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52 - Khazaei2017 PDF
52 - Khazaei2017 PDF
PII: S0747-5632(17)30146-2
DOI: 10.1016/j.chb.2017.02.065
Reference: CHB 4822
Please cite this article as: Khazaei F., Khazaei O. & Ghanbari-H. B., Positive psychology interventions
for internet addiction treatment, Computers in Human Behavior (2017), doi: 10.1016/j.chb.2017.02.065.
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1
Department of Psychology, Torbat-e Jam branch, Islamic Azad University, Torbat-e Jam, Iran.
(Email:Khazaei.fat@gmail.com)
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2
Department of Psychology, Ghochan branch, Islamic Azad University, Ghochan, Iran.
(Email:N.khazai@yahoo.com)
SC
3
Department of Psychology, Ferdowsi University of Mashhad, Mashhad, Iran.
(Email:Ghanbarih@um.ac.ir)
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Abstract — Internet addiction is a new form of dependence on equipment connected to
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the network. This type of addiction has many negative consequences, particularly in the
area of social relations. Although a variety of methods have been presented for the
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treatment of this problem, they are in their beginning stages and studies are in progress in
this field and secondly, they commonly ignore the effects of positive interventions in the
treatment. Positive psychology interventions (PIs) refer to individual/group-based
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treatment methods that increase positive emotions and can enhance social relationships of
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individual(s). The aim of the current study is to evaluate the efficacy of a group-based PI
in treating Internet addiction (IA). For this purpose, PI-based treatment sessions are
designed and forty-eight internet-addicted university students are randomly assigned to an
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experiment group (n=24)/control groups (n=24). Measures of the severity of Internet use
(SI), quality of relationships inventory (QRI), Bell's adjustment inventory (BI) and IA rate
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are assessed at baseline and after intervention. The results indicate that SI and IA rate in
the experiment group are lower than those in the control group, while social adjustment
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and quality of relationships in the experiment group revealed an increase compared to the
control group. According to the results, PI is an effective method for treating IA,
specifically in mitigating Internet use and improving the quality of social relationships.
PT
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Abstract — Internet addiction is a new form of dependence on equipment connected to
the network. This type of addiction has many negative consequences, particularly in the
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area of social relations. Although a variety of methods have been presented for the
treatment of this problem, they are in their beginning stages and studies are in progress in
this field and secondly, they commonly ignore the effects of positive interventions in the
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treatment. Positive psychology interventions (PIs) refer to individual/group-based
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treatment methods that increase positive emotions and can enhance social relationships of
individual(s). The aim of the current study is to evaluate the efficacy of a group-based PI
in treating Internet addiction (IA). For this purpose, PI-based treatment sessions are
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(SI), quality of relationships inventory (QRI), Bell's adjustment inventory (BI) and IA rate
are assessed at baseline and after intervention. The results indicate that SI and IA rate in
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the experiment group are lower than those in the control group, while social adjustment
and quality of relationships in the experiment group revealed an increase compared to the
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control group. According to the results, PI is an effective method for treating IA,
specifically in mitigating Internet use and improving the quality of social relationships.
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1. Introduction
Internet addiction (IA) refers to the lack of control over Internet use and can include addiction to
online games and use of virtual social networks. IA can give rise to a host of social and
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psychological problems and leave numerous negative impacts. Although researchers have come
up with a variety of therapeutic methods for IA, they are still in their early stages and seem to
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have a limited impact on the improvement of social relations. IA decreases face-to-face social
contacts, and consequently provokes negative feelings such as depression and loneliness (Yao
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and Zhong 2014). According to the literature, many psychopathologies such as ADHD,
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depression, anxiety, paranoid ideation, hostility, interpersonal sensitivity, schizophrenia and
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OCD can be associated with IA (Ha et al., 2007; Adalıer and Balkan 2012; Alavi, Maracy,
Jannatifard, and Eslami 2011; Adalier and Balkan 2012, Taymur et al. 2016). The symptoms of
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IA and various types of IA such as on-line game addiction (Hyun et al. 2015; Charlton and
Danforth 2007; Kim 2010) are identified by Young’s criteria (Young 1998; Flisher 2010; Hawi
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et al. 2015; Brand et al. 2016) and it requires the administration of an effective treatment.
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Young considers the eight basic criteria for the diagnosis of pathological gambling as a basis for
the diagnosis of IA. According to Young anyone who exhibits at least five of these symptoms is
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addicted to the internet: 1- mental preoccupation with the internet (thinking about the time spent
connected and looking forward to the next connection), 2- feeling the need to spend more time
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on the internet to gain more satisfaction, 3- failure to control, stop or limit internet use, 4- lack or
limitation of internet use leads to anxiety, depression or anger, 5- use of internet is more than
intended, 6- job opportunities and social relations are negatively affected by the excessive use of
the internet, 7- lying to family members, psychiatrist and others about the duration of internet
use, 8- use of internet as an escape from problems such as depression and disappointment.
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The IA treatment has not been standardized yet (Przepiorka et al. 2014; King et al. 2011; Byun et
al. 2009). Some researchers emphasize on the role of pharmacotherapy in the treatment of IA
(Przepiorka e al. 2014). This approach entails the use of various drugs and antagonists such as
antidepressant drug (Dell’Osso et al. 2008; Harden et al. 2002; Sattar et al. 2004), antipsychotic
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drug (Atmaca 2007; Cash et al. 2012; Camardese et al. 2015; Moreira et al. 2015; Kuss & Lopez-
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Fernandez 2016), opioid receptor antagonist (Bostwick 2008; Robbins & Clark 2015;
Lingford‐Hughes 2016), glutamate antagonist (Camardese et al. 2012; Przepiorka e al. 2014;
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Koob & Volkow 2016). Another approach is cognitive-behavioral therapy (CBT) to IA
(Jorgenson et al. 2016; King and Delfabbro 2014; Przepiorka e al. 2014; Ja¨ger et al. 2012; Kim
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et al. 2012; Young et al. 2011; Du et al. 2010) in which patients are trained to control feelings
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and thoughts that encourage them to escape into the internet. The CBT approach to IA may be
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associated with individual therapy, group therapy (Przepiorka at al. 2014) and family therapy
(Flisher 2010; Liu et al. 2015), but these approaches have not been included in positive
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psychology interventions (PIs) so far. PIs improve social relationships and can be considered as
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an IA treatment process. In this paper, we aim to evaluate the efficacy of PIs in treating IA. The
paper is organized as follows. Subsection 1.1 reviews the positive psychology. Our hypotheses
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are proposed in Subsection 1.2. Section 2 presents the material and methods. Finally, results and
One of the recently proposed approaches in psychology that has attracted growing attention of
2000 (Seligman et al. 2000, 2002, 2006, 2014), the primary goal of this branch of psychology
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was to extend the emphasis of Clinical Psychology beyond diseases and their direct alleviation
(Seligman, 2014). Layous, Chancellor, Lyubomirsky, Wang & Doraiswamy (2011) as positive
psychology theorists maintain that positive interventions both directly and indirectly (by
fostering positive thoughts, positive behavior and positive emotions) improve well-being and
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reduce negative emotions. Positive psychotherapy is intended to realize the goal of improving
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positive emotions and reducing negative emotions. Fredrickson (2011) argue that positive
psychology therapeutic techniques are based on community participation and reinforced positive
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emotions of people towards each other.
PIs are made based on positive psychology. Positive psychology studies positive emotions and
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personal traits in order to improve health. Positive psychology, unlike other approaches which
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focus on problems and weaknesses, emphasizes positive emotions and improvement of life
quality. From this point of view, positive emotions and capabilities are one of the best areas for
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the prevention of psychological trauma. PIs can reduce negative emotions such as anxiety, and
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according to the emotional architecture (Lotfi and Akbarzadeh 2014), it can be concluded that
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PIs enhance many cognitive functions such as learning and decision-making (Brand et al. 2016).
Emotional architecture is a neural network of emotional brain components which can act as a
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platform for psychology studies. According to emotional architecture, low levels of anxiety puts
brain’s neural weights in a better condition for learning and learning is more complete.
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Consequently, factors which contribute to lowering anxiety can improve learning and result in
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better decision making. Since PI reduces anxiety, it can be concluded that it improves decision
making.
Increase of positive emotions and emotional health is basically in the definition of PI and
O’Connell et al. 2016 show in their study that PI can improve social relations. They study people
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under the three categories of relationship-focused, self-focused and control. They introduced PI
to the self-focused (no social interaction) and relationship-focused (involving social interaction)
and adopted the following criteria: relationship satisfaction, social support, and happiness.
According to the results, "Those who completed relationship-focused PIs had greater increases in
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relationship satisfaction than the self-focused and active control activities at six-week follow-up.
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Additionally, only those in the relationship-focused condition felt their existing friendships had
improved at intervention cessation." So PIs improve the positive emotions and emotional well-
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being and consequently it can improve social relationships.
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1.2. The importance of PIs in IA treatment and our hypothesis
According to Huang et al. (2010), Li and Chung (2006), Internet addiction can cause many
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problems for the person, including psychological (anxiety, depression, loneliness), physical
(sleep and feeding problems), family (loss of family ties and separation between family
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members), education (school grades drop) and career problems (reduced work efficiency,
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dismissal from work). In general, Internet addiction is associated with behavioral control
problems. These problems are related to the lack of ability to have moderation in Internet use
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which causes problems such as personal turmoil and dysfunction in the daily activities (Shek,
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Sun, Yu, 2013). Loneliness is one of the amazing effects of Internet addiction among university
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students in America (Yen et al. 2009). A statistical research on the relationship between internet
addiction and depression and conflict with family has been conducted on 8941 newly pubescent
teenagers around the age of 20 in Taiwan (Huang and Deng 2009; Lin et al. 2009), South Korea
(Bayon et al, 2009), Norway (Bakken, 2009) etc. which in total accounts for 94 studies in 22
countries. The results of all these studies shows a significant relationship between internet
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addiction and depression, loneliness (which is a consequence of lack of social connection) and
family conflicts. In the literature, there are numerous studies which investigate communication
disorders as a result of Internet addiction (such as Moraham and Martin, 2000; Whang et al.
2003; Nalwa et al. 2003). Internet addiction has a clinical correlation with social communication
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disorders and the quality of relationships. Relationship quality is a high-level structure consisting
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of several distinct but interconnected dimensions. The importance of trust, satisfaction and
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of relationship quality lies in the fact that it can affect the physical and psychological health.
When people use effective communication patterns, there is a clear transmission and
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understanding of the content and intent of each message (Hartley, 2004). Effective
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communication is a process in which the transmitter and receiver are actively involved
(Bernstein 1985). Another aspect of the injuries of Internet addiction in the field of social
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individual's ability to build proper relationships with others and cooperate with them. Carinz et
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al., assert that the adjustment processes are formed in relation with effective social
communication and socialization lays the ground for increased adaptability. Accordingly,
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Internet addiction can be associated with reduced actual social relations and social adjustment.
Griffiths (1998) believes that the Internet provides a safe environment for engaging in the social
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relations. However, Pratarelli et al. (1998) believe that the Internet does not add anything, and
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rather removes thigs such as common fears in social interaction. That is why an Internet
connection are associated with disinhibition and early disclosure. In interpersonal relationships,
self-disclosure can increase intimacy but in real life, self-disclosure occurs only after confidence
is built between the parties to ensure that each party will not divulge the other's secret to their
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disclosure is increased. The results of studies conducted by Koch and Pratarelli (2004),
Engelberg and Sjöberg (2004) and Lee and Stapinski (2012) reveal a significant correlation
between internet addiction and decrease in social adjustment. In fact, there is a negative
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correlation between internet addiction and social adjustment in a way that increased use of the
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internet results in reduced social adjustment.
The importance of PIs in IA treatment is due to their health benefits including increased
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frequency and quality of social contacts (Park et al. 2016). PIs enhance social relationships
(O’Connell et al. 2016) as well as the frequency and quality of contacts. Yao and Zhong (2014)
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presumes that an increase in the frequency and quality of face-to-face social contacts can reduce
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IA. Thus, a PI-based treatment method that directly increase the number and quality of face-to-
face social contacts can lead to an indirect reduction in IA. On the other hand, IA provokes many
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negative emotions (King et al. 2016) and also may be caused by negative emotions such parent
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marital conflict (Yang et al. 2016) and negative passion (Burnay et al. 2015). In contrast, PIs
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which increase the positive emotions (Layous et al. 2011), can be considered as a proper strategy
for IA treatment.
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With regard to the issues raised above, it can be concluded that Internet addiction is associated
with the destruction of social relations. Several treatments have been proposed for this disorder,
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Positive psychology with its emphasis on improving social communication can be an effective
technique for the treatment of Internet addiction. Accordingly, this study seeks to answer the
improve the quality of interpersonal relationships in individuals with internet addiction, and
In this study, group-based positive psychology interventions (PIs) approach has been proposed
to increase social adjustment, improve the quality of relationships and reduce the severity of
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Internet use for individuals with Internet addiction. The proposed PIs reduce the severity of
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Internet use and can be considered as an IA treatment process. In this regard, three hypotheses
are presented:
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1. The social adjustment of students with Internet addiction who attend group-based
control group.
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2. The relationship quality of students with Internet addiction who attend group-based
control group.
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3. The severity of Internet use of students with Internet addiction who attend group-based
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control group.
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4. Internet addiction rate among students who attend group-based positive psychology
In our study, the severity of Internet use has been measured through the frequency of
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This is a causal-comparative research and the study population consisted of all undergraduate
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students of Binalud University and Azad University of Torbat-e Jam, Iran in the first semester
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Using the available samples based on Young’s Internet Addiction tests (Young 2009; Widyanto
& McMurran 2004; Rooij & Prause 2014), Yale-Brown obsessive-compulsive scale (Goodman
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et al. 1989; Rosario-Campos 2006), Bell's adjustment inventory (BI), the quality of relationships
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inventory (QRI) (Pierce et al. 1994) and the severity of Internet use (SI), 48 subjects, who had
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inclusion and exclusion criteria constituted the statistical sample of the study. Young's test is the
first inclusion criterion and Yale-Brown's scale ensured us that the participants had at least a
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specific level of obsession and compulsion in internet use. The participants were randomly
assigned to two groups of A and B (each with n=24). Subjects in Group A constituted the
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experiment group and received PIs but those in Group B formed the control group and were a
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The following criteria led to the exclusion of subjects from the study:
1
Available at https://psychology-tools.com/internet-addiction-test/
2
Available at https://psychology-tools.com/yale-brown-obsessive-compulsive-scale
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to have symptoms of Internet addiction were invited to participate in the study via a notification
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on the board and arranged to visit the researcher for final diagnosis. Then, Young’s Internet
Addiction Test and clinical interviews were administered to confirm the diagnosis. The subjects
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with a positive diagnosis were separated and enrolled as the sample population. The subjects
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were then randomly assigned to the control and experiment groups.
In the next step, the QRI, BI and SI were administered to the samples as the pre-intervention.
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The experimental group (n=24) received the proposed PIs by the therapist and the control group
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were on the waiting list. At the end of study, quality of relationships inventory (QRI), adjustment
inventory (BI), the severity of Internet use (SI) and IA rate of were administered to the samples
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as the post-test and the data were analyzed. A summary of applied PIs is provided in Table 1.
In Table 1, session 2, Klifton empowerment (Asplund et al. 2007) is a scale for the measurement
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of personal talents. Based on the interview's data, there 34 talents which can be developed in
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categories and includes important information and a lexicon for therapists to use these
capabilities.
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Activity Description
Sessions
In this session the assumptions and the role of positive psychotherapist in the treatment of
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Session 1
subjects is explained and responsibilities of the subjects are discussed.
Positive stories are reviewed and capabilities and strengths in the story are identified. To
Session 2 stimulate full participation of subjects in the discussion, it is helpful to prepare a version of
capabilities definitions by VIA-IS and Klifton empowerment.
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Positive psychotherapy is intended to help subjects nurture high capabilities and positive
Session 3
emotions. Therapists ask subjects to formulate a specific plan to implement their abilities.
The intervention is aimed to help better understand the role of positive and negative
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memories in maintaining the symptoms of depression. Subjects are counseled about how to
Session 4
express their anger, bitterness and other negative emotions. Then, the effects these emotions
on depression and wellbeing are discussed. .
It focuses on forgiveness. It is introduced as a means to sliding down the anger and other
Session 5 negative emotions. As a task of this session, subjects are asked to write a letter of
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forgiveness to someone who bear grudge against them.
It focuses on thankfulness. The role of the negative and positive memories are discussed
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Session 6 again, and the impact of the thankfulness on such memory is discussed. They are asked to
write a detailed letter of gratitude to someone whom they have never fully thanked and send
it to the person in question.
It is a review of treatment progress. Therapists discuss the progress of subjects in writing
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Session 7 letters of forgiveness and thankfulness, making gratitude notebooks and application of their
capabilities.
It aims to teach satisfaction versus perfectionism to subjects. They learn that although
Session 8
choices are vital to one’s wellbeing, over-sensitiveness in selection can be wearing.
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Session 9 It focuses on hope and optimism. It is especially helpful to subjects whose lack of positive
excitement is related to the future.
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It focuses on hope and optimism. It is especially helpful to subjects whose lack of positive
Session 10
excitement is related to the future.
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such as age, education, gender, as well as clinical information such as a history of physical and
psychiatric illnesses.
Social Adjustment: The adult version of Bell's adjustment inventory (BI) consists of 160 items at
five different personal and social measurement levels. Some of these items can be used for
personal measurement level and some others can be used for social adjustment level. In this
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study, the social adjustment level with 32 items was used. These 32 items are strongly related to
the social adjustment and their scoring can be easily performed using the related key to each
adjustment area. The total scores derived from scoring items represents the adjustment status of
an individual. With regard to the social adjustment of the above questionnaire, high scores
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indicate alienation and lack of social contact. It should be mentioned that no score was given to
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question marks or any unrelated answer to the items and Cronbach's alpha coefficient was
determined to be 0.89.
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Quality of Relationships Inventory (QRI): QRI was developed by Pierce et al (1994) to evaluate
the quality of relationships with important people in one’s life. Originally, the questionnaire
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consisted of 29 items, but later it was condensed into 25 items applied here and scored on a
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Likert scale from 1 to 4.
QRI applied here is composed of three subscales including perceived social support (7 items),
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interpersonal conflicts (12 items) and depth of relationships (6 items). Moreover, one can
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evaluate the quality of relationships with parents, friends and spouse in each item, but since the
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majority of subjects in the study were single, the quality of relationship with spouse was not
evaluated. Cronbach's alpha coefficient for subscales of social support, depth of relationships and
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interpersonal conflicts was, 0.83, 0.88 and 0.86 respectively. A Cronbach’s alpha coefficient of
The severity of Internet use (SI): Kim et al. (2012) have used SI measure in treating on-line game
addiction. Here, the SI is asked from both experiment and control groups (daily for the 7 days) at
baseline and after intervention, and the total hours of Internet use (during 7 days) are applied as
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SI = ∑ sii , (2)
i =1
where sii demonstrates the severity of internet use (hours of internet use) in the past ith day.
Young criteria: based on criteria provided by Young and reviewed in the introduction, an
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Internet addiction test3 is available on the Internet that can be used in research related to IA
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treatment. A score between 50 and 70 in this test is indicative of Internet addiction.
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2.3. Data analysis method
The data collected from administering questionnaires in the pre-intervention and post-
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intervention were analyzed by SPSS 20 software. First, descriptive statistics were used to
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show information such as demographic characteristics (frequency, percentage, mean
and standard deviation), and then inferential statistics including one-way and multi-way
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3. Results
According to the results, the social adjustment of students with Internet addiction, who were in
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the positive psychotherapy group, was significantly higher than subjects in the control group.
Moreover, the quality of relationships of these students was also greater than those in the control
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group. Also the severity of internet use and IA rate were reduced in experiment group. Figs. 1, 2,
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3 and 4 show the results. In the first step of the analysis, the mean scores of control
and experiment groups in two variables of social adjustment and the quality of relationships were
evaluated. Table 2 shows the mean scores of two groups. Table 2 also displays the mean and
3
https://psychology-tools.com/internet-addiction-test/
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standard deviation for the scores of interpersonal conflict in both experiment and control groups
According to the results, the mean scores of experiment group is higher than the control group.
The mean and standard deviation of the scores represent the depth of the relationships in both
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experiment and control groups. Therefore, the results show that the experiment group deal with
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less conflicts compared to the control group. To determine the significance of any variation of
means following the intervention, the univariate analysis of covariance was used. the univariate
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analysis of covariance was used. According to the results of univariate analysis of covariance for
social adjustment, F = 10.15 is obtained where degree of freedom = 1, mean square = 7.5 and
between experiment and control groups in terms of social adjustment scores. Thus, the
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hypothesis is confirmed, meaning that there is a significant difference between the social
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adjustment of participants in the experiment and control group by controlling the pre-
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intervention (P <0.0001 and F= 819.67). Also, the second hypothesis of the research was also
tested by univariate analysis of covariance and the results are as follows: F = 11.97 is obtained
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from perceived social support where degree of freedom = 1, mean square = 40.54 and significant
level = 0.002. In interpersonal conflicts, F = 11.7 is obtained with degree of freedom = 1, means
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square error = 11.7 and significant level = 0.40. Also the depth of relationships shows F = 14.91
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with degree of freedom = 1, mean square = 14.91 and significant level = 0.022.
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Table 2. the mean and standard deviation for the scores of interpersonal conflict
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18.75 2.63
intervention
BI
Pre-
25.5 1.18
intervention
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control
Post-
26.03 1.43
intervention
Pre-
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11.5 1.17
intervention
experiment
Post-
19 1.7
intervention
QRI
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Pre-
11.5 1.5
intervention
Control
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Post-
12.16 1.74
intervention
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positive psychotherapy can significantly increase the perceived social support (P< 0.01), the
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depth of relationships (P<0.05) and reduce interpersonal conflicts (P<0.05). Thus, the first,
second and third secondary hypotheses are also confirmed with the results demonstrating that
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group-based positive psychology can improve the perceived social support, interpersonal
conflicts and the depth of relationships in people with Internet addiction. Table 3 presents the
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mean and standard deviation of SI and Young score in both experiment and control groups in the
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pre-intervention and post-intervention. For SI, F = 37.9 and P <0.01 and for Young score, F =
114.9 and P<0.01. Figures 1, 2 and 3 summarize the results and also include those of the waiting
list. As presented in the Figures, there are no differences between the experimental, control and
waiting list groups at baseline. After that the social relationships of experiment group are
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increased while the SI is significantly decreased. According to the results, the proposed PI can be
considered for treating IA. In Figure 4, the IA rate (Eq. 1) is presented for the control and
experiment groups in which the Young’s test for 7 individuals had been remained positive after
interventions. Therefore, PIs improve the QRI (Figure 1) and BI (Figure 2), and decrease SI
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(Figure 3) and IA rate (Figure 4) based on Young's criteria.
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Table 3. the mean and standard deviation for the scores of internet addiction
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Measure Group Mean STD
Pre-
60.3 4.32
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intervention
experiment
Post-
12.6 1.90
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intervention
SI
Pre-
59.3 3.85
intervention
Control
Post-
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62.4 4.41
intervention
Pre-
63.5 4.74
intervention
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experiment
Post-
47.2 3.20
intervention
Young
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Pre-
63.2 4.50
intervention
Control
Post-
64.1 4.59
intervention
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Fig. 1 The result of proposed PIs in BI measure
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Fig. 3 The result of proposed PIs in SI measure (the severity of Internet use)
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Fig. 4 The results of Internet addiction treatment using positive psychology intervention. After treatment,
71% (i.e. 100-29) of the experiment group do not show internet addiction based on Young's criteria.
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4. Conclusion
The aim of the present study was to evaluate the effectiveness of group-based positive
psychology interventions (PIs) for the treatment of excessive internet use, reduction of internet
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addiction (IA) rate and improvement of adjustment capability and quality of relationships in
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people with Internet addiction. For this purpose, 48 students with Internet addiction were
randomly assigned to two experiment and control groups and research hypotheses were analyzed
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by univariate and multivariate covariance analysis. The results of hypotheses testing are as
follows. Firstly, the results showed that group-based positive psychology intervention alleviated
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the intensity of Internet use in people with Internet addiction. Secondly, the IA rate is reduced as
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result of the application of the designed PI. Thirdly, the analysis of covariance indicated that
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with addictions. Social adjustment is a key component of mental health. The more a person is
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able to engage constructively with the environment, the greater will be his adjustment, which can
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On the other hand, one of the causes of social maladjustment is Internet addiction, which is
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typically associated with disorders like depression, obsession, social anxiety and isolation. Thus,
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greater attention should be paid to the extent of social adjustment in these individuals. Positive
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psychology interventions can reduce the intensity of Internet use by fostering social harmony and
In fact, one of the main determinants of mental health is social adjustment and the ability to meet
the demands and requirements of the community. The more a person is able to grant these
demands and establish constructive interaction with the surrounding environment, the more
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adjustment capabilities he/she has and improved mental health is a natural outcome of this
process. On the other hand, one of the criteria for the loss of mental health is the destruction of
people's social adjustment capabilities. From the five diagnostic axes, the fourth and fifth axis
are focused on compatibility and performance in society. All this reflects the importance of
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social adjustment in psychological health. In the formation of psychological disorders, social
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adjustment is always one of the first component that will be affected by the disorder and interfere
with the individual's performance. Internet addiction has always been associated with disorders
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like depression, OCD, social anxiety and generalized anxiety disorder, therefore it is not
surprising that the lack of adjustment in these patients is higher than other groups. And this
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requires special attention. The mission of positive psychology is to enhance human abilities,
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thereby seeks to provide people with a happier and healthier life. Accordingly, it has a great
emphasis on adjustment components and does its best to enhancing people's health and
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adjustment and there is a strong negative correlation between these two variables. Therefore, it is
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concluded that all psychological treatments in general and positive psychology in particular
focus on the enhancement of social adjustment. Thereby seeking to restore psychological health
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and by emphasizing the factors associated with this feature is able to achieve this goal. This fact
is also confirmed by this study. Therefore, it can be concluded that positive treatment can
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increase social adjustment in those addicted to the Internet in two ways. Relying primarily on
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reducing the symptoms indirectly and in the second place with an emphasis on social adjustment
which is one of the components of positive psychology is directly looking to increase social
adjustment. The results of this study shows that it has successfully reached that goal.
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The fourth finding of this study was that the quality of relationships in students with Internet
addiction participating in group-based positive intervention was significantly higher than the
control group.
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As reported in the findings, the analysis of multivariate covariance suggested that group-based
positive intervention could significantly improve relationships in people with Internet addiction.
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However, the quality of relationships consists of three elements of perceived social support,
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interpersonal conflicts and depth of relationships, which constituted three secondary hypotheses.
Therefore, here an explanation of three secondary hypotheses based on the second main
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hypothesis has been presented. The results of statistical analysis confirmed three hypotheses
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under study, indicating that positive psychology interventions could foster social support, depth
psychology interventions help the treatment of Internet addiction in two ways: first by directly
fostering social adjustment and then by emphasizing the enhanced quality of social relations.
D
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These are the main elements of positive psychology with the results of this study suggesting that
positive psychology interventions can help the achievement of these goals in the treatment of
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Internet addiction. The mission of positive psychology is to enhance human abilities so that they
live a happy and healthy life. As such, the elements of enhanced social adjustment has been
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taken into account with an emphasis on improving health and compatibility. The results,
AC
consistent with the hypotheses demonstrate that positive psychological interventions in people
with addictive behaviors can improve interpersonal relationships, which is associated with
In fact, there is a strong negative correlation between the severity of symptoms of Internet
addiction and aggravation of interpersonal relationships (Koch and Pratarelli 2004) in such a way
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that as the symptoms are alleviated, the interpersonal communications are improved.
Accordingly, in this study, the treatment of disorder was accompanied with improved depth of
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In other words, Internet addiction is always associated with deteriorated interpersonal
relationships and increased conflicts in communications so that the disruption of social relations
RI
in people with Internet addiction is inevitable. This must be considered as one of the pillars of
psychological treatment of this disorder, an issue that has been stressed throughout in this study.
SC
Internet addiction is associated with disorders like depression and bipolar disorder (Young 1998;
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Sanders, Field, Diego and Kaplan, 2000), interpersonal problems, shyness and social anxiety
AN
(Bird, 2002; Toniuny et al., 2010) and more importantly, research have shown that internet
communications (Rastegar, Abdullahi and Shahgholian, 2014). The common aspect of these
studies is that the destruction of social relations in people with Internet addiction is inevitable
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and therefore, will certainly be one of the main aspects of the psychological treatment, something
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which is the focus of the present study. In this study, to improve interpersonal relationships,
group-based positive psychology intervention has been used. Rather than focusing on human
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disabilities and weaknesses, positive psychology shows an interest in human abilities, such as
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Seligman believes that all these features are possible in the social context and through social
strong emphasis on the improvement of interpersonal communication, since one cannot reach
personal growth and enjoy life alone. Psychologists of this school, have created a classification
system called CSV which classifies people's capabilities, compared to DSM which is a
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classification system psychiatric disorder. They define 6 groups of human capabilities in this
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positive psychology in general and altruism in particular. Therefore, there are appropriate
interventions designed to achieve this goal and they are adopted to improve the quality of
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communication in this study. Thus, it can be concluded that the essential elements of this therapy
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subcomponents, such as depth of relationship, interpersonal conflicts and social support,
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something which is approved by the results of the present study.
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5. Limitations and suggestions
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This research has a number of limitations. For example, this study sample was concentrated on a
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specific geographical context and cultural and ethnic diversity or other demographic
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characteristics were not taken into consideration. Also, this study was only conducted on
students with Internet addiction and the results were not assessed in other social classes. This
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restricts the possibility of evaluating situational differences. The study also focuses on the
dimension of time in IA while there are various aspects which can be investigated. The study
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results do not include the duration the effects last as well as individual differences. Finally,
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Moreover, since addiction is a disorder emanating from disturbed life style, treatments based on
References
Adalıer, A., & Balkan, E. (2012). The relationship between internet addiction and psychological
symptoms. International Journal of Global Education, 1(2).
Adalıer, A., & Balkan, E. (2012). The relationship between internet addiction and psychological
symptoms. International Journal of Global Education, 1(2).
PT
Alavi, S. S., Maracy, M. R., Jannatifard, F., & Eslami, M. (2011). The effect of psychiatric symptoms on
the internet addiction disorder in Isfahan’ s university students. Journal of Research in Medical
RI
Sciences, 16(6).
Asplund, J., Lopez, S. J., Hodges, T., & Harter, J. (2007). The Clifton StrengthsFinder® 2.0 technical
SC
report: Development and validation. The Gallup Organization, Princeton, NJ.
Atmaca, M. (2007). A case of problematic internet use successfully treated with an SSRI-antipsychotic
combination. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 31(4), 961-962.
U
Bakken, I. J., Wenzel, H. G., Götestam, K. G., Johansson, A., & ØREN, A. (2009). Internet addiction
AN
among Norwegian adults: a stratified probability sample study. Scandinavian journal of psychology,
50(2), 121-127.
Bostwick, J. M., & Bucci, J. A. (2008, February). Internet sex addiction treated with naltrexone. In Mayo
Clinic Proceedings (Vol. 83, No. 2, pp. 226-230). Elsevier.
D
Brand, M., Young, K. S., Laier, C., Wölfling, K., & Potenza, M. N. (2016). Integrating psychological and
neurobiological considerations regarding the development and maintenance of specific Internet-use
TE
Burnay, J., Billieux, J., Blairy, S., & Larøi, F. (2015). Which psychological factors influence Internet
EP
addiction? Evidence through an integrative model. Computers in Human Behavior, 43, 28-34.
Byun, S., Ruffini, C., Mills, J. E., Douglas, A. C., Niang, M., Stepchenkova, S. & Blanton, M. (2009).
C
Byun, S., Ruffini, C., Mills, J. E., Douglas, A. C., Niang, M., Stepchenkova, S., ... & Blanton, M. (2009).
Internet addiction: Metasynthesis of 1996–2006 quantitative research. CyberPsychology & Behavior,
12(2), 203-207.
Camardese, G., De Risio, L., Di Nicola, M., Pizi, G., & Janiri, L. (2012). A role for pharmacotherapy in
the treatment of “internet addiction”. Clinical neuropharmacology, 35(6), 283-289.
Camardese, G., Leone, B., Walstra, C., Janiri, L., & Guglielmo, R. (2015). Pharmacological treatment of
Internet addiction. In Internet addiction (pp. 151-165). Springer International Publishing.
ACCEPTED MANUSCRIPT
Cash, H., D Rae, C., H Steel, A., & Winkler, A. (2012). Internet addiction: A brief summary of research
and practice. Current psychiatry reviews, 8(4), 292-298.
Charlton, J. P., & Danforth, I. D. (2007). Distinguishing addiction and high engagement in the context of
online game playing. Computers in Human Behavior, 23(3), 1531-1548.
Dell’Osso, B., Altamura, A. C., Allen, A., Marazziti, D., & Hollander, E. (2006). Epidemiologic and
PT
clinical updates on impulse control disorders: a critical review. European archives of psychiatry and
clinical neuroscience, 256(8), 464-475.
Dell'Osso, B., Hadley, S., Allen, A., Baker, B., Chaplin, W. F., & Hollander, E. (2008). Escitalopram in
RI
the treatment of impulsive-compulsive internet usage disorder: an open-label trial followed by a double-
blind discontinuation phase. The Journal of clinical psychiatry, 69(3), 452-456.
SC
Du, Y. S., Jiang, W., & Vance, A. (2010). Longer term effect of randomized, controlled group cognitive
behavioural therapy for Internet addiction in adolescent students in Shanghai. Australian and New
Zealand Journal of Psychiatry, 44(2), 129-134.
U
Engelberg, E., & Sjöberg, L. (2004). Internet use, social skills, and adjustment. CyberPsychology &
Behavior, 7(1), 41-47.
AN
Flisher, C. (2010). Getting plugged in: an overview of internet addiction. Journal of paediatrics and child
health, 46(10), 557-559.
M
Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: The broaden-and-build
theory of positive emotions. American psychologist, 56(3), 218.
D
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., ... &
Charney, D. S. (1989). The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability.
TE
Griffiths, M. (1998). Internet Addiction: Does it really exist?. Psychology and the internet: intrapersonal,
interpersonal and transpersonal implications (pg. 61-75). Gackenbach. New York.
EP
Ha, J. H., Kim, S. Y., Bae, S. C., Bae, S., Kim, H., Sim, M. & Cho, S. C. (2007). Depression and Internet
addiction in adolescents. Psychopathology, 40(6), 424-430.
C
Harden, C. L., & Goldstein, M. A. (2002). Mood disorders in patients with epilepsy. CNS drugs, 16(5),
291-302.
AC
Hartley, J. (2004). Case study research. Essential guide to qualitative methods in organizational research,
323-333.
Hawi, N. S., Blachnio, A., & Przepiorka, A. (2015). Polish validation of the Internet addiction test.
Computers in Human Behavior, 48, 548-553.
Huang, L., & Deng, Y. L. (2009). Internet addiction disorder of vocational college freshmen and its
relationship to childhood psychological abuse and neglect. Chinese Journal of Clinical Psychology, 1, 57-
58.
ACCEPTED MANUSCRIPT
Huang, X. Q., Li, M. C., & Tao, R. (2010). Treatment of internet addiction. Current psychiatry reports,
12(5), 462-470.
Hyun, G. J., Han, D. H., Lee, Y. S., Kang, K. D., Yoo, S. K., Chung, U. S., & Renshaw, P. F. (2015).
Risk factors associated with online game addiction: a hierarchical model. Computers in Human Behavior,
48, 706-713.
Jäger, S., Müller, K. W., Ruckes, C., Wittig, T., Batra, A., Musalek, M., ... & Beutel, M. E. (2012).
PT
Effects of a manualized short-term treatment of internet and computer game addiction (STICA): study
protocol for a randomized controlled trial. Trials, 13(1), 1.
Jorgenson, A. G., Hsiao, R. C. J., & Yen, C. F. (2016). Internet Addiction and Other Behavioral
RI
Addictions. Child and Adolescent Psychiatric Clinics of North America.
Kim, M. G., & Kim, J. (2010). Cross-validation of reliability, convergent and discriminant validity for the
SC
problematic online game use scale. Computers in Human Behavior, 26(3), 389-398.
Kim, S. M., Han, D. H., Lee, Y. S., & Renshaw, P. F. (2012). Combined cognitive behavioral therapy and
bupropion for the treatment of problematic on-line game play in adolescents with major depressive
U
disorder. Computers in Human Behavior, 28(5), 1954-1959.
AN
King, D. L., & Delfabbro, P. H. (2014). The cognitive psychology of Internet gaming disorder. Clinical
psychology review, 34(4), 298-308.
King, D. L., Delfabbro, P. H., Griffiths, M. D., & Gradisar, M. (2011). Assessing clinical trials of Internet
M
addiction treatment: A systematic review and CONSORT evaluation. Clinical psychology review, 31(7),
1110-1116.
D
King, D. L., Kaptsis, D., Delfabbro, P. H., & Gradisar, M. (2016). Craving for internet games?
Withdrawal symptoms from an 84-h abstinence from Massively Multiplayer Online gaming. Computers
TE
Koch, W. H., & Pratarelli, M. E. (2004). Effects of Intro/Extraversion and Sex on Social Internet Use.
North American Journal of Psychology, 6(3).
EP
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet
Psychiatry, 3(8), 760-773.
C
Kuss, D. J., & Lopez-Fernandez, O. (2016). Internet addiction and problematic Internet use: A systematic
AC
Layous, K., Chancellor, J., Lyubomirsky, S., Wang, L., & Doraiswamy, P. M. (2011). Delivering
happiness: Translating positive psychology intervention research for treating major and minor depressive
disorders. The Journal of Alternative and Complementary Medicine, 17(8), 675-683.
Lee, B. W., & Stapinski, L. A. (2012). Seeking safety on the internet: Relationship between social anxiety
and problematic internet use. Journal of anxiety disorders, 26(1), 197-205.
Li, S. M., & Chung, T. M. (2006). Internet function and Internet addictive behavior. Computers in Human
Behavior, 22(6), 1067-1071.
ACCEPTED MANUSCRIPT
Lin, C. H., Lin, S. L., & Wu, C. P. (2009). THE EFFECTS OF PARENTAL MONITORING AND
LEISURE BOREDOM ON ADOLESCENTS'INTERNET ADDICTION. Adolescence, 44(176), 993.
Lingford Hughes, A. (2016). Substitution treatment in addiction: there is more than one way….
PT
Addiction.
Liu, Q. X., Fang, X. Y., Yan, N., Zhou, Z. K., Yuan, X. J., Lan, J., & Liu, C. Y. (2015). Multi-family
group therapy for adolescent Internet addiction: Exploring the underlying mechanisms. Addictive
RI
behaviors, 42, 1-8.
Lotfi, E., & Akbarzadeh-T, M. R. (2014). Practical emotional neural networks. Neural Networks, 59, 61-
SC
72.
U
Morahan-Martin, J., & Schumacher, P. (2000). Incidence and correlates of pathological Internet use
among college students. Computers in human behavior, 16(1), 13-29.
AN
Moreira, F. A., & Dalley, J. W. (2015). Dopamine receptor partial agonists and addiction. European
journal of pharmacology, 752, 112-115.
M
Nalwa, K., & Anand, A. P. (2003). Internet addiction in students: A cause of concern. CyberPsychology
& Behavior, 6(6), 653-656.
D
O’Connell, B. H., O’Shea, D., & Gallagher, S. (2016). Enhancing social relationships through positive
psychology activities: a randomised controlled trial. The Journal of Positive Psychology, 11(2), 149-162.
TE
Park, N., Peterson, C., Szvarca, D., Vander Molen, R. J., Kim, E. S., & Collon, K. (2016). Positive
Psychology and Physical Health Research and Applications. American Journal of Lifestyle Medicine,
EP
10(3), 200-206.
Peterson, C., & Seligman, M. E. (2004). Character strengths and virtues: A handbook and classification
(Vol. 1). Oxford University Press.
C
Pierce, G. R. (1994). The Quality of Relationships Inventory: Assessing the interpersonal context of
social support.
AC
Pratarelli, M. E., Browne, B. L., & Johnson, K. (1999). The bits and bytes of computer/Internet addiction:
A factor analytic approach. Behavior Research Methods, Instruments, & Computers, 31(2), 305-314.
Przepiorka, A. M., Blachnio, A., Miziak, B., & Czuczwar, S. J. (2014). Clinical approaches to treatment
of Internet addiction. Pharmacological Reports, 66(2), 187-191.
Robbins, T. W., & Clark, L. (2015). Behavioral addictions. Current opinion in neurobiology, 30, 66-72.
ACCEPTED MANUSCRIPT
Rosario-Campos MC. and EC Miguel, et. al. (May 2006). The Dimensional Yale-Brown Obsessive-
Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions.
11:5 Mol. Psychiatry, 495-504.'
Sattar, P. M., & Ramaswamy, S. M. (2004). Internet gaming addiction. Canadian journal of psychiatry,
49(12), 869.
PT
Seligman, M. E. (2002). Positive psychology, positive prevention, and positive therapy. Handbook of
positive psychology, 2, 3-12.
RI
Seligman, M. E., & Csikszentmihalyi, M. (2000). Special issue: Positive psychology. American
Psychologist, 55(1).
SC
Seligman, M. E., & Csikszentmihalyi, M. (2014). Positive psychology: An introduction (pp. 279-298).
Springer Netherlands.
U
Seligman, M. E., Rashid, T., & Parks, A. C. (2006). Positive psychotherapy. American psychologist,
61(8), 774.
AN
Shek, D. T., Sun, R. C., & Yu, L. (2013). Internet addiction. In Neuroscience in the 21st century (pp.
2775-2811). Springer New York.
M
Taymur, I., Budak, E., Demirci, H., Akdağ, H. A., Güngör, B. B., & Özdel, K. (2016). A study of the
relationship between internet addiction, psychopathology and dysfunctional beliefs. Computers in Human
Behavior, 61, 532-536.
D
Van Rooij, A., & Prause, N. (2014). A critical review of “Internet addiction” criteria with suggestions for
TE
Whang, L. S. M., Lee, S., & Chang, G. (2003). Internet over-users' psychological profiles: a behavior
sampling analysis on internet addiction. CyberPsychology & Behavior, 6(2), 143-150.
EP
Widyanto, L. & McMurran, M. (2004). The Psychometric Properties of the Internet Addiction Test. 7(4)
Cyberpsychol & Behav 443-50.
C
Yang, X., Zhu, L., Chen, Q., Song, P., & Wang, Z. (2016). Parent marital conflict and Internet addiction
among Chinese college students: The mediating role of father-child, mother-child, and peer attachment.
AC
Yao, M. Z., & Zhong, Z. J. (2014). Loneliness, social contacts and Internet addiction: A cross-lagged
panel study. Computers in Human Behavior, 30, 164-170.
Yen, J. Y., Yen, C. F., Chen, C. S., Tang, T. C., & Ko, C. H. (2009). The association between adult
ADHD symptoms and internet addiction among college students: the gender difference. Cyberpsychology
& Behavior, 12(2), 187-191.
ACCEPTED MANUSCRIPT
Young, K. S. (1998). Internet addiction: The emergence of a new clinical disorder. CyberPsychology &
Behavior, 1(3), 237-244.
Young, K. S. (2011). CBT-IA: The first treatment model for internet addiction. Journal of Cognitive
Psychotherapy, 25(4), 304-312.
Young, K. S. and R. C. Rogers (1998). "The relationship between depression and Internet addiction."
PT
CyberPsychology & Behavior 1(1): 25-28.
Young, Kimberly S. (2009). Internet Addiction: The Emergence of a New Clinical Disorder. 1(3)
Cyberpsychol & Behav 237-244.
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Positive psychology interventions (PIs) are proposed for treating Internet addiction.
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The quality of relationships and the social adjustment of students was improved by PIs.
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The severity of Internet use and Internet addiction rate were reduced by proposed PIs.
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The proposed method decreased the Internet addiction rate about 71% in experiment group.
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