title: Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before-After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy.
abstract: BACKGROUND
  The growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life.
  
  
  OBJECTIVE
  This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).
  
  
  METHODS
  Of the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction.
  
  
  RESULTS
  Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.
  
  
  CONCLUSIONS
  This study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the treatment from a behavioral perspective, and gave patients the confidence to continue to manage Internet use in their lives.
authors.affiliation: Laboratory of Panic and Respiration, Institute of Psychiatry of The Federal University of Rio de Janeiro (IPUB/UFRJ), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil. veruskaasantos@gmail.com.
authors.forename: Veruska Andrea
authors.identifier: http://orcid.org/0000-0002-8518-5408
authors.initials: VA
authors.lastname: Santos
authors.forename: Rafael
authors.identifier: http://orcid.org/0000-0003-3875-4601
authors.initials: R
authors.lastname: Freire
authors.forename: Morená
authors.identifier: http://orcid.org/0000-0003-2370-5495
authors.initials: M
authors.lastname: Zugliani
authors.forename: Patricia
authors.identifier: http://orcid.org/0000-0003-3950-9923
authors.initials: P
authors.lastname: Cirillo
authors.forename: Hugo Henrique
authors.identifier: http://orcid.org/0000-0003-0350-2594
authors.initials: HH
authors.lastname: Santos
authors.forename: Antonio Egidio
authors.identifier: http://orcid.org/0000-0002-2152-4669
authors.initials: AE
authors.lastname: Nardi
authors.forename: Anna Lucia
authors.identifier: http://orcid.org/0000-0002-8913-1028
authors.initials: AL
authors.lastname: King
keywords: Anxiety Disorders; Cognitive Behavioral Therapy; Cognitive Therapy; Generalized Anxiety Disorder; Internet Addiction; Panic Disorder; Therapeutics; Treatment