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

Against this backdrop, a new narrative review published in Discover Mental Health by Remedios Aguilar-Moya, Raquel Ibáñez-Martínez and David Melero-Fuentes of the Catholic University of Valencia asks a deceptively simple question: what does the scientific literature actually tell us about school-based programmes that try to prevent mental disorders and addictions together? The question matters because the two problems are deeply intertwined. Addictions frequently function as coping mechanisms for psychological distress, and substance use typically begins early, at precisely the developmental stage when the brain, family dynamics and social identity are all in flux. Yet, as the authors note, most school prevention programmes have historically addressed mental health and addictions as separate silos, evaluating their outcomes independently even though the two conditions co-occur in school-aged adolescents.

To map the field, the researchers searched PubMed, PsycINFO and ERIC without date restrictions, retrieving 2,096 records. After removing 778 duplicates and screening 1,322 titles and abstracts, they examined 31 full-text articles and supplemented the pool with four additional studies identified through citation searching. The final sample comprised 16 studies, including three programme protocols and a cluster of linked evaluations of the same interventions. The methodological approach was a narrative synthesis organised around categories such as aim, sample, target disorders, intervention provider, procedures, components and outcomes, with data extracted independently by two authors and discrepancies resolved by consensus.

The geography of the evidence is strikingly narrow. Australia dominates with eight of the 16 studies, concentrated in New South Wales, Queensland and Western Australia, followed by the United States with five studies in Minnesota, Baltimore, Virginia and Oregon. Canada, Italy and Finland contribute one study each. Ten of the articles focus on just three programmes: CLIMATE Schools, PreVenture and the Good Behavior Game. The authors caution that this concentration on high-income, largely English-speaking Western countries severely limits generalisability to low- and middle-income settings and to educational systems with different cultural structures, a gap they argue demands cross-cultural research incorporating socioeconomic variables.

Age targeting is equally concentrated. Most interventions, nine of the 13 non-protocol articles, focus on students aged roughly 13 to 15, the window when mental health and substance use problems typically first emerge and when early intervention is considered crucial. A handful of programmes reach younger children from age six, including the Good Behavior Game evaluations, which followed two cohorts into young adulthood at ages 19 to 21. Notably, no studies were found working with children under six. The developmental logic of the programmes also shifts with age: for children, protective factors centre on socio-emotional development with strong family and school involvement, including parent-child communication training, whereas adolescent programmes largely drop the family and rely on teachers and health professionals, sometimes adding selective components tailored to personality style, problematic coping behaviours, stress management or stigma reduction.

The content of the interventions clusters into four main blocks: addiction prevention, present in 11 articles; reduction of anxiety, depression and stress, in five; mental health promotion through reinforcement of emotional competence, in ten; and social skills training, in five. Anxiety appears as a target in 12 of the 16 articles and depression in 10, reflecting their status as the most prevalent and most researched disorders in youth populations. On the addiction side, alcohol prevention leads with 14 articles, followed by cannabis with eight, with tobacco and other drugs appearing less frequently. Only two studies address non-substance addictions, covering internet abuse, pathological gambling and compulsive shopping, a striking gap given that 34 percent of adolescents play digital video games daily, at least 22 percent play four or more hours a day, and 12 percent show risk of problematic play, with documented links to lower life satisfaction and psychological distress.

Delivery of these programmes rests overwhelmingly on teachers working in collaboration with external health experts, a model present in 12 of the 14 student-focused articles. Teachers participate in 13 of the 16 studies, supported in some cases by nurses, community workers, consultants or school health centre staff. The review highlights an unresolved tension here: some evidence suggests that external professionals specialised in depression achieve better outcomes than teachers alone, yet reviews of teacher-delivered programmes show little sustained impact on pupil mental health, and it remains unclear which type of school prevention officer is most effective for addictions specifically. Implementation research adds further caveats, identifying barriers such as disengaged management teams, unstable teaching staff and insufficient training as factors that can undermine even well-designed programmes.

Perhaps the most consequential finding concerns prevention strategy itself. Most reviewed interventions take a universal approach, delivered to entire classrooms without differentiation by need or risk. Yet the evidence increasingly questions whether one-size-fits-all models serve all students. The review cites work showing that universal strategies may be ineffective, or even inappropriate, for young people with existing mental disorders, and that certain universal programmes can produce iatrogenic effects, actually increasing clinical symptoms in some students. Universal, therapeutically based interventions appear less effective than targeted approaches, and some universal addiction programmes may achieve little benefit even in the short term. The selective PreVenture programme, which tailors content to personality-based risk profiles, represents one of the few evaluated alternatives in the sample.

The long-term picture is sobering. Only seven papers included longitudinal evaluation beyond immediate post-intervention measures, ranging from six-year outcomes for the Early Risers programme to 30-month and 72-month follow-ups of the CLIMATE Schools Combined trial. The 72-month results deserve particular attention: the programme, one of the first worldwide to jointly address anxiety, depression and substance use, showed significant preventive effects during adolescence, but by early adulthood there were no significant differences between the experimental and control groups in the predicted probability of alcohol use, leading the authors to conclude that universal prevention in adolescence alone is not sufficient for lasting effects. Other unexpected results complicate the narrative of success: one Good Behavior Game study found no programme impact among women, a Finnish psychoeducational intervention produced no change in stigma reduction, and another study pointed to the need for whole-community involvement beyond the classroom.

The authors conclude that the field stands at a point of unquestionable reflection. Preventive initiatives in schools can plausibly reduce the rates and costs associated with mental health and addictions, but they must be redirected on the basis of solid scientific evidence adjusted to the realities of target populations, with clearer decision rules about when universal approaches suffice and when selective or indicated interventions are required. Their recommendations for programme design are concrete: early intervention, training in social-emotional skills, building teacher literacy in mental health and addiction risk signals, hybrid universal-plus-selective models adapted to specific sociocultural and socioeconomic contexts, and genuine integration of teachers with mental health and addiction professionals. They also call on policymakers to promote comprehensive prevention models that account for differential vulnerabilities, noting that the current evidence base, skewed toward wealthy Western nations and a handful of flagship programmes, cannot yet tell the world’s schools, especially those in low- and middle-income countries, what will actually work for their students. Until that evidence gap closes, the promise of school-based prevention remains real but unproven at scale.

Subject of Research: School-based preventive interventions for mental disorders and addictions in children and adolescents

Article Title: A narrative review of school-based preventive interventions on mental disorders and addictions

Article References: Aguilar-Moya, R., Ibáñez-Martínez, R., & Melero-Fuentes, D. (2026). A narrative review of school-based preventive interventions on mental disorders and addictions. Discover Mental Health, 6(1), Article 188. https://doi.org/10.1007/s44192-026-00532-2

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00532-2

Keywords: school-based prevention, adolescent mental health, addictions, depression, anxiety, substance use, CLIMATE Schools, PreVenture, Good Behavior Game, universal interventions, selective prevention, narrative review