This paper must be 4 pages and have only 7 references and one of them has to be a book reference on the reference list. Ignore the page that says Prospectus Initial Guide Expectations and Rubric pleas

They also feel unsafe, helpless and excluded. Results also show that 18% of those who were cyberbullied resorted to self - harm while 30% experienced suicidal ideation. C O N C L U S I O N Cyberbul lying needs to be given more importance in the training of health professionals since it has a negative effect on wellbeing and mental health. Faye Grech * B. Psy(Melit .),M.P sy.(Melit.) Practicing Psychologist [email protected] Mary Anne Lauri B.A. (Hons)(Melit.), M.Sc.(Lond.),Ph.D.(Lond.),C.Psychol. Department of Psychology University of Malta Msida, Malta *Corresponding authorMMJ Malta Medical Journal Volume 34 Issue 2 2022 19 I N T R O D U C T I O N Technological advances have made informational access and exchange easier and more rapid. 1 Digital Media have changed the way we live and the way we communicate. A s with most things, there is the negative side of using technology . Using social media to harass others can cause physical and psychologica l distress and affects wellbeing of cybervictims. Cyberbullying, cyber harassment, electronic bullying and cyberaggression all refer to a phenomenon which has been receiving increasing attention in the press, in academia and in schools . 2 The emotional and psychological harm that can culminate from cyberbullying is significant, leaving adolescents scared and distressed . 3 - 4 Cyberbullies and cyber victims often experience negative outcomes such as school avoidance and failure, depression, an d low self - esteem. 4 - 5 Research on the topic shows that even cyberstanders are negatively impacted. 6 O nline risks for adolescents can take the form of content risks ( adolescent as recipient), contact risk ( adolescent as participant) or conduct risk ( adolesc ent as actor) . 7 - 8 This study focuses on conduct risk, particularly the risk of initiating the cyberbullying and contact risks particularly the risk of being cyberbullied . A D O L E S C E N T A S A C T O R O R C Y B E R B U LLY Cyberbullying is defined as an intentional and rep eated aggressive act in an electronic context (e.g., email, blogs, chatrooms, social media, text messages, instant messages, online games, or websites) against a person who cannot easily defend oneself. 4 - 5,9 It is deliberate and repeated. 9 C yberbullying a cts are done purposefully to hurt, in contrast to accidents or harmless teasing . 10 It can take the form of sending offending text or images, mocking, spreading false rumours and being excluded from a chat group. In the online context, bullying messages tra vel faster, and the audience is much larger . 11 - 12 M otivations for electronic aggression include revenge, jealousy, fun or entertainment . 13 Low self - control or impulsivity is found to be a characteristic of cyberaggressors. 14 - 15 A high score on impulsivity, or a low score on self - control, is associated with bullying others. 16 - 17 The cyberbully’s anonymity gives the bully a sense of power and control. 3 Different to face - to - face bullying, the cyberbully does not have to witness th e effects of the bullying on the victim, thus blurring the empathic interchange. 11 The online disinhibition effect makes bullies do and say hurtful things more than they would face - to - face. 18 There is a link between being a cyberbully and a being a cyberv ictim. Some c yberbullies admit that they themselves were bullied at a particular time . 14 C Y B E R V I C T I M S T argets of cyberbullying have several characteristics in common. They are more likely to be seeking acceptance and to be noticed online, they are often n ot savvy users and may not have been made aware of internet safety . Often, they did not get opportunities to develop resilience when dealing with adverse situations and have less access to caregiver support. Lastly they are less likely to report an unsafe cyber situation to an adult . 19 S tudies report that approximately half of adolescents experience cyberbullying while more than half report witnessing frequent online bullying with most students f a iling to report it . 20 L ong - term consequences of cyberbullyin g include hyperactivity, conduct issues, low pro - social behaviours, smoking, intoxication, and psychosomatic symptoms such as headaches . 21 Malta Medical Journal Volume 34 Issue 2 2022 20 Lodge, found that those who have experienced consistent cyberbullying are more likely to engage in criminal behaviour later on in life. 22 A dolescents who are cyber victims are more likely to have suicidal thoughts . 23 - 26 W H A T C A N V I C T I M S D O ? Cybervictims and cyberstanders can take action against cyberbullying, including printing complete emails, taking screenshots and making a report. The National Association of School Psychologists (NASP) 27 suggests eight steps to be taken by victims and their parents. First, the cyberbully should be asked to stop the harassment and delete any belligerent messages. This step shoul d be done carefuly but firmly to ensure that it does not transpire into retaliation . This is a crucial step since it defuses the cycle of attack and retaliation. Following this the vitim should be asked to ignore or block any communications, to ensure that the bullying is not continued or perpetrated. The third step should be of making a hard copy of the abusive material and showing it to the cyberbully’s caregivers to gain their support in halting this behaviour. In this way, parents can become collaborato rs who work together to help adolescents to deal with this negative situation. Adolescents should then clean up contact lists and reduce other’s access to the victim’s accounts. Should the situation persist or escalate , the issue should be reported to the website, internet service provider or company. Parents and adolescents should also ask for support from the school psychologist, counsellor or administrative staff. Finally, if less radical steps are unsuccessful, one should report to the Cyber Crime Unit . Programs such as Brave and BeSmartOnline! give children and adolescents information on how to deal with the cyberbullying . In Malta this programme includes talks delivered to educators and students in schools. BeSmartOnline! is working to raise awareness, educate and empower students, parent s , and educators on how to use the internet safely. They also strive to promote the website www.childwebalert.gov.mt , which pr ovides a site for reporting illegal and abusive online content . T H E M A L T E S E C O N T E X T Cyberbullying is reported to be one of the most common issues faced by students who seek support from a Maltese online support service. The reports received by BeSmartOnline! Hotline and Helpline are on the increase as shown in Figure 1 . In 2017, the natio nal support line 179 operated by FSWS - Aġenzija Appoġġ received a total of 104 reports related to cyberbullying . 28 According to a Maltese study by the Lauri and Farrugia, among participants aged between 9 and 16 years, 36.6% of students have been bothered online and 12.7% have seen hateful messages being directed at others. One fourth of the participants in this study preferred not talk to anyone about it . 29 From those students who sought help about this problem, many (42%) refer to a parent for help . Talk ing to peer s (39%) is the second most common way of seeking help. Only a few (9%) talk to a teacher or educator about it. Statistics gathered by the Cyber Crime Unit, a specialized section within the Malta Police Force, indicate d a general increase in case s involving the Unit . Figure 1 shows the increase in the reports received by the cybercrime unit between 2012 and 2016. According to the Cyber Crime unit consequences of cyberbullying primarily include fear, which stems from ( i ) the fact that the audience is unknown, and ( ii ) the internet’s digital permanence which makes it possible for the victim to read and reread the content. The Cyber C rime Unit expressed the need Malta Medical Journal Volume 34 Issue 2 2022 21 for more community outreach and a wareness about cybercrime and especially cyberbullying. Many children and parents refer to schools for information about i nternet - related safety . 29 When bullying is affecting a young person’s mental health especially when the person suffers from additional health problems, doctors can work with school psycholog ists and educators to provide the necessary support. Figure 1: Graph representing the number of reports received by BeSmartOnline Hotline and Helpline between 2012 - 2016 M A T E R I A L S A N D M E T H O D S The aim of this study was to find out the incidence of cyberbullying as well as its effects. Based on the literature the following the research questions were formulated: • What is the incidence of cyberbullying amongst Maltese adolescents aged between 13 a nd 16 who took part in this study? • What possible effects does cyberbullying have on the victims? P A R T I C I P A N T S For this study, classes of students aged between 13 and 16 from five schools were recruited. These were two State schools, two Church schools a nd one was an Independent school. Table 1 gives the population of students in State, Church and Independent schools and the corresponding sample numbers. Although the schools were not randomly chosen, they were selected to reflect different types of school s. Approval was obtained from the Faculty Research Ethics Committee. School administrators acted as gatekeepers and made initial contacts. They were responsible for the management of parental consent forms to maintain anonymity. Malta Medical Journal Volume 34 Issue 2 2022 22 Table 1 Student Population and student samples - state, church and independent schools Q U E S T I O N N A I R E The questionnaire used was based on a section of the EUKids Online questionnaire which was used in 27 countries in Europe in 2018. It was administered to a sample of 367 adolescents, during a Persona l Social and Career Development lesson. The data collected was analysed quantitatively using Statistical Package for the Social Sciences (SPSS). R E S U L T S Out of the 367 participating students, 80% ( n = 293 ) of the participants identified as Maltese and 20% id entified as ‘other’. With regards to gender, 52% were female, 46% were male, and 2% indicated ‘other’ or did not answer. One in four participating, 24.5% ( n =90) reported having experienced cyberbullying . In this study, of the 90 participants who experienced cyberbullying, 67, that is 74.4% also experienced face - to - face bullying . The relationship between those experiencing cyberbullying and being hurt also face - to - face was significant (χ2=3.869, df=1, p <0.05). Table 2 gives the forms of cyberb ullying, the percentages of participants who were victims of cyberbullying and the percentages who carried out bullying online. R espondents described how they felt when they experienced cyberbullying. Figure 2 shows that anger was the most common feeling . Anger may cloud one’s vision and impulsive responses may ensue leading to retaliation . Retaliation would mean that the victim becomes the bully . The adolescents may experience sadness and humiliation. They also feel humiliated because the bullying is bein g viewed by many other people especially when screenshots of chats are taken and forwarded to others. Victims also reported being afraid. Feeling unsafe has effects on wellbeing. The results show a significant difference in the mean life satisfaction score between those who were bullied and those who were not (t= - 2.366, df=353, p <0.02), with those who experienced cyberbullying indicating a lower score for life satisfaction and wellbeing. Other studies also report this finding . 30 - 31 Student Population between 14 - 16 (ISCED 3 Level) Sample State Schools 4,414 153 Church Schools 2,940 137 Independent schools 875 77 Total 8,229 367 Malta Medical Journal Volume 34 Issue 2 2022 23 Table 2 Experiences of cyberbullying and cybervictimization Experience Valid percentage of participants who selected: I did it Done to me Seen it happening Never Sending nasty/hurtful messages 23.2 28.3 40.3 27.7 Passing around/posting nasty/hurtful messages where everyone could see 7 10.9 37.4 49.2 Leaving out/excluding someone from a group/activity online 24.9 26.6 31.6 29.1 Rumouring online 9.8 11.2 42.6 37.8 Using nicknames on the internet in a disturbing way 14.9 10.1 35.5 46.5 Using offensive symbols online 24.1 10.2 39.7 36.5 Mocking on the internet 18.8 12.8 38.2 40.2 Making fun of shared information on the internet 28.5 8.2 37.9 32.8 Writing offensive comments on websites 8.1 3.7 34.8 54.5 Using humiliating expressions on the internet 10.2 6.8 32.7 52.8 Using someone’s identity without their permission online 6.8 6.5 26.5 61.1 Hiding identity on the internet 19.5 4.2 22.9 56.7 Entering someone’s private page without permission 9.8 7.0 18.2 67.5 Hacking someone's private page without permission 2.5 4.7 15.9 74.6 Sharing/threatening to share videos online without permission 5.9 7.3 29.9 58.0 Sharing photos online without permission 15.9 14.2 29.9 47.5 Using personal information in a way which the person does not like 7.1 11.3 30.0 54.4 Editing photos in an offensive manner on the internet 10.4 8.1 34.2 47.6 Using abusive/insulting language in e - mails 2.8 4.5 18.4 73.1 Using the internet as a slandering tool (making false and damaging statements) 1.7 6.5 28.1 62.2 Using passwords to access someone’s information or pretend to be someone 7.6 5.9 22.4 63.6 Finding out where someone is by tracking their phone/device 13.4 3.7 16.0 66.9 Malta Medical Journal Volume 34 Issue 2 2022 24 Figure 2 Cybervictims' feelings in relation to cyberbullying experiences by frequency E F F E C T S O F C Y B E R B U L L Y I N G V ictims of cyberbullying reported feeling distressed, experienced suicidal thoughts, self harmed, and some said that they did not want to go to school (see F igures 3a - e). Some students reported that their academic performance suffered. These results are in line with other stud ies. 32 Approximately 1 in 3 participants ( n = 131 ) admitted to hav ing instigated cyberbullying . Often, belligerent messages were sent via messaging, through for example, Facebook , Whatsapp and other social networking sites. Cyberbullies reported that the m otivations for bullying include retaliation or revenge, jealousy and sometimes teasing. Figure 4 shows the motivations behind cyberbullying as described by the participants of this study. In line with cyberbullying research with adolescents 13 results of this study suggest a high correlation between victimization and per petration. Those who instigated cyberbullying are more likely to have been victims (59% cyberbully - victims, 41% cyberbully only) (χ2=4.350, df=1, p <0.05). The fast - paced online world blurs the line between bully and victim in that it does not allow time fo r the victim to consider their response. Often t he exchange of bully and victim roles occurs frequently and spontaneously. Figure 5 describes the dynamics between the instigator, the victim and the bystander. There are instances when the cyberbully and the cybervictim change roles rapidly. The cyberworld is carried in our pockets, with immediate and quick access, and posting without much consideration is an e asy feat. I nstigation and retaliation are easy behaviours in the online world. Malta Medical Journal Volume 34 Issue 2 2022 25 Figure 3 Effects of cyberbullying Figure 4 Motivations for cyberbullying Malta Medical Journal Volume 34 Issue 2 2022 26 Figure 5 Dynamics between instigator, victim and cyber stander D I S C U S S I O N Not all young people react the same when they receive hurtful messages. Some participants suffer in silence, others take it in their stride to do something about it while others still perceive it to be acceptable to retaliate . I n this scenario the victim may become the bully and the bully becomes victim as explained in Figure 6. In the context of the fast - paced, rapid and ever - changing electronic envionment, this change of roles occurs all too quickly . I mpulsivity and lack of self - cont rol are the cogwheels which power the cycle. In light of the results in this study as well as others carried out on a larger sample, 29 Maltese adolescents are experiencing , perpetrating or witnessing cyberbullying regularly. This is a significant problem which needs a holistic approach in order to be addressed adequately . A national policy targeting cyberbullying is needed since addressing traditional bullying differs from that of c yberbullying . This phenomenon needs to be given more importance through a transdisciplinary approach. Research support s the ‘Stop, Block and Tell’ strategy, where children are urged to take four steps for managing the situation: (1) stop and calm down to avoid adverse reactions, (2) block the cyberbully, (3) limit communication to a friend list and (4) report to a trusted adult . 33 Malta Medical Journal Volume 34 Issue 2 2022 27 Figure 6 Cycle of cyberbullying: attack and retaliation C O N C L U S I O N For professionals in training work ing with children and young peop le , awareness of incidences of cyberbullying and its consequences are important. E ducation about the cycle of attack and retaliation is essential to understand conflict as a maintaining factor of online cycles of cyberbullying. The feeling of disinhibition and invisibility in the online context should be targeted through teaching ‘cyberethics’, ‘cybercitizenship’ and ‘netiquette’ . The ‘steeling effect’ suggested by Rutter is a result of t eaching self - control, reflection, and self - regulation to overcome the effect of impulsivity on the continuation of the cycle. It is possible that a dverse and challenging experiences are transform ed into opportunities of learning and growth preparing them to become healthy and productive members of society . 34 S U M M A R Y B OX Cyberbullying gives rise to symptoms such as hyperactivity, conduct issues, anger, sadness, fear and shame. European data shows that cyberbullying is on the increase. * Maltese data shows that 1 in 4 of adolescents who are experiencing cyberbullying may se lf - harm and 1 in 3 may have suicidal ideation. A C K N O W L E D G E M E N T S The authors would like to thank Ms Michela Pulis for her support in publishing this paper. Malta Medical Journal Volume 34 Issue 2 2022 28 R E F E R E N C E S 1. Tara fdar M, Gupta A, Turel O. The dark side of information technology use. Info Systems J. 2013 May;23(3):269 – 275. 2. Kowalski RM, Limber SP, Agatston PW. Cyberbullying:

bullying in the digital age. Oxford: Wiley - Blackwell. 2012; 3. Cannard L. Cyberbullying: A TAF E Perspective. Youth Studies Australia. 2009 Jun;28(2):41 – 49. 4. Feinberg T, Robey N. Cyberbullying: Intervention and prevention strategies. National Association of School ….

2009; 5. Moreno MA. Cyberbullying. JAMA Pediatr. 2014 May;168(5):500. 6. Bastiaensens S , Vandebosch H, Poels K, Van Cleemput K, DeSmet A, De Bourdeaudhuij I. Cyberbullying on social network sites. An experimental study into bystanders’ behavioural intentions to help the victim or reinforce the bully. Comput Human Behav. 2014 Feb;31(31):259 – 2 71. 7. Livingstone S, Mascheroni G, Ólafsson K, Haddon L. ) Children’sonline risks and opportunities: comparative findings from EU Kids Online andNet Children Go Mobile. London: London School of Economics and Polical Science.

2014; 8. Hasebrink U, Livingstone S, Haddon L, Ólafsson K.

Comparing children’s online opportunities and risks across Europe: cross - national comparisons for EU Kids Online [Internet]. 2009 [cited 2020 Dec 27]. Available from: http://eprints.lse.ac.uk/21656/ 9. Lee EB. Cyberbullying. J Black Stud. 2017 Jan;48(1):57 – 73. 10. Slee P. School Bullying: Teachers helping students cope.

New York: Routledge, 2017.: Routledge; 2016. 11. Bauman S. Cyberbullying: a virtual menace. National Coalition against Bullying National …. 2007; 12. Campbell MA. Cyber bullying: an old problem in a new guise?. Aust j guid couns. 2005 Jul;15(01):68 – 76. 13. Kellerman I, Margolin G, Borofsky LA, Baucom BR, Iturralde E. Electronic aggression among emerging adults.

Emerging Adulthood. 2013 Dec;1(4):293 – 304. 14. B ayraktar F, Machackova H, Dedkova L, Cerna A, Ševčíková A. Cyberbullying: The Discriminant Factors Among Cyberbullies, Cybervictims, and Cyberbully - Victims in a Czech Adolescent Sample. J Interpers Violence. 2015 Nov;30(18):3192 – 3216. 15. Erreygers S, Pabian S, Vandebosch H, Baillien E. Helping behavior among adolescent bystanders of cyberbullying:

The role of impulsivity. Learn Individ Differ. 2016 May;48:61 – 67. 16. Pabian S, Vandebosch H. (Cyber)bullying perpetration as an impulsive, angry reaction following (c yber)bullying victimization? 2016; 17. Jenkins LN, Demaray MK, Fredrick SS, Summers KH.

Associations Among Middle School Students’ Bullying Roles and Social Skills. J Sch Violence. 2016 Jul 2;15(3):259 – 78. 18. Joinson AN. Disinhibition and the Internet. In J.

Ga ckenbach(Ed.), Psychology and the Internet:

Intrapersonal, interpersonal, and transpersonalimplications. 2nd ed. 2007. 19. Willard NE. Cyberbullying and cyberthreats: Responding to the challenge of online social aggression, threats, and distress. Research Pre ss.; 2007. 20. Smahel D, Machackova H, Mascheroni G, Dedkova L, Hasebrink U. EU Kids Online 2020: Survey results from 19 countries. 2020 Feb 11; 21. Sourander A, Brunstein Klomek A, Ikonen M, Lindroos J, Luntamo T, Koskelainen M, et al. Psychosocial risk factors associated with cyberbullying among adolescents: a population - based study. Arch Gen Psychiatry. 2010 Jul;67(7):720 – 728. 22. Lodge J. The bully/victim continuum: Stability of peer victimisation in schooland patterns of Internalising and externalising problems in early adulthood. . Eleventh Australian Institute of Family Studies Conference, Melbourne. 2010; 23. Chadwick S. Impacts of cyberbullying, building social and emotional resilience in schools. Cham: Springer International Publishing; 2014. Malta Medical Journal Volume 34 Issue 2 2022 29 24. Smith PK, Mahdav i J, Carvalho M, Fisher S, Russell S, Tippett N. Cyberbullying: its nature and impact in secondary school pupils. J Child Psychol Psychiatry. 2008 Apr;49(4):376 – 385. 25. Hinduja S, Patchin JW. Cyberbullying: An Exploratory Analysis of Factors Related to Offen ding and Victimization. Deviant Behav. 2008 Jan 22;29(2):129 – 156. 26. Cross D, Shaw T, Hearn L, Monks H, Epstein M. Australian Covert Bullying Prevalence' ' Study. Edith Cowan University Publications. 2009; 27. Feinberg T. Cyberbullying: Intervention and Prevent ion Strategies. , National Association of School Psychologists.

2009 Dec; 28. Lauri MA, Farrugia L, . Internet Safety, Safer Internet for Children, Online safety. Malta Communications Authority; 2015. 29. Lauri MA. Children’s =nternet Use and Parents' Perception s of their Childre's Online Experiences. Malta Communications Authority. 2015; 30. Bilić V, Buljan Flander G, Rafajac B. Life Satisfaction and School Performance of Children Exposed to Classic and Cyber Peer Bullying. Collegium antropologicum. 2014 Mar 31; 31. I nzunza JA. Guzmán, J., Alfaro, J., & Varela, J. (2018) Sense of Community and Life Satisfaction in Chilean Adolescents. Applied Research in Quality of Life, 1 - 13. 32. Dittrick CJ. Psychological Impact of Cyber - Bullying:

Implications for School Counsellors. Ca nadian Journal of Counselling and Psychotherapy. 2013;47(3):383 – 402. 33. Diamanduros T, Downs E, Jenkins SJ. The role of school psychologists in the assessment, prevention, and intervention of cyberbullying. Psychol Sch. 2008 Sep;45(8):693 – 704. 34. Ungar M. The Social Ecology of Resilience A Handbook of Theory and Practice. 2012. Malta Medical Journal Volume 34 Issue 2 2022 30 Copyright ofMalta Medical Journalisthe property ofUniversity ofMalta, Faculty of Medicine &Surgery anditscontent maynotbecopied oremailed tomultiple sitesorposted to alistserv without thecopyright holder'sexpresswrittenpermission. However,usersmay print, download, oremail articles forindividual use.