Self-Help CBT Training - symptomsofanxietydisorder.com
- Self-Help CBT Training - symptomsofanxietydisorder.com
- Best CBT - Cognitive behavioral therapy Online Courses
- Affiliate - Renaissance Life Therapies
- Does Online CBT-I Really Work? Reviewing the Best Online
- Online Real Estate Education| CBT Real Estate
Calm Before the Storm Progress Report 39: The Art of the New Deal ( USA Introduction & First Term )
submitted by SanMarinoStronk to CBTSmod [link] [comments]
Hello and welcome to another CBtS Progress Report. Today we finally leave the Iberian Peninsula for good and begin showing USA content. While I’m working on the main US tree, today I want to do 3 things: introduce the 1933 situation, talk about general mechanics, and show the focus tree and events for the first term, ending in January 1937. After the second Inauguration you’ll get a new tree, with economic/political trees custom for each President and shared military and foreign mega-trees. So, let’s begin! The USA in 1933
In 1933, the United States are suffering the effects of the Great Depression. Herbert Hoover, of the Republican Party, has been unable to fix the crisis and thus he lost the 1932 Presidential Election to the now President-Elect Franklin Delano Roosevelt, a democrat and former Governor of New York. Roosevelt has grand plans for the country, his economic platform, called the “New Deal”, will try to fix the economy, while other minor issues ( Prohibition, the Philippines ) are dealt with. For now, this is the state of US politics
on the 1st of January, 1933
If you remember the old teaser, you’ll notice some changes: the Republicans are now MarLib ( Hoover, Landon ) and LibCon ( Taft ), while Democrats remain with the SocCon ( Garner, Dixiecrats) and SocLib ( FDR, New Deal supporters ). The SocDem slot remains up for grabs, as both parties can nominate a SocDem like Dewey or Wallace. Huey Long’s political affiliation is not yet decided, and Republicans may suffer a few more changes. The United States begins with these National Spirits: The Great Depression:
the main economic maluses are here. It is extremely severe, and can be slowly removed with focuses but specially with Congress Acts and Agencies. Extremely High Unemployment Rate:
This spirit represents the whooping 25% unemployment rate the USA had reached, and it will slowly fade away once you pass the NIRA. The speed at which the spirit is removed depends on what laws you pass. Abysmal Crop Prices:
With demand falling, crop prices were greatly reduced as well, creating a crisis in the countryside. As with unemployment, once the AAA is passed it will start to fade away, depending on what stuff you pass. Slum Proliferation:
Represents, in general, the miserable living conditions many Americans had in the period. Can be slowly removed with Acts and other decisions. Racial Segregation:
self-explanatory. Its maluses ( and its small PP bonus) can’t be removed, but can be mitigated by electing Jim Farley in 1940.
Now that you got the starting picture, let’s discuss a bit the USA special mechanics and then we’ll have a look at FDR’s first term! Congress Congress.
Many would expect a custom interface to be developed, since we have already shown a few for other countries. I was also the dev who designed a new Parliament system, so… Congress from vanilla stays. The base of the system works in two-parties systems, and with improvements it is a good mechanic. Why I kept it? Simply, I wanted to start USA development ASAP, and waiting for a complex GUI for Congress would have delayed release. So what things are new here? The Congress tab has some new things. First of all, all Acts are here. They are not focuses gated behind Congress Support, now you complete the focus and unlock the Act, and once you have enough Support you click and you pass it. There are two kinds of acts:
: always viewable, unlocked to pass once you complete the relevant focus, big effects, exclusive to one party ( Ex: National Labor Relations Act )
viewable after a certain date, always available to pass, small effects, some of them are bipartisan ( Ex. Marihuana Tax Act )
Both of them require the same amount of support and will remove the same amount ( yes, passing stuff removes support ), so prioritise the special acts and pass the mundane ones when you have nothing to do. To gain support in Congress, you can use lobbying, special events, or complete certain focuses, such as the Neutrality Acts or abolishing Prohibition. This is all dependent on Congress Stance. To sum up, Congress can be Hostile, Neutral or Friendly. This models both your party majority and the willingness of Congress to co-operate with you. It can be increased by winning Midterms and other special things such as Neutrality Acts. It can be decreased by losing midterms and doing things against the Congress, like going interventionist or try to pack the Court. Stance has an impact on the price of lobbying, and the amount of support it takes to pass an Act. A Hostile Congress will be a though nut to crack and you won’t be able to pass many acts, modelling how FDR lost the Congress from 37 onward. It rewards the player for winning midterms and punishes players who do unilateral things such as ditching isolationism. President Popularity
As I was designing the USA, I thought about how to represent the 1936 Election. Mainly, if Landon should be an option, as it was a complete landslide and historically it wouldn’t make sense. However, it would suck that you are forced to play as FDR all the way to 1941, so I designed a dynamic system that would allow Landon to be an option: President Popularity! President Popularity is a hidden variable that measures, surprise, your popularity as president. But hoi4 already has a party popularity system, you may ask, and yes, it has, but that measures the support for the party and the ideology, while this measures only the support of the President. A President might be unpopular even amongst his own, and likewise you can have a super-popular president across the political spectrum. But how does it work? As I said, Pres Pop is a hidden variable that can increase or decrease based on your actions as President. Wanna go against isolationism? Lose popularity. Reduced unemployment? Gain popularity. The interesting thing is that it is completely hidden. You can’t see it, you don’t see how your actions impact it, etc… You are blind. This adds a layer of political strategic thinking to the first half of the game, not too complex but interesting anyway. Popularity has two main effects: Midterms and Presidential Elections.
When a midterm election arrives
, you can decide if the President should get involved in it. If you choose to do so, the midterm_results variable will be 80% determined by your President Popularity and 20% by your Party ( sum of all factions ) Popularity. Less involvement in the midterm means more proportion of ideology and less of presidential popularity. Then, depending on the midterm_results variable you get one of the 4 outcomes, Landslide Victory, Victory, Defeat, and Disastrous Defeat, impacting Congress Support and Congress Stance. Presidential Elections are easier: depending on President Popularity the options will appear in the event. High popularity, as historically in 1936, means that your President will be the only option in the event. Medium popularity will let you choose, while low popularity will prevent re-election. THE FIRST TERM Economic & Political Tree
FDR will be inaugurated on March 4, and will allow you to begin the tree
. The first section has 7 focuses and deals with the First Hundred Days. When FDR is inaugurated, a mission
, requiring you pass all laws unlocked by tree in 100 days, will start. This is trivial: the focuses take overall about 95 days to complete, and you have more than enough support in Congress to pass all the laws, that are:
-Emergency Banking Act: improves Great Depression spirit ( the spirit has 15 stages towards recovery )
-Economy Act: improves Great Depression spirit, takes one military factory away
-Federal Emergency Relief Act: improves Slums spirit ( 4 stages )
-Civilian Conservation Corps Reforestation Relief Act: Adds 5 infrastructure, speeds up unemployment reduction
-National Industrial Recovery Act: begins to lower unemployment
-Agricultural Adjustment Act: begins to increase crop prices
-Tennessee Valley Authority Act: Adds factories, slots and infrastructure to Tennessee
Once you complete each focus, you can go to the decisions tab and pass the corresponding law, getting an event detailing its effects. Unlike the rest of the laws, these don’t take Congress Support when you complete them. Once you complete the First Hundred Days, the rest of the tree will open up. It is divided in two parts. If you want to solve the crisis through harsh spending cuts, go to the tree on the left. The one on the right represents a more spending-focused approach ( historical ) with a special focus on agency creation. The fiscal conservatism path is quicker and you will reach the Social Security and National Housing Acts faster, but is overall weaker than the spending one. Spending will grant more factories and agency creation decisions
that provide boosts against the Depression:
Most of them are unlocked by passing the relevant act or by date. Army Tree ( First Term as the rest of the trees ) Whole military tree
From 1933 to 1937 no significant improvements were done to the US Army, so they shouldn’t really have a tree. However I like to give choices to the player, so if they can overcome Congress opposition ( the first focus requires a super-majority ) you can gain some small equipment and doctrine boosts. Again, not a branch meant to be taken. Air Tree
The Army Air Corps saw significant developments in these four years, in part thanks to the Air Mail Scandal. Once it happens
in 1934 you can bypass the focus and gain more doctrine boosts and experience, while on the other column there are normal tech boosts. A powerful tree, I recommend giving it a go, it can be helpful in keeping your planes up-to-date. Navy Tree
The Navy Tree is 100% historical. It revolves around the Vinson-Trammel Act, that once passed unlocks a powerful tree that grants 3 naval templates, tech boosts, a lot of dockyards and bases, and finally the Naval Act of 1936, granting dockyards and the now very valuable naval xp. Foreign Tree
The USA is in the middle of the isolationist period, and the foreign tree for the first term reflects it. As you begin your USA campaign you will find 3 missions
to withdraw from Haiti and Nicaragua, and grant independence to the Philippines, forcing you to go through the tree.
The branch of the left lets you grant independence to the Philippines ( through a Congress Act ) and after that you can sign the 1935 ( name depends on in-game year ) Neutrality Act. Passing it will increase Congress Support and PP, useful for your other, economic acts. You can also pass the Reciprocal Trading Act, gaining a couple of factories. On the center, the Good Neighbor Policy will see the USA withdraw from Haiti and Nicaragua, and signing the Montevideo Convention that forbids American involvement in other South and Central American countries domestic politics. In the right branch you can recognize the USSR, and after that you can either demand repayment of tsarist debts ( they will almost always refuse ) or an anti-espionage treaty that will grant a small amount of PP and stability to both countries. Flavor Events
I like flavor events. They make you feel that you are running a country and not a map, and thus I like to make lots of them
. The USA, for the First Term, has around 40 flavor events. For example, I thought about making Prohibition-era crime a spirit, but instead it is represented by 4 flavor events, that fire during 1933 and take 2.5% stability each ( except one ) and 2 event chains that fire during 1934 in which the player has to pick the best strategy to get Bonnie & Clyde and John Dilinger in prision ( or kill them ). Other major event chain during 1934 is the midterm, but I already explained how that works. During 1935, you will have to deal with Huey Long. A quite convoluted event chain, with potential self-harming choices, can lead to Huey’s survival, however, he won’t be able to do anything in our next event that fires in 36, the National Conventions. Mathematically speaking, it is impossible to get such low Popularity that you can’t run for re-election, so FDR will be nominated, and since you play as the Democrats ( for now ) you can only see how the Republicans nominate Landon. Thus we arrive at November, when the Election will happen, however the new President won’t come into power, and be given the new tree, until January 20, as per the 20th Amendment. But that’s a story for other time… QUESTIONS
Will it be a random chance event if Huey Long survives or not, similar to the Hindenburg in base game, or will the player have some form of involvement with Huey Longs' assassination attempt?
Huey Long’s survival can be guaranteed through a convoluted event chain. It wouldn’t be nice to play all the way till 35 and have him murdered without being able to influence it.
Is Huey Long a Social democrat? And why the odd ball Jim Farley choice?
Atm Long is a SocDem, legacy of previous devs. I’m seriously considering moving him to Authoritarian. Jim Farley ran in the 1940 primary like Garner or Cordell Hull, so if FDR decides not to run you can pick him.
So is the Huey path to the presidency his OTL plan of running 3rd party, getting FDR to lose in 36 and then becoming the Dem nominee in 40? Assuming the OTL path plays out what should the US IC be like by 41? Adding to the above question if i'm doing a historical US run will I be able to actually build up a navy as large as the OTL WW2 USN ended up being?
- I decided that in order to get Long, you have to decide not to run as FDR in 1940, opening the primary.
2/3. I’ll try to stay close to history but balance to ensure a good WW2 experience to the other majors is a priority.
Will the US have options to intervene in Latin American politics like in our timeline?
Is the racial discriminatory policies placed during ww2 going to be represented and is it possible to avoid them? Is the production rates of the US during the war going to be on irl levels or toned down for balance? How involved can the US get in south america, and how is the good neighbour policy, Monroe doctrine and the end of interventions in central america and the Caribbean islands going to be implemented? Can those occupations continue for more interventionist presidents?
- They will be represented, but possible avoidances are tbd.
- Responded in the last question
- Good Neighbor Policy can be ditched once 1937 comes knocking and you get your new shiny foreign tree. Rest you saw in the PR
- You can continue the occupations in the first term, eating the maluses, or withdraw and then go back later in the game
Since he was quite pro-Soviet at the time, will Henry Wallace push for deeper cooperation between USA and USSR?
TBD. War and Post-War foreign policies are not designed yet. But probably, I like choices.
How does foreign policy look like? Are there different paths? Will anti-interventionism impact the player if they try to intervene? How will USA support for Republic of China, the UK and the Soviet Union be represented? Will there be different ways of dealing with the great depression?
- There are 3 different paths.
- Of course.
- Passing certain Acts will allow you to send equipment, except with China, where you can send a small amount directly without passing anything.
- You saw that FDR has 2 sub-paths, and Landon will have 2 paths as well. By 40 however, it should be mostly over.
Is it possible that Democratic or Republican party gets outsted by some other party? Is there a possibility that POTUS gets impeached (or dies in office) and if it is will acting president get his own focus tree? Will outcomes of assasinations attempts on FDR and Huey Long be random (like Stalin in 2RCW) or will player be capable of influencing them?
- Only FDR can die in office, otherwise it is making everything complicated for the sake of making everything complicated.
- FDR cannot be killed yet, and Long as I said can be avoided.
Will the US be able to reverse the Good Neighbor Policy and return to the Big Stick Diplomacy in the early game?
You can reverse the GNP in the second term.
Will FDR always die in 1945 as per OTL? Is there any chance that he can eek out a little longer? At least until the 1948 election?
It will be a mean_time_to_happen event, but don’t expect him to live past 45.
Will the Great Depression and it’s duration be effected by what president you choose, and if so in what ways? For instance, Will there be a different focus tree for reconstruction, depending on what president you choose? I know, for instance, that Huey and fdr, while both having similar ideas, differed in the fact that Huey was much more extreme in some ways with his reform. Will this be shown in game?
Huey’s focuses will be a slog as Congress tries to block you, and will be more impactful, in the good and the bad sense of the word. The New Deal proved itself successful so Landon will probably have it a little harder.
Are there two parliamentary systems? If so, how will the senate elections be handled? Which countries can America declare war on, and which alliances can they join? Do these diplomatic options change with the presidents?
- You saw in the PR, it works like vanilla, and midterms are abstracted, with something similar probably getting attached to Presidential Elections down the line.
- The USA can declare war on the usual suspects ( Axis ) and american countries if they adopt “non-friendly” ideologies or otherwise go against your interests. They can join the Allies, their equivalent ( like a french faction ) or form their own. ( Other countries may have focuses to invite the USA to their factions, but that’s not on my end ). Diplomacy is very open, but some paths will be blocked to some Presidents.
So, how is the presidential election of 1948 going to be handled? If a new president gets elected, they won't take office until 1949, which is technically outside of the game's timespan. So will the 1948 election just be ignored, or will there be a small exception to the 1933-1948 timeline to allow the new president to take office?
I’ll make an exception as a prize for playing all the way till 48
Will Henry Wallace be able to do a detente with the ussr? Also will this mod address segregation?
TBD and yes
Will there be primaries to decide who becomes the nominee for each party, or are you limited to a choice between the incumbent and a scripted opponent?
After the second term of a President, you can get primaries. Otherwise you always re-nominate, and you can’t impact the other party primaries.
Can you avoid war with Japan in some way?
That depends more on Japan really. Going full isolationist will greatly reduce the chance of going to war with Japan
So will any news areas be able to be admitted to statehood (by that I mean Alaska, Hawaii, Puerto Rico, etc.)?
Le 2nd American Civil War yes?
One last thing: we are still looking for devs to help us with the majors: Britain, France, Japan and also the US. It would greatly speed up development and also improve it, because exchange of opinions is always productive, and allows for faster research and design. If you want to help any of the mentioned majors’ development, just fill the application and help the whole community to try out the mod earlier. As usual, next PR will be in an unknown date about an unknown subject ( although slavs will probably be in it…) Rejected Titles
-How to save your economy in 15 easy steps
-Let's make a New Deal
-Learning your Alphabet Agencies
-A Huey Long way to go
-CBTS PR with WPA , CCC and AAA
Any advice on how to become successful while having learning difficulties and memory problems?
Below I have given a short summary of my life. This feels like a rant and I don't know what kind of advice to expect. Anything is welcome. :) submitted by enzio901 to selfimprovement [link] [comments]
Childhood until age 16
I am an only child to a middle class family in Sri Lanka. Sri Lanka is a conservative majority buddhist country, similar to India. Was not athletic at all.Kinda good at studies and did chess in school. Was shy, introverted and lived in my comfort zone bubble. Read sci-fi etc at home.
Age 16 - Discovery of Self improvement
Before this I never tried anything new. I dated a girl in school (first time) for a few months. It ended pretty soon because I was needy, insecure. I noticed how some boys in school had more dating life than others and also had better leadership qualities among peers. After some naive internet searching I stumbling on the PUA community and through it the larger self improvement community online.
I started taking lot of action. I enrolled in societies in school such as Model United Nations, history society. I went to parties more, started learning about fashion, got enrolled in a gym, got enrolled in a krav maga class etc. At was becoming more confident. Girls and guys to whom I was invisible started talking to me. Even my parents were happy at my progres. I saw that continuing this journey, in 5 years time I will be a mature man full of great experiences. Rather than being satisfied with the genetic abilities I inherited, I developed the growth mindset. That you could improve yourself my learning techniques and excel.
At that time I didn't have much of an idea about a future career path. I was very interested in science since childhood. But I had an aversion to maths. So, I thought maybe I will be a biologist. I got very good marks for my ordinary level (OLs) exams and choose Biology, Physics, Maths and Chemistry for Advanced level (ALs).
Noticing that I have a learning problem
The courseload in AL's is way higher than OLs. And I soon found myself struggling. My experience is like this. Teacher teaches concept A in first part of lecture. Then teaches concept B that builds on concept A. I understand concept A but forgets it soon. So, I don't understand concept B at all. When I go home I read the textbooks and other resources and study concept A multiple times until it sticks and then goes to concept A. Still I have to restudy things every week to retain them. I was overwhelmed soon. (didn't know about anki flashcards at the time). Teachers would complain that I don't pay attention in class not knowing my problem. But I would somehow get good marks at final exams so they didn't care in the end.
Because of my self improvement mindset I have started other things as well. I experience this same slow learning problem in what ever I tried to learn. I had to practice the karate move so many times more than others. Same with swimming, learning to drive etc. All those instructors/teachers get frustrated at me and complain that I don't pay attention and that's why I don't learn. But in reality I was paying maximum attention but It just doesn't stick in my mind. I have to repeat it countless times.
And another wierd problem I noticed was that I absolutely had no sense of direction. When I go somewhere I don't remember enough to retrace my way back. I go somewhere 50 times and still forget how to go there. I only remember very distinguishable landmarks such as churches, temples, rivers, bridges, parks etc. But the city is made up of mundane similar looking buildings. I had to use google maps to even remember the stop I have to take in the bus sometimes.
I have a poor short term memory. Forgets peope's names instantly. Don't rememer the names of roads, shops, restaurants work places etc.
At the end of my AL's I was stuck in a cycle of doing, redoing, studying, restudying the course material with only around 6 hours of daily sleep. At the end I got 3A's and a B. But I was completetly burnt out. And my self esteem had plumutted because I saw no improvement in personal development goals besides my academic goals. I saw several psychologists regarding low self-esteem but none help. They just did CBT and lectured without actually listening the underlying issues behind my low-self esteem.
I learned loci technique and other techniques such as converting information into visuals. The latter helped somewhat but the loci was useless because anyway I had a poor spartial memory to begin with.
I thought that better for me to do accounting than science since the former was too difficult. And I was sick of the culture here and thought going to a western country would help me find more like minded people.
I had no one else to advice me and my parents took a student loan and let me go to Australia to study accounting. Compared to science the courseload was very light. I got good marks in first semester exams evernthough I haven't done the subject in my OL's and AL's.
I also got in touch with the local PUA community because that was the only self improvement community that I knew. They were all great and not like toxic, sexist people we hear on the news. (Maybe it's the city). One Japanese guy was teaching us meditation and spirituality also.
One day I was discussing life with a similar aged guy I met on this community and we were discussing about living a meaningful life. And I was speechless when he asked me why I did accounting. I had no interest in it. All my life I wanted to do science.
Then I read books by Babara Oakley. She teaches that everyone can do maths and science with proper learning techniques. Then I discovered CS and switched majors in second semester. That was terrible. Dispite the learning techniques, I failed all my exams. I had two option, go back into accounting or go home and try to do CS with the support of my parents. (With No cooking, chores related to living alone etc). I choose to come back. So, I have wasted an year of my life and significant potion of the loan my dad took for my education. I felt like a failure. W
Starting the degree in sri lanka
I moved in with my parents again and started a software engineering degree at an institute affiliated with a UK university. I was ashamed to even talk with some people I knew. The courseload was not as challenging as the one abroad. And I have kinda mastered using Anki flashcards at this point. So, with better study techniques and support from my parents I ended my 2nd year with a good GPA.
I was selected at one of the top 10 software engineering companies to do the mandatory one year internship required by my degree. This was another failure. Most of my peers including ones who went to less recognized companies got the opportunity to work in a single technlogy the entire year. I was shuffled around 3 different teams doing different technologies. Being a slow learner as myself it was hard. And I never learned one thing deeply. And there were periods of time where I didn't have work for months. Other than my last project that lasted around 4 months I didn't get to work with production software and was assigned to research tasks. My peers could create a professional mobile application or a full stack app from scratch but I felt incompentent. I doubted myself whether I am cut for this profession. After 1 year of working in the industry I'm not proficient in any web development framework.
I'm doing my final year in uni. I made some lifestyle changes and managed to go to the gym 3 times a week consistentlly for 5 months now. I learned how to swim after 25 years of not being able to. Still I'm not learning things like cooking etc beause I get overwhelmed when there are too many things.
Still sometimes I pointlessly think about my past failures and wastes hours on the internet researching about memory, neuroscience, nootropics etc. I regret wasting my parents money. I regret wasting years of my life. I regret not just doing accounting and staying in australia. I know I should be focusing on the tasks at hand like getting a good grade in my exam and continuing the good habits already doing. There are people who have it far worse than I am. I still have supportive parents path in my life. Most of the time I manage to stay focused and productive. But sometimes like today I go off and just ruminate on these things that will not help me. It seems like my memory problems cannot be fixed and I will have to learn to live with it. Like Using gps to go to places I have gone before. But this so damn hard.
I went to a psychiatrist who said I don't need any meditation at the moment and I will begin improving my self esteem when I complete my education, start a career and start becoming independent.
Ironically my self improvement journey started with wanting to date. But I shelved this in a rather unhealthy manner trying to keep my academic life afloat and trying to fix my mental health. Dating culture is more conservative than the west. People date to get married. There are no casual affairs unless you are a cassanova who know how to make it happen. Eventhough I am somewhat stable in my academics right now I didn't want to try dating until atleast my education is complete. I tend to get into depressive episodes when stressful things happen.
I know this postponing is unhealthy but I need to be realistic in my life and prioritize learning from my past experiences/failures. And I feel like I'm not ready to get into a relationship right now having unresolved issues myself. All I want is to date many girls and maybe have sex without being too serious and hopefully it will lead into finding someone I find interesting and will lead into a relationship. I
Complete my degree with a good class.
Work one year (or 2 if not enough) in a company and get some experience.
Meanwhile learn lifeskills such as cooking. Start solo travelling around Sri Lanka to gain experience and confidence. Continue going to the gym and swimming. More interaction and flirting with the opposite sex. Without exceptations ofroucse. just for fun and experience.
Apply for PR to Canada as a skilled migrant.
Migrate to Canada. Get some initial support form my cousin and her husband. She's very close to me.
Find a job, apartment car etc.
At this point I will be somewhat confident in my abilities. Physically fit. Travelled and more experienced.
Start dating maybe.
Start living in a culture feel belonged.
Stop it ! Get some help ! (NUKE)
https://imgur.com/a/oZbqV submitted by red6onit to EndReddit [link] [comments]
Here's all of what you need to know about a (recent) phenomenon some call Internet Addiction Disorder (IAD) Abstract
Problematic computer use is a growing social issue which is being debated worldwide. Internet Addiction Disorder (IAD) ruins lives by causing neurological complications, psychological disturbances, and social problems. Surveys in the United States and Europe have indicated alarming prevalence rates between 1.5 and 8.2% . There are several reviews addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD [2-5], and some reviews [6-8] addressing the treatment of IAD. The aim of this paper is to give a preferably brief overview of research on IAD and theoretical considerations from a practical perspective based on years of daily work with clients suffering from Internet addiction. Furthermore, with this paper we intend to bring in practical experience in the debate about the eventual inclusion of IAD in the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Keywords: Addiction, Computer, Internet, reSTART, Treatment. INTRODUCTION
The idea that problematic computer use meets criteria for an addiction, and therefore should be included in the next iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM), 4th ed. Text Revision  was first proposed by Kimberly Young, PhD in her seminal 1996 paper . Since that time IAD has been extensively studied and is indeed, currently under consideration for inclusion in the DSM-V . Meanwhile, both China and South Korea have identified Internet addiction as a significant public health threat and both countries support education, research and treatment . In the United States, despite a growing body of research, and treatment for the disorder available in out-patient and in-patient settings, there has been no formal governmental response to the issue of Internet addiction. While the debate goes on about whether or not the DSM-V should designate Internet addiction a mental disorder [12-14] people currently suffering from Internet addiction are seeking treatment. Because of our experience we support the development of uniform diagnostic criteria and the inclusion of IAD in the DSM-V  in order to advance public education, diagnosis and treatment of this important disorder. CLASSIFICATION
There is ongoing debate about how best to classify the behavior which is characterized by many hours spent in non-work technology-related computeInternet/video game activities . It is accompanied by changes in mood, preoccupation with the Internet and digital media, the inability to control the amount of time spent interfacing with digital technology, the need for more time or a new game to achieve a desired mood, withdrawal symptoms when not engaged, and a continuation of the behavior despite family conflict, a diminishing social life and adverse work or academic consequences [2, 16, 17]. Some researchers and mental health practitioners see excessive Internet use as a symptom of another disorder such as anxiety or depression rather than a separate entity [e.g. 18]. Internet addiction could be considered an Impulse control disorder (not otherwise specified). Yet there is a growing consensus that this constellation of symptoms is an addiction [e.g. 19]. The American Society of Addiction Medicine (ASAM) recently released a new definition of addiction as a chronic brain disorder, officially proposing for the first time that addiction is not limited to substance use . All addictions, whether chemical or behavioral, share certain characteristics including salience, compulsive use (loss of control), mood modification and the alleviation of distress, tolerance and withdrawal, and the continuation despite negative consequences. DIAGNOSTIC CRITERIA FOR IAD
The first serious proposal for diagnostic criteria was advanced in 1996 by Dr. Young, modifying the DSM-IV criteria for pathological gambling . Since then variations in both name and criteria have been put forward to capture the problem, which is now most popularly known as Internet Addiction Disorder. Problematic Internet Use (PIU) , computer addiction, Internet dependence , compulsive Internet use, pathological Internet use , and many other labels can be found in the literature. Likewise a variety of often overlapping criteria have been proposed and studied, some of which have been validated. However, empirical studies provide an inconsistent set of criteria to define Internet addiction . For an overview see Byun et al. .
Beard  recommends that the following five diagnostic criteria are required for a diagnosis of Internet addiction: (1) Is preoccupied with the Internet (thinks about previous online activity or anticipate next online session); (2) Needs to use the Internet with increased amounts of time in order to achieve satisfaction; (3) Has made unsuccessful efforts to control, cut back, or stop Internet use; (4) Is restless, moody, depressed, or irritable when attempting to cut down or stop Internet use; (5) Has stayed online longer than originally intended. Additionally, at least one of the following must be present: (6) Has jeopardized or risked the loss of a significant relationship, job, educational or career opportunity because of the Internet; (7) Has lied to family members, therapist, or others to conceal the extent of involvement with the Internet; (8) Uses the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression) .
There has been also been a variety of assessment tools used in evaluation. Young’s Internet Addiction Test , the Problematic Internet Use Questionnaire (PIUQ) developed by Demetrovics, Szeredi, and Pozsa  and the Compulsive Internet Use Scale (CIUS)  are all examples of instruments to assess for this disorder. PREVALENCE
The considerable variance of the prevalence rates reported for IAD (between 0.3% and 38%)  may be attributable to the fact that diagnostic criteria and assessment questionnaires used for diagnosis vary between countries and studies often use highly selective samples of online surveys . In their review Weinstein and Lejoyeux  report that surveys in the United States and Europe have indicated prevalence rates varying between 1.5% and 8.2%. Other reports place the rates between 6% and 18.5% .
“Some obvious differences with respect to the methodologies, cultural factors, outcomes and assessment tools forming the basis for these prevalence rates notwithstanding, the rates we encountered were generally high and sometimes alarming.”  ETIOLOGY
There are different models available for the development and maintenance of IAD like the cognitive-behavioral model of problematic Internet use , the anonymity, convenience and escape (ACE) model , the access, affordability, anonymity (Triple-A) engine , a phases model of pathological Internet use by Grohol , and a comprehensive model of the development and maintenance of Internet addiction by Winkler & Dörsing , which takes into account socio-cultural factors (e.g., demographic factors, access to and acceptance of the Internet), biological vulnerabilities (e.g., genetic factors, abnormalities in neurochemical processes), psychological predispositions (e.g., personality characteristics, negative affects), and specific attributes of the Internet to explain “excessive engagement in Internet activities” . NEUROBIOLOGICAL VULNERABILITIES
It is known that addictions activate a combination of sites in the brain associated with pleasure, known together as the “reward center” or “pleasure pathway” of the brain [33, 34]. When activated, dopamine release is increased, along with opiates and other neurochemicals. Over time, the associated receptors may be affected, producing tolerance or the need for increasing stimulation of the reward center to produce a “high” and the subsequent characteristic behavior patterns needed to avoid withdrawal. Internet use may also lead specifically to dopamine release in the nucleus accumbens [35, 36], one of the reward structures of the brain specifically involved in other addictions . An example of the rewarding nature of digital technology use may be captured in the following statement by a 21 year-old male in treatment for IAD:
“I feel technology has brought so much joy into my life. No other activity relaxes me or stimulates me like technology. However, when depression hits, I tend to use technology as a way of retreating and isolating.” REINFORCEMENT/REWARD
What is so rewarding about Internet and video game use that it could become an addiction? The theory is that digital technology users experience multiple layers of reward when they use various computer applications. The Internet functions on a variable ratio reinforcement schedule (VRRS), as does gambling . Whatever the application (general surfing, pornography, chat rooms, message boards, social networking sites, video games, email, texting, cloud applications and games, etc.), these activities support unpredictable and variable reward structures. The reward experienced is intensified when combined with mood enhancing/stimulating content. Examples of this would be pornography (sexual stimulation), video games (e.g. various social rewards, identification with a hero, immersive graphics), dating sites (romantic fantasy), online poker (financial) and special interest chat rooms or message boards (sense of belonging) [29, 37]. BIOLOGICAL PREDISPOSITION
There is increasing evidence that there can be a genetic predisposition to addictive behaviors [38, 39]. The theory is that individuals with this predisposition do not have an adequate number of dopamine receptors or have an insufficient amount of serotonin/dopamine , thereby having difficulty experiencing normal levels of pleasure in activities that most people would find rewarding. To increase pleasure, these individuals are more likely to seek greater than average engagement in behaviors that stimulate an increase in dopamine, effectively giving them more reward but placing them at higher risk for addiction. Go to: MENTAL HEALTH VULNERABILITIES
Many researchers and clinicians have noted that a variety of mental disorders co-occur with IAD. There is debate about which came first, the addiction or the co-occurring disorder [18, 40]. The study by Dong et al.  had at least the potential to clarify this question, reporting that higher scores for depression, anxiety, hostility, interpersonal sensitivity, and psychoticism were consequences of IAD. But due to the limitations of the study further research is necessary. THE TREATMENT OF INTERNET ADDICTION
There is a general consensus that total abstinence from the Internet should not be the goal of the interventions and that instead, an abstinence from problematic applications and a controlled and balanced Internet usage should be achieved . The following paragraphs illustrate the various treatment options for IAD that exist today. Unless studies examining the efficacy of the illustrated treatments are not available, findings on the efficacy of the presented treatments are also provided. Unfortunately, most of the treatment studies were of low methodological quality and used an intra-group design.
The general lack of treatment studies notwithstanding, there are treatment guidelines reported by clinicians working in the field of IAD. In her book “Internet Addiction: Symptoms, Evaluation, and Treatment”, Young  offers some treatment strategies which are already known from the cognitive-behavioral approach: (a) practice opposite time of Internet use (discover patient’s patterns of Internet use and disrupt these patterns by suggesting new schedules), (b) use external stoppers (real events or activities prompting the patient to log off), (c) set goals (with regard to the amount of time), (d) abstain from a particular application (that the client is unable to control), (e) use reminder cards (cues that remind the patient of the costs of IAD and benefits of breaking it), (f) develop a personal inventory (shows all the activities that the patient used to engage in or can’t find the time due to IAD), (g) enter a support group (compensates for a lack of social support), and (h) engage in family therapy (addresses relational problems in the family) . Unfortunately, clinical evidence for the efficacy of these strategies is not mentioned. Non-psychological Approaches
Some authors examine pharmacological interventions for IAD, perhaps due to the fact that clinicians use psychopharmacology to treat IAD despite the lack of treatment studies addressing the efficacy of pharmacological treatments. In particular, selective serotonin-reuptake inhibitors (SSRIs) have been used because of the co-morbid psychiatric symptoms of IAD (e.g. depression and anxiety) for which SSRIs have been found to be effective [42-46]. Escitalopram (a SSRI) was used by Dell’Osso et al.  to treat 14 subjects with impulsive-compulsive Internet usage disorder. Internet usage decreased significantly from a mean of 36.8 hours/week to a baseline of 16.5 hours/week. In another study Han, Hwang, and Renshaw  used bupropion (a non-tricyclic antidepressant) and found a decrease of craving for Internet video game play, total game play time, and cue-induced brain activity in dorsolateral prefrontal cortex after a six week period of bupropion sustained release treatment. Methylphenidate (a psycho stimulant drug) was used by Han et al.  to treat 62 Internet video game-playing children diagnosed with attention-deficit hyperactivity disorder. After eight weeks of treatment, the YIAS-K scores and Internet usage times were significantly reduced and the authors cautiously suggest that methylphenidate might be evaluated as a potential treatment of IAD. According to a study by Shapira et al. , mood stabilizers might also improve the symptoms of IAD. In addition to these studies, there are some case reports of patients treated with escitalopram , citalopram (SSRI)- quetiapine (antipsychotic) combination  and naltrexone (an opioid receptor antagonist) .
A few authors mentioned that physical exercise could compensate the decrease of the dopamine level due to decreased online usage . In addition, sports exercise prescriptions used in the course of cognitive behavioral group therapy may enhance the effect of the intervention for IAD . Psychological Approaches
Motivational interviewing (MI) is a client-centered yet directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence . It was developed to help individuals give up addictive behaviors and learn new behavioral skills, using techniques such as open-ended questions, reflective listening, affirmation, and summarization to help individuals express their concerns about change . Unfortunately, there are currently no studies addressing the efficacy of MI in treating IAD, but MI seems to be moderately effective in the areas of alcohol, drug addiction, and diet/exercise problems .
Peukert et al.  suggest that interventions with family members or other relatives like “Community Reinforcement and Family Training”  could be useful in enhancing the motivation of an addict to cut back on Internet use, although the reviewers remark that control studies with relatives do not exist to date.
Reality therapy (RT) is supposed to encourage individuals to choose to improve their lives by committing to change their behavior. It includes sessions to show clients that addiction is a choice and to give them training in time management; it also introduces alternative activities to the problematic behavior . According to Kim , RT is a core addiction recovery tool that offers a wide variety of uses as a treatment for addictive disorders such as drugs, sex, food, and works as well for the Internet. In his RT group counseling program treatment study, Kim  found that the treatment program effectively reduced addiction level and improved self-esteem of 25 Internet-addicted university students in Korea.
Twohig and Crosby  used an Acceptance & Commitment Therapy (ACT) protocol including several exercises adjusted to better fit the issues with which the sample struggles to treat six adult males suffering from problematic Internet pornography viewing. The treatment resulted in an 85% reduction in viewing at post-treatment with results being maintained at the three month follow-up (83% reduction in viewing pornography).
Widyanto and Griffith  report that most of the treatments employed so far had utilized a cognitive-behavioral approach. The case for using cognitive-behavioral therapy (CBT) is justified due to the good results in the treatment of other behavioral addictions/impulse-control disorders, such as pathological gambling, compulsive shopping, bulimia nervosa, and binge eating-disorders . Wölfling  described a predominantly behavioral group treatment including identification of sustaining conditions, establishing of intrinsic motivation to reduce the amount of time being online, learning alternative behaviors, engagement in new social real-life contacts, psycho-education and exposure therapy, but unfortunately clinical evidence for the efficacy of these strategies is not mentioned. In her study, Young  used CBT to treat 114 clients suffering from IAD and found that participants were better able to manage their presenting problems post-treatment, showing improved motivation to stop abusing the Internet, improved ability to control their computer use, improved ability to function in offline relationships, improved ability to abstain from sexually explicit online material, improved ability to engage in offline activities, and improved ability to achieve sobriety from problematic applications. Cao, Su and Gao  investigated the effect of group CBT on 29 middle school students with IAD and found that IAD scores of the experimental group were lower than of the control group after treatment. The authors also reported improvement in psychological function. Thirty-eight adolescents with IAD were treated with CBT designed particularly for addicted adolescents by Li and Dai . They found that CBT has good effects on the adolescents with IAD (CIAS scores in the therapy group were significant lower than that in the control group). In the experimental group the scores of depression, anxiety, compulsiveness, self-blame, illusion, and retreat were significantly decreased after treatment. Zhu, Jin, and Zhong  compared CBT and electro acupuncture (EA) plus CBT assigning forty-seven patients with IAD to one of the two groups respectively. The authors found that CBT alone or combined with EA can significantly reduce the score of IAD and anxiety on a self-rating scale and improve self-conscious health status in patients with IAD, but the effect obtained by the combined therapy was better. Multimodal Treatments
A multimodal treatment approach is characterized by the implementation of several different types of treatment in some cases even from different disciplines such as pharmacology, psychotherapy and family counseling simultaneously or sequentially. Orzack and Orzack  mentioned that treatments for IAD need to be multidisciplinary including CBT, psychotropic medication, family therapy, and case managers, because of the complexity of these patients’ problems.
In their treatment study, Du, Jiang, and Vance  found that multimodal school-based group CBT (including parent training, teacher education, and group CBT) was effective for adolescents with IAD (n = 23), particularly in improving emotional state and regulation ability, behavioral and self-management style. The effect of another multimodal intervention consisting of solution-focused brief therapy (SFBT), family therapy, and CT was investigated among 52 adolescents with IAD in China. After three months of treatment, the scores on an IAD scale (IAD-DQ), the scores on the SCL-90, and the amount of time spent online decreased significantly . Orzack et al.  used a psychoeducational program, which combines psychodynamic and cognitive-behavioral theoretical perspectives, using a combination of Readiness to Change (RtC), CBT and MI interventions to treat a group of 35 men involved in problematic Internet-enabled sexual behavior (IESB). In this group treatment, the quality of life increased and the level of depressive symptoms decreased after 16 (weekly) treatment sessions, but the level of problematic Internet use failed to decrease significantly . Internet addiction related symptom scores significantly decreased after a group of 23 middle school students with IAD were treated with Behavioral Therapy (BT) or CT, detoxification treatment, psychosocial rehabilitation, personality modeling and parent training . Therefore, the authors concluded that psychotherapy, in particular CT and BT were effective in treating middle school students with IAD. Shek, Tang, and Lo  described a multi-level counseling program designed for young people with IAD based on the responses of 59 clients. Findings of this study suggest this multi-level counseling program (including counseling, MI, family perspective, case work and group work) is promising to help young people with IAD. Internet addiction symptom scores significantly decreased, but the program failed to increase psychological well-being significantly. A six-week group counseling program (including CBT, social competence training, training of self-control strategies and training of communication skills) was shown to be effective on 24 Internet-addicted college students in China . The authors reported that the adapted CIAS-R scores of the experimental group were significantly lower than those of the control group post-treatment. The reSTART Program
The authors of this article are currently, or have been, affiliated with the reSTART: Internet Addiction Recovery Program  in Fall City, Washington. The reSTART program is an inpatient Internet addiction recovery program which integrates technology detoxification (no technology for 45 to 90 days), drug and alcohol treatment, 12 step work, cognitive behavioral therapy (CBT), experiential adventure based therapy, Acceptance and Commitment therapy (ACT), brain enhancing interventions, animal assisted therapy, motivational interviewing (MI), mindfulness based relapse prevention (MBRP), Mindfulness based stress reduction (MBSR), interpersonal group psychotherapy, individual psychotherapy, individualized treatments for co-occurring disorders, psycho- educational groups (life visioning, addiction education, communication and assertiveness training, social skills, life skills, Life balance plan), aftercare treatments (monitoring of technology use, ongoing psychotherapy and group work), and continuing care (outpatient treatment) in an individualized, holistic approach.
The first results from an ongoing OQ45.2  study (a self-reported measurement of subjective discomfort, interpersonal relationships and social role performance assessed on a weekly basis) of the short-term impact on 19 adults who complete the 45+ days program showed an improved score after treatment. Seventy-four percent of participants showed significant clinical improvement, 21% of participants showed no reliable change, and 5% deteriorated. The results have to be regarded as preliminary due to the small study sample, the self-report measurement and the lack of a control group. Despite these limitations, there is evidence that the program is responsible for most of the improvements demonstrated. CONCLUSION
As can be seen from this brief review, the field of Internet addiction is advancing rapidly even without its official recognition as a separate and distinct behavioral addiction and with continuing disagreement over diagnostic criteria. The ongoing debate whether IAD should be classified as an (behavioral) addiction, an impulse-control disorder or even an obsessive compulsive disorder cannot be satisfactorily resolved in this paper. But the symptoms we observed in clinical practice show a great deal of overlap with the symptoms commonly associated with (behavioral) addictions. Also it remains unclear to this day whether the underlying mechanisms responsible for the addictive behavior are the same in different types of IAD (e.g., online sexual addiction, online gaming, and excessive surfing). From our practical perspective the different shapes of IAD fit in one category, due to various Internet specific commonalities (e.g., anonymity, riskless interaction), commonalities in the underlying behavior (e.g., avoidance, fear, pleasure, entertainment) and overlapping symptoms (e.g., the increased amount of time spent online, preoccupation and other signs of addiction). Nevertheless more research has to be done to substantiate our clinical impression.
Despite several methodological limitations, the strength of this work in comparison to other reviews in the international body of literature addressing the definition, classification, assessment, epidemiology, and co-morbidity of IAD [2-5], and to reviews [6-8] addressing the treatment of IAD, is that it connects theoretical considerations with the clinical practice of interdisciplinary mental health experts working for years in the field of Internet addiction. Furthermore, the current work gives a good overview of the current state of research in the field of internet addiction treatment. Despite the limitations stated above this work gives a brief overview of the current state of research on IAD from a practical perspective and can therefore be seen as an important and helpful paper for further research as well as for clinical practice in particular. ACKNOWLEDGEMENTS
Declared none. CONFLICT OF INTEREST
The authors confirm that this article content has no conflict of interest. REFERENCES
- Weinstein A, Lejoyeux M. Internet addiction or excessive Internet use. The American Journal of Drug and Alcohol Abuse. 2010 Aug;36(5 ):277–83. [PubMed]
- Beard KW. Internet addiction: a review of current assessment techniques and potential assessment questions. CyberPsychology & Behavior. 2005 Feb;8(1 ):7–14. [PubMed]
- Chou C, Condron L, Belland JC. A review of the research on Internet addiction. Educational Psychology Review. 2005 Dec;17(4 ):363–88.
- Douglas AC, Mills JE, Niang M, Stepchenkova S, Byun S, Ruffini C, et al. Internet addiction: meta-synthesis of qualitative research for the decade 1996-2006. Computers in Human Behavior. 2008 Sep;24(6 ):3027–44.
- Wolfling K, Buhler M, Lemenager T, Morsen C, Mann K. Gambling and internet addiction. Review and research agenda. Der Nervenarzt. 2009 Sep;80(9 ):1030–9. [PubMed]
- Petersen KU, Weymann N, Schelb Y, Thiel R, Thomasius R. Pathological Internet use - epidemiology, diagnostics, co-occurring disorders and treatment. Fortschritte Der Neurologie Psychiatrie. [Review] 2009 May;77(5 ):263–71. [PubMed]
- Peukert P, Sieslack S, Barth G, Batra A. Internet- and computer game addiction: Phenomenology, comorbidity, etiology, diagnostics and therapeutic implications for the addictives and their relatives. Psychiatrische Praxis. 2010 Jul;37(5 ):219–24. [PubMed]
- Widyanto L, Griffiths MD. 'Internet addiction': a critical review. International Journal of Mental Health and Addiction. 2006 Jan;4(1 ):31–51.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. (4th ed., text rev.) Washington, DC: 2000. Author.
- Young KS. Internet addiction: The emergence of a new clinical disorder. 104th annual meeting of the American Psychological Association; August 11 1996; Toronto, Canada.
- American Psychiatric Association. DSM-5 Publication Date Moved to May 2013. 2009 [cited 2011 August 21]; [Press release]. Available from: http: //www.psych.org/MainMenu/Newsroom/ NewsReleases/2009NewsReleases/DSM-5-Publication-Date- Moved-.aspx .
- Block JJ. Issues for DSM-V: Internet addiction. The American Journal of Psychiatry. 2008 Mar;165(3 ):306–7. [Editorial] [PubMed]
- Pies R. Should DSM-V designate "Internet addiction" a mental disorder? Psychiatry. 2009 Feb;6(2 ):31–7. [PMC free article] [PubMed]
- O'Brien CP. Commentary on Tao et al. (2010): Internet addiction and DSM-V. Addiction. [Comment/Reply] 2010 Mar;105(3 ):565.
- Czincz J, Hechanova R. Internet addiction: Debating the diagnosis. Journal of Technology in Human Services. 2009 Oct;27(4 ):257–72.
- Young KS. Caught in the net: how to recognize the signs of Internet addiction and a winning strategy for recovery. New York: J. Wiley; 1998.
- Young KS. Internet addiction: the emergence of a new clinical disorder. CyberPsychology & Behavior. 1998 Fal ;1(3 ):237–44.
- Kratzer S, Hegerl U. Is "Internet Addiction" a disorder of its own? A study on subjects with excessive internet use. Psychiatrische Praxis. 2008 Mar;35(2 ):80–3. [PubMed]
- Grant JE, Potenza MN, Weinstein A, Gorelick DA. Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse. 2010 Aug;36(5 ):233–41. [PMC free article] [PubMed]
- American Society of Addiction Medicine. Public Policy Statement: Definition of Addiction. 2011 [cited 2011 August 21]; http: //www.asam.org/1DEFINITION_OF_ ADDICTION_LONG_4-11.pdf. Public Policy Statement: Definition of Addiction. 2011 [cited 2011 Augus.
- Davis RA. A cognitive behavioral model of pathological internet use (PIU) Computers in Human Behavior. 2001;17(2 ):187–95.
- Dowling NA, Quirk KL. Screening for Internet dependence: Do the proposed diagnostic criteria differentiate normal from dependent Internet use? CyberPsychology & Behavior. 2009 Feb;12(1 ):21–7. [PubMed]
- Caplan SE. Problematic Internet use and psychosocial well-being: development of a theory-based cognitive-behavioral measurement instrument. Computers in Human Behavior. 2002;18(5 ):553–75.
- Winkler A, Dörsing B. Treatment of internet addiction disorder: a first meta-analysis [Diploma thesis] Marburg: University of Marburg; 2011.
- Byun S, Ruffini C, Mills JE, Douglas AC, Niang M, Stepchenkova S, et al. Internet addiction: metasynthesis of 1996-2006 quantitative research. CyberPsychology & Behavior. 2009 Apr;12(2 ):203–7. [PubMed]
- Demetrovics Z, Szeredi B, Rozsa S. The three-factor model of Internet addiction: the development of the Problematic Internet Use Questionnaire. Behavior Research Methods. 2008;40(2 ):563–74. [PubMed]
- Meerkerk G, Van Den Eijnden R, Vermulst A, Garretsen H. The Compulsive Internet Use Scale (CIUS): some psychometric properties. CyberPsychology & Behavior. 2009 Feb;12(1 ):1–6. [PubMed]
- Chakraborty K, Basu D, Kumar K. Internet addiction: Consensus, controversies, and the way ahead. East Asian Archives of Psychiatry. 2010 Sep;20(3 ):123–32. [PubMed]
- Young KS, Nabuco de Abreu C. Internet Addiction: A handbook and guide to evaluation and treatment. New Jersey: John Wiley & Sons Inc; 2011.
- Young KS, Griffin-Shelley E, Cooper A, O'Mara J, Buchanan J. Online infidelity: A new dimension in couple relationships with implications for evaluation and treatment. Sexual Addiction & Compulsivity. 2000;7(1-2 ):59–74.
- Cooper A, Putnam DE, Planchon LA, Boies SC. Online sexual compulsivity: getting tangled in the net. Sexual Addiction & Compulsivity. 1999;6(2 ):79–104.
- Grohol JM. Internet addiction guide. Internet addiction guide. 1999 [updated 2005, April 16; cited 2011 April 20]; Available from: http: //psychcentral.com/ netaddiction/
- Linden DJ. The Compass of Pleasure: How Our Brains Make Fatty Foods, Orgasm, Exercise, Marijuana, Generosity, Vodka, Learning, and Gambling Feel So Good. Viking Adult. 2011.
- Gabor Maté MD. In the Realm of Hungry Ghosts: Close Encounters with Addiction. North Atlantic Books. 2010.
- Bai Y-M, Lin C-C, Chen J-Y. Internet Addiction Disorder Among Clients of a Virtual Clinic. Psychiatric Services. 2001;52(10 ):1397. [Letter] [PubMed]
- Ko C-H, Liu G-C, Hsiao S, Yen J-Y, Yang M-J, Lin W-C, et al. Brain activities associated with gaming urge of online gaming addiction. Journal of Psychiatric Research. 2009;43(7 ):739–47. [PubMed]
- Amichai-Hamburger Y, Ben-Artzi E. Loneliness and Internet use. Computers in Human Behavior. 2003;19(1 ):71–80.
- Eisen S, Lin N, Lyons M, Scherrer J, Griffith K, True W, et al. Familial influences on gambling behavior: an analysis of 3359 twin pairs. Addiction. 1998 Sep;1998:1375–84. [PubMed]
- Grant JE, Brewer JA, Potenza MN. The neurobiology of substance and behavioral addictions. CNS Spectrums. 2006. 2006 Dec;11(12 ):924–30. [PubMed]
- Dong G, Lu Q, Zhou H, Zhao X. Precursor or sequela: pathological disorders in people with Internet addiction disorder. Public Library of Science One [serial on the Internet] 2011;6(2 ) Available from: http: //www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal. pone.0014703 . [PMC free article] [PubMed]
- Young KS. Internet Addiction: Symptoms, Evaluation, And Treatment. Innovations in Clinical Practice [serial on the Internet]. 1999;17 Available from: http: //treatmentcenters.com/downloads/ internet-addiction.pdf .
- Arisoy O. Internet addiction and its treatment. Psikiyatride Guncel Yaklasimlar. 2009;1(1 ):55–67.
- Atmaca M. A case of problematic Internet use successfully treated with an SSRI-antipsychotic combination. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2007 May;31(4 ):961–2. [Letter] [PubMed]
- Huang X-q, Li M-c, Tao R. Treatment of Internet addiction. Current Psychiatry Reports. 2010 Oct ;12(5 ):462–70. [PubMed]
- Sattar P, Ramaswamy S. Internet gaming addiction. Canadian Journal of Psychiatry. 2004 Dec;49(12 ):871–2.
- Wieland DM. Computer addiction: implications for nursing psychotherapy practice. Perspectives in Psychiatric Care. 2005 Oct-Dec;41(4 ):153–61. [PubMed]
- Dell'Osso B, Hadley S, Allen A, Baker B, Chaplin WF, Hollander E. Escitalopram in the treatment of impulsive-compulsive Internet usage disorder: an open-label trial followed by a double-blind discontinuation phase. Journal of Clinical Psychiatry. 2008 Mar;69(3 ):452–6. [PubMed]
- Han DH, Hwang JW, Renshaw PF. Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Experimental and Clinical Psychopharmacology. 2010 Aug;18(4 ):297–304. [PubMed]
- Han DH, Lee YS, Na C, Ahn JY, Chung US, Daniels MA, et al. The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. Comprehensive Psychiatry. 2009 May-Jun;50(3 ):251–6. [PubMed]
- Shapira NA, Goldsmith TD, Keck PE , Jr, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic Internet use. Journal of affective disorders. 2000 Jan-Mar;57(1-3 ):267–72. [PubMed]
- Bostwick JM, Bucci JA. Internet sex addiction treated with naltrexone. Mayo Clinic Proceedings. 2008;83(2 ):226–30. [PubMed]
- Greenfield DN. Suchtfalle Internet. Hilfe fuer Cyberfreaks, Netheads und ihre Partner. Virtual addiction: Zuerich: Walter. 2000.
- Lanjun Z. The applications of group mental therapy and sports exercise prescriptions in the intervention of Internet addiction disorder. Psychological Science (China) 2009 May;32(3 ):738–41.
- Miller WR, Rollnick S. In: Motivational interviewing: preparing people for change. 2nd ed. Miller WR, Rollnick S, editors. New York: Guilford Press; 2002.
- Miller NH. Motivational interviewing as a prelude to coaching in healthcare settings. Journal of Cardiovascular Nursing. 2010 May-Jun;25(3 ):247–51. [PubMed]
- Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. Journal of consulting and clinical psychology. 2003 Oct;71(5 ):843–61. [PubMed]
- Meyers RJ, Miller WR, Smith JE. Community reinforcement and family training (CRAFT) In: Meyers RJ, Miller WR, editors. A community reinforcement approach to addiction treatment. New York, NY: Cambridge University Press; US; 2001. pp. 147–60.
- Kim J-U. A reality therapy group counseling program as an Internet addiction recovery method for college students in Korea. International Journal of Reality Therapy. 2007 Spr ;26(2 ):3–9.
- Kim J-U. The effect of a T group counseling program on the Internet addiction level and self-esteem of Internet addiction university students. International Journal of Reality Therapy. 2008 Spr; 27(2 ):4–12.
- Twohig MP, Crosby JM. Acceptance and Commitment Therapy as a treatment for problematic Internet pornography viewing. Behavior Therapy. 2010 Sep;41(3 ):285–95. [PubMed]
- Abreu CN, Goes DS. Psychotherapy for Internet addiction. In: Young KS, de Abreu CN, editors. Internet addiction: A handbook and guide to evaluation and treatment. Hoboken, NJ: John Wiley & Sons Inc; US; 2011. pp. 155–71.
- Young KS. Cognitive behavior therapy with Internet addicts: treatment outcomes and implications. CyberPsychology & Behavior. 2007 Oct;10(5 ):671–9. [PubMed]
- Cao F-L, Su L-Y, Gao X-P. Control study of group psychotherapy on middle school students with Internet overuse. Chinese Mental Health Journal. 2007 May;21(5 ):346–9.
- Li G, Dai X-Y. Control study of cognitive-behavior therapy in adolescents with Internet addiction disorder. Chinese Mental Health Journal. 2009 Jul;23(7 ):457–70.
- Zhu T-m, Jin R-j, Zhong X-m. Clinical effect of electroacupuncture combined with psychologic interference on patient with Internet addiction disorder. Chinese Journal of Integrated Traditional & Western Medicine. 2009 Mar;29(3 ):212–4. [PubMed]
- Orzack MH, Orzack DS. Treatment of computer addicts with complex co-morbid psychiatric disorders. Cyberpsychology & Behavior. 1999;2(5 ):465–73. [PubMed]
- Du Y-s, Jiang W, Vance A. 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. 2010;44(2 ):129–34. [PubMed]
- Fang-ru Y, Wei H. The effect of integrated psychosocial intervention on 52 adolescents with Internet addiction disorder. Chinese Journal of Clinical Psychology. 2005 Aug;13(3 ):343–5.
- Orzack MH, Voluse AC, Wolf D, Hennen J. An ongoing study of group treatment for men involved in problematic Internet-enabled sexual behavior. CyberPsychology & Behavior. 2006 Jun;9(3 ):348–60. [PubMed]
- Rong Y, Zhi S, Yong Z. Comprehensive intervention on Internet addiction of middle school students. Chinese Mental Health Journal. 2006 Jul;19(7 ):457–9.
- Shek DTL, Tang VMY, Lo CY. Evaluation of an Internet addiction treatment program for Chinese adolescents in Hong Kong. Adolescence. 2009;44(174 ):359–73. [PubMed]
- Bai Y, Fan FM. The effects of group counseling on Internet-dependent college students. Chinese Mental Health Journal. 2007;21(4 ):247–50.
- reSTART: Internet Addiction Recovery Program. First detox center for Internet addicts opens its doors: Creates solutions for computer related addictive behaviors. 2009. [[cited 2011 August 21]]. Available from: http: //www.netaddictionrecovery.com .
- Lambert MJ, Morton JJ, Hatfield D, Harmon C, Hamilton S, Reid RC, et al. Administration and Scoring Manual for the OQ-45.2 (Outcome Measures) American Professional Credentialing Services L.L.C. 2004.
Social Anxiety and Me: Passing On What I've Learned
submitted by misterala to socialanxiety [link] [comments]
Hello. This post will be long, but I hope it'll be useful. I wanted to write something about social anxiety to try and help others and give something back, but I'm a bit too spineless to do it publicly (yet) - I'm actually a freelance writer, and feel it'd be a bit damaging for editors to know about my anxiety (if it's not already obvious!) Although for the record, everyone I've told has been wonderfully supportive, so that may be all in the mind. Given the nature of the condition, that'd be wholly unsurprising.
So, some notes before I begin:
1) I'm on the mild end of social anxiety, and I'm one of those types who seems to get by okay. A friend of mine with depression once described herself as 'like a high functioning alcoholic' as in she can hold it together for the most part in public. That's probably true of me: I have a good job, go out in public, I don't avoid functions I feel I have to go to, and if pressured into doing scary social things I will (with mixed success), but I have an avoidant streak I'm forcing myself to counter. More on that later.
2) I'm based in the UK, so my therapy was free on the NHS. I'm massively grateful to the NHS for covering this, which is one of the reasons I wanted to write something up, so at least some of the professional help I received free of charge can be passed on to others who can't afford the help.
3) I have never been serious enough to qualify for medication, so I can't talk about their effectiveness or otherwise. I did try some over the counter stuff once (HTP-5), when I had to go to a networking event where I knew nobody, and it relaxed me a little: no idea if it was the placebo effect though!
- Discovering the condition:
I went up until the age of 25 without knowing SA existed. I assumed it was just a character quirk unique to me that I would clam up, avoid situations and run through a post-mortem in my head after every (imagined or real) social disaster. Then one day while waiting for my bus home from the office after a particularly troubling event, I was idly googling on my phone and discovered a full list of symptoms, ticking them off one by one. Both inspiring and terrifying to learn that A) I wasn't alone and B) I had a mental illness.
I sat on that information for a little while. Then I went to a hypnotherapist, where I had three sessions. Weird experience, very relaxing, and possibly helpful in the short run, but it was expensive and I didn't see a dramatic change so let it drop.
After breaking up with my girlfriend of 7 years, I realised that being newly single, there wasn't a better time to get this checked. So I went to my GP… I had been once before to a different surgery, but the weird thing is that because my SA is triggered by certain situations, I was outgoing and chatty with the doctor, and I don't think I was believed: fobbed off with a few internet links. This time I was determined, but I didn't register high enough on their charts, so they said I could self refer to a mental health specialist. Which I did, and now I have an NHS therapist.
So here's the current psychological understanding of how SA works for those that don't know. It's essentially a vicious cycle that gets worse the longer its allowed to progress unchecked.
Dreading social interactions - Nerves - Perceived poor social performance/physical anxiety symptoms - Negative thoughts about self - Avoiding social interactions
That's actually a simplified diagram, because of the limits of text. This is the actual model: http://www.brainhe.com/students/types/images/clip_image004.gif
But the results are the same. That goes round and round in a circle, each time reinforcing itself meaning it becomes a self-fulfilling prophecy, and that bit harder to break. CBT works by breaking these at the weakest point to gradually make it less and less of a problem.
My therapist began by printing off some sheets to read through from 'Overcoming Social Anxiety and Shyness by Gillian Butler. I was impressed enough to buy the whole thing, which is available as a kindle download so people won't know what you're reading: http://www.amazon.co.uk/Overcoming-Social-Anxiety-Shyness-Gillian/dp/1849010005
(Just to be clear: I'm not affiliated with the author at all, it's just the handout my therapist worked with - so that's good enough for me. Good place to start anyway.)
That's the psychological stuff out of the way, from here on in, it's just stuff from my own experience. Your mileage will probably vary (there's a lot of stuff in the book/sessions that doesn't apply to me: it's a broad condition!)
You can always make excuses for not doing something that makes you anxious - including not getting professional help. Be super critical of every decision you make. Are you doing it because you genuinely can't, or are you making excuses? Avoidance is a fairly big part of the vicious cycle, because it prevents opportunities to see that things weren't as bad as you imagined (and reinforces the belief that you had to do it, because it would have been a disaster if you hadn't avoided). In short, it's a safety behaviour that offers short term relief, but makes things worse in the long run.
I've always thought of myself as quite perceptive, and have an uncanny ability to figure out if I like someone within minutes of meeting them (I'm good at picking out bastards). The trouble is that SA people think they're a bit too good at this, and choose to interpret reactions in the worst possible light. Take an example where you meet someone you haven't seen in a while, and you note a 'negative expression' for a second before smiling and chatting. Is that because they don't like you, or have noticed something about you, or because you took them by surprise? Look for evidence to back up your negative view - if there's none there, your SA is taking over. You can't know what's going on in their head.
This also applies to the 'post mortem' we all do on negative experiences: just because we obsess about every little reaction and event, doesn't mean everyone else does. In fact, in most cases they won't even remember because people are pretty self-absorbed. If they noticed at all, it won't stick with them in the long run. I don't remember the exact quote but it seems pertinent here: "You can't compare yourselves to others, when you only see their 'best of' moments, and yourself at your best and worse". Sure it was more catchy than that, but you get this idea.
It's in our natures to be hypercritical of ourselves - more so than we would ever be of other people. Setbacks happen, but it's important not to dwell upon them. Counter to this, it's also easy to overlook improvements and dwell on the failures. I've come a pleasing way over the course of my therapy and over the last few years in general: I used to be terrified of answering phones, but do that all the time now, for example.
Everyone is anxious sometimes: the purpose of improving SA is to make it manageable to live with. Any improvement is a cause for celebration, so don't be too hard on yourself.
TL;DR: I have mild social anxiety, a therapist and a pretty good knowledge of how it works. Maybe this will help others.
Affiliates. Welcome! There is a very real opportunity for you to earn excellent commission income by becoming an affiliate. Renaissance Life Therapies, are based in Harley Street, London, which is recognised the world over as being the centre of medical excellence.We are looking to expand our online services to the rest of the UK and the world. Cognitive behavioral therapy can help your clients to live happier and more fulfilling lives. Psychology Tools for Living Well is a self-help course Click the blue links below to go directly to the help option that interests you… Or read a little further and find out how to access the help step by step… Take a free anxiety self test here. CLICK HERE TO ACCESS THE COURSE ABOUT (CBT) for Anxiety. The steps to accessing this site’s training courses are listed in the next module. "My experience with this real estate school was wonderful. The convenience of online, self-paced, real estate continuing education was a perfect fit for my busy life and the pricing can’t be beat! The courses I took provided me a fantastic review. Of course, the latest updates were covered, as well. Our whole operation is based on cognitive behavioral therapy (CBT), which is one of the most commonly used psychotherapeutic approaches for treating mental health problems.CBT online helps you to identify, challenge and overcome your dysfunctional thoughts, behaviors and emotions. Checkout the video where Dr. Elizabeth Lombardo, PhD, will tell you about the basics of CBT and how it works.