Integrative Medicine Case Reports, Volume 4, Issue 1 (January), 2023

Prevalence of Internet Addiction among Students at an Indian Higher Educational Institution and some proposed Yogic Prescriptions for its mitigation

Rudra B. Bhandari^* and Rahul Chaihal

Department of Yoga Science, University of Patanjali, Haridwar, Uttarakhand, India

Introduction

The use of the internet for shopping, business, travel, research, learning, entertainment and particularly social networking via E-mail, Facebook^TM, Twitter, LinkedIn, Whatsapp, Telegram, Instagram, Google+, YouTube, etc., has drastically altered human lifestyle, behaviour, health and productivity. Increased self-confidence, frequent communication with family and friends, and feelings of empowerment are some positive consequences of internet use (1). However, internet use may also result in compulsive overuse, described as Internet Addiction (2) (IA). Specifically, internet use for more than 19 hours per week is called IA, as reported by Kimberly Young in 1996 (3,4). IA is an impulse control disorder without intoxicating drug use (5).

College-going students have been more prone to IA (6) due to their online teaching-learning schedule supporting excessive internet use (7). Teenagers using the internet for long hours may paradoxically result in social isolation, self-distance, and family conflicts (8). College students with weak self-management and cognitive capabilities who use the internet for social networking and studies are more prone to IA (9). Depressed girls are more prone to IA than depressed boys (10).

Internet-addicted teens have shown physical aggression toward parents when they try to divert them from online gadgets, and adults have faced marital conflicts/breakdowns. Research and clinical practices have also reported negative consequences of IA in adolescents due to their unmanaged lifestyle (11). The other adverse effects of IA are marital conflicts, sleep deprivation, poor dietary habits, poor work performance, isolation, dullness, false speaking, personality change, decreased libido, social withdrawal, self-neglect, family conflict, depression, anger, anxiety disorders, suicidal tendency, backache, obesity, vein thrombosis, and pulmonary embolus (8); and impaired cognitive growth/development and functioning (12). India holds the second rank globally in internet users, with 481 million in December 2017, expected to be 500 million by June 2018 (13). Thus, IA is a growing concern in India.

Yoga as a mind-body-spirit practice has been a preventive and therapeutic measure of various psychological, somatic, psychosomatic, and somato-psychic health problems (14). Yoga therapy (YT) empowers individuals to progress toward improved health and well-being by applying the philosophy and practices of yoga (15). The three accepted benefits of yoga are improved psychosomatic efficiency, cleansing of psychosomatic planes, psychic centres and energy channels, and paranormal attainments (16). Body, breath, mind, diet, lifestyle, and environment are six essential factors of YT (15). Yoga and meditation have been indicated for substance abuse and addictive behaviours due to their potential impacts on reducing stress, addictive behaviours, mood swings, depression, and anxiety; and optimising psychological health, consciousness, self-awareness, self-esteem, self-efficacy and person-to-environment interactions (17). Supporting this notion, a 3-month yoga program administered to 45 internet addicts significantly improved their body pain, sleep, appetite, communication, and outside recreational activities (18). Yoga practice induces relaxation associated with decreased arousal, deactivated stress response system, and improved physical and mental well-being (19,20). Therefore, this study aimed to compute the reliability of Young’s Internet Addiction Test in the Indian population and explore the prevalence of IA among a specific cohort of Indian higher education students. Additionally, we propose a rationally valid integral yoga lifestyle prescription for preventing/managing IA that is to be tested in a future study.

Materials and method

Participants, design and setting

A cross-sectional survey on IA was conducted among 154 postgraduate (PG) and undergraduate (UG) yoga students randomly selected from the University of Patanjali (UOP), Haridwar, in May 2018. Of 154 participants (Males/Females: 84/70, UG/PG: 84/70) aged 17 to 29 (Mean ± SD: 21.52 ± 1.57) years, proportionate counts were selected from urban and rural areas. The participants had been practising yoga for at least six months. Baseline data on IA was generated by administrating a self-report Internet Addiction Test (IAT) developed by Young (21) after taking their informed consent. Participants spent 5–10 minutes to complete IAT. The study was approved by the Institutional Ethics Committee of the UOP (UOP/IEC/2018/01-A).

Measure

IAT is the 5-point Likert scale with 20 items to be rated as 0, 1, 2, 3, 4, and 5 if the given behaviour is applicable, rarely applicable, occasionally applicable, frequently applicable, often applicable, and always applicable in the user’s life. IAT includes six factors–salience (10, 12, 13, 15, and 19); excessive use (1, 2, 14, 18, and 20); neglect work (6, 8, and 9); anticipation (7,11); lack of control (5, 16, and 17); and neglect of social life (3 and 4). Overall, Cronbach’s α, 0.88 (22) computed for IAT, indicated it is a reliable psychometric measure of IA (23). Cronbach’s α and Spearman-Brown coefficients calculated from the current sample were 0.765 and 0.737.

Data analysis

SPSS (21^st version) was used to compute the descriptive statistical measures—mean, standard deviation, and frequency in count and percentage.

Results

Table 1 depicts the prevalence of IA among all participants and compares the prevalence between male and female, urban and rural, and PG and UG participants. Table 2, Table 3 and Table 4 display mean ± SD for six factors and aggregate IA in terms of gender, region and educational programme.

Yoga lifestyle prescription for preventing and mitigating IA

Cleansing practices: Jala Neti and Trataka (24).

Postures: Pavanmuktasana (anti-rheumatic series) with mild bhastrika (24), Tadasana, Adhomukha Svanasana, Uttanasana, alligator twists (25), Vajrasana, Vipreetakarani, Shashankasana and Shavasana (24).

Breath regulations: Alternate nostril breathing (20), crown breath (Dhrti-Sakti-Vikasaka) (26), the breath of fire (27–29), Kapalabhati, Ujjayi, Bhramari, and Moorcha (24).

Locks and Gestures: Jalandhar Bandha and Moola Bandha, Gyan Mudra, Shambhavi Mudra, Khechari and Nashikagra Mudra (30,31).

Meditation: Meditation on the breath (20) and five elements (32).

Dietary recommendations

Breakfast: carbohydrates (oats, wheat flakes, whole-grain bread), proteins (egg, yoghurt, milk, and sprouts), fruits and nuts (carrot, lemon juice, almonds, chia seeds, flax seeds, pumpkin seeds, apricots, walnuts, figs, raisins) (33), drinks (green tea) (34–36).

Table 1: Frequency in count (C) and percentage (%) based on interpretation norms of IAT

Table 2: Region-wise mean ± SD for factors and total IA

Table 3: Gender-wise mean ± SD for factors and total IA

Table 4: Program-wise mean ± SD for factors and total IA

Lunch: Cereals (2 cups rice+2 chapattis), pulses- 0.5 cups, and vegetables (0.75 cups cooked + salad), curd- 0.5 cups/buttermilk- 1 glass, oily fish (salmon, mackerel, herring, kippers, sardines) (37–39).

Dinner: Cereals (2 cups rice +2 chapattis), pulses- 0.5 cups, vegetables (0.75 cups cooked + salad) (40), 1 teaspoon glutamine powder with cold water at bed time (34,35,37,39).

Lifestyle tips

The below lifestyle tips from Ayurvedic Swasthavritta help to prevent and mitigate IA (41,42).

• Ushapan drinking water immediately after waking in the early morning (at least 30 to 40 minutes before sunrise) detoxifies the body, removes constipation, and boosts psychosomatic health.

• Using collyrium (powders of a conch shell, Samudra-phone, marine oyster shell, crystal, ruby, coral, Asmantaka, lapis lazuli, pearl, iron, copper, and antimony mixed in equal parts and then stuffed in a ram’s horn), (43) daily prevents and moderate eyes problems. About 3-minute cold water eye irrigation in the morning and after meals with a blown mouth releases eye tension and strain.

• Medicated oil application (Shadvindu Taila) (44) into nostrils by fingers improves the gleam of skin and strength of the shoulders, neck, face, and chest preventing early hair whitening and neck stiffness, locked jaw, frequent headache, facial palsy, etc.

• Medicated oil (Ksheera Bala tail) (44) massage over the body, especially on the head, ears, and feet, moisturises the skin, nourishes the tissues, delays ageing, improves vision, and induces sound sleep.

• Familial support, parents’ positive attitude, and parent-child solid relationship may prevent and mitigate IA (21).

Discussion

Of 154 yoga students surveyed, 27.27%, 53.25% and 19.48% exhibited normal, mild and moderate IA with no extreme addiction cases. There was a higher prevalence of IA in participants from urban backgrounds than in rural locations. This higher IA in urban areas might be due to higher internet facilities or the economic status of urban dwellers as compared to rural dwellers (45). The IA was higher in females as compared to males. Chiu et al. consistently reported higher IA in female students than males in Taiwan’s schools (46).

Conversely, Shek et al. reported high internet addictive behaviour in high school male adolescents compared to females in Hong Kong’s schools (47). The higher rate of IA in female students might be due to the selection of more female students from the urban area compared to males. In urban areas, economic status and technological access are better than in rural areas. The higher mean IA value in urban participants than in rural ones shows an immediate need for IA prevention via lifestyle prescription implementation among urban students. The mild IA was higher in PG than UG students, but moderate IA was more in UG than PG students.

Yoga and meditation have been effective treatments for substance abuse and addictive behaviours through their potential impacts on numerous psychological, behavioural and physical components (48). Based on CBT and extant research findings on yogic efficacies for preventing and managing addictions, an integral yogic prescription is rationally proposed hereunder.

Jala Neti (rinsing nasal passages with saline water) and Trataka (one-pointedness externally/internally) are prescribed yogic cleansing techniques to improve IA (49). Jala Neti has a soothing effect on the brain, moderates migraine and depression and induces freshness to remove the drowsiness (24). It enhances eyesight, and mitigates defective vision, nervous instability, insomnia, and mental fluctuations (31,39).

The gentle practice of anti-rheumatic series (Pavanmuktasana) loosens joints, reduces musculoskeletal stiffness, and may be indicated for frequently reported symptoms of IA─neck pain, backache, poor dietary habits, eye problems, and anxiety (21). Tadasana provides steadiness and better awareness. Adhomukhasana, Uttanasana, and Svanasana soothe the nervous system and relieve back stifness (24,51). Alligator twists tone the liver and pancreas, remove excess trunk fat and improve digestion (25). Vajrasana practice after the meal helps improve digestive function and eases mind control (24). Vipreetakarani channelises pranic flow to purify the subtle body, which helps prevent somatic diseases and sublimate sexual energy from lower to higher centers (24). Shashankasana relaxes the sciatic nerve, soothes anger, and moderates sexual disorders. Savasana relaxes the whole psychophysiological system (24).

Breath regulation is one of the essential yogic practices for controlling the mind and easing addiction recovery (48). Breath of fire is found to be supportive of addiction recovery (52). Subsequent exhalations in Kapalbhati clear the nasal passages, and airways, remove psychic morbidity and tranquilise the mind (24). The practice of Ujjayi stimulates the baroreflexes to set a parasympathetic tone (53). Bhramari mitigates anxiety, anger, and stress and improves awareness (54). Morcha is indicated for anxiety, obsessions, compulsions and phobias. Alternate nostril breathing soothes the mind, synchronises the mind flow and the breath, and balances the sympathetic and parasympathetic tone (20). Crown breath (Tatha dhrti sakti vikasaka) empowers the psycho-immunity and will (26). Jalandhar Bandha stimulates baroreflex and interferes with blood flow in vertebral arteries resulting in reduced anxiety and stress. In contrast, Moola Bandha activates the external anal sphincter (EAS), ischiocavernosus, bulbospongiosus, perineal muscles, the urethral sphincter, and the pelvic diaphragm and pudendal nerve leading to improved psychosexual function (24,55,56). The fMRI recorded cerebral cortical control areas and brain activities during sustained wilful contraction of EAS (for 10 sec) were multifocal at anterior cingulate, prefrontal, parietal, occipital, and insular regions (57) and invariably recommended for neuropsychiatric problems– depression, emotional traumas, anxiety, phobias, obsessions, hysteria, suppressed desires, psychosexual dysfunctions, and impaired neuroendocrine secretions (56). Breath awareness and Jnana Mudra magnify postural benefits. Shambhavi and Nashik Agra Mudra strengthen eye muscles, mitigate stress and anger, and enhance mental concentration (24). Meditation transcends painful events in life and leads to a degree of happiness and calmness (20). Meditation on the breath induces self-awareness and peace.

A balanced dietary prescription proposed for internet addicts may improve their irregular dietary habits and nutritional deficiencies. Healthy lifestyle tips recommended from Ayurvedic Swasthavritta─waking in the early morning, defecation, cold water eye irrigation, nasal insufflation, yoga exercise, and massage may improve eye health, sleep, headache, musculoskeletal pain, somatic and psychic morbidities.

The administration of the proposed yoga prescription may be more productive by considering the appropriate teaching method, individual differences; region, body constitution, age, disposition, occupation, mental and bodily capacities, and ideology of the internet addicts, along with the optimal time (seasons, timing, and duration of yoga practice) to realise its expected benefits (16). As part of the selected sample, the unequal ratio of male and female students from UG and PG might have affected the overall prevalence of IA among university students. Future studies should include a proportionate sample regarding education level and gender.

Conclusion

The Internet Addiction Test developed by Young was applicable to the sampled university students. Mild IA was found in these students, with differences in prevalence correlated with their gender, education level, and region of upbringing. The higher IA in females and urban participants suggests the need for developing an inexpensive and standard yoga lifestyle prescription (YLP) as proposed herein. The efficacy of the proposed YLP for overcoming IA needs to be validated in further interventional studies.

Ethical statement

Ethical approval was obtained from the Institutional Ethics Committee of Patanjali University, Haridwar, India (Approval no. UoP/IEC/2018/01-A) dated 18/May/2018.

Acknowledgements

The authors thankfully acknowledge the Department of Yoga Science, the University of Patanjali, for academic and logistic support and respondents of this study for their consent and support for data collection.

Authors’ contribution

RBB: Conception, Study Design, Literature Review, Data Analysis, Manuscript Writing and Editing.
RC: Literature review, data collection, compilation and collation.

Source of funding

This study received no financial aid from a funding agency.

Conflict of interest

The authors declare no conflicts of interest regarding research, and authorship.

Received Date: 06-06-22; Revised Date: 30-07-22
Accepted Date: 29-08-22

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