CBT-Based Prevention More Effective for High-Risk Adolescent Gaming Disorder: Study

To thoroughly assess the comparative effectiveness of cognitive behavioral therapy and media literacy programs within universal and indicated prevention models, a randomized controlled trial PROTECTconfirm was carried out between July 1, 2020, and August 31, 2024. The study involved 44 schools in the Baden-Württemberg district, Germany, including 1,793 students in 90 classrooms observed at 1, 4, and 12-month follow-up intervals. Individual randomization was done within classrooms for participants to receive either PROTECTtraining, a CBT-based program targeting cognitions restructuring and improving coping skills, or PROTECTinfo, an equivalent control intervention based on the media literacy program that provided general information about potential hazards of media use.

Both interventions were delivered in the form of four 90-minutes-long weekly sessions performed by local prevention professionals during school time with live supervision. The primary outcomes assessed the severity of symptoms of gaming disorder and internet use disorder at 12-months interval using the modified version of the Video Game Dependency Scale.

Key findings:

• A total of 1,793 students participated, with 896 randomized to PROTECTtraining (mean [SD] age, 13.1 [1.5] years; 498 male [56.1%]) and 897 randomized to PROTECTinfo (mean [SD] age, 13.1 [1.5] years; 484 male [54.8%]).
• Among the 205 high-risk adolescents, PROTECTtraining achieved significantly lower 12-month symptom severity compared to PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]).
• Within-group symptom reductions were larger for CBT (Cohen d = −0.91; 95% CI, −1.10 to −0.72) than for media literacy (Cohen d = −0.61; 95% CI, −0.80 to −0.42), yielding a statistically significant between-group effect favoring CBT (between-group Cohen d = −0.30; 95% CI, −0.55 to −0.05).
• In the total sample of 1,793 students, 12-month symptom scores did not differ significantly between groups (mean [SD] score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; between-group Cohen d = −0.07; 95% CI, −0.16 to 0.01).
• The secondary measures for internalizing, externalizing, and transdiagnostic psychological problems were not significantly different between groups at the 12-month mark.

In summary, the results of the PROTECTconfirm study have shown that a CBT-based intervention program is considerably more successful in lowering the symptoms of gaming disorder and internet use disorder than media literacy programs in adolescents at risk. The results of the study reveal that specific CBT programs are very clinically useful if used as indicated prevention and not as universal school interventions for all children. These findings prompt the healthcare and educational systems to develop screening and referral procedures to deliver specific behavioral treatments to those adolescents who need them the most.

Reference:

Lindenberg K, Kewitz S, Neumann I, et al. Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder: A Randomized Clinical Trial. JAMA Netw Open. 2026;9(9):e2631942. doi:10.1001/jamanetworkopen.2026.31942