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Culture Documents
r a, Kadir Ozdel
Buket Belkz Gngo
a
Sevket Ylmaz Teaching & Research Hospital, Psychiatry Department, Bursa, Turkey
Sevket Ylmaz Training Research Hospital, Psychiatry Department, Bursa, Turkey
Sevket Ylmaz Teaching & Research Hospital, Family Medicine, Bursa, Turkey
d
Dskap Yldrm Beyazd Training Research Hospital, Psychiatry Department, Ankara, Turkey
b
c
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 30 September 2015
Received in revised form
11 March 2016
Accepted 12 March 2016
Available online 28 March 2016
Background and aims: Psychopathological symptoms, particularly depression and anxiety, increase with
the severity of Internet Addiction (IA). In this study, we aimed to assess the relationship of severity of IA
and Dysfunctional Attitudes (DA) with psychopathological characteristics.
Methods: Two hundred and twelve university students were included in the study. The subjects were
assessed using the Internet Addiction Scale (IAS), the Symptom Checklist (SCL-90) and the Dysfunctional
Attitude Scale (DAS).
Results: The subjects were divided into three groups according to the IAS, which was conducted to screen
for IA: no addiction, mild and moderate/high addiction. 108 (50.9%) of the subjects were found to have no
addiction, 70 (33.01%) to have a mild addiction and 34 (16.03%) to have a moderate/high addiction.
Psychopathological symptoms and dysfunctional attitudes increase with the severity of IA. In addition to
the psychopathologic features, dysfunctional attitudes have limited effects on explaining the IA.
Conclusions: In the cognitive-behavioral treatment of IA, focusing on a perfectionist attitude and a need
for approval, which are part of a dysfunctional attitude, may be benecial.
2016 Elsevier Ltd. All rights reserved.
Keywords:
Internet addiction
Psychopathology
Dysfunctional attitudes
Perfectionist attitudes
Need for approval
1. Introduction
Although the Internet has accelerated and has facilitating effects
on most aspects of our lives, Internet addiction is one of the
negative results of this technology (Przepiorka, Blachnio, Miziak, &
Czuczwar, 2014). Internet addiction, which is associated with an
individual's loss of control over their Internet use, is considered to
be a health problem requiring attention (Brand, Young, & Laier,
2014; Ko, Yen, Yen, Chen, & Chen, 2012; Morrison & Gore, 2010).
In an extensive study carried out in Europe, it was found that the
prevalence of IA is 1% among adolescents, the group at risk for IA is
12.7%, and this rate is 13.7% in total (Tsitsika et al., 2014). In a study
(K. Ozdel).
http://dx.doi.org/10.1016/j.chb.2016.03.043
0747-5632/ 2016 Elsevier Ltd. All rights reserved.
nearly half of the Internet addicts seeking treatment have depressive symptoms (Mller, Ammerschlaeger, Freisleder, Beutel, &
Woeling, 2012). In studies on IA, addiction scores showed a positive correlation with depression and anxiety scores (Mller, Beutel,
ling, 2014) and those individuals with IA had higher
& Wo
depression and anxiety scores (Tonioni et al., 2012). Ko et al. (2014)
found in their study that resistant depressive symptoms accompany resistant IA individuals, and following treatment of IA,
depression, social anxiety and aggressive behaviors diminish in
Internet addicts.
Dysfunctional attitudes (DA) used to evaluate a depressive individual's prevailing negative attitudes are associated with the self,
the outer world, and the future, and compose an important part of
Beck's dysfunctional cognitive items (Weissman & Beck, 1978). This
is why Weissman and Beck developed the Dysfunctional Attitude
Scale to analyze dysfunctional attitudes, and this scale has
frequently been used in the literature to discuss dysfunctional beliefs which are strongly related to dysfunctional schemas. This
scale, which is used especially for the aim of evaluating the predisposition of individuals towards depressive symptoms, analyzes
negative thoughts, negative emotional schemas and negative beliefs in the framework of a perfectionist attitude and a need for
approval basically. Besides this, it is reported that DA is linked with
many psychologic factors, such as approval, love, success, right,
afford, autonomy and anaclitic self-esteem, which are necessary
regarding cognitive therapy (Weissman & Beck, 1978; Wong, Chan,
& Lau, 2008).
There are a considerable number of studies reporting a signicant relationship between changes in DAS and depressive symptoms (Wong et al., 2008; De Graaf, Roelofs, & Huibers, 2009). It was
found that DA is an important factor particularly in patients with
depression, that DA may contribute to the development of
depression along with environmental stress factors, and that DA is
decreased during the process of depression treatment (Beevers,
Strong, Meyer, Pilkonis, & Miller, 2007; Farmer et al., 2001).
Moreover, it is known that depressive symptoms have signicant
effects on many addictions. Despite this, it can be said that there are
not so many studies in the literature on the interaction between
addiction and dysfunctional attitudes. Heinz, Veilleux, and Kassel
(2009) have shown in their study that DA has a potential importance in problematic alcohol use and the amount of alcohol consumption. Ramsey, Brown, Stuart, Burgess, and Miller (2002) have
reported that negative experiences associated with addiction can
be decisive in the treatment of alcohol addiction. Thus we can focus
on dysfunctional attitudes during the cognitive behavioral therapy
process.
Our knowledge of IA and DA is limited, and the one study in the
literature in this eld showed that DA scores were high in individuals with IA, and that a perfectionist attitude (PA) is a predictor
of
IA
(Senormanc
et
al.,
2014).
Numerous
psychopathological components were assessed in the treatment
and investigation of the causes of Internet addiction, and it was
emphasized that these psychopathological elements are essential
regarding addiction. However, the literature contains a limited
number of studies investigating IA together with psychopathological components and dysfunctional situations. In this study, we
aimed to assess the relationship of the severity of IA and DA with
psychopathological characteristics. We designed this study to
investigate the level of effect that dysfunctional attitudes, as well as
general psychopathology, have in explaining IA.
2. Method
This study was carried out by assessing students studying at
Bursa Orhan Gazi University in 2014. Students attending the
533
534
3. Results
Independent samples t-test was used for assessing sociodemographic data; One-Way ANOVA for comparing the psychopathology and dysfunctional attitudes in the three different
Internet addiction groups; and Pearson correlations and hierarchical regression analysis for investigating the relationship between general psychopathology and dysfunctional attitudes.
124 (58.5%) of our subjects were men, and 88 (41.5%) were
women. The subjects, whose average age was 19.36 1.75, were
divided into three groups (no Internet addiction, mild Internet
addiction, and moderate/severe Internet addiction). 108 (50.94%)
subjects were found to have no Internet addiction, 70 (33.02%) to
have a mild addiction and 34 (16.04%) to have a moderate/severe
addiction. 62 of our participants (29.24%) declared the presence of a
failing school year. In addition to this, 167 of our participants
(78.77%) reported that they used a smart phone, and 36 (16.98%)
used a tablet. 42 participants (19.81%) were smokers. An assessment of socio-demographic characteristics revealed no statistically
signicant difference between average scores for Internet addiction
according to independent samples t-test carried out based on
gender (t "0.793, p 0.429), tablet use (t "0.499, p 618),
Android phone use (t "0.030, p 0.976), presence of failing
school year (t "0.308, p 0.759), and smoking (t 1.388,
p 0.167). Subjects that had a family history of psychiatric referral
(n: 27) had statistically signicantly higher IAS scores than those
who did not (n: 185) (F 1.73; t 2.34; p 0.020). Subjects that
had a history of psychiatric referral (n:29) had statistically signicantly higher IAS scores than those who did not (n:183) (F 1.212;
t 3.78 p 0.001).
A comparison of the average of the three IA groups revealed that
the scores of total SCL-90 and Somatization, Obsessive-Compulsive,
Interpersonal Sensitivity, Hostility, Depression, Anxiety, Phobic
Anxiety, Paranoid Ideation, Psychoticism And Additional scale
increased with the severity of Internet addiction (p < 0.001 for total
SCL-90 and all subscales). A comparison of DAS and sub-scale
scores of the three groups revealed that while average scores for
DAS (p 0.005) and the sub-scales of PA (p 0.001) and NA
(p 0.035) were statistically signicantly higher in IA groups, no
statistically signicant difference in the averages for the sub-scales
of AA (p 0.473) and TA (p 0.266) was found (Table 1).
According to the correlation analysis of IAS, SCL-90 and its subscales, and DAS and its sub-scales in our study, a statistically high
positive correlation was found between IAS and total SCL-90 scores
(r 0.47; p < 0.001) and IAS and total DAS scores (r 0.34;
p < 0.001) (Table 2).
A statistically high positive correlation was found between IAS
and scl-90 sub-scales of Somatization (r 0.37; p < 0.001),
Obsessive-Compulsive (r 0.43; p < 0.001), Interpersonal Sensitivity (r 0.41; p < 0.001), Depression (r 0.44; p < 0.001), Anxiety
(r 0.47; p < 0.001), Anger-Hostility (r 0.37; p < 0.001), Phobic
Anxiety (r 0.36; p < 0.001), Paranoid Ideation (r 0.34;
p < 0.001), Psychoticism (r 0.41; p < 0.001), and Additional Scale
(r 0.34; p < 0.001) (Table 2).
A high positive correlation was found between IAS scores and
scores for the sub-scale of PA (r 0.28; p < 0.001), a moderate
positive correlation was found between IAS scores and scores of the
sub-scale of NA (r 0.21; p < 0.01), and no statistically signicant
correlation was found between IAS scores and scores for the subscales of AA (r 0.10) and TA (r 0.09) (Table 2).
According to hierarchical regression analysis; Step 1 (General
Psychopathology) explained 21.6% of IAS scores. According to hierarchical regression analysis; Step 2 (General Psychopathology
scores, Perfectionist Attitude, Need for Approval, Autonomous
Attitude, Tentative Attitude subscales scores) explained 22.8% of
IAS scores (Table 3).
4. Discussion
In our study, the percentage of people who were at risk for IA
and who had IA was 16.04%. Studies conducted in Turkey found
varying rates of university students who have IA, such as 12.2% and
7.2% (Dalbudak et al., 2013; Senormanc et al., 2014). Considering
the fact that different assessment tools and different methods for IA
assessment were used, and that the incidence of IA varies between
countries, regions and studies, we might say that the percentage of
addicted people in our study was higher than some studies and
lower than others (Budak et al., 2015; Tsitsika et al., 2014; Alavi
et al., 2011; Ni, Yan, Chen, & Liu, 2009).
The ndings achieved in our study show that Internet addiction
interacts with general psychopathologic features and dysfunctional
attitudes (Table 1, Table 2). Depressive symptoms and adverse life
Table 1
Comparing scale and subscale scores according to severity of Internet addiction (IA).
Somatizationa
Obsessive-compulsivea
Interpersonal sensitivitya
Depressiona
Anxietya
Anger-hostilitya
Phobic anxietya
Paranoid thoughtsa
Psychotisma
Additional scalea
General psychopathologya
Dysfunctional attitudesb
Perfectionist attitudec
Need for approvald
Autonomous attituded
Tentative attituded
a
b
c
d
Without IA n 108
Mild IA n 70
Moderate/high IA
n 34
Mean
SD
Mean
SD
Mean
SD
0.49
0.97
0.71
0.66
0.59
0.65
0.34
0.79
0.40
0.71
0.63
117.31
43.38
37.62
17.75
18.17
0.47
0.65
0.65
0.61
0.62
0.73
0.50
0.70
0.48
0.62
0.50
29.10
14.28
11.42
6.28
4.96
0.75
1.39
1.08
0.95
1.00
0.95
0.52
1.06
0.70
1.01
0.95
123.40
45.48
41.03
18.41
18.76
0.48
0.73
0.62
0.61
0.71
0.77
0.57
0.61
0.60
0.63
0.52
23.60
12.10
10.41
5.76
3.61
1.05
1.75
1.46
1.55
1.57
1.42
0.94
1.31
1.00
1.28
1.36
134.35
53.47
42.44
19.14
19.55
0,68
0,84
0.90
0.95
0.99
0.91
0.90
0.80
0.79
0.92
0.80
24.64
14.13
9.93
6.04
4.43
16.66
17.58
16.95
22.16
24.76
12.85
12.65
8.24
15.39
10.26
22.50
5.37
7.14
3.39
0.75
1.33
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.005
0.001
0.035
0.473
0.266
535
IAS
DAS
PA
NA
AA
TA
IAS
OC
IS
AH
PHA
PT
PSY
AS
GP
0.25***
0.28***
0.21**
0.10
0.09
0.37***
0.18**
0.21**
0.07
0.04
0.23**
0.43***
0.27***
0.31***
0.15*
0.07
0.24***
0.41***
0.40***
0.37***
0.29***
0.26***
0.26***
0.44***
0.29***
0.30***
0.16*
0.16*
0.23**
0.47***
0.26***
0.33***
0.10
0.09
0.19**
0.37***
0.34***
0.37***
0.19**
0.21**
0.23**
0.36***
0.32***
0.34***
0.14*
0.19**
0.23**
0.34***
0.37***
0.40***
0.20**
0.21**
0.23**
0.41***
0.33***
0.38***
0.17*
0.19**
0.19**
0.34***
0.26***
0.31***
0.10
0.12
0.21**
0.47***
0.34***
0.37***
0.18**
0.16*
0.26***
Internet Addiction Scale (IAS), Somatization (S), Obsessive-Compulsive (OC), Interpersonal Sensitivity (IS), Depression (D), Anxiety (A), Anger-Hostility (AH), Phobic Anxiety
(PHA), Paranoid Thoughts (PT), Psychotism (PSY), Additional Scale (AS), General Psychopathology (GP), Dysfunctional Attitudes (DA), Perfectionist Attitude (PA), Need for
Approval (NA), Autonomous Attitude (AA), Tentative Attitude (TA) ***p < 0.001, **p < 0.01, *p < 0.05.
Table 3
Hierarchical regression analysis results associated with the IAS scores.
95% condence interval
Predictor
R2
Adjusted R2
0.220***
0.216***
Step 1
General psychopathology
Step 2
General psychopathology
Dysfunctional attitudes
Perfectionist attitude
Need for approval
Autonomous attitude
0.246***
0.228***
SE
Beta
LB
UB
12.730
1.671
0.469***
9.436
16.025
12.116
0.087
0.208
"0.060
"0.370
1.829
0.095
0.127
0.204
0.270
0.446***
0.072
0.132
"0.021
"0.097
8.509
"0.100
"0.042
"0.461
"0.902
15.722
0.275
0.458
0.342
0.161
Dependent variables: Internet Addiction Scale, 1 point (Never), 2 points (Rarely) 3 points (Sometimes) 4 points (Frequently) and 5 points (Always). ***p < 0.001, LB Lower
Bound, UP Upper Bound.
536