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Cognitive-Behavioral Therapy for Internet Addiction

Steven Dubovsky, MD reviewing Wolfing K et al. JAMA Psychiatry 2019 Jul 10


A targeted approach improved symptoms, time spent online, and psychosocial functioning in a group of young men. Internet addiction (IA), which is being debated as a formal diagnosis for the DSM and elsewhere, has been defined as a pathological, impairing pattern of preoccupation with Internet activities such as gaming, gambling, pornography, streaming video, and surfing for random information. These investigators randomized 143 well-educated men (about half with mild–moderate comorbid depression) with various IA subtypes in Germany and Austria (mean age, 26) to a manual-based cognitive-behavioral therapy (CBT) designed for this condition (short-term treatment for Internet and computer game addiction [STICA]) or to a wait-list control (WLC). STICA consisted of fifteen weekly 100-minute group sessions interspersed with eight 60-minute individual sessions aimed at maintaining motivation for therapy. At the end of treatment, in analyses controlling for factors such as comorbidity and IA severity, remission (minimal IA symptoms) was 10 times more likely with STICA than WLC. Effect sizes with STICA compared with WLC were very high for improved symptoms, high for reduced time spent online and improved psychosocial functioning, and nonsignificant for depression. COMMENT That a diverse population of well-educated men has significant social and occupational impairment supports the impression of a spectrum of behaviors characterized by craving, loss of control, excessive salience of and overinvolvement with Internet-generated stimulation, and even tolerance and withdrawal leading to escalating involvement, as is seen in substance addiction. Variants of CBT combined with motivational enhancement seem promising for these conditions, as well as perhaps for other syndromes of excessive and irrational engagement with stimuli that provide immediate mental or physical reward. CITATION: Wolfing K et al. Efficacy of short-term treatment of Internet and computer game addiction: A randomized clinical trial. JAMA Psychiatry 2019 Jul 10; [e-pub]. (https://doi.org/10.1001/jamapsychiatry.2019.1676)

Frequent Social Media Use Linked to Psychological Distress in Teens

Jenny Radesky, MD reviewing Viner RM et al. Lancet Child Adolesc Health 2019 Aug 13


Cyberbullying and inadequate sleep explained these associations in girls, and to a lesser degree in boys.

Studies of the effects of social media use on teens' mental health have shown mixed results, and most have not followed teens over time. These researchers analyzed data from a longitudinal study in England that followed 12,866 teens from age 13 to 16 years with a series of surveys on social media use and psychological well-being.

“Very frequent” social media use (>3 times per day) was common and increased from age 13 to 16 (from 34% to 62% in boys, and 51% to 75% in girls). Compared with teens who used social media <1 time per week, girls with very frequent social media use were 31% more likely to have psychological distress at age 14 to 15 and boys were 67% more likely. Girls with persistently high social media use had lower well-being, life satisfaction, and happiness, and more anxiety. In girls, cyberbullying, poor sleep quality, and low physical activity accounted for most of the association between social media use and psychological distress and well-being, whereas in boys these factors accounted for only a small amount.



This study provides solid evidence of a link between frequent social media use and worse psychological health in teens. Social media use should be discussed at tween and teen well visits, to encourage strategies such as keeping devices out of bedrooms, using “nightshift” or “do not disturb” settings, or turning off Wi-Fi at night. Cyberbullying can be addressed through school curricula (parents can ask schools to use a new digital citizenship curriculum https://www.commonsense.org/education/digital-citizenship) and by parent–teen conversations about upsetting content children may see online. Finally, activities such as face-to-face time with friends, sports, or clubs might help avoid boredom-induced social media checking.


Viner RM et al. Roles of cyberbullying, sleep, and physical activity in mediating the effects of social media use on mental health and wellbeing among young people in England: A secondary analysis of longitudinal data. Lancet Child Adolesc Health 2019 Aug 13; [e-pub]. (https://doi.org/10.1016/S2352-4642(19)30186-5)

E-Cigarette Use in Young People Tied to Marijuana Use

By Kelly Young Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD


Youths who use e-cigarettes are more likely to also use marijuana, according to a meta-analysis in JAMA Pediatrics.

Researchers analyzed 21 observational studies of nearly 130,000 adolescents and young adults. Those who used e-cigarettes were 3.5 times more likely to use marijuana than those who did not use e-cigarettes. The association was stronger among studies of adolescents aged 12 to 17 years than among studies of 18- to 24-year-olds. It was also stronger among those who reported dual use of e-cigarettes and tobacco products.

In addition, the association was significant in three longitudinal studies, suggesting that e-cigarette use usually precedes marijuana use.

The authors conclude: "These findings highlight the importance of addressing the rapid increases in e-cigarette use among youths as a means to help limit marijuana use in this population."

Background: NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of accuracy of youth self-reporting of substance use (Free)

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