Impact of Motivational Enhancement Therapy on Internet Use Disorder and Psychological Distress Among Medical Students.

The concept of addiction has evolved significantly in recent decades, expanding beyond substance dependence to include behavioural and process addictions. Among these, Internet Addiction (IA) or Internet Use Disorder (IUD) has emerged as a critical global health concern. Characterized by excessive or poorly controlled preoccupations, urges, or behaviours regarding computer use and internet access, IA leads to significant impairment and distress.

Medical students represent a highly vulnerable demographic. The rigorous demands of the medical curriculum often result in high levels of stress, leading many students to use the internet and smartphones as a primary coping mechanism and source of entertainment. While the internet is an invaluable educational tool, the pathway from adaptive to pathological use is notoriously ambiguous.

Despite the growing burden of this obscure disorder, standardized, evidence-based treatment guidelines remain sparse. Motivational Enhancement Therapy (MET), a manual-based brief psychotherapy designed to enhance intrinsic motivation to change addictive behaviours, has proven highly efficacious in substance use disorders. However, its application in behavioural addictions like IUD is still in its nascent stages. This study seeks to quantify the prevalence of internet and smartphone addiction among medical students, identify associated psychopathology, and critically evaluate the impact of MET on this population.

Study Design and Participants

A hospital-based cross-sectional study with an interventional component was conducted over one-year during June 2018 to September  2019 among  250 medical students of SCB Medical College and Hospital. The study population was selected via systematic random sampling. Informed written consent was obtained from all participants, and the study was approved by the Institutional Ethics Committee.

Assessment Tools

Participants were evaluated using the following standardized instruments:

·         Internet Addiction Test (IAT): A 20-item scale measuring the intensity of internet obsession. Scores categorize users into normal (<30), mild (31-49), moderate (50-79), and severe (80+) addiction.

·         Smartphone Addiction Scale-Short Version (SAS-SV): A 10-item scale identifying the level of smartphone addiction risk.

·         General Health Questionnaire (GHQ-28): A screening tool to assess psychological distress (somatic symptoms, anxiety, social dysfunction, and severe depression).

Intervention

Students identified with moderate to severe internet addiction were invited to participate in a 4-session Motivational Enhancement Therapy (MET) program. The sessions spanned 12 weeks and utilized standard MET principles: expressing empathy, developing discrepancy, avoiding argumentation, rolling with resistance, and supporting self-efficacy.

Statistical Analysis

Data were analyzed using SPSS. Paired t-tests were used to compare pre- and post-intervention scores, and independent t-tests were used for gender comparisons. Statistical significance was established at .

Prevalence of Internet and Smartphone Addiction

The baseline assessment of 250 students revealed that a significant portion of the cohort struggled with digital dependency. Only about one-third of the students exhibited completely normal internet use patterns.

Description: This table outlines the distribution of the study population across different severity levels of internet addiction based on IAT scores.

Table 1: Prevalence and Severity of Internet Addiction (n=250)

Smartphone addiction showed even higher prevalence rates, with nearly half the population meeting the criteria for addiction.

Description: This table categorizes the participants based on their risk and active addiction levels to smartphones using the SAS-SV.

Table 2: Prevalence and Severity of Smartphone Addiction (n=250)

3.2 Gender Variations in Addiction and Distress

When analyzing the data by gender, males consistently scored higher on both internet and smartphone addiction scales.

Description: An independent t-test comparing the mean scores of male and female students across addiction and psychological distress scales.

Table 3: Gender-wise Variation in IAT, SAS-SV, and GHQ-28 Scores

*Statistically significant ( ).

The data indicates statistical significance in addiction severity between genders, with males being more prone to internet and smartphone addiction. However, the level of psychological distress (GHQ-28) did not show a statistically significant gender difference.

3.3 Psychological Distress and Addiction Severity

A strong association was found between the severity of internet addiction and the presence of psychological distress, validating the hypothesis that problematic digital use correlates with negative mental health outcomes.

Description: This table highlights the percentage of students experiencing psychological distress (measured via GHQ-28) based on their level of internet addiction.

Table 4: Presence of Psychological Distress Among Subjects with Internet Addiction

3.4 Impact of Motivational Enhancement Therapy (MET)

A cohort of 35 students with moderate to severe addiction completed the full 4-session MET intervention. The pre- and post-intervention scores demonstrate a dramatic clinical improvement.

Description: Paired t-test results comparing baseline and post-intervention scores for the 35 participants who underwent the MET program.

Table 5: Pre and Post-MET Mean Scores for Addiction and Distress (n=35)

*Highly statistically significant ( ).

The MET intervention yielded a highly statistically significant reduction across all three metrics. Students not only reduced their addictive behaviours regarding the internet and smartphones but also experienced a profound decrease in overall psychological distress.

The current study sheds light on the alarming prevalence of digital behavioural addictions among medical students. We found a 26.4% prevalence of internet addiction (combining moderate and severe cases), which aligns with Asian (26.5%) and European (22.8%) data, but is slightly higher than the general Indian national average (19.85%). The prevalence of smartphone addiction was exceptionally high at 49.2%, likely due to the easy accessibility of smartphones, free campus Wi-Fi, and the integration of digital tools into modern medical education.

Our findings reveal a clear gender disparity; males exhibited significantly higher scores on both the IAT and SAS-SV (p<0.05). This echoes previous literature suggesting that males are drawn more heavily to online gaming and social networking, whereas females tend to use digital devices more moderately, primarily for entertainment and calling.

Crucially, over 50% of the total sample exhibited psychological distress on the GHQ-28. Among those with moderate internet addiction, 68.5% reported significant distress. This bidirectional relationship suggests that students may use the internet as a maladaptive coping mechanism for academic stress, which in turn exacerbates feelings of isolation, anxiety, and depression.

The most promising outcome of this study is the remarkable efficacy of Motivational Enhancement Therapy (MET). Originally designed for substance abuse, MET successfully transitioned to treating behavioural addictions here. Following four sessions, participants showed a highly significant drop in IAT, SAS-SV, and GHQ-28 scores (p=0.001). By helping students resolve ambivalence and build intrinsic motivation, MET enabled them to consciously restructure their leisure time, increase face-to-face socialization, and adopt healthier coping mechanisms.

Internet Use Disorder and smartphone addiction are highly prevalent among medical students, carrying a heavy burden of comorbid psychological distress. While the digital age demands connectivity, the lack of boundaries can severely impact student well-being and academic performance. This study provides robust statistical evidence that Motivational Enhancement Therapy (MET) is a highly effective, non-pharmacological intervention for mitigating digital addictions. Medical institutions must prioritize mental health by integrating early screening for digital addiction and providing accessible, brief interventions like MET to foster healthier, more resilient future healthcare professionals.

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