Effectiveness of Cognitive Behavioral Therapy–Based Intervention in Preventing Gaming Disorder and Unspecified Internet Use Disorder in Adolescents

Abstract

IMPORTANCE Behavioral addictions were introduced as novel mental disorders in the InternationalClassification of Diseases, 11th Revision, based on evidence that human behavior itself can become addictive, similar to addiction to substances. However, previous studies on prevention of gaming disorder and unspecified internet use disorder lacked randomization, follow-up measurements, and diagnostic interviews that assessed incidence rates; this trial was intended to fill this gap. OBJECTIVESTo investigate whether the PROTECT (Professioneller Umgang mit technischen Medien [Professional Use of Technical Media]) intervention can reduce the symptom severity and prevent full syndrome and subthreshold onset of gaming disorder and unspecified internet use disorder in at-risk adolescents. DESIGN, SETTING, AND PARTICIPANTS A multicenter cluster randomized clinical trial conducted recruitment, screening, intervention delivery, and data collection among at-risk adolescents aged 12 to 18 years in 33 high schools in Germany. Inclusion criteria for the study and symptom severity analyses were elevated symptoms of gaming disorder and unspecified internet use disorder. A subsample that met the inclusion criteria for incidence analyses (no full syndrome of gaming disorder or unspecified internet use disorder, depression, or anxiety at baseline) was analyzed for illness onset. Participants were randomized to either the PROTECT intervention group or the assessmentonly control group. Participants were assessed at baseline, 1-month follow-up, 4-month follow-up,

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“…The results of the present study also showed that the prevalence rate increased slowly during adolescence and declined around the age of 20, even if it was not statistically significant. Similar trends between age and prevalence rate of GD have been found in the previous studies ( Lindenberg, Kindt, & Szász-Janocha, 2022 ). Adolescents seem to be particularly vulnerable to developing GD, and adolescent GD was positively associated with various behavioral and emotional problems ( Brunborg, Mentzoni, & Frøyland, 2014 ; Lemmens, Valkenburg, & Peter, 2011 ).…”

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“…Moreover, most interventional research has focused on therapeutic interventions for established disorders, particularly in the fields of internet related gambling and gaming, and there has been very little research into preventative strategies. Thus, while a recent study demonstrated that manualized cognitive behavioral therapy-based interventions may produce a reduction in PUI symptom-severity among 'at risk' children and young people, a reduction in the incidence of new cases has yet to be demonstrated [275].…”

The Case for Prevention Research in Adolescent-Onset Mental Illness—Game On!

“…Lindenberg et al conducted a novel 2-group, 33-site cluster randomized clinical trial to compare a school-based, cognitive behavioral therapy–based indicated preventive group intervention (PROTECT) vs assessment-only that is intended to prevent gaming disorder or unspecified internet use disorder among at-risk adolescents (n = 422). Lindenberg et al designed their study according to American Psychological Association recommendations for efficient psychological prevention and established dual foci: symptom reduction and prevention of illness onset. The trial showed greater symptom severity reduction in the PROTECT intervention group than in the assessment-only control group at 12 months, with a medium to large effect size in addition to greater reduction in reported procrastination.…”

“…The use of preventive intervention in this study is also relevant, given the historical challenges in resourcing this type of work . Lindenberg et al exemplify the potential for youth-focused prevention to mitigate the global burden of psychiatric disease given the concurrent onset of mental illnesses during this developmental stage. The study design reflects its superiority to previous research in this area, with its use of participant randomization, 12-month follow-up, and confirmatory diagnostic interviews.…”

“…The PROTECT intervention group demonstrated significantly greater reduction in severity than the assessment-only control group, with an impact that went above and beyond factors such as illness course instability, spontaneous remission, and regression to the mean. Yet the absence of a difference in incidence rate between the 2 groups was not anticipated by Lindenberg et al Recommendations for larger samples, within-school randomization, and adaptive designs in future studies will guide researchers in the race to decrease new-onset gaming disorder or unspecified internet use disorder among youth.…”