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

September 1, 2026 updated by: Suraj Shakya, Tribhuvan University, Nepal

Effectiveness of a Group Cognitive-Behavioral Intervention for Problematic Internet Use Among Undergraduate Students in Nepal: A Quasi-Experimental Trial

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 Overview

Status

Completed

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

59

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Nepal
    • Kathmandu
      • Kathmandu, Kathmandu, Nepal, 44600
        • Central Department of Psychology, Tribhuvan University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

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

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Non-Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Experimental
Participants received the six-session group cognitive-behavioral intervention for problematic internet use, delivered weekly in 90-minute group sessions. Delivered across three cohorts: Cohort 1 (single college: n = 8), Cohort 2 (single college: n = 12), and Cohort 3 (mixed colleges: n = 10). Assessed at baseline, immediately post-intervention, 2 weeks, 1 month, and 3 months.
Behavioral: Group Cognitive-Behavioral Intervention for Problematic Internet Use
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.
No Intervention: Control
Participants received no intervention during the trial period. Assessed on the same schedule as the experimental group: baseline, immediately post-intervention, 2 weeks, 1 month, and 3 months. Delivered across the same three cohorts (Cohort 1: n = 8; Cohort 2: n = 11; Cohort 3: n = 10).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Internet Addiction Test Score
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)
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.
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 Outcome Measures

Outcome Measure
Measure Description
Time Frame
General Self-Efficacy Scale Score
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)
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.
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)

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Satisfaction with Therapy and Therapist Scale-Revised Score
Time Frame: Weeks 1, 2, 3, 4, 5, and 6 (Immediately after each intervention session)
13-item STTS-R (Oei & Green, 2008), administered online to the experimental group after each session with anonymity maintained from facilitators; higher scores indicate greater satisfaction with the therapy and the therapist. Analyzed using the Percentage of Maximum Possible method.
Weeks 1, 2, 3, 4, 5, and 6 (Immediately after each intervention session)
Session Attendance
Time Frame: Week 6, based on attendance during Weeks 1-6 (experimental arm only)
Number of the six sessions attended, used as an indicator of participant adherence
Week 6, based on attendance during Weeks 1-6 (experimental arm only)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Tribhuvan University, Nepal

Investigators

  • Study Director: Suraj Shakya, PhD, Tribhuvan University, Nepal

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 3, 2024

Primary Completion (Actual)

August 5, 2025

Study Completion (Actual)

August 5, 2025

Study Registration Dates

First Submitted

August 27, 2026

First Submitted That Met QC Criteria

September 1, 2026

First Posted (Actual)

September 8, 2026

Study Record Updates

Last Update Posted (Actual)

September 8, 2026

Last Update Submitted That Met QC Criteria

September 1, 2026

Last Verified

September 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TribhuvanU
  • TU-NPAR-079/80 EFRG-11 (Other Grant/Funding Number: Tribhuvan University)
  • ERBTU-081-001 (Other Identifier: Tribhuvan University Ethical Review Board)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

De-identified individual participant data and the study protocol will be shared upon reasonable request to the corresponding author, subject to approval by the Ethical Review Board of Tribhuvan University.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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