APUNTE INICIAL SOBRE LA OBJETIVIDAD Y LA SUBJETIVIDAD EN ESTA INVESTIGACIÓN

Treatment options form another thorny area related to problematic internet use as there is variability regarding treatment which has led to there being a lack of consensus amongst health professionals. This has limited the efficacy and validity of the various treatments available. Thus, similar to prevalence rates, there are inconsistencies which show the lack of an officially recognised definition and means of assessment as well as the unknown causes of the disorders, and variety of sampling methodologies, which overall, lead to limited knowledge as to which type of intervention can be the optimal.

To illustrate the confusion surrounding this particular area, Thorens, Khazaal, Billieux, Van der Linden, and Zullino (2009) conducted a study to examine the attitudes and beliefs of Swiss mental health professionals concerning problematic internet use. They found that even though the majority of health professionals reported increased awareness of the problem, they were less likely to screen, diagnose and treat it, owing to the lack of official guidelines and protocols related to its definition, assessment and treatment. Even though

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there is a lack of consensus regarding treatments, there are various means which health professionals have employed in order to try to minimize the harmful consequences of excessive internet use. Psychosocial treatments, for instance cognitive behavioural therapy, motivational interviewing, reality therapy, group therapy, Naikan cognitive therapy, family therapy and multimodal psychotherapy are some of the options which have been proven to be very effective in controlling the amount of time spent online, as well as in ameliorating symptoms such as anxiety and depression which are associated with excessive internet usage (Essig, 2012; Winkler, Dorsing, Rief, Shen, & Glombiewski, 2013). However, each type of therapy is grounded in its own theoretical framework and as such, there is variety in the way problematic internet use is dealt with. More specifically, cognitive behavioural treatments help the person in need to modify maladaptive cognitions and encourage them to have more healthy cognitions and behaviours while motivational therapy helps individuals to change their maladaptive behaviours based on an empathetic and supportive approach. Moreover, reality therapy practitioners state that all responsibility lies with the individual and she/he needs to be reactive in changing actions and cognitions in order to deal with the negative effects of excessive internet use. Finally, Naikan therapy is a psychotherapeutic method that combines meditation-like body engagement with the recovery of memory and the reconstruction of one’s life through applying the notions of the self and healing. Even though it is reported that the majority of these therapies are effective, there is a lack of studies that confirm their reliability and validity with the exception being cognitive behavioural therapy.

More specifically, Young (2007) and Young and Nabuco de Abreu (2010) examined the efficiency of cognitive behavioural therapy specifically for problematic internet use. They assessed the outcome variables for individuals undergoing treatment in terms of client motivation, online time management, improvement in social and sexual functioning, engagement in offline activities, and ability to abstain from problematic applications. Clients were assessed in the third, eighth and twelfth sessions and a six-month follow-up. They found that most of the participants were able to manage their symptoms by the eighth session and symptom management was sustained at a six-month follow up. The effectiveness of cognitive behavioural therapy has also been supported with case study research (King, Delfabbro, Griffiths, & Gradisar, 2012).

Another treatment option which was first introduced in China by Su, Fang, Miller, and

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Wang (2011) is the Healthy Online Self-Helping Centre (HOSC). It was found that participation in this programme was associated with a reduced amount on time spent online.

Subjects reported less problematic internet use and improved online satisfaction one month after their participation. Although this programme is built around a paradox, for it necessitates online participation while trying to control online activities, it has some advantages which make it appealing as a treatment option. It is cost effective, provides immediate feedback to the user and it takes into account the willingness of the user to undertake a change. However, its clinical significance and effectiveness compared with other treatment options needs further investigation.

Pharmacological interventions have been applied as another mean for treating problematic internet use. Health professionals based on the observable similarities between problematic internet use and substance-related and addictive disorders, have administered pharmaceutical agencies which have been found to be effective for controlling substance taking behaviour. More specifically, similar to findings regarding substance-related and addictive disorders research has revealed deficiencies in the reward pathway in problematic internet users (Hou et al., 2012; Kim et al., 2011; Liu et al., 2010). It has been proposed that this deficit predisposes individuals to use substances or indulge in pleasurable activities such as gambling in an attempt to ameliorate pre-existing anhedonic states. Agencies such as naltrexone (an opioid block receptor) and escilopram (a serotonin release agent) which have been used effectively in treating substance and addictive disorders have also been found to be effective for treating problematic internet use (Bostwick & Bucci, 2008; Sattar &

Ramaswamy, 2004).

Even though psychosocial and pharmacological treatments have shown positive outcomes, more research needs to be conducted in order to assess their long-term efficacy as well as whether a combination of both types of interventions could maximize treatment efficacy (Huang, Li et al., 2010; Winkler et al., 2013). Additionally, factors such as the inclusion of a control group, random sample allocation, effect size, uniformity in diagnostic criteria and definitions, specifications of which potential subtypes of problematic internet use are being targeted as well as protocols for pharmaceutical interventions are some of the

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grounds for the systematic criticisms made regarding the majority of studies conducted in the field (Huang, 2010; King, Delfbbro, Griffiths, & Gradisar, 2011). Thus, future research needs to accommodate these factors in order to validate the effectiveness of each potential intervention available for addressing problematic internet use.