CBT Efficacy for Preventing Adolescent Gaming Disorders
The Final Boss
The Final Boss
PRESS START
© Jessica Epere,MD PGY-2
Background
Study: Effectiveness of Cognitive Behavioral Therapy-Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents: A Cluster Randomized Clinical Trial Authors: Katajun Lindenberg, PhD; Sophie Kindt, MSc; Carolin Szász-Janocha, MSc
Background
Gaming Disorder was included in the International Classification of Disease (ICD-11) in 2018 under Disorders Due to Addictive Behaviours. It follows the understanding that addiction can also develop from human behavior itself, in a similar manner to addiction to substances.
Gaming disorder Criteria
"Pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences." - WHO
Gaming disorder Criteria
Unspecified Internet USe Disorder
Unspecified Internet Use Disorder was recommended to include online behaviors that do not fit the specific criteria for Gaming Disorder (i.e. excessive social media, shopping, or general internet use). They typically have the same core identifiers: impaired control, increased priority, and negative functional consequences that cause significant distress.
Relevance
Epidemiologic studies show a 4.6% prevalence of gaming disorder and 6.0% prevalence of internet use disorder (roughly 1 in 20 and 1 in 16 people, respectively). In line with this finding, excessive use of video games and the internet is highly prevalent among youth and young adults, given that they are particularly vulnerable to developing disorders associated with the reward system. In one study, the prevalence of gaming disorder and unspecified internet use disorder more than tripled from 2.8% in children (aged 11-12 years) to 9.1% in young adults (aged 18 to 21 years).
Social Implications
These disorders are associated with numerous impairments, such as comorbid psychiatric disorders, lower life satisfaction, and lower academic achievements. Individuals with these behaviors show limited motivation to seek help and treatment, which further emphasizes the need to prevent illness onset. The excessive use of video games and internet applications has been growing (most notably during the height of the COVID-19 pandemic). From September 2019 to March 2020, the average amount of time adolescents in Germany spent on video gaming increased by 75.0% on weekdays and by 29.3% on weekends.
The Guardian,2026.
Study OveRview
Selection Process
At-risk students ages 12-18 scoring >20 on CIUS
33 high schools in Germany - 18 schools in the intervention cluster (167 students) - 15 schools in control cluster (255 students)
Timeline
All participants were given assessments at baseline, 1-month follow-up, 4-month follow-up, and 12-month follow-up that measured the symptom severity scales.
The students in the control group completed assessments only, while the students in the intervention group received CBT sessions in addition to completing the assessments.
At the 12-month mark, structured clinical interviews were conducted and audiotaped to assess for the onset of full or subthreshold disorders. These recordings were coded by a blinded rater.
The Protect Intervention
The goal of the PROTECT (PROfessional use of TEChnical media) intervention was to prevent adolescents who were already at a moderate to high risk from fully developing Gaming Disorder/Internet Use Disorder.
It consisted of school-based, manualized, cognitive behavioral therapy sessions that were conducted on-site at the schools by trained psychologists.
The Protect Intervention
4 sessions x 90 minutes each • Group setting (3-11 Students) • 2 Psychologists
Appraisal/ Maladaptive Cognitions
Alternative Coping (behavioral)
Alternative Coping (emotional)
Addictive Reward Processing
Results
The primary outcomes looked at reduction in symptom severity, and incidence of new onset gaming disorder and unspecified internet use disorder, as assessed by the CSAS (modified German video game dependency scale).
The secondary outcomes looked at procrastination, general psychopathology, depressive symptoms, social anxiety, performance anxiety/school anxiety, emotion regulation, school-related social behavior and learning behavior, and self-efficacy.
Primary Outcomes
Overall, the study found a significantly greater reduction in symptom severity of gaming disorder / unspecified internet use disorder in the intervention group (PROTECT CBT program + assessments) compared with the control group (assessments only).
Of note, raw scores initially demonstrated an increase in symptom severity in the PROTECT group within the first month, while there was a decrease in symptom severity in the control group. This was later followed by a larger decrease in symptom severity for those in the PROTECT group during months 2 - 12.
39.8%
reduction of symptoms over 12 months in the PROTECT group
VS
27.7%
reduction of symptoms over 12 months in the Control group
What About Prevention?
When comparing the incidence rates of developing gaming disorder/internet use disorder, the difference between treatment groups was not significant.
StudenT's Perception
- 90.7% were satisfied with PROTECT - 85.5% would recommend PROTECT to a friend - Mean evaluation score was 7.53 out of 10 points
75%
Secondary Outcomes
There was a significantly greater reduction in procrastination among students in the PROTECT group compared with the control group.
Other comorbidities (such as depressive symptoms, social anxiety, emotion regulation, and school-related social and learning behaviors) showed improvement in both groups with no statistically signifant difference between the two.
Closing Thoughts
Overall, the findings suggest an effective approach for how to manage behavioral addictions in youth. Given that adolescents often have low motivation to seek treatment, delivering prevention within the school system helps to bypass the need for proactive help-seeking. Would increased intervention (more than four 90-minute sessions) achieve statistically significant effects on broader comorbid symptoms like depression and social anxiety?
game over
Compulsive Internet Use Scale
The Final Boss
Jessica Epere
Created on February 14, 2026
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Transcript
CBT Efficacy for Preventing Adolescent Gaming Disorders
The Final Boss
The Final Boss
PRESS START
© Jessica Epere,MD PGY-2
Background
Study: Effectiveness of Cognitive Behavioral Therapy-Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents: A Cluster Randomized Clinical Trial Authors: Katajun Lindenberg, PhD; Sophie Kindt, MSc; Carolin Szász-Janocha, MSc
Background
Gaming Disorder was included in the International Classification of Disease (ICD-11) in 2018 under Disorders Due to Addictive Behaviours. It follows the understanding that addiction can also develop from human behavior itself, in a similar manner to addiction to substances.
Gaming disorder Criteria
"Pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences." - WHO
Gaming disorder Criteria
Unspecified Internet USe Disorder
Unspecified Internet Use Disorder was recommended to include online behaviors that do not fit the specific criteria for Gaming Disorder (i.e. excessive social media, shopping, or general internet use). They typically have the same core identifiers: impaired control, increased priority, and negative functional consequences that cause significant distress.
Relevance
Epidemiologic studies show a 4.6% prevalence of gaming disorder and 6.0% prevalence of internet use disorder (roughly 1 in 20 and 1 in 16 people, respectively). In line with this finding, excessive use of video games and the internet is highly prevalent among youth and young adults, given that they are particularly vulnerable to developing disorders associated with the reward system. In one study, the prevalence of gaming disorder and unspecified internet use disorder more than tripled from 2.8% in children (aged 11-12 years) to 9.1% in young adults (aged 18 to 21 years).
Social Implications
These disorders are associated with numerous impairments, such as comorbid psychiatric disorders, lower life satisfaction, and lower academic achievements. Individuals with these behaviors show limited motivation to seek help and treatment, which further emphasizes the need to prevent illness onset. The excessive use of video games and internet applications has been growing (most notably during the height of the COVID-19 pandemic). From September 2019 to March 2020, the average amount of time adolescents in Germany spent on video gaming increased by 75.0% on weekdays and by 29.3% on weekends.
The Guardian,2026.
Study OveRview
Selection Process
At-risk students ages 12-18 scoring >20 on CIUS
33 high schools in Germany - 18 schools in the intervention cluster (167 students) - 15 schools in control cluster (255 students)
Timeline
All participants were given assessments at baseline, 1-month follow-up, 4-month follow-up, and 12-month follow-up that measured the symptom severity scales.
The students in the control group completed assessments only, while the students in the intervention group received CBT sessions in addition to completing the assessments.
At the 12-month mark, structured clinical interviews were conducted and audiotaped to assess for the onset of full or subthreshold disorders. These recordings were coded by a blinded rater.
The Protect Intervention
The goal of the PROTECT (PROfessional use of TEChnical media) intervention was to prevent adolescents who were already at a moderate to high risk from fully developing Gaming Disorder/Internet Use Disorder.
It consisted of school-based, manualized, cognitive behavioral therapy sessions that were conducted on-site at the schools by trained psychologists.
The Protect Intervention
4 sessions x 90 minutes each • Group setting (3-11 Students) • 2 Psychologists
Appraisal/ Maladaptive Cognitions
Alternative Coping (behavioral)
Alternative Coping (emotional)
Addictive Reward Processing
Results
The primary outcomes looked at reduction in symptom severity, and incidence of new onset gaming disorder and unspecified internet use disorder, as assessed by the CSAS (modified German video game dependency scale).
The secondary outcomes looked at procrastination, general psychopathology, depressive symptoms, social anxiety, performance anxiety/school anxiety, emotion regulation, school-related social behavior and learning behavior, and self-efficacy.
Primary Outcomes
Overall, the study found a significantly greater reduction in symptom severity of gaming disorder / unspecified internet use disorder in the intervention group (PROTECT CBT program + assessments) compared with the control group (assessments only).
Of note, raw scores initially demonstrated an increase in symptom severity in the PROTECT group within the first month, while there was a decrease in symptom severity in the control group. This was later followed by a larger decrease in symptom severity for those in the PROTECT group during months 2 - 12.
39.8%
reduction of symptoms over 12 months in the PROTECT group
VS
27.7%
reduction of symptoms over 12 months in the Control group
What About Prevention?
When comparing the incidence rates of developing gaming disorder/internet use disorder, the difference between treatment groups was not significant.
StudenT's Perception
- 90.7% were satisfied with PROTECT - 85.5% would recommend PROTECT to a friend - Mean evaluation score was 7.53 out of 10 points
75%
Secondary Outcomes
There was a significantly greater reduction in procrastination among students in the PROTECT group compared with the control group.
Other comorbidities (such as depressive symptoms, social anxiety, emotion regulation, and school-related social and learning behaviors) showed improvement in both groups with no statistically signifant difference between the two.
Closing Thoughts
Overall, the findings suggest an effective approach for how to manage behavioral addictions in youth. Given that adolescents often have low motivation to seek treatment, delivering prevention within the school system helps to bypass the need for proactive help-seeking. Would increased intervention (more than four 90-minute sessions) achieve statistically significant effects on broader comorbid symptoms like depression and social anxiety?
game over
Compulsive Internet Use Scale