Group Cognitive-Behavioral Intervention for Problematic Internet Use in Nepalese University Students

Tribhuvan University, Nepal59 enrolled

Overview

Problematic internet use, using the internet in ways that interfere with daily life, is a growing concern among university students in Nepal, where studies report prevalence rates between 21.5% and 35.4%. Despite this, structured, evidence-based intervention trials in Nepalese academic settings remain scarce. This study tested a six-session group program based on cognitive-behavioral therapy, which helps people change unhelpful behaviors around internet use. Sessions lasted 90 minutes and were delivered weekly by supervised Master's-level psychology students who completed 40 hours of CBT training, which the makes the program affordable and scalable for university settings. Fifty-nine undergraduate students took part: 30 received the group program and 29 formed the comparison group. Both groups completed the Internet Addiction Test and the General Self-Efficacy Scale at five time points: before the program, immediately after, and at 2 weeks, 1 month, and 3 months later. Students in the program showed significantly greater reductions in internet addiction symptoms than the comparison group immediately after the program (p = .049) and at 1 month, where a large effect was observed (d = -0.83, p = .003). At 3 months, the difference between groups was no longer statistically significant because the comparison group also continued to improve; however, the program group maintained a large reduction from baseline (d = 1.18). Students in the program also showed a significant increase in self-efficacy that remained stable through every follow-up (all p \< .032). Adherence and acceptability were high: participants attended an average of 5.06 of 6 sessions, 80% attended at least 5 sessions, and satisfaction with the therapy reached 78.3% of the maximum possible score. These findings suggest that a structured, group-based CBT program is an effective and acceptable approach for managing problematic internet use among Nepalese undergraduates and offers a potentially scalable framework for academic institutions in low-resource settings.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

Interventions

Group Cognitive-Behavioral Intervention for Problematic Internet UseBEHAVIORAL

A six-session manualized group program for problematic internet use among Nepalese undergraduates delivered weekly in 90-minute sessions. Grounded in cognitive-behavioral therapy, Young's CBT-IA model, and Davis's cognitive-behavioral model of pathological internet use. Sessions 1-2: orientation, psychoeducation, behavioral monitoring, and planning healthier internet habits (behavior modification). Session 3: cognitive restructuring. Sessions 4-5: harm reduction and emotional/psychological drivers of addiction. Session 6: relapse prevention and consolidation. Culturally adapted for Nepalese youth through multidisciplinary expert review (clinical psychologists, psychiatry, Ayurveda/Yoga, clinical psychology residents). Facilitated by two Master's-level psychology trainees after 40 hours of supervised CBT training by the project lead, with weekly supervision and a structured manual for fidelity.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Undergraduate students enrolled at colleges affiliated with Tribhuvan University, Kathmandu, Nepal * Internet Addiction Test score above 30 (mild, moderate, or severe categories of problematic internet use) at Phase 1 screening * Willing to provide informed consent and to attend scheduled group sessions Exclusion Criteria: * IAT score of 30 or below at Phase 1 screening (did not meet inclusion criteria) * Declined to participate / unwilling to provide informed consent * Withdrawal before the first intervention session

Outcomes

Primary Outcomes

Internet Addiction Test Score

20-item Internet Addiction Test evaluating the severity of problematic internet use on a 0-5 Likert scale (Young, 1998); higher scores indicate more severe problematic internet use. In this study, scores ≥ 31 defined "mild" to "severe" problematic use.

Time frame: Baseline (pre-intervention), Week 6 (post-intervention), Week 8 (2-week follow-up), Week 10 (1-month follow-up), and Week 18 (3-month follow-up)

Secondary Outcomes

General Self-Efficacy Scale Score

10-item Nepali version of the General Self-Efficacy Scale assessing broad optimistic self-beliefs regarding general coping ability (Schwarzer et al., 1997); higher scores indicate greater general self-efficacy. Change from baseline was the analysis metric.