Internet addiction is associated with social anxiety in young adults

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1 To come Annls of Clinicl Psychitry 2015;27(1):xxx-xxx Reserch Article Internet ddiction is ssocited with socil nxiety in young dults Aviv Weinstein Dikl Dorni Rotem Elhdif Yehely Bukovz Anstsy Yrmulnik Deprtment of Behviorl Science University of Ariel Ariel, Isrel Pinhs Dnnon Beer Ykov Mentl Helth Center nd Sckler School of Medicine Tel Aviv University Tel Aviv, Isrel Bckground: Problemtic Internet use (PIU) or excessive Internet use is chrcterized by excessive or poorly controlled preoccuptions, urges, or behviors regrding computer use, nd Internet ccess tht leds to impirment or distress. Cross-sectionl studies on smples of ptients reported high comorbidity of Internet ddiction with psychitric disorders, especilly ffective disorders (including depression), nxiety disorders (generlized nxiety disorder, socil nxiety disorder), nd ttention-deficit/hyperctivity disorder. Methods: We hve investigted the ssocition between Internet ddiction nd socil nxiety in 2 smples of 120 university students (60 mles nd 60 femles in ech smple). Results: We found correltion between Internet ddiction nd socil nxiety in the 2 smples (r =.411, P <.001; r = 0.342, P <.01) respectively. Secondly, we found no difference between mles nd femles on the level of Internet ddiction. Finlly we did not find preference for socil networks mong prticipnts with high levels of socil nxiety. Conclusions: The results of the study support previous evidence for cooccurrence of Internet ddiction nd socil nxiety, but further studies need to clrify this ssocition. Correspondence Aviv Weinstein Deprtment of Behviorl Science University of Ariel Ariel, Isrel E-mil vivweinstein@yhoo.com I n t ro d u c t i o n Problemtic Internet use, or Internet ddiction, is chrcterized by excessive or poorly controlled preoccuptions, urges, or behviors regrding Internet use tht led to impirment or distress. The incresed use of the Internet over the pst 15 yers hs ttrcted the ttention of reserchers 2 Februry 2015 Vol. 27 No. 1 Annls of Clinicl Psychitry

2 Annls of Clinicl Psychitry nd clinicins in the field. Young 1 nd Griffiths 2,3 were the first to define this disorder nd hve done extensive reserch on it. There re t lest 3 subtypes of Internet ddiction: excessive gming-gmbling, sexul preoccuptions (cybersex), nd socilizing or socil networking including e-mil/text messging. Internet ddicts my use the Internet for extended periods, isolte themselves from other forms of socil contct, nd focus lmost entirely on the Internet rther thn broder life events. Cross-sectionl studies on smples of ptients report high comorbidity of Internet ddiction with psychitric disorders, such s ffective disorders, nxiety disorders (including generlized nxiety disorder, socil nxiety disorder), nd ttention-deficit/hyperctivity disorder (ADHD). Some hve suggested 4 tht the reltionship between loneliness nd preference for online socil interction is spurious nd tht socil nxiety is the confounding vrible in Internet ddiction. There is evidence for co-occurrence of Internet ddiction with depressive disorders in dults. 5-7 Anxiety disorder ws found in severl studies of dult problemtic Internet users. 8,9 Among dolescents, Internet ddiction ws ssocited with depression mong South Koren dolescents, 10 long with high levels of depression nd suicidl idetion. 11,12 ADHD symptoms, depression, socil phobi, nd hostility were high mong dolescents with Internet ddiction in Tiwn. 13,14 Excessive gming ws ssocited with severe depressive socil phobi nd Internet ddiction symptoms in Tiwn. Femle online gmers hd fewer weekly online gming hours nd shorter previous online gming history, but tended to hve more severe somtic, pin, nd socil phobic symptoms. 15 (See Weinstein et l for reviews on Internet ddiction nd co-occurrence with psychitric disorders.) Our purpose in this study ws to ssess Internet ddiction nd socil nxiety in 2 cohorts of university students in Isrel. Bsed on previous studies in dults, 8,9 we hypothesized first tht Internet ddiction would be ssocited with socil nxiety in both smples. Secondly, bsed on previous evidence for sex differences between nxious Internet ddicted individuls, we predicted tht men would show higher levels of Internet ddiction thn femles. Third, bsed on studies showing tht Internet-ddicted individuls with high levels of socil nxiety prefer socilizing online thn rel-life communiction, 22,23 we predicted tht such individuls would prefer using socil networks over other forms of Internet ddiction. Methods Study 1 A totl of 120 students prticipted in our first study, 60 mles nd 60 femles, ge 20 to 60 with men ge of 29 yers nd 1 month (SD = 9.47). The mle men ge ws 29 yers nd 8 months (SD = 9.83), femle men ge ws 28 yers nd 5 months (SD = 9.15). Reported use of the Internet in ll prticipnts included 46.7% for socil networks, 48.3% minly for studies, work, nd e-mil, 5% for plying computer gmes. Among mles, 55% reported min use for studies, work, nd e-mil wheres mong femles 57.6% reported min use for socil networks. Among the prticipnts, 49.2% were students erning bchelor s degree, 35.8% hd high school certificte, 10% hd dvnced post-high school eduction, 4.2% hd mster s degree nd bove, nd 0.8% hd not finished high school. Employment sttus included 44.2% with full-time job, 33.33% with prt-time job, nd 22.47% were unemployed. Mritl sttus included 67.5% single, 27.5% mrried, nd 5% divorced. The mjority of prticipnts (82.5%) were born in Isrel; the rest were born in the Ukrine, United Kingdom, Switzerlnd, United Sttes, Lithuni, Morocco, Argentin, nd Russi. We used demogrphic questionnire with detils on sex, ge, yer of birth, country of birth, mritl sttus, employment, eduction, nd Internet use. Socil nxiety ws mesured using the Liebowitz Socil Anxiety Scle, 24 which evluted nxiety nd voidnce of socil situtions nd hs been vlidted The questionnire hs 24 items: 13 describe situtions in which performnce is required nd 11 describe socil interctions. The responses of fer or voidnce re from 1 (never) to 4 (very much). In our study, the questionnire hd Cronbch internl vlidity of α = We mesured Internet ddiction using the Young Internet Addiction Test (IAT), 1 which consists of 20 items mesuring compulsive use of the Internet on scle of 1 (never) to 6 (lwys). The cut-off point of Internet ddiction is score 80. The questionnire hs been vlidted in mny studies in the United Kingdom, 27 United Sttes, 28,29 Finlnd, 30 Germny, 31 nd Irn. 32 In our study, the IAT hd Cronbch internl vlidity of α = The questionnires were delivered on the Internet using specil groups nd forums dedicted to socil nxiety nd Internet ddiction. A demogrphic questionnire lso ws dministered nd it ws mde cler in dvnce tht prticiption ws nonymous nd voluntry. The study AACP.com Annls of Clinicl Psychitry Vol. 27 No. 1 Februry

3 To come Figure 1 Difference in IAT scores between low nd high socil nxiety prticipnts in Study 1 Men IAT score High socil nxiety P <.05. IAT: Young Internet Addiction Test. Low socil nxiety ws pproved by the institutionl review bord (IRB- Helsinki committee) of the university. Results We found positive moderte Person correltion (r = 0.342; P <.001) between Internet use nd socil nxiety. To exmine further the ssocition between Internet use nd socil nxiety, prticipnts were divided into high socil nxiety (men score >1.5) nd low socil nxiety (men score <1.5) groups. A post-hoc t test found tht those with high socil nxiety score hd higher level of Internet ddiction compred with low socil nxiety (t [2,118] = 2.991, P <.05). Men IAT scores were 61.5, (SD = 20.82) nd 43 (SD = 15.01) for the high nd low socil nxiety groups respectively. See Figure 1 for comprison of IAT scores between low nd high socilly nxious prticipnts. To test the second hypothesis tht men re more ddicted to the Internet thn women, we did comprison between IAT scores in men nd women nd found no significnt difference between them (t [2,116] = 1.529, P = ns). Frequency mesures of Internet use showed tht mong those who hve high socil nxiety score, 75% were men nd 25% women. To test the third hypothesis tht those with high levels of socil nxiety would use socil networks on the Internet more often, we compred frequencies of Internet use between the high nd low socil nxiety groups nd found no significnt differences. The Tble shows frequencies of Internet use in low nd high socil nxiety prticipnts. To test possible difference between men nd women in socil nxiety, we did repeted mesures nlysis of vrince (ANOVA) on socil nxiety scores nd sex. It reveled significnt socil nxiety effect (F 1,115 = 10.14, P <.05) but no significnt sex effect (F 2,115 = 0.718, P = ns) or sex by socil nxiety interction (F 1,115 = 0.079, P = ns). Study 2 Procedure. The second study included 120 students, ge rnge 20 to 40. There were 60 women, men ge 23 yers nd 8 months (SD = 2), nd 60 men, men ge 25 yers nd 8 months (SD = 2.5). The questionnires were the sme s in the first experiment, including demogrphic questionnire with detils on sex, ge, yer of birth, country of birth, mritl sttus, employment, eduction, nd Internet use. Socil nxiety ws mesured using the Liebowitz Socil Anxiety Scle, 24 which in our study hd Cronbch internl vlidity of α = Internet ddiction ws mesured using the IAT, 1 which in our study hd Cronbch internl vlidity of α = Questionnires were dministered to students t the university. Prticipnts were informed tht the questionnire ws nonymous nd they were free to withdrw from the study ny time. The study ws pproved by the university s institutionl review bord for humn experiments (Helsinki). Results. To test our first hypothesis, the tem looked for correltion between socil nxiety scores nd Internet ddiction scores; there ws positive moderte Person correltion (r = 0.410, P <.001) between Internet use nd socil nxiety. We hve performed seprte correltion nlysis between socil nxiety nd Internet ddiction scores for men nd women nd found moderte positive correltion for men (r = 0.531; P <.001) nd wek correltion for women (r = 0.301; P <.001). To test the second hypothesis tht men re more ddicted to the Internet thn women, we did post-hoc comprison using t test nd found no significnt difference between men nd women (t [2,118] = , P = ns). In our nlysis of sex differences in socil nxiety, posthoc comprison using t test found no significnt differences between men nd women (t [2,118] = 2.273, P = ns). To exmine further the ssocition between Internet use nd socil nxiety, prticipnts were divided into high socil nxiety (men score >1.5) nd low socil nxiety (men score <1.5) groups. A post-hoc t test found tht those with high socil nxiety score hd higher level of Internet ddiction compred with low socil nxiety 4 Februry 2015 Vol. 27 No. 1 Annls of Clinicl Psychitry

4 Annls of Clinicl Psychitry men IAT score (t [2,118] = 3.26, P <.05). Men IAT scores for the high socil nxiety group were 30.55, (SD = 2.48) nd the men IAT score of the low socil nxiety group ws (SD = 1.3). See Figure 2 for differences in IAT scores between the low nd high socil nxiety prticipnts. Discussion Tble Frequencies of Internet use in low nd high socil nxiety prticipnts in Study 1 Socil nxiety Frequency Percent Low Studies, work, e-mil % Computer gmes 5 4.7% Socil networks % Totl % High Studies, work, e-mil % Computer gmes 1 8.3% Socil networks % Totl % The min finding in this study, which evluted 240 men nd women, ws moderte positive ssocition between Internet ddiction nd socil nxiety in smple of prticipnts in Internet forums for Internet ddiction nd socil nxiety nd second smple of university students. Secondly, there ws no sex difference in Internet ddiction scores between mles nd femles. Third, mong those with high levels of socil nxiety there ws no preference for socil networks over other forms of Internet use, indicting tht they do not use the Internet minly for socil purposes necessrily. Our results support findings of previous reserch showing n ssocition between poor socil skills nd excessive Internet use 33 nd tht in mles fer, nxiety, nd depression were correlted positively with cognitions bout problemtic Internet use. 34 Also, dolescents with Internet ddiction hve high levels of socil nxiety. 35 There is supporting evidence for positive correltion between problemtic Internet use nd shyness, loneliness, nd voiding socil reltionships, nd dting nxiety. 41 Furthermore, problemtic Internet users were more neurotic nd less extrverted, more socilly nxious nd emotionlly lonely, nd gining greter support from Internet socil networks thn verge Internet users. 42 Specificlly, socil nxiety is ssocited with lck of confidence in presenttion skills nd n intention to crete positive impression on others. To reduce nxiety, socilly nxious individuls prefer encounters with lowrisk socil communiction. They therefore choose online interction over fce-to-fce communiction becuse of the lower risk involved in online communiction, which enbles them to hide nd control the less positive spects of their ppernce nd behvior. 43 Furthermore, students who were lonely or did not hve good socil skills could develop strong compulsive Internet use behviors resulting in negtive life outcomes (eg, hrming other significnt ctivities such s work, school, or significnt reltionships) insted of relieving their originl problems. Such ugmented negtive outcomes were expected to isolte individuls from helthy socil ctivities nd led them into more loneliness. 22 These studies support our min finding tht the higher the level of socil nxiety the greter becomes the occuption nd ddiction to the Internet. These findings re comptible with the socil compenstion hypothesis tht sttes the Internet primrily benefits individuls who feel uncomfortble communicting fceto-fce. A study mong students in the Midwestern United Sttes 23 showed tht individuls higher in socil nxiety reported greter feelings of comfort nd self-disclosure when socilizing online thn less socilly nxious individuls, but reported less self-disclosure when communicting fce-to-fce. However, in second study, socil nxiety ws ssocited most strongly with lower qulity of life nd higher depression mong individuls who communicted frequently online. Their results suggested tht, wheres socil nxiety my be ssocited with using the Internet s n lterntive to fce-to-fce communiction, such strtegy my result in poorer well-being. This explntion lso is comptible with the explntion tht socilly nxious individuls my find it esier to interct online where nonymity cn be mintined rther thn engge in fce-to-fce interction where being observed by others might induce fer of negtive evlution. 44 Furthermore, mong computer video gme ddicts in Tiwn, the more severe the symptoms of socil nxiety were the greter ws the ddiction to computer gmes becuse they provided the plyer with lterntive virtul relity tht enbled him to void socil difficulties in rel life. 15 On the other hnd, Internet ddiction mkes individuls become more introverted, tke step bck from fmily nd friends, nd enhnce socil nxiety. 21,45 Internet ddiction cn therefore increse the AACP.com Annls of Clinicl Psychitry Vol. 27 No. 1 Februry

5 To come Figure 2 Difference in IAT scores between low nd high socil nxiety prticipnts in Study 2 Men IAT score High socil nxiety P <.05. IAT: Young Internet Addiction Test. Low socil nxiety fer nd nxiety of negtive socil evlution nd dely fce-to-fce interction. 46 The reltionships my be bidirectionl so perhps those who suffer from socil nxiety turn to the Internet becuse it is esier to use; but on the other hnd, excessive Internet use cn excerbte socil isoltion in those who re lredy suffering from it. There lso re contrdictory findings from study in Sydney, Austrli, showing tht the Internet cn be used to del with socil nxiety nd ctully cn reduce it. Chtting online therefore cn be trining for developing better socil skills. 47 The lck of finding of sex differences in Internet ddiction scores in both our studies is surprising becuse study in South Kore showed tht Koren mles re more likely to be ddicted to the Internet thn women. 20 In Isfhn, Irn, nxious mle science students were reported to hve used the Internet to escpe from troubling thoughts nd consequently developed socil nxiety, 19 nd nxious mle students t the University of Srgodh in Pkistn reported higher incidence of Internet ddiction, which ws detrimentl to their cdemic chievements nd socil ctivity. 21 An explntion for sex differences could be tht sex nd culturl expecttions differ between men nd women; wheres men re expected to be bold, tough, nd ssertive, women re expected to be gentle, kind, nd sensitive. The drive to be successful in Internet gmes nd ctivity therefore my drive mbitious men to be more vulnerble to Internet ddiction 20 wheres women in Tiwn were more in control thn men nd therefore less vulnerble to develop Internet ddiction. 13 These culturl differences my not hold for Western societies nd perhps for our popultion. Yet, other biologicl nd psychologicl fctors my be involved in the propensity to be ddicted to the Internet nd to sex differences in tht respect. Limittions of the study include the smple size, which lthough it is dequte to detect n ssocition between Internet ddiction nd socil nxiety, my be too smll to detect more subtle effects such s sex differences in Internet ddiction nd socil nxiety. Secondly, the smple of the second study consisted of university students nd my not be representtive of the generl dult popultion in terms of the frequency of Internet ddiction or the prevlence of socil nxiety. Third, lthough there is growing recognition of Internet ddiction mong clinicins, it is still unrecognized s psychitric disorder nd there re controversil issues concerning ssessment nd dignosis Finlly, the prticipnts in both studies were reltively young dults (on verge between 24 yers nd 8 months to 29) nd tht my hve ffected rtes of Internet ddiction nd prevlence of socil nxiety. In conclusion, our study found moderte positive ssocition between Internet ddiction nd socil nxiety in 2 smples of the generl popultion. We did not find ny sex difference in Internet ddiction or levels of socil nxiety in both popultions nor did we find ny preference for socil networks in those with high socil nxiety. Further studies will be required to explore further the reciprocl reltionship between Internet ddiction nd socil nxiety tht run through the fbric of modern society. References 1. Young KS. Cught in the net. New York, NY: John Wiley Sons; Griffiths M. Internet ddiction: does it relly exist? In: Psychology nd the Internet. J Gckenbch, ed. Burlington, MA: Acdemic Press; 1998: Griffiths M. Internet ddiction time to be tken seriously? Addiction Reserch nd Theory. 2000;8: Cpln SE. Reltion mong loneliness, socil nxiety, nd problemtic Internet use. Cyberpsychol Behv. 2007;10: te Wildt BT, Putzig I, Zedler M, et l. Internet dependency s symptom of depressive mood disorders [in Germn]. Psychitr Prx. 2007;34(suppl 3):S318-S Morrison CM, Gore H. The reltionship between excessive Internet use nd depression: questionnirebsed study of 1,319 young people nd dults. Psychopthology. 2010;43: Libertore KA, Rosrio K, Colón-De Mrtí LN, et l. Prevlence of Internet ddiction in Ltino dolescents with psychitric dignosis. Cyberpsychol Behv Soc Netw. 2011;14: Februry 2015 Vol. 27 No. 1 Annls of Clinicl Psychitry

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