Testing the efficacy of group cognitive-behavioral therapy for pathological internet use among undergraduates in Nigeria

Ede, Moses Onyemaechi; Okeke, Chinedu Ifedi; Igbo, Janet N.; Aye, Eucharia

doi:10.47626/2237-6089-2021-0348

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Trends in Psychiatry and Psychotherapy

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Original Article • Trends Psychiatry Psychother. 45 • 2023 • https://doi.org/10.47626/2237-6089-2021-0348 copy

Testing the efficacy of group cognitive-behavioral therapy for pathological internet use among undergraduates in Nigeria

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

The aim of this study was to examine the effect of group cognitive-behavioral therapy (GCBT) on pathological internet use (PIU).

Method

The study applied a group randomized controlled trial design to assign participants to intervention and control groups. A total of 40 college students aged 18 to 30 who were pathological internet users (PIUs) participated in this study and were randomly assigned to treatment and control groups. Participants completed a self-report scale entitled the Problematic Internet Use Scale (PIUS) at three time points. The intervention lasted 8 weeks. The data collected were statistically analyzed using repeated-measures analysis of variance (ANOVA).

Results

The results showed that GCBT has significant efficacy, decreasing the symptoms of PIU among the GCBT participants compared to those in the control group and that the improvements were maintained at follow-up. We also found a significant interaction effect by time for PIU.

Conclusion

From the study findings, we can conclude that GCBT has significant benefit for mitigating the severity of PIU in college students. Therefore, mental health professionals are encouraged to explore the benefits of GCBT in treating symptoms associated with PIU in school settings and beyond.

Group cognitive-behavioral therapy; pathological internet use; college students; Nigeria

Time frame (weeks)	Session	Topic	Activities	Techniques	Specific objective
1, 2	1, 2	Introduction, purpose, and rules; meaning of PIU.	Familiarization with the participants. Acquainted the participants with the purpose and relevance of the group process in improving students’ behaviors. Spelling out the boundary for group interaction. Making a contract on group norms such as confidentiality, commitment and treat each other with respect. Encouraged to think about, open up and discuss their concerns. Explained the meaning of PIU and basic needs for group formation. Explored their basic daily functioning that is impaired as a result of excessive internet use. Explored the factors of the internet addiction in terms of basic needs. Being conscious of symptoms of PIU and its management skills using CBT. Practice exercise was given to the participants.	Establishing therapeutic relationship; attending skills; listening skills; clarification; emotional disputation; cognitive restructuring; relaxation; reframing technique.	To help participants appreciate the nature and problem of PIU and commit to genuinely engage in the program. To understand and commit to genuine participation in group interaction.
3	3	Dealing with the consequences of PIU using CBT	Participants were allowed to discuss the problems they encountered in their study. Some of these problems include inadequate preparation for examinations, late submission of assignments, inadequate concentration in classes, and examination phobia. The researchers encouraged the participants to offer possible solutions to the problems identified. Explain briefly choice and CBT theories to the group members. Teach the group to use time management techniques. Homework assignment: apply time management techniques, practice exercise.	Cognitive disputation; time management; mood monitoring; restructuring; problem-solving skills; reflection of feeling; coping skills; thought monitoring and stopping; reframing technique.	Understand and admit that PIU has possibly, negatively impacted their lives as students. Understand the tenets of CBT theory and technique.
4	4	Exploration of alternative activities	Encourage the group to establish alternative activities. Present participants’ optional activities. Encourage the group members to use homework/assignment and self-help. Reviewed the timetables brought by individual participants. Guidelines for effective study habits were discussed. Homework/assignment.	Time management; assertive training; discussion; problem-solving skills; reframing technique.	Consider and adopt other activities to replace their intensive internet use.
5	5	Recognize internet usage pattern and their addiction triggers; help the group make a concrete plan to do better.	Review the group rules and follow up on the homework/assignment. Complete time plan form. Present it to the whole group. Reviewing previous discussion. Practice coping skills. Termination.	Discussion; proximity control; assertive training; interpretation.	Identifying antecedent behaviors and committing to developing specific plans to counter PIU.
6, 7	6, 7	Help the group make and use a verbal contract and positive reminder cards	Review the homework assignment. Make an oral or written contract with group members. Encourage the participants to make commitment plans. Make positive cues and encourage the group to use them in their real life. Homework/assignment: apply positive reminder cards. Reminding the participants of the last meeting.	Time management; proximity control; discussion; assertive training; interpretation; discussion, explanation.	Monitoring assimilation and encouraging the use of CBT techniques.
8	8	Revision of the program/termination	Follow up of the homework/assignment. Review significant accomplishments of the participants. Remind the group that even though the group experience has ended, confidentiality is still expected and important. Light and healthy refreshment is offered at the end the group session. Thank the group for their commitment and cooperation	Proximity control; discussion; interpretation; shaping and reinforcement.	Following up with participants on progress with techniques and any reported changes (positive or negative).

Characteristics	CBT group n (%)	Waitlist control group n (%)	Statistic	Sig
			χ ²
Gender
Male	13 (65.0)	17 (85.0)	2.133	0. 144
Female	7(35.0)	3 (15.0)
Age t test
Average age	23.20 ± 4.02	23.95 ± 3.83	0.604	0.550
Age range	18-30 years
Skewness	0.094
Kurtosis	-1.23
Location χ²
Rural	7 (35.0)	5 (25.0)	0.476	0.490
Urban	13 (65.0)	15 (75.0)
Psychological problem
Withdrawer	2 (10.0)	2 (10.0)	0.577	0.989
UC	3 (15.0)	2 (10.0)
LIAA	3 (15.0)	3 (15.0)
LR	4 (20.0)	3 (15.0)
EUDP	5 (25.0)	6 (30.0)
MC	3 (15.0)	4 (20.0)
Absence rate
High	11 (55.0)	8 (40.0)	0.902	0.342
Low	9 (45.0)	12 (60.0)
Average time spent online
Weekdays	6 (30.0)	7 (35.0)	0.114	0.736
Weekend	14 (70.0)	13 (65.0)
Internet sport activities
Bet 9ja	5 (25.0)	7 (35.0)	1.019	0.961
Gaming	2 (10.0)	2 (10.0)
Sure Bet	4 (20.0)	3 (15.0)
Naira Bet	4 (20.0)	3 (15.0)
Winner Golden	2 (10.0)	3 (15.0)
Merry Bet	3 (15.0)	2 (10.0)
Level of study
Year 1	6 (30.0)	7 (35.0)	0.130	0.937
Year 2	10 (50.0)	14 (45.0)
Year 3	4 (20.0)	4 (20.0)
Ethnicity
Igbo	7 (35.0)	6 (30.0)	0.420	0.936
Hausa	3 (15.0)	4 (20.0)
Yoruba	5 (25.0)	6 (30.0)
Others	5 (25.0)	4 (20.0)

Outcome	Waitlist-control group (n = 20) Mean (SD)			Treatment group (n = 20) Mean (SD)			df	F	Sig	95%CI	η_p²
Outcome	Time 1	Time 2	Time 3	Time 1	Time 2	Time 3	df	F	Sig	95%CI	η_p²
PIUS	6.978 (2.95)	-	-	69.73 (2.12)	-	-	(1.37)	1.03	317	-0.145-0.436	0.013
PIUS	-	70.03 (2.78)	-	-	24.92 (1.60)	-	(1.37)	3953.37	0.000	-6.565--43.658	0.99
PIUS	-	-	70.34 (1.63)	-	-	24.13 (1.67)	(1.37)	7739.604	0.000	-7.268--45.140	0.99

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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[1] Correspondence: Eucharia Aye Department of Educational Foundations, Faculty of Education, University of Nigeria Nsukka, Enugu State, Nigeria E-mail: eucharia.aye@unn.edu.ng