INTRODUCTION:

While a Smartphone, tablet, or computer can be a hugely productive tool, compulsive use of these devices can interfere with work, school, and relationships. When you spend more time on social media or playing games than you do interacting with real people, or you can’t stop yourself from repeatedly checking texts, emails, or apps—even when it has negative consequences in your life—it may be time to reassess your technology use. Smartphone addiction, sometimes colloquially known as “nomophobia” (fear of being without a mobile phone), is often fuelled by an Internet overuse problem or Internet addiction disorder¹.

The term Nomophobia is constructed on definitions described in the DSM-IV. The various psychological factors are involved when a person overuses the mobile phone, e.g. low self-esteem, extrovert personality. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. The term, “NOMOPHOBIA,” was coined by the United Kingdom (UK) Post Office in 2008 during a study who commissioned YouGov, a UK-based research organization. The study found that nearly 53% British who used mobile phones, pretend to be apprehensive when they “lose their mobile phone, run out of battery or credit, or have no network coverage”. That study also revealed that approximately 58% of male and 47% of female suffered from the mobile phone anxiety, and additionally 9% felt strained when their mobile phones were switched off. 55% of the participants agreed that they are not able to maintain connectivity with their dear and near one, which was the main reason for their phobia. A study was conducted among undergraduate students in Health Services, found that out of 547 males, 23% of the students were labelled as nomophobic, while 64% students were at risk of developing nomophobia. Almost 77% students checked their cell phones more than 35 times per day. Another study revealed that more than 50% nomophobics never switch off their mobile phones.²

Smartphone Addiction Can Encompass A Variety of Impulse-Control Problems, Including:

· Virtual relationships:

Addiction to social networking, dating apps, texting, and messaging can extend to the point where virtual, online friends become more important than real-life relationships. We’ve all seen the couples sitting together in a restaurant ignoring each other and engaging with their Smartphone’s instead. While the Internet can be a great place to meet new people, reconnect with old friends, or even start romantic relationships, online relationships are not a healthy substitute for real-life interactions. Online friendships can be appealing as they tend to exist in a bubble, not subject to the same demands or stresses as messy, real-world relationships. Compulsive use of dating apps can change your focus to short-term hook-ups instead of developing long-term relationships.

· Information overload:

Compulsive web surfing, watching videos, playing games, or checking news feeds can lead to lower productivity at work or school and isolate you for hours at a time. Compulsive use of the Internet and Smartphone apps can cause you to neglect other aspects of your life, from real-world relationships to hobbies and social pursuits.

· Cybersex addiction:

Compulsive use of Internet pornography, sexing, nude-swapping, or adult messaging services can impact negatively on your real-life intimate relationships and overall emotional health. While online pornography and cybersex addictions are types of sexual addiction, the Internet makes it more accessible, relatively anonymous, and very convenient. It’s easy to spend hours engaging in fantasies impossible in real life. Excessive use of dating apps that facilitate casual sex can make it more difficult to develop long-term intimate relationships or damage an existing relationship.

· Online compulsions:

Such as gaming, gambling, stock trading, online shopping, or bidding on auction sites like eBay can often lead to financial and job-related problems. While gambling addiction has been a well-documented problem for years, the availability of Internet gambling has made gambling far more accessible. Compulsive stock trading or online shopping can be just as financially and socially damaging. eBay addicts may wake up at strange hours in order to be online for the last remaining minutes of an auction. You may purchase things you don’t need and can’t afford just to experience the excitement of placing the winning bid.³

Causes and effects of Smartphone:

· While you can experience impulse-control problems with a size and convenience of Smartphone and tablets means that we can take them just about anywhere and gratify our compulsions at any time. In fact, most of us are rarely ever more than five feet from our Smartphone’s. Like the use of drugs and alcohol, they can trigger the release of the brain chemical dopamine and alter your mood. You can also rapidly build up tolerance so that it takes more and more time in front of these screens to derive the same pleasurable reward.

· Heavy Smartphone use can often be symptomatic of other underlying problems, such as stress, anxiety, depression, or loneliness. At the same time, it can also exacerbate these problems. If you use your Smartphone as a “security blanket” to relieve feelings of anxiety, loneliness, or awkwardness in social situations, for example, you’ll succeed only in cutting yourself off further from people around you. Staring at your phone will deny you the face-to-face interactions that can help to meaningfully connect you to others, alleviate anxiety, and boost your mood. In other words, the remedy you’re choosing for your anxiety (engaging with your Smartphone), is actually making your anxiety worse.⁴

Smartphone’s negative impact on one’s life:

· Increasing loneliness and depression. .

· Fuelling anxiety

· Exacerbating attention deficit disorders.

· Diminishing your ability to concentrate and think deeply or creatively. Disturbing your sleep.

· Encouraging self-absorption.

Signs and Symptoms:

The below mentioned signs and symptoms are observed in Nomophobia cases

· Anxiety

· Respiratory alterations

· Trembling

· Perspiration

· Agitation

· Disorientation

· Tachycardia.

· Disorientation

· Depression

· Panic

· Fear

· Dependence

· Rejection

· Low self-esteem

· Loneliness

Warning Signs of Smartphone Overuse:

· Trouble completing tasks at work or home. Do you find laundry piling up and little food in the house for dinner because you’ve been busy chatting online, texting, or playing video games? Perhaps you find yourself working late more often because you can’t complete your work on time.

· Isolation from family and friends. Is your social life suffering because of all the time you spend on your phone or other device? If you’re in a meeting or chatting with friends, do you lose track of what’s being said because you’re checking your phone? Have friends and family expressed concern about the amount of time you spend on your phone? Do you feel like no one in your “real” life—even your spouse—understands you like your online friends?

· Concealing your Smartphone use. Do you sneak off to a quiet place to use your phone? Do you hide your Smartphone use or lie to your boss and family about the amount of time you spend online? Do you get irritated or cranky if your online time is interrupted?

· Having a fear of missing out. Do you hate to feel out of the loop or think you’re missing out on important news or information if you don’t check your phone regularly? Do you need to compulsively check social media because you’re anxious that others are having a better time, or leading a more exciting life than you? Do you get up at night to check your phone?

· Feeling of dread, anxiety, or panic if you leave your Smartphone at home, the battery runs down or the operating system crashes. Or do you feel phantom vibrations—you think your phone has vibrated but when you check, there are no new messages or updates?⁵

Multidisciplinary Approach for Smartphone Addiction:

Self-help tips for Smartphone addiction:

The more you understand your Smartphone use, the easier it will be to curb your habits and regain control of your time.

Recognize the triggers that make you reach for your phone:

Is it when you’re lonely or bored? If you are struggling with depression, stress, or anxiety, for example, your excessive Smartphone use might be a way to self-soothe rocky moods. Instead, find healthier and more effective ways of managing your moods, such as practicing relaxation techniques.

Understand the difference between interacting in-person and online:

Human beings are social creatures. We’re not meant to be isolated or to rely on technology for human interaction. Socially interacting with another person face-to-face—making eye contact, responding to body language—can make you feel calm, safe, and understood, and quickly put the brakes on stress. Interacting through text, email or messaging bypasses these nonverbal cues so won’t have the same effect on your emotional well-being. Besides, online friends can’t hug you when a crisis hits, visit you when you’re sick, or celebrate a happy occasion with you.

Build your coping skills:

Perhaps tweeting, texting or blogging is your way of coping with stress or anger. Or maybe you have trouble relating to others and find it easier to communicate with people online. Building skills in these areas will help you weather the stresses and strains of daily life without relying on your Smartphone.

Recognize any underlying problems that may support your compulsive behavior:

Have you had problems with alcohol or drugs in the past? Does anything about your Smartphone use remind you of how you used to drink or use drugs to numb or distract yourself?

Strengthen your support network:

Set aside dedicated time each week for friends and family. If you are shy, there are ways to overcome social awkwardness and make lasting friends without relying on social media or the Internet. To find people with similar interests, try reaching out to colleagues at work, joining a sports team or book club, enrolling in an education class, or volunteering for a good cause. You’ll be able to interact with others like you, let relationships develop naturally, and form friendships that will enhance your life and strengthen your health.⁶

Modify your Smartphone use, step-by-step:

Your goal should be to cut back to more healthy levels of use.

1. Set goals for when you can use your Smartphone:

For example, you might schedule use for certain times of day, or you could reward yourself with a certain amount of time on your phone once you’ve completed a homework assignment or finished a chore, for instance.

2. Turn off your phone at certain times of the day:

Such as when you’re driving, in a meeting, at the gym, having dinner, or playing with your kids. Don’t take your phone with you to the bathroom.

3. Don’t bring your phone or tablet to bed:

The blue light emitted by the screens can disrupt your sleep if used within two hours of bedtime. Turn devices off and leave them in another room overnight to charge. Instead of reading eBooks on your phone or tablet at night, pick up a book. You’ll not only sleep better but research shows you’ll also remember more of what you’ve read.

4. Replace your Smartphone use with healthier activities:

If you are bored and lonely, resisting the urge to use your Smartphone can be very difficult. Have a plan for other ways to fill the time, such as meditating, reading a book, or chatting with friends in person.

5. Play the “phone stack” game:

Spending time with other Smartphone addicts? Play the “phone stack” game. When you’re having lunch, dinner, or drinks together, have everyone place their Smartphone’s face down on the table. Even as the phones buzz and beep, no one is allowed to grab their device. If someone can’t resist checking their phone, that person has to pick up the check for everyone.

6. Remove social media apps from your phone:

So you can only check Face book, Twitter and the like from your computer. And remember: what you see of others on social media is rarely an accurate reflection of their lives—people exaggerate the positive aspects of their lives, brushing over the doubts and disappointments that we all experience. Spending less time comparing you unfavorably to these stylized representations can help to boost your mood and sense of self-worth.

7. Limit checks:

If you compulsively check your phone every few minutes, wean yourself off by limiting your checks to once every 15 minutes. Then once every 30 minutes, then once an hour. If you need help, there are apps that can automatically limit when you’re able to access your phone.

8. Curb your fear of missing out:

Accept that by limiting your Smartphone use, you’re likely going to miss out on certain invitations, breaking news, or new gossip. There is so much information available on the Internet, it’s almost impossible to stay on top of everything, anyway. Accepting this can be liberating and help break your reliance on technology.⁷

Treatment for Smartphone and Internet addiction:

· Cognitive-behavioral therapy:

Provides step-by-step ways to stop compulsive behaviors and change your perceptions about your Smartphone

· Marriage or couples counselling:

If excessive use of Internet pornography or online affairs is affecting your relationship, counselling can help you work through these challenging issues and reconnect with your partner.

· Group support:

Organizations such as Internet Tech Addiction Anonymous (ITAA) and On-Line Gamers Anonymous offer online support and face-to-face meetings to curb excessive technology use. Of course, you need real-life people to benefit fully from any addiction support group. Sex Addicts Anonymous can be a place to try if you’re having trouble with cybersex addiction.

· Patients were also successfully treated using tranylcypromine combined with clonazepam. However, it is important to note that these medications were designed to treat social anxiety disorder and not nomophobia directly.⁸

Helping a child or teen with Smartphone addiction:

Youngsters lack the maturity to curb their Smartphone use on their own, but simply confiscating the device can often backfire, creating anxiety and withdrawal symptoms in your child. Instead, there are plenty of other ways to help your child find a healthier balance:

· Be a good role model:

Children have a strong impulse to imitate, so it’s important you manage your own Smartphone and Internet use. It’s no good asking your child to unplug at the dinner table while you’re staring at your own phone or tablet. Don’t let your own Smartphone use distract from parent-child interactions.

· Use apps to monitor and limit your child’s Smartphone use:

There are a number of apps available that can limit your child’s data usage or restrict texting and web browsing to certain times of the day. Other apps can eliminate messaging capabilities while in motion, so you can prevent your teen using a Smartphone while driving.

· Create “phone-free” zones:

Restrict the use of Smartphone’s or tablets to a common area of the house where you can keep an eye on your child’s activity and limit time online. Ban phones from the dinner table and bedrooms and insist they’re turned off after a certain time at night.

· Encourage other interests and social activities:

Get your child away from screens by exposing them to other hobbies and activities, such as team sports, Scouts, and after-school clubs. Spend time as a family unplugged.

· Talk to your child about underlying issues:

Compulsive Smartphone use can be the sign of deeper problems. Is your child having problems fitting in? Has there been a recent major change, like a move or divorce, which is causing stress? Is your child suffering with other issues at school or home?

· Get help:

Teenagers often rebel against their parents, but if they hear the same information from a different authority figure, they may be more inclined to listen. Try a sports coach, doctor, or respected family friend. Don’t be afraid to seek professional counseling if you are concerned about your child’s Smartphone use.⁹

CONCLUSION:

Basically, human beings are social creatures. Previously our social bonding was quite strong. We used to do a lot of face to face social interaction. Due to rapid urbanization, migration and increasing numbers of nuclear families, disintegration of social fabric has taken place in our society leading to a vacuum kind of situation. Mobile phones have effectively filled this vacuum, e.g., with the help of social media through which we are connected with others, nearly all the time. Now we have thousands of social media friends (virtual friends), while in reality, may be with very few we really interact. The continuous pressure of remaining on social media, we tend to use our mobile phones continuously and that is creating problem for us, viz., NOMOPHOBIA. Now a day, after college education most children are usually away from their home for education or job purpose. Overuse of mobile phone by parents and their children is a way to obtain a mutual sense of security and social control via mobile phones. Simultaneously, when children use their mobile phones, they are virtually free from parental supervision in spite of the fact that they are sitting in the same room. They can be blissfully 1000 miles away through mobile phones networking/chatting with their peers. Mobile phone gives them a sense of “connection” with people, virtually. The terminology “techno-stress” is frequently used to address a similar condition when people avoid face-to-face social interactions and are restricted within themselves, without concern for others. Eventually they become depressed in later life. As already described, anxiety is induced in nomophobia cases by many factors, such as the loss of a cell phones, loss of signal, and with drained batteries of mobile phones.¹⁰ NOMOPHOBICS show some peculiar characteristics, such as – using mobile phone impulsively, as a protective mechanism to avoid social communication. Sometimes they carry multiple mobile phones along with battery charger to avoid the experience of disconnection from the virtual world. Nomophobics prefer virtual interactions and avoid face to face social interactions. Some of them look at the phone screen frequently to avoid missing any notification, which is termed as “ringxiety”. NOMOPHOBIA can put economic strain in the family due to use of excessive data which is costly also. Overusing a mobile phone apps for purchasing like “Amazon”, “Flipkart” etc., items can cause financial insecurity for the individual. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. The complexity of this condition is very challenging to the patients' family members as well as for the physicians as nomophobia shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion.¹¹

REFERENCES:

1. Charlie D'Agata Nomophobia: Fear of being without your cell phone. CBS News. April 3, 2008.

2. Archana Jayakumar (April 3, 2008). "Break free from Nomophobia, drunkorexia". Mid-day.com. Archived from the original on April 4, 2008. Retrieved 2011-08-10.

3. Aboujaoude, Elias (2018-10-29). "Problematic Internet use two decades later: apps to wean us off apps". CNS spectrums: 1–3. doi:10.1017/S109285291800127X. ISSN 1092-8529. PMID 30507371.

4. Brandless Support (28 June 2012). "Nomophobia: The Fear of Being Without a Gnome...er, Phone". SocialTechPop. Retrieved 15 June 2016.

5. Bragazzi, N. L., & G. D. Puenete (2014). A proposal for including nomophobia in the new DSM-V. Psychology Research and Behavior Management 7. 155-160.

6. Adriana Bianchi and James G. Philips (February 2005). "Psychological Predictors of Problem Mobile Phone Use". CyberPsychology & Behavior. 8 (1): 39–51. CiteSeerX 10.1.1.563.385. doi:10.1089/cpb.2005.8.39. PMID 15738692.

7. King, A. L. S., A. M. Valenca, A. C. O. Silva, T. Baczysnki, M. R. Carvalho & A. E. Nardi (2013). "Nomophobia: Dependency on virtual environments or social phobia?". Computers in Human Behavior. 29: 140–144. doi:10.1016/j.chb.2012.07.025.

8. King, A. L. S., A. M. Valença & A. E. Nardi (2010). "Nomophobia: the mobile phone in panic disorder with agoraphobia: reducing phobias or worsening of dependence?". Cognitive and Behavioral Neurology. 23 (1): 52–54. doi:10.1097/wnn.0b013e3181b7eabc. PMID 20299865.

9. "Nomophobia is the fear of being out of mobile phone contact - and it's the plague of our 24/7 age". Evening Standard. April 1, 2008. Archived from the original on July 6, 2008. Retrieved 2011-08-10.

10. Dixit, Sanjay; Shukla, Harish; Bhagwat, AK; Bindal, Arpita; Goyal, Abhilasha; Zaidi, Aliak; Shrivastava, Akansha (2010). "A Study to Evaluate Mobile Phone Dependence Among Students of a Medical College and Associated Hospital of Central India". Indian Journal of Community Medicine. 35 (2): 339–41. doi:10.4103/0970-0218.66878. PMC 2940198. PMID 20922119.

11. Nomophobia | Revolvy [Internet]. [cited 2019 Jan 25]. Available from: https://www.revolvy.com/page/Nomophobia.

Received on 06.08.2019 Modified on 30.08.2019

Asian J. Nursing Education and Research. 2019; 9(4):583-587.

DOI: 10.5958/2349-2996.2019.00128.9