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Computers in Human Behavior 61 (2016) 532e536

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Computers in Human Behavior


journal homepage: www.elsevier.com/locate/comphumbeh

A study of the relationship between internet addiction,


psychopathology and dysfunctional beliefs
! a,
Ibrahim Taymur a, *, Ersin Budak b, Hakan Demirci c, Hatice Alkan Akdag
d

r a, Kadir Ozdel
Buket Belkz Gngo
a

Sevket Ylmaz Teaching & Research Hospital, Psychiatry Department, Bursa, Turkey
Sevket Ylmaz Training Research Hospital, Psychiatry Department, Bursa, Turkey
Sevket Ylmaz Teaching & Research Hospital, Family Medicine, Bursa, Turkey
d
Dskap Yldrm Beyazd Training Research Hospital, Psychiatry Department, Ankara, Turkey
b
c

a r t i c l e i n f o

a b s t r a c t

Article history:
Received 30 September 2015
Received in revised form
11 March 2016
Accepted 12 March 2016
Available online 28 March 2016

Background and aims: Psychopathological symptoms, particularly depression and anxiety, increase with
the severity of Internet Addiction (IA). In this study, we aimed to assess the relationship of severity of IA
and Dysfunctional Attitudes (DA) with psychopathological characteristics.
Methods: Two hundred and twelve university students were included in the study. The subjects were
assessed using the Internet Addiction Scale (IAS), the Symptom Checklist (SCL-90) and the Dysfunctional
Attitude Scale (DAS).
Results: The subjects were divided into three groups according to the IAS, which was conducted to screen
for IA: no addiction, mild and moderate/high addiction. 108 (50.9%) of the subjects were found to have no
addiction, 70 (33.01%) to have a mild addiction and 34 (16.03%) to have a moderate/high addiction.
Psychopathological symptoms and dysfunctional attitudes increase with the severity of IA. In addition to
the psychopathologic features, dysfunctional attitudes have limited effects on explaining the IA.
Conclusions: In the cognitive-behavioral treatment of IA, focusing on a perfectionist attitude and a need
for approval, which are part of a dysfunctional attitude, may be benecial.
2016 Elsevier Ltd. All rights reserved.

Keywords:
Internet addiction
Psychopathology
Dysfunctional attitudes
Perfectionist attitudes
Need for approval

1. Introduction
Although the Internet has accelerated and has facilitating effects
on most aspects of our lives, Internet addiction is one of the
negative results of this technology (Przepiorka, Blachnio, Miziak, &
Czuczwar, 2014). Internet addiction, which is associated with an
individual's loss of control over their Internet use, is considered to
be a health problem requiring attention (Brand, Young, & Laier,
2014; Ko, Yen, Yen, Chen, & Chen, 2012; Morrison & Gore, 2010).
In an extensive study carried out in Europe, it was found that the
prevalence of IA is 1% among adolescents, the group at risk for IA is
12.7%, and this rate is 13.7% in total (Tsitsika et al., 2014). In a study

* Corresponding author. Sevket Ylmaz Training & Research Hospital, Psychiatry


!itim Arastrma Hastanesi, Postal Code: 16100,
Department, Sevket Ylmaz Eg
Yldrm, Bursa, Turkey.
E-mail addresses: dritay@yahoo.com (I. Taymur), ersin240@hotmail.com
(E. Budak), drhakandemirci@hotmail.com (H. Demirci), htcalkan@yahoo.com
!), buket.gungor@yahoo.com (B.B. Gngo
r), kadirozdel@gmail.com
(H.A. Akdag

(K. Ozdel).
http://dx.doi.org/10.1016/j.chb.2016.03.043
0747-5632/ 2016 Elsevier Ltd. All rights reserved.

with university students in Turkey, 12.2% of students (Dalbudak


et al., 2013) were found to have IA, and this number was determined to be 7.2% in another study (Senormanc et al., 2014).
It is considered that IA is linked to several psychopathologies.
The study of Alavi, Maracy, Jannatifard, and Eslami (2011) with
university students showed that many psychopathologic features
(somatization, depression, anxiety, paranoid ideation, hostility,
interpersonal sensitivity, obsessive-compulsive specications) are
much more frequent in adolescents with IA. In a similar study by
Adaler and Balkan (2012), it was found that many symptoms
related to psychopathologic features are much more frequent in
adolescents with IA than in those without IA. Moreover, in studies
analyzing psychiatric comorbidity in IA, it was found that psychopathologies such as ADHD, depression, schizophrenia and OCD
accompany IA (Ha et al., 2006; Ko, Yen, Chen, Chen, & Yen, 2008).
It can be said that depression and anxiety are among the most
emphasized psychopathologies in the process of understanding IA.
It was found that individuals with IA are affected more by
depression and anxiety (Goel, Subramanyam, & Kamath, 2013), and

I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536

nearly half of the Internet addicts seeking treatment have depressive symptoms (Mller, Ammerschlaeger, Freisleder, Beutel, &
Woeling, 2012). In studies on IA, addiction scores showed a positive correlation with depression and anxiety scores (Mller, Beutel,
ling, 2014) and those individuals with IA had higher
& Wo
depression and anxiety scores (Tonioni et al., 2012). Ko et al. (2014)
found in their study that resistant depressive symptoms accompany resistant IA individuals, and following treatment of IA,
depression, social anxiety and aggressive behaviors diminish in
Internet addicts.
Dysfunctional attitudes (DA) used to evaluate a depressive individual's prevailing negative attitudes are associated with the self,
the outer world, and the future, and compose an important part of
Beck's dysfunctional cognitive items (Weissman & Beck, 1978). This
is why Weissman and Beck developed the Dysfunctional Attitude
Scale to analyze dysfunctional attitudes, and this scale has
frequently been used in the literature to discuss dysfunctional beliefs which are strongly related to dysfunctional schemas. This
scale, which is used especially for the aim of evaluating the predisposition of individuals towards depressive symptoms, analyzes
negative thoughts, negative emotional schemas and negative beliefs in the framework of a perfectionist attitude and a need for
approval basically. Besides this, it is reported that DA is linked with
many psychologic factors, such as approval, love, success, right,
afford, autonomy and anaclitic self-esteem, which are necessary
regarding cognitive therapy (Weissman & Beck, 1978; Wong, Chan,
& Lau, 2008).
There are a considerable number of studies reporting a signicant relationship between changes in DAS and depressive symptoms (Wong et al., 2008; De Graaf, Roelofs, & Huibers, 2009). It was
found that DA is an important factor particularly in patients with
depression, that DA may contribute to the development of
depression along with environmental stress factors, and that DA is
decreased during the process of depression treatment (Beevers,
Strong, Meyer, Pilkonis, & Miller, 2007; Farmer et al., 2001).
Moreover, it is known that depressive symptoms have signicant
effects on many addictions. Despite this, it can be said that there are
not so many studies in the literature on the interaction between
addiction and dysfunctional attitudes. Heinz, Veilleux, and Kassel
(2009) have shown in their study that DA has a potential importance in problematic alcohol use and the amount of alcohol consumption. Ramsey, Brown, Stuart, Burgess, and Miller (2002) have
reported that negative experiences associated with addiction can
be decisive in the treatment of alcohol addiction. Thus we can focus
on dysfunctional attitudes during the cognitive behavioral therapy
process.
Our knowledge of IA and DA is limited, and the one study in the
literature in this eld showed that DA scores were high in individuals with IA, and that a perfectionist attitude (PA) is a predictor
of
IA
(Senormanc
et
al.,
2014).
Numerous
psychopathological components were assessed in the treatment
and investigation of the causes of Internet addiction, and it was
emphasized that these psychopathological elements are essential
regarding addiction. However, the literature contains a limited
number of studies investigating IA together with psychopathological components and dysfunctional situations. In this study, we
aimed to assess the relationship of the severity of IA and DA with
psychopathological characteristics. We designed this study to
investigate the level of effect that dysfunctional attitudes, as well as
general psychopathology, have in explaining IA.
2. Method
This study was carried out by assessing students studying at
Bursa Orhan Gazi University in 2014. Students attending the

533

university in 2014 were interviewed. Before participation, students


were informed about the study.
2.1. Participants
Two hundred and fty students who indicated that they use the
Internet were included in our study. Participation in the study was
on a voluntary basis, and consent for participation was obtained
from each student assessed. Exclusion criteria were faulty or
incomplete measurement. Data from the faulty and incomplete
analysis for 38 students were excluded from the study. Therefore,
our study was conducted with 212 people, 124 men, and 88 women.
2.2. Procedure
The students were assessed in groups in a silent class environment. The subjects were initially given the required information,
and then they were assessed using scales with socio-demographic
data forms and paper-and-pencil tests.
2.3. Measures
2.3.1. Sociodemographic form
The socio-demographic questionnaire was composed of 8
questions. These were age, gender, tablet use (yes/no), Smart phone
use (yes/no), presence of failing school year (yes/no), smoking (yes/
no), family history of psychiatric referral (yes/no) and history of
psychiatric referral (yes/no).
2.3.2. Internet addiction
The Internet Addiction Scale (IAS), developed by Nichols and
Nicki in 2004, was used by Kayri and Gn (2009) with university students in Turkey. The scale consists of 31 items and has no
reverse-scoring items. Attitudes are scored as 1- Never 2- Rarely 3Sometimes 4- Frequently and 5- Always using a Likert scale
(a 0.93). Dalbudak et al. (2013) determined the cutoff score of the
scale for addiction at 81 and divided the IA into three groups for
IAS: 30e60 (no addiction), 61e80 (mild addiction) and 81 and
higher (risk for addiction/addicted).
2.3.3. Psychopathology
The Symptom Checklist-90 (SCL-90) is an assessment tool consisting of 90 items and nine subscales to assess psychiatric symptoms (Derogatis, 1983). The validity and reliability study of the scale
! (1991) in Turkey, and the reliability cowas carried out by Dag
efcients for sub-scales were determined as Somatization
(a 0.82); Obsessive-Compulsive (a 0.84); Interpersonal Sensitivity (a 0.79); Depression (a 0.78); Anxiety (a 0.73); AngerHostility (a 0.79); Phobic Anxiety (a 0.78); Paranoid Ideation
(a 0.63); Psychoticism (a 0.73); and Additional Scale (a 0.77).
2.3.4. Dysfunctional attitudes
The Dysfunctional Attitudes Scale (DAS) is used for analyzing
dysfunctional beliefs, thoughts, and emotions (Weissman & Beck,
1978; Sahin & Sahin, 1992). The scale consists of 40 items, and
each item is scored between 1 (completely disagree) and 7
(completely agree). The internal consistency of the scale was
determined at 0.79, and the total item correlation coefcient at
0.34. The scale was found to be a valid and reliable assessment tool.
Turkish version of the DAS consists of 4 factors: Perfectionist Attitude (PA), Need for approval (NA), Autonomous Attitude (AA), and
Tentative Attitude (TA). Higher scores refer to higher levels of
dysfunctional attitudes (Sahin & Sahin, 1992).

534

I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536

3. Results
Independent samples t-test was used for assessing sociodemographic data; One-Way ANOVA for comparing the psychopathology and dysfunctional attitudes in the three different
Internet addiction groups; and Pearson correlations and hierarchical regression analysis for investigating the relationship between general psychopathology and dysfunctional attitudes.
124 (58.5%) of our subjects were men, and 88 (41.5%) were
women. The subjects, whose average age was 19.36 1.75, were
divided into three groups (no Internet addiction, mild Internet
addiction, and moderate/severe Internet addiction). 108 (50.94%)
subjects were found to have no Internet addiction, 70 (33.02%) to
have a mild addiction and 34 (16.04%) to have a moderate/severe
addiction. 62 of our participants (29.24%) declared the presence of a
failing school year. In addition to this, 167 of our participants
(78.77%) reported that they used a smart phone, and 36 (16.98%)
used a tablet. 42 participants (19.81%) were smokers. An assessment of socio-demographic characteristics revealed no statistically
signicant difference between average scores for Internet addiction
according to independent samples t-test carried out based on
gender (t "0.793, p 0.429), tablet use (t "0.499, p 618),
Android phone use (t "0.030, p 0.976), presence of failing
school year (t "0.308, p 0.759), and smoking (t 1.388,
p 0.167). Subjects that had a family history of psychiatric referral
(n: 27) had statistically signicantly higher IAS scores than those
who did not (n: 185) (F 1.73; t 2.34; p 0.020). Subjects that
had a history of psychiatric referral (n:29) had statistically signicantly higher IAS scores than those who did not (n:183) (F 1.212;
t 3.78 p 0.001).
A comparison of the average of the three IA groups revealed that
the scores of total SCL-90 and Somatization, Obsessive-Compulsive,
Interpersonal Sensitivity, Hostility, Depression, Anxiety, Phobic
Anxiety, Paranoid Ideation, Psychoticism And Additional scale
increased with the severity of Internet addiction (p < 0.001 for total
SCL-90 and all subscales). A comparison of DAS and sub-scale
scores of the three groups revealed that while average scores for
DAS (p 0.005) and the sub-scales of PA (p 0.001) and NA
(p 0.035) were statistically signicantly higher in IA groups, no
statistically signicant difference in the averages for the sub-scales
of AA (p 0.473) and TA (p 0.266) was found (Table 1).

According to the correlation analysis of IAS, SCL-90 and its subscales, and DAS and its sub-scales in our study, a statistically high
positive correlation was found between IAS and total SCL-90 scores
(r 0.47; p < 0.001) and IAS and total DAS scores (r 0.34;
p < 0.001) (Table 2).
A statistically high positive correlation was found between IAS
and scl-90 sub-scales of Somatization (r 0.37; p < 0.001),
Obsessive-Compulsive (r 0.43; p < 0.001), Interpersonal Sensitivity (r 0.41; p < 0.001), Depression (r 0.44; p < 0.001), Anxiety
(r 0.47; p < 0.001), Anger-Hostility (r 0.37; p < 0.001), Phobic
Anxiety (r 0.36; p < 0.001), Paranoid Ideation (r 0.34;
p < 0.001), Psychoticism (r 0.41; p < 0.001), and Additional Scale
(r 0.34; p < 0.001) (Table 2).
A high positive correlation was found between IAS scores and
scores for the sub-scale of PA (r 0.28; p < 0.001), a moderate
positive correlation was found between IAS scores and scores of the
sub-scale of NA (r 0.21; p < 0.01), and no statistically signicant
correlation was found between IAS scores and scores for the subscales of AA (r 0.10) and TA (r 0.09) (Table 2).
According to hierarchical regression analysis; Step 1 (General
Psychopathology) explained 21.6% of IAS scores. According to hierarchical regression analysis; Step 2 (General Psychopathology
scores, Perfectionist Attitude, Need for Approval, Autonomous
Attitude, Tentative Attitude subscales scores) explained 22.8% of
IAS scores (Table 3).

4. Discussion
In our study, the percentage of people who were at risk for IA
and who had IA was 16.04%. Studies conducted in Turkey found
varying rates of university students who have IA, such as 12.2% and
7.2% (Dalbudak et al., 2013; Senormanc et al., 2014). Considering
the fact that different assessment tools and different methods for IA
assessment were used, and that the incidence of IA varies between
countries, regions and studies, we might say that the percentage of
addicted people in our study was higher than some studies and
lower than others (Budak et al., 2015; Tsitsika et al., 2014; Alavi
et al., 2011; Ni, Yan, Chen, & Liu, 2009).
The ndings achieved in our study show that Internet addiction
interacts with general psychopathologic features and dysfunctional
attitudes (Table 1, Table 2). Depressive symptoms and adverse life

Table 1
Comparing scale and subscale scores according to severity of Internet addiction (IA).

Somatizationa
Obsessive-compulsivea
Interpersonal sensitivitya
Depressiona
Anxietya
Anger-hostilitya
Phobic anxietya
Paranoid thoughtsa
Psychotisma
Additional scalea
General psychopathologya
Dysfunctional attitudesb
Perfectionist attitudec
Need for approvald
Autonomous attituded
Tentative attituded
a
b
c
d

Moderate/high > mild > no.


Moderate/high > no.
Moderate/high > mild, no.
Moderate/high, mild, no.

Without IA n 108

Mild IA n 70

Moderate/high IA
n 34

Mean

SD

Mean

SD

Mean

SD

0.49
0.97
0.71
0.66
0.59
0.65
0.34
0.79
0.40
0.71
0.63
117.31
43.38
37.62
17.75
18.17

0.47
0.65
0.65
0.61
0.62
0.73
0.50
0.70
0.48
0.62
0.50
29.10
14.28
11.42
6.28
4.96

0.75
1.39
1.08
0.95
1.00
0.95
0.52
1.06
0.70
1.01
0.95
123.40
45.48
41.03
18.41
18.76

0.48
0.73
0.62
0.61
0.71
0.77
0.57
0.61
0.60
0.63
0.52
23.60
12.10
10.41
5.76
3.61

1.05
1.75
1.46
1.55
1.57
1.42
0.94
1.31
1.00
1.28
1.36
134.35
53.47
42.44
19.14
19.55

0,68
0,84
0.90
0.95
0.99
0.91
0.90
0.80
0.79
0.92
0.80
24.64
14.13
9.93
6.04
4.43

16.66
17.58
16.95
22.16
24.76
12.85
12.65
8.24
15.39
10.26
22.50
5.37
7.14
3.39
0.75
1.33

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.005
0.001
0.035
0.473
0.266

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I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536


Table 2
Correlations between the scale and the subscale scores.

IAS
DAS
PA
NA
AA
TA

IAS

OC

IS

AH

PHA

PT

PSY

AS

GP

0.25***
0.28***
0.21**
0.10
0.09

0.37***
0.18**
0.21**
0.07
0.04
0.23**

0.43***
0.27***
0.31***
0.15*
0.07
0.24***

0.41***
0.40***
0.37***
0.29***
0.26***
0.26***

0.44***
0.29***
0.30***
0.16*
0.16*
0.23**

0.47***
0.26***
0.33***
0.10
0.09
0.19**

0.37***
0.34***
0.37***
0.19**
0.21**
0.23**

0.36***
0.32***
0.34***
0.14*
0.19**
0.23**

0.34***
0.37***
0.40***
0.20**
0.21**
0.23**

0.41***
0.33***
0.38***
0.17*
0.19**
0.19**

0.34***
0.26***
0.31***
0.10
0.12
0.21**

0.47***
0.34***
0.37***
0.18**
0.16*
0.26***

Internet Addiction Scale (IAS), Somatization (S), Obsessive-Compulsive (OC), Interpersonal Sensitivity (IS), Depression (D), Anxiety (A), Anger-Hostility (AH), Phobic Anxiety
(PHA), Paranoid Thoughts (PT), Psychotism (PSY), Additional Scale (AS), General Psychopathology (GP), Dysfunctional Attitudes (DA), Perfectionist Attitude (PA), Need for
Approval (NA), Autonomous Attitude (AA), Tentative Attitude (TA) ***p < 0.001, **p < 0.01, *p < 0.05.

Table 3
Hierarchical regression analysis results associated with the IAS scores.
95% condence interval
Predictor

R2

Adjusted R2

0.220***

0.216***

Step 1
General psychopathology
Step 2
General psychopathology
Dysfunctional attitudes
Perfectionist attitude
Need for approval
Autonomous attitude
0.246***

0.228***

SE

Beta

LB

UB

12.730

1.671

0.469***

9.436

16.025

12.116
0.087
0.208
"0.060
"0.370

1.829
0.095
0.127
0.204
0.270

0.446***
0.072
0.132
"0.021
"0.097

8.509
"0.100
"0.042
"0.461
"0.902

15.722
0.275
0.458
0.342
0.161

Dependent variables: Internet Addiction Scale, 1 point (Never), 2 points (Rarely) 3 points (Sometimes) 4 points (Frequently) and 5 points (Always). ***p < 0.001, LB Lower
Bound, UP Upper Bound.

events have a signicant role in the severity of addiction, relapse,


and treatment process. DA are closely associated with depressive
symptoms and disorders and are found to be an important determinant of the psychopathology of addiction (Heinz et al., 2009;
Ramsey et al., 2002). In the literature, there is only one study
investigating DA in IA. This study found that DA scores are high in
people with IA, and perfectionist attitude (PA) is an important
predictor of IA (Senormanc et al., 2014). In another study investigating only perfectionism and problem Internet use, perfectionism
was similarly found to be a signicant predictor of IA (Lehmann
&Konstam, 2011). At this point, we can assume that more studies
are needed to enlighten the interaction between IA, DA, and psychopathologic features.
Studies investigating the general psychopathology of Internet
addiction reported that depression and anxiety are a prominent
psychopathology (Mller et al., 2014; Tonioni et al., 2012; Goel
et al., 2013; Mller et al., 2012). As a result of correlation analysis
carried out in our study, anxiety and depression were found to be
prominent psychopathological symptoms associated with IA. The
ndings of our study and the previous studies are highly consistent.
In addition to this, dysfunctional attitudes have an important place
in assessing depression and anxiety in terms of cognitivebehavioral therapy. It might be benecial to focus on depression
and anxiety in the assessment of IA and not to disregard these
characteristics in the treatment process. As a result of the correlation analysis carried out in our study, a signicant positive correlation was found between DA and all psychopathologies in SCL-90.
Besides this, many studies in the literature show that there are
effects of DA on several psychopathologic characteristics, such as
psychosis, bipolar disorder and personality problems (Farabaugh
et al., 2007; Wright, Lam, & Newsom-Davis, 2005; Zimmerman,
Coryell, Corenthal, & Wilson, 1986). Because DA focuses on cognitions, emotions, and behaviors for many aspects and conditions in
one's life, it may demonstrate a predisposing effect in the development of all psychopathologies.

People with high Perfectionist Attitude were found to have


greater expectations and standards, and to be highly self-critical
and self-blaming (Kaviani, Mohammadi, & Zarei, 2014). It was
found that people with abnormal perfectionist attitude had
impaired problem-solving skills (O'Connor & O'Connor, 2003),
were susceptible to anxiety and depression and may demonstrate
addiction-predisposed behaviors (Kaviani et al., 2014). In their
studies with healthy subjects on DAS and mood and character
traits, Otani et al. (2013b) found that a perfectionist pattern is
associated with increased preservation and repetitive behaviors.
With a dysfunctional perfectionist attitude, the Internet may create
an enabling environment for preservative and repetitive behaviors.
The Internet may provide a compelling arena for perfectionist
people, where they can be alone, away from expectations and
criticism. However, receiving a rapid and easy response in something that they control or engage in may also be associated with a
reward system.
The need for approval in DAS is considered to be a pattern
associated with addiction. Need for approval and high reward
dependence were found to be correlated with healthy subjects
(Otani et al., 2013a). The fact that the Internet is easily accessible
and that it is easily possible to avoid feelings of loneliness thanks to
social networks may be an enabler for Internet addiction. Nevertheless, attitudes of the need for approval associated with addiction
increase with negative life events and may be predisposing for
Internet addiction.
Positive effects of using cognitive and behavioral therapies for
the treatment of alcohol and substance addiction, smoking addiction, eating disorders, and pathological gambling have been reported (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). Also,
cognitive-behavioral therapy and treatments based on motivational interviewing were found to be benecial in the treatment of
IA (vanRooij, Zinn, Schoenmakers, & van de Mheen, 2012). It was
concluded that CBT is effective in the treatment of IA and that time
management skills are improved, and emotional, cognitive and

536

I. Taymur et al. / Computers in Human Behavior 61 (2016) 532e536

behavioral symptoms are affected positively by CBT (Hall &


Parsons, 2011; Young, 2007). Identifying dysfunctional attitudes
of PA and NA, which increase with the severity of IA in the process
of therapy, and screening for these dysfunctional attitudes in the
process of treatment may increase the effectiveness of cognitive
and behavioral therapy.
Consequentially, many psychopathological symptoms, particularly depression and anxiety, increase with the severity of Internet
addiction (IA). On the other hand, the severity of IA also increases
dysfunctional attitudes (PA and NA). It has been shown that general
psychopathologic features are active factors in explaining IA. In
addition to this, we can say that besides the psychopathologic
features, dysfunctional attitudes also have a partial effect in
dening IA. However, we must say that although this effect is statistically signicant, it is not strong (Table 3).
As a consequence of developing Internet technologies, the
relationship and interaction between psychopathological characteristics and IA may increase in the coming years. In the diagnosis
and treatment of IA, evaluating dysfunctional attitudes, as well as
general psychopathological symptoms, may be benecial. It can be
useful to focus on PA and NA during cognitive behavioral therapies
applied for IA.
The limitations of this study include the fact that the results can
be generalized only to university students and that the number of
subjects was limited.
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