Cognitive Behavioral Therapy

To understand why some people engage in compulsive or unhealthy activities, it is important to recognize the power within the interrelationship of what we think, how we feel and what we do. For example, opening up our laptop might remind you of playing your favorite online game. This triggers thoughts about the importance of achieving in the game, reminders of past victories and predictions about how much fun it is to play. These cognitions in turn trigger feelings of pleasure and excitement towards the game. With those thoughts and feelings in place, you are likely to start playing.

Most people have little real difficulty coming offline and gaining satisfaction from a myriad of other activities. However, problems often emerge when a person starts to believe that the only place in which they can find success or happiness is online. This type of unrealistic or inflexible cognition can degrade the quality of a person's experience and lead to an ever-narrowing view of how to derive satisfaction from life. Moreover, that person might put more and more time into the online activity and withdrawal from other situations — family, friends, school or work for example — because they believe they will fail in any forum except online.

Over time, the individual might develop a compulsive relationship with online activities, for example gaming. The more strongly the belief that gaming is the only way to succeed, the more strong the drive to engage in gaming. Furthermore, as individuals spend more time gaming, they begin to feel anxious about the offline world, whether that means a growing belief that they will fail offline or distress about the consequences of ignoring the offline world (which often makes failure more likely, further reinforcing their unrealistic beliefs). An attempt to escape from the anxiety further fuels the compulsion.

How can we prevent or repair this maladaptive spiral? The secret lies in recognizing that thoughts, behaviors and feelings are interdependent. Change one and the relationships with the others change as well.

CBT Triangle

With children for example, it is important to make certain they have a variety of positive experiences, both on- and offline. When we at Digital Media Health consult with families, we emphasize clear guidelines including a signed usage contract, a thorough understanding of children's online activities and sharing the experience of exploring the online world. A proactive approach early on helps shape appropriate behaviors, develop critical thought towards online material and associates these behaviors and thoughts with positive feelings.

For individuals experiencing mild difficulties disengaging from their digital activities, a relatively straightforward intervention is likely to succeed. The simplest solution to spending too much time online is to find alternative activities. While a relatively simple intervention in theory, it is often challenging to implement. Just imagine trying to stop an activity that brings you pleasure and reduces stress. You almost certainly would feel initial distress weaning yourself from online activities.

It may take post-it notes reminding the individual that any short term distress is worth a long term healthier lifestyle. It might take experimenting with different activities. The individual might schedule a cooking class during 'online time,' use a timer to constrain gaming, go out more with friends or spend more time at work.

In situations where an individual is unable to reduce their nonproductive online time, it might be appropriate to involve a trained professional. The most effective approach to changing entrenched unhealthy behaviors is Cognitive Behavioral Therapy (CBT), an approach that focuses on the interrelationships among cognitions, behaviors and feelings.

Treatment initially focuses on reducing the most problematic behaviors by changing computer usage habits, improving time management skills, removing cues for unhealthy behavior (for example, erasing bookmarks to gaming sites) and constraining the amounts of time using the technology. Healthy offline behaviors are reinforced, while productive online activities are closely monitored.

Next, CBT focuses on the underlying cognitions that reinforce the compulsive behavior. For example, the thought I can only succeed when playing an online game is unrealistic and unhealthy. It is almost certainly also connected to core beliefs a person has about themselves such as I am inherently defective or I am an absolute failure. These thoughts and beliefs need to be uncovered and replaced with more realistic thoughts, for example While I do enjoy overcoming in-game challenges, I can succeed at other activities that have a more positive impact on my life or Success in the offline world is challenging but I can meet that challenge. Over time, these more adaptive and flexible cognitions become the automatic thoughts underlying feelings and behaviors.

Thoughts to Feelings

Finally, treatment turns to the future; how will the person continue to engage in healthy behavior? A person learns to manage future temptations by practicing applying their newly-formed healthier cognitions. It also is important to recognize that they are likely to periodically engage in unhealthy online activities. These slips are moments of risk and opportunity; again, it depends on the individual's cognitions about the experience. They might interpret a slip as a catastrophic failure and proof that treatment does not work. Or they might interpret it as a 'bump in the road.' It is easy to predict very different outcomes based on the interpretation.

Throughout the course of treatment, it is vital to understand other factors that impact the unhealthy behavior. A well-trained CBT clinician can assess a person for underlying psychosocial issues such as depression, anxiety, trauma or substance abuse. Moreover, it is vital to constantly assess the individual's motivation for change and to adjust the treatment approach appropriately.

Over time, individuals learn to recognize risk factors, to uncover and change their own automatic, unrealistic thoughts and to engage in more positive behaviors that takes them away from the unhealthy activity and towards a more positive relationship with technology, themselves and the world.