifiable, negative effect of internet use.
  • The internet is a medium, not an activity in and of itself. If you spend your time online shopping, you may have a shopping addiction. If you spend all of your time online gambling, it’s likely that you have a gambling addiction, not an internet addiction.
  • Internet addiction is resistant to treatment, have significant risks, and high relapse rates compared to substance addiction.
  • Computers and virtual connections have become an integral part of daily life. You can’t just pull the plug from an addict and expect them to function. For example, a student may have an internet addiction, but needs to use the internet for her classes. The thing she needs to avoid to do well is also the same thing she needs to do her job.

As you can see, it’s debatable whether or not internet addiction is comparable to other addictions like substance abuse. One point in Konnikova’s article that I was especially interested by was when she stated “The internet is a vehicle and not a target of disorder.” Again, this means if you spend all of your time gambling online, you probably have a gambling addiction and if you spend all of your time online shopping you probably have a shopping addiction. The article mentioned a good example of a young college student who became depressed and started skipping and class. She began spending most of her time using the internet to set up extreme sexual encounters with people she met online.  Clearly she has a problem because her life is being negatively affected, but what exactly is the problem? Is it the fact that she is obsessively using the internet, or is it the fact that she’s using the internet to engage in harmful behavior? What if she instead obsessively used the internet to learn languages or write educational articles? Is it a problem, even if she’s still missing class?

Internet use and substance abuse are not really the same because the internet is just a medium, not an activity in itself. People who spend excessive amounts of time online most likely aren’t longing to be virtually connected in the same way that an alcoholic longs for a drink. What is addicting however, is the behavior the user engages in on the internet, like gambling or shopping.

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