Behavioral Therapy Beats Media Education in School Programs for Gaming Disorder

A sweeping four-year study conducted across the German state of Baden-Württemberg has delivered one of the clearest answers yet to a question that parents, teachers, and policymakers have been asking for years: can schools actually protect adolescents from gaming disorder and problematic online habits? The answer, according to a research team led by Prof. Dr. Katajun Lindenberg of the Institute of Psychology at Heidelberg University, is a qualified but striking yes — provided the right kind of program is used and, crucially, provided it reaches the students who need it most. The findings, published in the journal JAMA Network Open, emerge from a randomized study involving approximately 1,800 adolescents from 44 secondary schools, making it one of the most comprehensive investigations of school-based digital addiction prevention carried out to date.

The stakes of this research extend well beyond academic curiosity. Gaming disorder, recognized by the World Health Organization in the International Classification of Diseases, and unspecified internet use disorder describe patterns of digital behavior in which gaming or online activity takes on a compulsive quality, crowding out other interests and continuing despite negative consequences. In adolescents, such patterns can lead to reduced mental and physical health as well as serious impairments in important areas of life, including school performance, family relationships, friendships, and leisure time. Excessive use of social media falls into the same problematic category. Against the backdrop of ongoing debates about how to protect the mental health of young people in the digital age, Lindenberg emphasizes that the question of effective interventions is highly relevant.

The policy landscape makes this urgency concrete. Alongside much-discussed regulatory measures such as age restrictions, there are parallel calls for approaches designed to empower young people to use video games and the Internet responsibly. These include prevention programs built on behavioral therapy principles and programs rooted in media education. Until now, however, robust empirical evidence comparing these two approaches head to head in real school settings has been scarce. Our research provides important empirical insights into which programs and content are particularly effective and which target groups benefit the most, Lindenberg notes, underscoring the practical orientation of the study.

To generate that evidence, the Heidelberg team designed a comparison between two interventions developed specifically for the school setting: PROTECTtraining, a behavioral therapy-based program, and PROTECTinfo, a media education program. The two interventions were deliberately engineered to be identical in duration and implementation effort, differing only in content. This methodological decision is what gives the study its analytical power. When two programs demand the same time, the same staffing, and the same logistical footprint, any difference in outcomes can be attributed to what the programs actually teach rather than to how they are delivered. In total, 1,793 students aged 11 to 18 took part in a four-week intervention consisting of four 90-minute sessions each.

Half of the participating adolescents completed PROTECTtraining, the behavioral therapy program. Its curriculum drew on well-established clinical techniques: among other elements, it explained the vicious cycle of addiction — the self-reinforcing loop in which short-term relief from negative emotions drives escalating use, which in turn deepens those emotions — and provided practical training in behavior change and emotion regulation. These components reflect the core machinery of cognitive behavioral therapy, which aims to interrupt maladaptive patterns by giving individuals concrete tools to recognize triggers, restructure their responses, and manage the emotional states that fuel compulsive behavior.

The second group participated in PROTECTinfo, the media education program, which covered a broad and socially relevant set of topics including media literacy, gaming, cyberbullying, and legal aspects of online behavior. This represents the approach most commonly deployed in schools: educating students about the digital world, its risks, and its norms, with the expectation that knowledge and awareness will translate into healthier habits. Both programs were delivered in the same format — four weekly sessions of 90 minutes over four weeks — ensuring that the comparison tested content, not delivery.

The researchers assessed participants’ online addiction behaviors and mental well-being at four points: at the beginning of the programs, at the end of the programs, and at follow-up intervals of four and twelve months. This longitudinal design allowed the team to distinguish short-term effects from durable ones, a critical distinction in prevention research where early gains often fade. In addition, the team conducted a separate analysis for adolescents who had been identified as having a comparatively high risk of addiction at the start of the study — a subgroup analysis that would prove decisive for interpreting the results.

The final survey, conducted one year after the programs began, revealed a nuanced picture. Among adolescents without a risk of addictive behavior, who constituted the majority of study participants, there was hardly any measurable effect on their symptoms. In other words, for the broad population of students who are not at risk, neither program produced substantial lasting change — a finding with significant implications for how prevention resources are allocated. In contrast, for adolescents at high risk of addiction, both interventions proved effective, but the behavioral therapy intervention was significantly more effective than its media education counterpart.

The magnitude of that difference is the study’s headline finding. In a direct comparison, the behavioral therapy program is 50 percent more effective against gaming disorder and other problematic online behaviors than the media education program, Prof. Lindenberg stresses. This effect size is substantial for a prevention intervention, particularly one delivered in a standard school setting with modest time investment. The result suggests that teaching at-risk adolescents the specific psychological mechanisms of addiction and equipping them with regulation and behavior-change skills does more to shift long-term outcomes than general education about media and its risks.

Beyond the head-to-head comparison, the Heidelberg researcher draws a broader structural conclusion from the data: targeted measures tailored to at-risk groups in the school setting achieve significantly better results and are more resource-efficient than prevention programs implemented on a broad scale. The pattern in the data supports this reading — the majority of students, those without addiction risk, showed hardly any measurable symptom change, while the high-risk subgroup, a smaller population, responded meaningfully to intervention, especially to the behavioral therapy approach. Concentrating effort on identifying and treating at-risk students, rather than delivering universal programs with diffuse effects, may therefore deliver more benefit per unit of investment.

The research was funded by the then Federal Ministry of Education and Research (BMBF) and the former Baden-Württemberg Ministry of Social Affairs and Integration, reflecting the policy significance attached to the question at both the national and state levels. The study, titled Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder, appeared in JAMA Network Open on 4 September 2026. For schools and health authorities weighing how to respond to growing concern about adolescent screen use, the message from Baden-Württemberg’s 44 secondary schools is clear: behavioral therapy-based prevention works, works best for those at highest risk, and outperforms media education by a wide margin when the two are measured against each other over a full year.

Subject of Research: School-based prevention of gaming disorder and problematic internet use in adolescents

Article Title: School-based prevention programs for gaming disorder and problematic online habits

Article References: School-based prevention programs for gaming disorder and problematic online habits. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: gaming disorder, internet use disorder, adolescents, school-based prevention, cognitive behavioral therapy, media education, media literacy, randomized controlled trial, Heidelberg University, JAMA Network Open, Baden-Württemberg, mental health