{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:16:45Z","timestamp":1788538605659,"version":"build-2803163510"},"reference-count":51,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Mitigating the harmful effects of digitalization on youth mental health is essential.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To evaluate the effectiveness of cognitive behavioral therapy (CBT) compared with a media literacy\u2013based intervention for gaming disorder and unspecified internet use disorder and to determine whether universal or indicated prevention yields stronger benefits.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n PROTECTconfirm was a randomized clinical trial conducted from July 1, 2020, to August 31, 2024, across 44 secondary schools in Baden-W\u00fcrttemberg, Germany, with 1-, 4-, and 12-month follow-up. All students were included in universal prevention analyses, whereas indicated prevention analyses included a subgroup of adolescents at high risk meeting 2 or more\n Diagnostic and Statistical Manual of Mental Disorders<\/jats:italic>\n (Fifth Edition) criteria for gaming disorder or unspecified internet use disorder at baseline.\n <\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Students were individually randomized within 90 classes to PROTECTtraining, a CBT-based program; or PROTECTinfo, a structurally parallel media literacy program. Both consisted of four 90-minute sessions delivered weekly during school hours by trained local prevention professionals under live supervision and adherence protocols.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was gaming disorder symptom severity and unspecified internet use disorder symptom severity, assessed at 12 months with a modified version of the Video Game Dependency Scale. Secondary outcomes included internalizing, externalizing, and transdiagnostic symptoms. Primary and secondary outcomes were analyzed according to the intention-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 1793 students were randomized to PROTECTtraining (n\u2009=\u2009896; mean [SD] age, 13.1 [1.5] years; 498 male students [56.1%]) or PROTECTinfo (n\u2009=\u2009897; mean [SD] age, 13.1 [1.5] years; 484 male students [54.8%]). Participants in the subsample of 205 adolescents at high risk showed significantly lower 12-month severity of gaming disorder and unspecified internet use disorder symptoms with PROTECTtraining than with PROTECTinfo (mean [SD] Modified Video Game Dependency Scale score: 14.7 [9.7] vs 17.7 [10.3]; within-group Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.91 [95% CI, \u22121.10 to \u22120.72] vs Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.61 [95% CI, \u22120.80 to \u22120.42]; between-group Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.30 [95% CI, \u22120.55 to \u22120.05]), but not in the total sample (mean [SD] Modified Video Game Dependency Scale score: PROTECTtraining, 8.8 [8.3] vs PROTECTinfo, 9.4 [8.4]; within-group Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.11 [95% CI, \u22120.18 to \u22120.05] vs Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.04 [95% CI, \u22120.11 to 0.02]; between-group Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.07 [95% CI, \u22120.16 to 0.01]). Secondary outcomes did not differ significantly between groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of 1793 adolescents, the CBT-based intervention reduced gaming disorder symptoms and unspecified internet use disorder symptoms more effectively than the media literacy\u2013based intervention among adolescents at high risk. These findings support the use of CBT-based approaches primarily within indicated, rather than universal, prevention.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n German Clinical Trials Register (DRKS) trial registration:\n DRKS00033989<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.31942","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:37:14Z","timestamp":1788536234000},"page":"e2631942","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive Behavioral Therapy vs Media Literacy for Prevention of Gaming Disorder and Unspecified Internet Use Disorder"],"prefix":"10.1001","volume":"9","author":[{"given":"Katajun","family":"Lindenberg","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"},{"name":"Department of Psychotherapy for Children and Adolescents, Institute for Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany"},{"name":"Department of Clinical Psychology and Psychotherapy for Childhood and Adolescence, Johannes Gutenberg-University Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Kewitz","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ina","family":"Neumann","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Brand","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Huth","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Lardinoix","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Leo","sequence":"additional","affiliation":[{"name":"Department of Psychotherapy for Children and Adolescents, Institute for Psychology, Goethe University Frankfurt, Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Sz\u00e1sz-Janocha","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology of Childhood and Adolescence, Institute for Psychology, Heidelberg University, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel L.","family":"King","sequence":"additional","affiliation":[{"name":"College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutz","family":"Wartberg","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Human Sciences, MSH Medical School Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"zoi260880r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2022.152346","article-title":"Advances in problematic usage of the internet research\u2014a narrative review by experts from the European network for problematic usage of the internet.","volume":"118","author":"Fineberg","year":"2022","journal-title":"Compr Psychiatry"},{"issue":"1","key":"zoi260880r3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1024\/1422-4917\/a000837","volume":"50","author":"Lindenberg","year":"2021","journal-title":"Z Kinder Jugendpsychiatr Psychother"},{"issue":"2","key":"zoi260880r4","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1556\/2006.2020.00035","article-title":"Which conditions should be considered as disorders in the International Classification of Diseases (ICD-11) designation of \u201cother specified disorders due to addictive behaviors\u201d?","volume":"11","author":"Brand","year":"2020","journal-title":"J Behav Addict"},{"key":"zoi260880r5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.neubiorev.2019.06.032","article-title":"The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors.","volume":"104","author":"Brand","year":"2019","journal-title":"Neurosci Biobehav Rev"},{"key":"zoi260880r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2024.107980","article-title":"Problematic social media use in childhood and adolescence.","volume":"153","author":"Montag","year":"2024","journal-title":"Addict Behav"},{"key":"zoi260880r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2021.107183","article-title":"Prevalence of gaming disorder: a meta-analysis.","volume":"126","author":"Kim","year":"2022","journal-title":"Addict Behav"},{"issue":"6","key":"zoi260880r8","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1177\/0004867420962851","article-title":"Global prevalence of gaming disorder: a systematic review and meta-analysis.","volume":"55","author":"Stevens","year":"2021","journal-title":"Aust N Z J Psychiatry"},{"key":"zoi260880r9","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2021.106845","article-title":"Prevalence of social media addiction across 32 nations: meta-analysis with subgroup analysis of classification schemes and cultural values.","volume":"117","author":"Cheng","year":"2021","journal-title":"Addict Behav"},{"issue":"4","key":"zoi260880r10","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1024\/0939-5911\/a000672","article-title":"Covid-19-Pandemie und Verhaltenss\u00fcchte.","volume":"66","author":"Rumpf","year":"2020","journal-title":"Sucht"},{"issue":"2","key":"zoi260880r11","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s11121-017-0813-1","article-title":"Policy and prevention approaches for disordered and hazardous gaming and internet use: an international perspective.","volume":"19","author":"King","year":"2018","journal-title":"Prev Sci"},{"issue":"2","key":"zoi260880r12","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1556\/2006.2025.00043","article-title":"The effectiveness of school-based interventions to reduce problematic digital technology use and screen time: a systematic review and meta-analysis.","volume":"14","author":"\u017dmavc","year":"2025","journal-title":"J Behav Addict"},{"issue":"2","key":"zoi260880r13","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1024\/0939-5911\/a000917","article-title":"Guideline on early interventions for internet use disorders.","volume":"71","author":"Lindenberg","year":"2025","journal-title":"Sucht"},{"issue":"2","key":"zoi260880r14","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1024\/0939-5911\/a000922","article-title":"Guidelines on the treatment of gaming disorder.","volume":"71","author":"te Wildt","year":"2025","journal-title":"Sucht"},{"issue":"2","key":"zoi260880r17","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1024\/0939-5911\/a000810","article-title":"Res@t: resource-strengthening training for adolescents with problematic digital-media use and their parents.","volume":"69","author":"Paschke","year":"2023","journal-title":"Sucht"},{"issue":"2","key":"zoi260880r18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.48995","article-title":"Effectiveness of cognitive behavioral therapy\u2013based intervention in preventing gaming disorder and unspecified internet use disorder in adolescents: a cluster randomized clinical trial.","volume":"5","author":"Lindenberg","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi260880r19","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2021.102079","article-title":"School-based depression and anxiety prevention programs: an updated systematic review and meta-analysis.","volume":"89","author":"Werner-Seidler","year":"2021","journal-title":"Clin Psychol Rev"},{"issue":"1","key":"zoi260880r20","doi-asserted-by":"publisher","first-page":"6","DOI":"10.3390\/adolescents6010006","article-title":"School mental health interventions for adolescents: a meta-analysis of effectiveness and relevant moderators.","volume":"6","author":"Lemberger-Truelove","year":"2026","journal-title":"Adolescents"},{"key":"zoi260880r21","doi-asserted-by":"publisher","DOI":"10.1055\/a-2321-3135","author":"Lindenberg","year":"2024","journal-title":"KJP up2date"},{"key":"zoi260880r22","doi-asserted-by":"publisher","journal-title":"JAMA","DOI":"10.1001\/jama.2025.4347"},{"key":"zoi260880r23","doi-asserted-by":"publisher","journal-title":"BMJ","DOI":"10.1136\/bmj.g1687"},{"issue":"20","key":"zoi260880r24","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.","volume":"310","author":"World Medical Association","year":"2013","journal-title":"JAMA"},{"issue":"5","key":"zoi260880r25","doi-asserted-by":"publisher","first-page":"842","DOI":"10.1111\/add.12849","article-title":"Prevalence of internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample.","volume":"110","author":"Rehbein","year":"2015","journal-title":"Addiction"},{"issue":"11","key":"zoi260880r27","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1089\/cyber.2017.0260","article-title":"Internet-related disorders: development of the Short Compulsive Internet Use Scale.","volume":"20","author":"Besser","year":"2017","journal-title":"Cyberpsychol Behav Soc Netw"},{"issue":"1","key":"zoi260880r28","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1024\/1422-4917\/a000814","volume":"50","author":"Lindenberg","year":"2021","journal-title":"Z Kinder Jugendpsychiatr Psychother"},{"issue":"2","key":"zoi260880r29","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1037\/pas0000062","article-title":"The Internet Gaming Disorder Scale.","volume":"27","author":"Lemmens","year":"2015","journal-title":"Psychol Assess"},{"issue":"2","key":"zoi260880r30","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1007\/s11469-019-00088-z","article-title":"Measurement and conceptualization of gaming disorder according to the World Health Organization Framework: the development of the Gaming Disorder Test.","volume":"19","author":"Pontes","year":"2021","journal-title":"Int J Ment Health Addict"},{"key":"zoi260880r31","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1016\/j.chb.2016.03.038","article-title":"The Social Media Disorder Scale.","volume":"61","author":"van den Eijnden","year":"2016","journal-title":"Comput Human Behav"},{"issue":"1-2","key":"zoi260880r32","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1080\/0954026021000046137","article-title":"The Strengths and Difficulties Questionnaire: a pilot study on the validity of the self-report version.","volume":"15","author":"Goodman","year":"2003","journal-title":"Int Rev Psychiatry"},{"issue":"1-2","key":"zoi260880r34","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.jad.2011.03.026","article-title":"Screening for depression in adolescent paediatric patients: validity of the new Depression Screener for Teenagers (DesTeen).","volume":"133","author":"Pietsch","year":"2011","journal-title":"J Affect Disord"},{"issue":"4","key":"zoi260880r35","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/S0005-7967(97)10031-6","article-title":"Development and validation of measures of social phobia scrutiny fear and social interaction anxiety.","volume":"36","author":"Mattick","year":"1998","journal-title":"Behav Res Ther"},{"issue":"3","key":"zoi260880r37","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1007\/s10862-015-9529-3","article-title":"The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): validation and replication in adolescent and adult samples.","volume":"38","author":"Kaufman","year":"2016","journal-title":"J Psychopathol Behav Assess"},{"issue":"8","key":"zoi260880r39","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1007\/s11136-007-9240-2","article-title":"The KIDSCREEN-27 quality of life measure for children and adolescents: psychometric results from a cross-cultural survey in 13 European countries.","volume":"16","author":"Ravens-Sieberer","year":"2007","journal-title":"Qual Life Res"},{"issue":"3","key":"zoi260880r40","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1159\/000376585","article-title":"The WHO-5 Well-Being Index: a systematic review of the literature.","volume":"84","author":"Topp","year":"2015","journal-title":"Psychother Psychosom"},{"issue":"2","key":"zoi260880r41","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1026\/0012-1924\/a000216","article-title":"Kurzversion des Big Five Inventory f\u00fcr Kinder und Jugendliche (BFI-K KJ).","volume":"65","author":"Kupper","year":"2019","journal-title":"Diagnostica"},{"issue":"1","key":"zoi260880r42","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2466\/pr0.1997.80.1.83","article-title":"The Lie\/Bet Questionnaire for screening pathological gamblers.","volume":"80","author":"Johnson","year":"1997","journal-title":"Psychol Rep"},{"issue":"3","key":"zoi260880r43","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1080\/00224499.2017.1291798","article-title":"The development of the Problematic Pornography Consumption Scale (PPCS).","volume":"55","author":"Bothe","year":"2018","journal-title":"J Sex Res"},{"issue":"10","key":"zoi260880r44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0141094","article-title":"The Pathological Buying Screener: development and psychometric properties of a new screening instrument for the assessment of pathological buying symptoms.","volume":"10","author":"M\u00fcller","year":"2015","journal-title":"PLoS One"},{"issue":"6","key":"zoi260880r45","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption\u2014II.","volume":"88","author":"Saunders","year":"1993","journal-title":"Addiction"},{"issue":"4","key":"zoi260880r46","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1080\/14659890701476532","article-title":"Validation of the CAST, a general population cannabis abuse screening test.","volume":"12","author":"Legleye","year":"2007","journal-title":"J Subst Use"},{"issue":"1","key":"zoi260880r47","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1037\/0022-006X.59.1.12","article-title":"Clinical significance: a statistical approach to defining meaningful change in psychotherapy research.","volume":"59","author":"Jacobson","year":"1991","journal-title":"J Consult Clin Psychol"},{"key":"zoi260880r49","doi-asserted-by":"publisher","DOI":"10.1556\/2006.2025.00551","article-title":"Efficacy of a mobile-based approach-avoidance task training (PROTECTapp) for problematic usage of the internet in young adults: a randomized controlled trial.","author":"Huth","year":"2026","journal-title":"J Behav Addict"},{"issue":"4","key":"zoi260880r50","doi-asserted-by":"publisher","DOI":"10.1024\/0939-5911\/a000973","article-title":"Reducing problematic internet use in adolescents and young adults using a smartphone-based approach-avoidance training (PROTECTapp): a randomized controlled pilot study.","volume":"72","author":"Lindenberg","year":"2026","journal-title":"Sucht"},{"key":"zoi260880r51","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2025.152653","article-title":"Research protocol for BootStRaP assessment phase: a nine-nation study on boosting societal adaptation and mental health in a rapidly digitalising, post-pandemic Europe.","volume":"145","author":"Fineberg","year":"2026","journal-title":"Compr Psychiatry"},{"key":"zoi260880r15","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-43784-8","volume-title":"Internet Addiction in Adolescents: The PROTECT Program for Evidence-Based Prevention and Treatment","author":"Lindenberg","year":"2020"},{"key":"zoi260880r16","author":"W\u00f6lfling","year":"2022"},{"key":"zoi260880r26","volume-title":"Computerspielabh\u00e4ngigkeitsskala (CSAS): Ein Verfahren Zur Erfassung Der Internet Gaming Disorder Nach DSM-5","author":"Rehbein","year":"2015"},{"key":"zoi260880r33","author":"Lidzba","year":"2013"},{"key":"zoi260880r36","volume-title":"Phobiefragebogen F\u00fcr Kinder Und Jugendliche","author":"D\u00f6pfner","year":"2006"},{"key":"zoi260880r38","volume-title":"Zusammenstellung sozialwissenschaftlicher Items und Skalen. ZIS Version 13.00","author":"Gl\u00f6ckner-Rist","year":"2009"},{"key":"zoi260880r48"},{"key":"zoi260880r1","unstructured":"International Classification of Diseases: ICD-11 for Mortality and Morbidity Statistics. World Health Organization. Accessed March 5, 2026. https:\/\/icd.who.int\/browse\/2025-01\/mms\/en"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2853788\/lindenberg_2026_oi_260880_1788194890.14894.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:37:18Z","timestamp":1788536238000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2853788"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":51,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.31942","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}