Unveiling the Dangers of Internet and Gaming Addiction

Foreign. Hi, everybody, and welcome to today's presentation on Internet and gaming addiction. Over the next 30 minutes to an hour, we're going to define Internet and gaming addiction and explore the metamorphosis of what we consider regular Internet use and video game use into addictive behaviors. We'll also explore what makes Internet and video games addictive because, you know, some sites are more addictive than others. I don't think most of us will probably get hooked on Google News, but there are some other sites that tend to have more of a drawing capacity to them. And then we'll review current treatment best practices and interventions as we know them for Internet and gaming addiction. Why do we care? Well, the Internet provides an immense amount of information, although not all of it is credible. So people can find constant novelty which gives them a chance to escape. I, for example, am into organic gardening. I can spend days going through the information that's out there in text and on YouTube videos and all kinds of other stuff, learning about organic gardening. Does that mean it's an addiction for me? No, because I can put it down and go do, do what I need to do. But it's important to understand that someone who is struggling and who wants to escape can generally find a way to escape on the Internet, whether it's gaming, social networking, gambling, porn, video games, video games, online gambling, online shopping. That's one I didn't mention. And pornography all have the potential to become problematic because they do have a rewarding capacity, attention and release sort of thing going on. Social media also has an addictive quality that can cause withdrawal and exacerbate mood disorders and addictions. When we think about social media, you know, I'm thinking about Facebook in particular, but also for the younger generation, my daughter's generation, it's more of an Instagram sort of addiction. And hearing that ding and keeping up on what's going on and knowing what's going on and putting your two cents in is very important in the teen and tween world. But for a lot of adults, it also can be just completely overwhelming and encompassing and exhausting staying up on all of that. And when people are not able to access their social media, for example, when they're at work or eating dinner with their family or something like that, they get anxious, they start to feel stressed out. So we want to look at what is it about that social media platform or being involved with the that platform that is so rewarding. And it's more rewarding than all of these other face to face sort of activities. So the Symptoms of Internet and gaming addiction are very symptom similar to the symptoms of pretty much any other addiction. It's a behavior that someone uses to escape from either emotional or physical pain, or both, and they continue to do it despite negative consequences. As humans, as living organisms, we choose things that are the most rewarding. So if you're choosing video games, if you're choosing online gambling over spending time with your family, then we want to look at why that's more rewarding. Yes, you know, it's fun, but you know, why is spending time with the family not fun? What is it that makes you not want to spend the time with them? Lack of control. Spending more and more time playing video or computer games to get the same enjoyment. And this is true of gambling, video games as well as online social media and things like that. Needing to be more involved, more in control of what's going on, needing to get more of a reaction. Withdrawing from face to face friends and family to the point of disrupting family, social or work life. There are a lot of people who spend an inordinate amount of time on Facebook and other places. They also spend so much time that they're relinquishing sleep, they're not getting their day to day tasks done, they're not spending time with their face to face friends, and they may even be doing it at work, which can often get them in trouble. A lot of businesses and places block many of these sites that tend to be more addictive. But guess what? People bring their mobile devices in order to get around the organization's firewalls. Experiencing feelings of anger, depression, moodiness, anxiety or restlessness when you're not online. And gaming is just one example when you're not in that situation, when you're not escaping, then you're facing reality, or at least you're immersed in reality as reality exists. And if you're having difficulty dealing with life on life's terms either because you don't feel good about yourself, your coping skills are overwhelmed, you are just completely exhausted and stressed out, whatever the case may be, then when you're not in that escape zone, you're going to tend to feel those negative emotions even more. And the reason a lot of people go into that ex that exists, that escape zone, is to escape from the anger, anxiety, depression and moodiness. Another symptom is spending significant sums of money or time with online services, computer upgrades, gaming systems, trying to make sure that you are able to access your addictive behavior, whatever that may be, and, and you're able to be Sort of top of your game, if you will. And preoccupation, thinking obsessively about being on the computer or playing video games, even when you're doing other things, when you're at work, when you're driving, thinking about what you're going to do as soon as you can get onto the computer, when you're laying down, going to sleep, you can't sleep because you'd rather be on the computer. So we're going to start kind of backwards and work to the beginning. The consequences of Internet addiction Carpal tunnel. A lot of people who are into gaming develop carpal tunnel syndrome. This isn't necessarily a symptom of all Internet addictions, but it is a symptom of, especially gaming. Everybody who has carpal tunnel is an Internet Internet addict. No, but it is important to understand that this can. Can be one of the negative consequences. And if you keep playing, playing these games despite not being able to feel your fingers, it's going to indicate that there's a greater problem because you're sacrificing your health and welfare in order to engage in this behavior. Migraines Staring at a computer screen for anybody is taxing on their vision over a period of time. Staring at a computer screen in poor light and probably poor posture over a period of hours can contribute to migraines. A lot of times when we're playing computer games, when we're online, I know I'm as guilty as anybody else. When I'm searching online, especially on one of my portable devices, my posture is deplorable, which can lead to neck and shoulder strain, which can contribute to migraines. So it's important to understand that migraines can be exacerbated or even just caused by some of the things that come out of being on the Internet for too long. Sleep disturbances. I said before, a lot of people will forego sleep in order to stay on the Internet. Insufficient sleep can be the person who started playing a game at, you know, six in the evening, and they look up and it's three in the morning and they're like, oh, crap, I gotta get up for work in two hours. Might as well just skip sleep altogether, keep playing and then I'll go to work. That doesn't function for very long in, in a healthy capacity. So it's important to understand that sleep helps your body repair, helps your body prepare. When we are sleepy, you know, think about the last time you were sleepy, you know, really exhausted, not just, you know, you know, kind of, kind of tired. How well did you function at work? How well did you pay attention when you were driving? How easily did the day go compared to days when you had an adequate amount of sleep? So insufficient sleep has multiple repercussions for people. And then circadian rhythm disruption. Many people will play video games, look on the Internet, do those sorts of things, and not pay attention to whether it's day or night. Outside, they may not turn on lights. They may be in a dark room so the body doesn't get the signals that of, oh, I'm supposed to be awake, or oh, I'm supposed to be asleep. Circadian rhythm disruptions lead to sleep problems, which can also exacerbate depression and anxiety because the neurotransmitters start to get out of whack. Speaking of which, when you engage in a behavior that is extremely rewarding for a period of time, not just like, you know, one, one time or one evening, but over a period of days or weeks, the body says, oh, there is way too much dopamine in this system, so I need to shut down some of the ports that transport it out throughout the rest of the body. Your body adjusts. Your brain really wants to protect itself, so it shuts down some of the dopamine receptors. Now, when you're not engaged in that high pleasure activity, you have a normal level of dopamine, but not enough is there now to keep the body feeling happy. When you don't feel happy, you want to engage in the addictive behavior again. So it sets up a cycle. The really cool thing is that once the body realizes that it's not going to be flooded with dopamine all the time, it will start opening those receptors back up or working around, depending on how, how much damage was done. The short version, the brain can recover, and people who had a relatively normal level of neurotransmitters to begin with will eventually get back to that homeostatic state where they feel pretty good, even if they're not engaging in addictive behaviors or things that make them feel really, really happy. Physical consequences, our backaches as well. When you're not sitting with good posture, when you're hunched over. I mean, I watch people, I watch my kids, I watch other people playing video games, doing things on the Internet. And like I said, I'm as guilty as anybody. Even when I'm surfing on the Internet, I may be sitting in a precarious position, which can lead to muscle strain, back tension, etc. Additionally, we're not really made to sit still for that long. So if you're putting that much pressure on your spine and you're not moving around a lot. It can just by nature cause backaches, hamstring, tightness, those sorts of things. Why do we care? Well, all of these physical things can make it harder to deal with life on life's terms. And you're taking somebody when we're talking about any kind of addiction and specifically Internet addiction here, people who have addictive behaviors are having difficulty dealing with life on life's terms. So these consequences of Internet addiction are just making the situation worse. It's a downward spiral. Social consequences. When we talk to people who come to treatment, more than 50% report that there was a strain in their relationship or marriage as a result of their Internet use. That's a big percentage. But I want you to think about the other person, the other person in the relationship. If your spouse is choosing to play World of Warcraft instead of spend time with you, what message does that communicate? Now on the other side of it, you know, thinking from my perspective, if my patient is choosing World of Warcraft over spending time with their spouse, I'm wondering why that's more rewarding. I'm wondering what's going on in the marriage or what's going on with the person engaging in the World of Warcraft play. Maybe they don't feel good about themselves. They are dealing with some anger that they can't communicate what's going on that makes this escape behavior rewarding enough to risk losing their marriage. Additionally, and you know, I have teens and tweens at home and they are constantly texting, they are constantly on Instagram, they don't really do Facebook. That's kind of an old people's thing now. But they have learned to communicate through text. And you know, as an old fashioned person that grew up in, you know, the 80s before computers happened, and when I went to counseling class, we learned that 80% of our communication is nonverbal. Well, you lose, you know, at least 60% of that through texts. Yes, you have emojis. I'm going to give emojis 20%. But you're still losing 60% of your communication through if you're texting. So people are not learning to interpret nonverbal behavior. They're not learning to communicate in a face to face situation. If they are growing up texting and in an online situation, another situation that arises when people are online a lot is there are fewer controls on their interpersonal behavior. You know, when we were in school, when we were growing up, we learned that you can't throw a complete temper tantrum, hissy fit every time you don't get your own way unless you're like three. But once you get older, we learn that that's not acceptable behavior. There is a condition, if you want to call it that, called virtual discontrol, in which when people are on the Internet, they feel anonymous, they feel like they can say anything and do whatever. So people tend to be really nasty and lash out a lot more on the Internet than they would in real life. People will say things in comments on YouTube videos or in texts that they would never say in a face to face situation. Unfortunately, if you've learned to communicate that way all your life, then when you're in a face to face situation, you don't know how to not act that way. So it creates a lot of strain in interpersonal relationships which can send people back into the virtual world where they feel more comfortable, where they know they know how to behave and get along. Additionally, as we're growing up, we learn coping skills by observing people. If you are constantly texting, then you are not observing how people deal with life on life's terms. So they're not learning coping skills, they're not learning to interpret nonverbal behavior, and they're not learning to self soothe and manage those angry and aggressive impulses when they're communicating in an online environment. Finally, aggressive behavior is often rewarded online. Online communication, whether it's Instagram or Snapchat or any of those tend to be very cliquish. It's like high school times 10. So people can get their feelings hurt really easy and people can be really nasty really easy. And people can bully a whole lot easier. You know, we've heard of all the problems coming up with bullying and social media. Why are we talking about this? This is a consequence. Well, all of these youth that are growing up with these interpersonal deficits are going to have difficulty functioning in the face to face world. So they're going to gravitate toward a digital world which can lead to Internet addiction, gaming addiction, wanting to stay in that virtual world as much as possible. So what makes the Internet and in particular video games addictive? High score or beating the game? These are two things that are more common with gambling and video games. If this is a rewarding feature for your particular client, then my follow up question to them would be, tell me some ways in real life that you have been a success, that you have achieved something and gotten your own personal high score. A lot of times they can't identify Anything. They don't feel like they're successful in real life, so they go somewhere where they feel like they can be successful. There's no ending to the game. And this can be massive multiplayer online role playing games or, you know, a variety of different situations. Pornography is another one. And then there are also a myriad of shopping sites online. So when we're talking about something that you can immerse yourself in, if there's no ending to it, that can be very, you know, rewarding to some people because they know they can stay, keep doing that indefinitely so they don't have to face the real world again. If somebody says that, you know, it's just, it's constantly new. I'm always seeing new things and learning new things. Well, that's awesome. Tell me about how you can do that in real life. Or what are some ways that you try to learn new things or what things do you explore in real life? And that can be a treatment goal as well. If novelty is something that somebody really likes, and we're going to get to novelty and discovery also in a minute. But this fact that there's no ending, have them identify some things they want to learn about, some things they want to do where there's essentially no ending, and have them explore those in the what I call the face to face world. Role playing is another addictive quality of a lot of games and Internet sites. This can be popular on, like I said, in games, but also on social networking because there are a lot of people who create profiles and portray themselves to be something that they're not. They're taking on a role, they're trying on different Personas to see how they feel comfortable. Some people also take on a role online in order to vent their frustrations and their anger and everything that they don't feel safe venting in a face to face situation because they know it wouldn't be appropriate novelty and discovery. If people like learning, that's great, but there has to be a time when they can turn it off. A good portion of World of Warcraft is spent exploring imaginary worlds. And Minecraft is also. In both World of Warcraft and Minecraft, people can spend time just imagining back in the day, you know, back before there were computers, people who would buy the dime store novels would do the same sort of thing. So why didn't they develop addictions? Because eventually you'd run out of books. You would, the book you're reading would be at an end and you wouldn't have another one to replace it. Online there are There's a never ending source of books. My son just read the Harry Potter series. As soon as he finished the series he went to Harry Potter fanfiction. I mean, he's an avid reader and I'm thrilled that he reads. But it highlights the fact that if you get an interest in something, you can pretty much stay immersed in it for as long as you want to. And finally, online situations, online venues provide a place for people to develop acceptance. The people in these rooms are often or in these games can be your allies, they can be your adversaries. You can forge relationships. Now I don't want you to think that all online relationships are bad. There's a lot to be said for meeting people from other places, meeting people who have similar interests, who may be on a completely different continent. That's awesome. It's when this is the only place you can find acceptance and when you shun face to face relationships to the exclusion of having online relationships, that it becomes a problem. And like I said earlier, with role playing, video games and the online world, social networking is a place to anonymously try out different Personas to see what you feel more comfortable with or maybe just to get out some of that stuff you don't feel comfortable saying or doing in real life. Now is this appropriate? Not necessarily. Does it happen? Oh yeah. Researchers at Hammersmith Hospital in London conducted a study in 2005 which found that dopamine levels in players brains doubled while they were playing. Doubled. That is big. Normally it's just a little drop in the bucket. This is doubling. So it's important to understand that there is a lot of reward value in playing video games. So what are the risk factors? Who are the people that are more likely to develop addictions? And we talked a little bit about this. People who have poor interpersonal skills typically have poor interpersonal relationships. That's a problem because our relationships, they've found, tend to be our biggest buffer against stress. So if you feel like you are completely isolated and nobody gets you and you don't have good relationships with others where you can lean on them and look for support, look for guidance, just look for acceptance. Whatever the case may be, you're probably going to be at risk of dysphoria and I don't want to say of addiction or of depression. Most people who don't have good interpersonal relationships have some sort of mental health or addictive consequence, a need to escape not being able to deal with life on life's terms. And you know, you may be getting handed a bushel full of lemons. And not everybody is expected to deal with everything by themselves at all times. It's just not possible. So everybody needs to escape every once in a while. But when you need to escape constantly, or when the only option you feel like you have is to escape, then you are at high risk of developing addictive behaviors. If you're easily bored the day to day, the mundane people who are really, really smart often get easily bored and they need to engage in something that has that stimulation, that has that never ending novelty in order to feel excitement. My question to them is, what are some things you can do where you can feel excitement in the real world? You know, going out and weeding the garden ain't going to do it for them. What is it that you might enjoy doing? Rock climbing, Whitewater rafting, Teaching at a seminar? What is it that might be mentally and physically stimulating? And then you have people that are just what I call adrenaline junkies. They need to feel that rush. There are some theories that say they may have brain differences than the rest of us that make it harder for them to feel pleasure. There are other theories that say that they've already kind of monkeyed with their dopamine system enough that they need to have the adrenaline rush in order to feel any pleasure. That's one of the things that you can kind of work out in counseling to figure out whether this has always existed or it started about the same time as the addictive behaviors. Now, if you haven't watched other presentations on addiction, I think it's really important for everybody to understand that addictive behaviors are sort of the tip of the iceberg. The behaviors leading up to that, the thinking changes, the thinking errors, the depression, the anxiety, the low self esteem, that all started long before the person finally said, I just, I've got to get out of this, I've got to escape, I have got to numb this out for a little while because I can't take it anymore. So true. Recovery is going back and looking at what sort of started causing it. It's kind of like having an infection on your arm. You get a cut, you know, we all have them. If you just put a band aid over it and you don't address the bacteria that's in there, it's just going to fester. So we need to figure out what's causing the infection so the wound can heal appropriately and not just, you know, try to pretend it's not there. So treatment abstinence from problematic applications and sites, because you know what, abstinence from the Internet in this day and age, probably not going to happen. Most people have to be plugged into a certain extent for work, to communicate, email, watching tv, Netflix, whatever. So identifying the problematic applications and sites, if it's video games, gambling sites, porn, shopping, and figuring out how to keep those out of your life and we'll talk about those in a minute. And then balanced Internet usage the rest of the time. Not spending 4, 5, 8 hours continuously on the Internet doing what you need to do on there, getting off. If your job involves being on the Internet all the time, then leaving the Internet to the job and then when you go home engaging in the face to face world, this balance will depend on every individual person. So I can't say two hours or six hours or anything. It depends on what their lifestyle is like, how bad the problem is, what the sites are that are causing them problems, and what problems the Internet use is causing in their life. If it's causing problems in their family life, then we probably want to have them look at not using the Internet during family time. Looking at compromises we're not eliminating, we are moderating interventions prevent use. Parental controls can help by turning off the WI fi, turning off the Internet at a certain time. In most cases you can also turn off data plans for mobile devices. If you go into your data, your mobile devices account, you can turn off the data at a certain period of time. So like with our kids at home, we turn off data usage and we turn off the Internet at 9:30 period. They can't get out. Would it be nice to think that everybody could exercise self control and get off the Internet at 9 o' clock and go to bed and do that kind of thing? Great. Yeah, it would be awesome. But that's not realistic because we all can get sucked into things on the Internet and kind of lose track of time. So parental controls is one thing. And yes, maybe you're not controlling it for your adolescent. Maybe you are the one who has the issue. That's okay. If you have it set to turn off at a certain time, you try to respect that. And if it turns into a craving and you just can't get it off your head, then you have a relapse prevention plan in place. And it also means that you have to get up, log onto the computer, log into the control panel and change the Internet settings. The other thing you can do is just give the password to somebody else. So you don't even have that option. Firewalls preventing certain sites from even being able to come into your house. You can use Keywords to block all sites that have certain content. There's lots of software out there that can help protect people and protect families from addictive sites being introduced into that environment. Timers. Setting a timer on, you know, you can set one on your desk if that's going to work for you. For my son, that didn't work. Setting a timer for him, he would turn it off and he'd be like, okay, I'm just going to finish this mission real quick. Twenty minutes later, it's like he's still on the computer. So we started setting a timer downstairs. So he has to walk downstairs and turn off the timer, which means he has to stop his computer game right? Then he can't do the I'm just going to finish this mission or just one more minute. And then have clients look for and accentuate exceptions when they're not on the Internet or on these problematic applications and sites. What are they doing? What is it that they enjoy doing besides gaming? Besides gambling, besides looking at pornography? Have them increase those. So when they are, when they come home from work, maybe their first reaction is to come home, put their bags down and turn on the computer. Well, we want to change that routine. They need to come home, put their bags down and do something else for 15 minutes. And generally at the end of 15 minutes, they're not watching their watch going, I've got to get on the Internet. They've gotten into something else. So we want to break that habitual pattern of getting on the Internet and have them remember the things that they liked. If there's nothing else that they want to do, or if they can identify a bunch of stuff that they would enjoy doing instead, but then they never do it, then we need to start looking and saying, okay, why is all this stuff that you said you wanted to do not motivating to you? What is it that is getting in the way? Decisional balance exercises are excellent for that. To help people identify underlying motivations to continue to engage in escape behaviors instead of interface with the face to face world. Again, when you're preventing use, don't forget tablets, smartphones, any mobile devices. Another thing that can help is moving the computer into the main living area of the house. People are less likely to stay on the computer and just completely immersed in it if other people are walking around, watching tv, talking. And it's easier to monitor computer and Internet usage. And I said earlier, I just mentioned decisional balance exercises. Decisional balance exercises help you identify the benefits to this behavior because you're doing it, because it's more beneficial or more rewarding to you than anything else right now for whatever reason. So we need to look at why. It also helps you identify the benefits and drawbacks to recovery. When we look at the benefits to the addictive behavior, it can help us understand issues that may need attention. The benefits to engaging in this online world, you don't have to deal with people and the face to face drama that's always going on. Okay, so then I would ask what's stressful about that? And maybe we need to look at working on some interpersonal skills, coping skills, or re evaluating your relationships because maybe the relationships you have in the face to face world are just flat dysfunctional. We also want to identify areas to target alternate rewards. If this environment, this online environment is so much more accepting and rewarding, okay, how can you find that in the face to face world? What's missing in the face to face world and how can we kind of try to find that there? So you can have people in, in real life or I guess online is real life as well, but people where you're meeting face to face. In addition to online drawbacks, what are the drawbacks to, you know, let's use online video games? To being on. On video games constantly. We talked about migraines, headaches, just loss of time. And this is true. As with social networking as well. I know people who can get online on Facebook at 4 in the afternoon and before they know it, it's 10 in the evening and they haven't gotten anything else done identifying those drawbacks and highlighting them because they're not rewarding. So we want to remember that everything has benefits and drawbacks. Then we want to look at recovery. What are the benefits to giving up these video games, giving up the online gambling, giving up whatever it is you're doing. We want to highlight these, we want to make this as rewarding as possible. So if you think it's going to improve your relationship with your family, that's great. We need to make sure that happens and not just have it be some theoretical construct out here. If you think it will free up your time so you can do other things, what other things can you do? And let's start keeping a list of these new things that you're able to accomplish so you feel like you have a sense of accomplishment and achievement. And then we want to look at drawbacks to recovery or abstinence. You know, if you don't want to recover, if you don't want to give up your video games, why? What are you afraid of what are you afraid you'll have to deal with? What skills do you need? So this face to face world is not so bleh to you. And it may be scary, it may be intimidating, it may be depressing, it may be not rewarding. Have your clients tell you what it is. But then we can start to figure out, how can we make life outside of video games and online gambling and stuff more rewarding so they can enjoy watching squirrels eat peanuts and sunrises and sunsets and whatever it is that does it for them. Some of the interventions that have been studied in the literature, cognitive behavioral therapy. This targets the way you think and the automatic beliefs, those tapes that you have in your head that you tell yourself that that create a reaction. When you get cut off in traffic and you get upset, you have to ask yourself, why did I just get upset? Well, between the time you got cut off and the time you got upset, you had all these automatic beliefs that just flooded through your head. That happens all the time. Anytime something happens and you react, then there were. There was a flood of automatic beliefs. Cognitive behavioral therapy helps you identify some unproductive beliefs and address them and figure out what you want to devote your energy to. Because some things, you know, they just really suck and there's nothing you can do about them. So just getting angry and using up all that energy, being angry, is that how you really want to use the energy that you do have? And if not, what could you do instead? Dialectical behavior therapy teaches distress tolerance and impulse control. It teaches you that you can feel a feeling because feelings are very natural reactions. But you don't have to act on every feeling. Feelings crest and go away generally in under 10 minutes, unless you feed them. And if you feed them, like the feeling of resentment, you can make that last for years. Feeling a feeling and letting it dissipate. Then you can use your rational, cognitive thought processes to go, okay, let's go back to the cognitive behavioral therapy and go, is this something that I really want to devote my energy to? In this process, you're also learning impulse control. The fact that you can feel a feeling without having to act on it. You can get angry without having to lash out. You can feel sad without having to just let it completely crumble your world. Motivational enhancement therapy teaches people how to keep going, even when the going gets tough. Change is not easy. So helping people figure out how to stay motivated, how to keep moving forward, even though it kind of sucks right now, is really important in the recovery process, because there are going to be Days that life hands you lemons. So how do you keep moving forward? Part of that is staying focused on your long term goal and asking yourself with every action that you choose, is this getting me closer to or further away from my ultimate goals? Acceptance and commitment. Therapy kind of goes along with that and teaches people to accept, not judge how they feel, accept how they're thinking, feeling and what's going on, and then making choices cognitively and rationally that get them closer to their goal instead of just reacting to make it stop. Finally, psychoeducation. A lot of people, and I've said this before, I'll say it again, people don't come to treatment and go, I am all that in a bag of chips. So let's just talk about my depression. The two don't go together. The two don't go together with addiction either. So when people come to treatment, generally their self esteem has taken a beating for one reason or another. So we need to look at that and help people figure out why they are all that in a bag of chips. Interpersonal skills, communication and relationship skills. How do you communicate in the face to face world? How can you effectively communicate if people have difficulty with communication or they feel like people don't like talking to them? You can role play and figure out if there are some nonverbals that they're communicating that may be intimidating or off putting. Looking at relationship skills. You have to nurture relationships online. If you're in a relationship, and I use the term loosely with someone and you get angry, you get in a fight, you get bored with them, you just quit talking to them and move on and there's, you know, billions of other people out there. In the face to face world, there are not so many options. And finding relationships and developing relationships means working through challenges, arguments, frustrations, those sorts of things which a lot of people who never nurtured relationships in the outside world really developed coping skills. Learn some. And the first thing I do is I start with my client's strengths. I say, when you get stressed, what do you do? When you get depressed, what do you do? These are the coping skills that they've used that have worked in the past. So let's build on those instead of reinventing the wheel. And then finally goal setting. You would be surprised probably or maybe not, at how difficult this concept is for counselors and clients alike. When I do goal setting workshops or treatment planning workshops, I tell people to tell me something that they do, you know, one of their hobbies and whether it's taking apart an engine or planting a garden. And I say, okay, now let's take the engine example for. For this presentation. Tell me, I've got, you know, a thousand parts sitting out here. Tell me, how am I going to put this engine back together and make sure it is functioning optimally? And, you know, the person would start walking you through. Well, the first thing you've got to do is blah. That's all goal setting is. Then I say, okay, now let's do that with real life. You are feeling depressed right now, and in order to get out of this depression, or you think you will be free of this depression when you are, you know, what does it look like when you're not depressed anymore? This is our ultimate goal. Okay, now tell me the first step to getting there. Then the second step. It's not rocket science. So helping people understand that they can set their own goals, but also helping them understand that when you set goals, every time you achieve a goal, even a little goal, there has to be a reward. Achieving the goal in and of itself is generally not enough of a reward. So what are you going to do when you achieve this first goal? What are you going to do? Make sure there are sufficient, adequate rewards. Sometimes people need medications to help them temporarily rebalance their neurotransmitters. This is something obviously they're going to talk over with their physician or their psychiatrist. There are three kind of classes, if you will, of medications that they've studied. The SSRIs. These are your antidepressants. Lexapro and Wellbutrin have specifically been studied in the research that I looked at. I don't know about the rest of them. Naltrexone is an opiate agonist. It's one that we use in substance abuse treatment if somebody overdoses on opiates. And dexmethylphenidate is a generic form of an ADHD medication. So you can see that these three kind of classes of medications treat very different conditions or symptoms, which is why it's important for the person to really talk with their counselor and their doctor to figure out what is it that's underpinning this behavior. Depression, anxiety, the need for the dopamine rush, the need for focus. You know, just kind of experimenting will be part of the process, too, because we can't do tests to tell which neurotransmitters are out of balance in your brain. It's a lot of it is just taking your history and making an educated guess, which I'm sure makes people feel really good. Exercise. It doesn't have to be going to the gym and lifting weights for an hour. Just doing anything to get your blood flowing increases serotonin and dopamine, which are your relaxation and your reward chemicals. Additionally, sunlight can help regulate the neurotransmitters, which are serotonin and dopamine and acetylcholine, and all those your happy chemicals to help your body not not only make them, but get the right balance. And it can also help help your body develop melatonin, which will improve mood and sleep. So sunlight, you get it in the morning, it says, I'm supposed to be awake. And the body says, okay, no more melatonin. It's time to be awake. As the sun goes down, your body starts to relax. It releases serotonin, which is your calming neurotransmitter. And melatonin is made from serotonin, which is why a good sleep routine is so important. Making sure that you do the same two or three things every day before you go to bed, even if you're not going to bed at exactly the same time, to cue your body in that, hey, it's time to release serotonin so we can start winding down for bedtime. Another intervention is just good nutrition. A lot of people who are on the Internet a lot, especially gamers, will not drink enough water because they don't want to have to get up and go to the bathroom. They don't want to have to leave the game. Water is important to flush toxins from the body. Dehydration can cause symptoms of depression. Foggy head, difficulty concentrating. One of the things I point out with my clients is you'll actually probably perform better in your game if you stay hydrated because you won't be foggy headed and have difficulty concentrating. You know, it's a give and take here. And then good nutrition that provides the building blocks for all those happy chemicals can include adding things to your diet like oats, bananas, chicken, dairy products, green leafy vegetables, almonds and walnuts. A nutritionist friend of mine said use a salad plate instead of a dinner plate because most Americans way overeat. But at every meal, have three colors on your plate. If you do that, you don't need to worry about counting food pyramid groups and calories and all that stuff. Have three colors on your plate at every meal and try to eat every three to four hours in order to keep your blood sugar stable. And that will really help with concentration and mood and a lot of the other issues that people talk about. So we've gone over A lot of stuff. Think back over the past week. Was there a situation in which you, a client or a friend, were spending too much time on the Internet and it was causing problems? What did you or that person do? And with this new information, what could you do differently? Or what could that person have done differently? And how can you start integrating this new information into your routine? Knowing that circadian rhythms are important and sleep routines are important, how can you integrate that into your routine? It's a simple change, but it makes a big difference for people. Like other addictions, Internet addiction can have physical, social, financial, and emotional consequences. In our digital age, it's highly unlikely that people completely unplug. We need to be on email. Our boss gets really upset if we go 24, 36 hours without checking email. Do you have to be on Facebook? Do you have to be on social networking sites? Some people do for marketing. But the number of people that actually have to be on there, especially for the amount of time they are on there, is very small. It's important to consider what do you actually have to do? Similar to other behavioral addictions like eating and sex, it's necessary to identify the motivations behind the Internet use. Because just stopping Internet use, like I said, that was the way to escape. Escape. But if you take out the escape route, then the person is left immersed in whatever they were escaping from, and that's awful. So we can't just say, well, stop using and everything will be fine. That's not going to happen. There was something that happened before this became a problem that they were trying to escape from, and we need to address that. Additionally, by its very rewarding nature, Internet addiction will cause neurochemical imbalances, which can lead to depression and apathy. Yes, you can be too happy. Too much dopamine and happy chemicals flooding the system for too long will cause the brain to adjust. It'll say, oh, I need to turn down the. The amount of dopamine. The brain can readjust. But it's important to understand that your brain has a certain level of neurochemicals that it wants to maintain. And when you start monkeying with it, either by taking drugs, supplements, medications, or engaging in addictive behaviors, it's going to try to adjust to maintain that level. So it's going to do what it needs to do to protect itself. Recovery involves addressing underlying mood, self esteem, and coping issues. Identifying triggers for use and ways to deal with them. When. Why is it that you want to get on the Internet? What are those issues? And what are things that trigger you to want to get on the Internet. You know, there are certain TV shows, times of day, you know, maybe times of the month. I remember when I was working in a facility at the end of the month, every month, we had this meeting. And it was a seven hour meeting. I can't sit still for seven hours. I can barely sit still for seven minutes. And I would dread that meeting. And the night before, I would just get into the most horrible mood. So identifying things that may trigger an escape behavior and figuring out ways to deal with them are part of the recovery process. And they're also part of creating a relapse prevention plan. You have to understand what function this addiction is serving for you and figure out other ways to meet that need. You have to figure out how you're going to stop yourself from engaging in this behavior, because it's the easiest one right now. So what kind of safeguards are you going to put up so you can't easily access the Internet or particular sites on the Internet? And you know, what are you going to do instead? Just stopping yourself from accessing the Internet leaves you sitting there stressed and twiddling your thumbs. There has to be a what are you going to do instead? Stead. Thank you for attending today and I hope to see you in future presentations.