Are You Screening for Cyberbullying and Bullying in Your Intake Interventions for Healthcare

Why Screening for Cyberbullying Is Essential at Intake


July 6, 2023 | Reading Time: 10 Minutes

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Armed with increasingly sophisticated tools, bullies are almost every therapist’s problem. The results of digital harassment and cyberbullying can be a cornerstone of child abuse, sexual abuse, sibling abuse, elder abuse, or homicide threats. Most cyberbullying and incivility occur with children, a growing body of literature points to cyberbullying in almost every threatened group served by psychotherapists and healthcare providers. Although offering services without asking about a client’s or patient’s experience with bullying or cyberbullying may need to be reconsidered.

Definitions of Cyberbullying

Researchers in the field agree that cyberbullying is a form of digital harassment intended to intimidate, humiliate or threaten the victim and includes the following:

  • Bullies can harass their victims in their own homes at all hours of the day. 
  • They can spread vicious rumors instantly. 
  • Pictures and photoshopped images can humiliate and shame the victim. 
  • Direct links to cybersecurity and social engineering, where evil-doers intentionally harm others, particularly in older populations.

In a widely cited, foundational article published by the Journal of Clinical Practice and Epidemiology (2015), lead author Elisa Cantone and colleagues conducted a systematic search and reported on 17 studies evaluating randomized-controlled trials (RTCs) to assess the effectiveness of school interventions on bullying and cyberbullying. The researchers provide vivid examples of cyberbullying in their definition:

Cyberbullying is characterized by the use of electronic forms of contact (e.g., phone calls, text messages, picture/video clips, e-mails, chat rooms, instant messaging, websites), that allow the perpetrator to remain anonymous and intensify feelings of discomfort in the victim. Cyberbullying can take on the following forms: flaming (online fights using electronic messages with angry and vulgar language); harassment (repeatedly sending mean, insulting messages); cyberstalking (repeated, intense harassment and denigration that includes threats or creates significant fear); denigration (spreading rumors online; sending or posting gossip about a person to damage his/her reputation or friendships); impersonation (pretending to be someone else and sending or posting material to get that person in trouble or danger, or damage that person’s reputation or friendships); outing (sharing someone’s secrets or embarrassing information or images online); trickery (tricking someone into revealing secrets or embarrassing information, then sharing it online); and exclusion (intentionally and cruelly excluding someone from an online group).

Repercussions of Cyberbullying

Despite the almost 30 years since a foundational Smith and Sharp publication (1994), cyberbullying persists and can profoundly affect individuals’ personal lives, professional productivity, and academic lives. Current research has further revealed the extreme potential outcomes of these negative effects, including suicidal ideations (Hinduja & Patchin, 2019; Mitchell et al. (2018). A separate study by Kwan et al. (2020) established a strong link between cyberbullying and numerous psychological difficulties, such as depression, anxiety, suicidal tendencies, aggression, substance abuse, self-harm, ADHD, and impulsivity. The effects of cyberbullying can also manifest as psychological stress, digital-induced tension, and heightened burnout, collectively diminishing overall well-being (Oksanen, Oksa, Savela, Kaakinen, & Ellonen, 2020).

Cyberbullying is also understood to correlate with adverse social behaviors, encompassing low self-esteem, issues with peers, delinquent behavior, and increased stress levels. Moreover, individuals subjected to cyberbullying are more likely to suffer from sleep disturbances and physical discomfort, including headaches and stomach pain, than those not victimized (Li, Sidibe, Shen, & Hesketh, 2019). This wealth of evidence underscores the critical need to prevent, identify and combat cyberbullying.

Cyberbullying Theory

The Cantone research team mentioned earlier and subsequent researchers have built on the work of Smith and Sharp (1994), who identified three main roles within the bullying cycle: 

  • the bully
  • the victim
  • and the bystanders. 

Editors-in-Chief of the International Journal of Bullying Prevention, James O’Higgins & Sameer Hinduja (2019), further explain that “bullying, face-to-face or online, always involves aggression, repetition, intentionality, and a power imbalance.”


When serving in her role prior to being the Vice President of the United States, Kamila Harris authored a 2011 article posted on the California Attorney General’s website, wherein she explained that a staggering 56 percent of teenagers disclose that they have experienced cyberbullying, with specific groups, such as lesbian, gay, bisexual, and transgender teens, facing more attacks than others. Adolescents subjected to cyberbullying are more prone to suffer from depression and drug misuse. Additionally, they carry a higher risk in the offline world of becoming targets of sexual harassment and physical abuse.


In a landmark prevalence study published in the Journal of Adolescent Health, Selkie and colleagues reported a systematic review and quality assessment of prevalence rates in middle and high-school-aged adolescents. Of 1,447 journal articles, they selected 58 studies that met their inclusion criteria. Their conclusions state the following:

The news media is rife with stories of cyberbullying, and extreme cases linked to suicides by the victim have been reported. While these cases have received much attention, the range of cyberbullying prevalence found in this review suggests that cyberbullying may be a common occurrence among today’s youth and could lead to other negative consequences outside of the most severe cases. Educators, providers and researchers can play a role in prevention and intervention regarding cyberbullying. 

  • Some of those news media reports include the following:
  • ABC News reported that Phoebe Prince, a 15-year-old from Massachusetts, tragically ended her own life following relentless cyberstalking and bullying by her peers on social media platforms.
  • On the other side of the country, in California, Olivia Gardner, a sixth-grade student from Novato, was subject to severe online bullying. As reported by the SFGATE, her cyberbullies pursued her across three different schools via an “Olivia Haters” webpage on a well-known social networking site.
  • On April 25, 2022, CBS News reported that a 15-year-old boy named Nate Bronstein took his life after relentless cyberbullying by his classmates. He was enrolled at one of the most prestigious private schools in Chicago. The parents are filing a lawsuit alleging that the school failed to inform them of the abuse. 

Sibling Cyberbullying

In a recently published longitudinal study of sibling bullying (2022), researchers Ulmar Toseeb and Dieter Wolke concluded that the increase in the frequency of bullying experiences from early to middle adolescence correlates with a heightened severity of mental health issues in later adolescent years. The developmental paths of behavioral issues are affected by bullying experiences during early adolescence. Whether one is the bully or the bullied, sibling bullying is linked with adverse mental health outcomes. 

As can be imagined, when sibling bullying extends into the Internet, repercussions can worsen exponentially. Researchers Slava Dantchev and Martina Zemp reported a study of sibling, peer, and cyberbullying in 329 children and adolescents (2021). They concluded, “A cumulative relationship between bullying victimization across contexts and emotional problems, conduct problems and sleep problems could be identified while bullying perpetration across contexts was only linked to more conduct problems in a cumulative manner.” A key issue here is that many parents do not know the difference between sibling rivalry and sibling bullying. Armed with the power and deliverability of the Internet, techno-savvy cyberbullies can make their target sibling(s) suffer consequences that have no hope of being detected or reported to schools.


The most common site for bullying and cyberbullying for adults is the workplace, particularly when management has failed to establish clear interventions for fair and robust conflict management. 

Social media is another site for frequent cyberbullying in adults. Minorities are particularly vulnerable in the workplace, especially when they lack the information needed to prevent social media exposure by sharing information that finds its way to workplace cyberbullies. 

Older Adults

The website explains that cyberbullying against the elderly, largely through email, can manifest in numerous ways, including:

  • Psychological harm involves expressing anger, issuing threats, making accusations, and delivering demeaning remarks, typically alternating with intervals of silence or disregarding the victim.
  • Financial exploitation focuses on acquiring the victim’s financial details, creating online access to their monetary accounts, and pilfering their funds.

Speaking up about cyberbullying can be an especially challenging task for the elderly, who might not fully grasp its meaning. Like victims across all age groups, older adults can feel helpless and infringed upon, struggle with understanding and acknowledging the situation, suffer from shame and self-condemnation for falling prey, and worry about increased bullying or dismissal if they come forward. Moreover, older adults often face cyberbullying perpetrated by their own family members and veer into elder abuse.

Suggestions for Counselors & Psychotherapists

Despite the daunting research, most clinicians today have had little or no training in how to manage cyberbullying. Given the widespread repercussions of cyberbullying, it behooves all clinicians to become familiar with the issues, especially the interventions and supporting resources to help clients and patients cope with the escalating familiar and societal problem. 

How to Detect Cyberbullying

Clinicians including a simple cyberbullying question on their intake forms can go a long way to detecting and addressing the issues. The question can possibly look like this:

Have you experienced bullying or cyberbullying? If yes, please tell me where, how often, and by whom: ___________________________________________

How to Address Cyberbullying is an official US government website dedicated to Online Safety Education plays a crucial role in empowering individuals, especially those who have been victims of cyberbullying, with the knowledge and tools necessary to safeguard themselves from further incidents. Their educational approach covers various aspects:

  1. Digital Literacy. Begins with building a strong foundation of digital literacy, which includes understanding the nature and characteristics of various online platforms and how to use them appropriately and securely.
  2. Privacy Settings: An integral part of this education involves learning about privacy settings on different platforms. Victims should be taught how to properly set up their profiles to limit their exposure to potential harassers. This includes restricting who can see their posts, personal information, or online presence.
  3. Blocking and Reporting: Individuals should be educated about features that enable them to block or mute other users. Blocking can prevent harassers from making contact, reducing the potential for continued abuse. Furthermore, they need to be knowledgeable about reporting bullying incidents to their respective social media platforms or local law enforcement if the situation calls for it.
  4. Information Sharing: Online safety education should emphasize the importance of being cautious about the information shared online. Cyberbullies can maliciously use personal data, location details, and sensitive photos or comments. Minorities and other marginalized groups can find themselves exposed in the workplace if they are not aware of the public nature of their social media. Therapists can actively take steps to help clients minimize such exposure by more skillfully navigating social media.
  5. Recognizing and Avoiding Scams: As part of this education, individuals can learn to recognize online scams or phishing attempts that could compromise their privacy or security, which could, in turn, lead to an increased risk of cyberbullying.
  6. Secure Communication: Knowledge about secure communication practices, like strong passwords and two-factor authentication, is important information to share with clients. This can help prevent unauthorized access to personal accounts, a tactic often used by cyberbullies.
  7. Educate through a Patient Gateway or Portal. An easy way to offer relevant educational materials is to search YouTube for short security videos assigned in-session or between sessions with follow-up. Organizing and making carefully vetted videos available through a patient gateway or portal is also advisable, particularly for people who need direct suggestions for educating and protecting themselves.
  8. Emotional Support: Online safety education should also underscore the importance of seeking emotional support when dealing with cyberbullying. This could mean contacting a trusted friend, family member, teacher, or mental health professional.
  9. Cyber Laws and Rights: Educating victims about cyber laws and their rights is crucial. Knowledge about what constitutes cyberbullying in the eyes of the law and what legal recourse is available can empower victims to take action.

By imparting these skills and information, online safety education can play a significant role in helping individuals protect themselves from cyberbullying, reducing its potential impact, and fostering a safer online community.

Cyberbullying Resources

A number of groups have dedicated significant resources to the issue, including the following:

  • California Education Code §§ 32261, 32265, 32270, and 48900 define bullying of pupils to include bullying committed by means of an electronic act and authorizes school officials to suspend or recommend for expulsion pupils who engage in bullying.
  • Common Sense Media offers tips on cyberbullying: what it is and why it matters.
  • offers tips to share with your kids on how to prevent and stop cyberbullying.
  • provides information and tools on cyberbullying: what to look for, what to teach your kids, lessons from a mother’s experience, and much more.
  • The National Crime Prevention Council offers advice on how parents can play a central role in preventing cyberbullying and stopping it when it happens.
  • National Suicide Prevention Hotline US 1-800-273-TALK (8255)
  • Springer Health, the scientific journal, made available the International Journal of Bullying Prevention In 2019. The journal holds more than 50 open-source articles that are available online at no cost for consumers as well as professionals.
  • State-by-state cyberbullying laws
  •, mentioned above, is a program of Wired Safety with information on how to recognize and prevent cyberbullying.
  • Substance Abuse and Mental Health Services. SAMHSA offers these resources: These include:
  • National Helpline (1-800-662-HELP): SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.
  • SAMHSA’s Behavioral Health Treatment Services Locator: This is an online resource for locating mental health treatment facilities and programs in the United States.
  • Mental Health Resources: SAMHSA provides an array of publications and online resources on mental health, which can be useful for people dealing with the psychological effects of cyberbullying.
  • Symantec provides information for parents on cyberbullying.
  • US Department of Health & Human Services. The DHHS considers the issue so important that It has developed a website called, The site links many other resources, including a short video for teachers. That video is prominently displayed on the website’s homepage.
  • Videos featuring kids talking about cyberbullying from the Attorney General and Wired Safety.
  • Resources for Families and Caregivers: Resources that can help families and caregivers understand and address mental health issues can indirectly assist with the impact of cyberbullying.
  • Suicide prevention resources include various materials, such as the National Suicide Prevention Lifeline (1-800-273-TALK).

Most of these resources are designed to be used by clinicians, families, school districts, and other parties to help mitigate the potentially devastating effects of cyberbullying.


Thesis, Dissertation, or Practice Development Ideas

Anyone looking for research or practice development ideas may want to review and perhaps add to the list started below. Developing a specialization as a psychotherapist to help individuals deal with cyberbullying involves acquiring specific skills, knowledge, and experience. Here is an outline of the steps you might consider:

  1. Education and Training:
    • Pursue specialized training in cyberpsychology or online behavior. While such programs are still the exception rather than the rule, this emerging field will continue growing. 
  2. Certification:
    • Consider certifications in areas like cyberpsychology or Internet addiction. These are often available through professional organizations or continuing education programs and can help demonstrate your expertise.
  3. Professional Development and Continuing Education:
    • Attend workshops, seminars, or courses on cyberbullying, digital behaviors, or Internet safety to stay up-to-date with the latest research and therapeutic approaches. If you’d like to organize such a program for you or your group, complete this request form.
    • Pursue training in effective therapy approaches for cyberbullying victims, such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), or trauma-focused therapy.
  4. Work Experience and Supervision:
    • Gain experience working with children, adolescents, or adults who have experienced cyberbullying. This could be in a school setting, a community mental health center, or private practice. Reach out to them to start a discussion rather than waiting for one to come to you.
    • Seek supervision or consultation from professionals experienced in this area.
  5. Advocacy, Research & Publication:
    • Advocate for policies or programs that support cyberbullying prevention and intervention.
    • Conduct or contribute to research on cyberbullying and its psychological effects to deepen your understanding and contribute to the field.
    • Submit your papers to the Journal of Technology in Behavioral Science (JTiBS), which I founded to create a scholarly publication that invites such important topics.
  6. Networking and Collaboration:
    • Join professional organizations or groups focused on cyberbullying or related topics to connect with others in the field and share knowledge and resources.
    • Collaborate with schools, parents, and community organizations to provide education and prevention programs.
  7. Self-Care and Digital Literacy:

By following these steps, you can better position yourself as a psychotherapist specializing in helping individuals deal with the effects of cyberbullying. If you have other thoughts about this important topic, please add them below.

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