A 4-Session School Course Cut Gaming Symptoms in High-Risk Teens

Many parents worry about how much their teenager games. A smaller group worry about something more serious: gaming that starts to take over.

A large new trial tested whether a short school programme can help.

It worked for the teens who needed it most. For everyone else, it made little difference.

That turns out to be the most useful finding of all.

What is video game addiction?

Doctors call it gaming disorder. The World Health Organization added it to its international disease classification, ICD-11.

The WHO describes a pattern of impaired control over gaming, gaming taking priority over other interests and daily activities, and carrying on despite harm.

To be diagnosed, it must cause significant problems in daily life, and normally be present for at least 12 months.

The WHO stresses that gaming disorder affects only a small proportion of people who game. In other words, most gaming is not a disorder.

Still, the WHO advises people who game to keep an eye on how much time they spend, especially when it crowds out other daily activities.

What the research shows

The trial, called PROTECTconfirm, was published in JAMA Network Open. It ran from 2020 to 2024 in 44 secondary schools in Baden-Württemberg, Germany.

Two programmes, matched in every way but content

Students were randomly assigned, within their classes, to one of two programmes. Both had four weekly 90-minute sessions in school hours, led by trained local staff such as school psychologists and social workers.

What the skills course actually taught

The skills programme started with how addictive habits form. Students then practised spotting and challenging unhelpful thoughts about gaming.

It also covered planning rewarding offline activities, solving everyday problems and handling difficult emotions without escaping into screens.

The media-literacy class had no skills training. It focused on information about phones, privacy, online life and gaming risks.

That design is stronger than comparing against nothing. Both groups got the same time and attention, so any difference comes from the content.

How the trial was run

Of 2,198 students in the participating classes, 1,793 (81.6%) took part in the study. Students were randomised individually within 90 classes, so classmates could end up in different programmes.

Sessions were led by trained local prevention staff under live supervision, with checks that they stuck to the manual.

Who took part

The trial included 1,793 students aged 11 to 18, with an average age of 13. About 11% of them were at high risk at the start, meeting at least two diagnostic criteria for gaming or internet use disorder.

The results after 12 months

Symptoms were measured on a standard gaming and internet use scale, where lower scores are better.

In high-risk teens, both programmes reduced symptoms. But the skills programme did better, with an effect about one and a half times larger.

Across all students, the difference wasn’t statistically significant.

Improvement and harm

Reliable improvement was more common than reliable worsening in both groups, by about four to five times over 12 months.

High-risk teens in the skills programme did best of all. 46.4% improved reliably, and only 3.6% got worse.

Effects beyond gaming

The effects were mostly limited to gaming and internet-use symptoms. The skills group showed a small drop in anxiety and low mood symptoms, but it didn’t differ significantly from the media-literacy group.

So the course seems to work on its target, rather than improving teen mental health across the board.

What students preferred

Here’s a twist: students rated the media-literacy class higher, with average satisfaction scores of 7.41 versus 6.60.

The authors argue schools should choose what works, not just what students enjoy most.

Why target the high-risk group?

The authors suggest a two-step approach: screen all students, then give the skills programme to those at risk.

Serious symptoms are relatively uncommon and develop over time. Giving everyone the same programme spreads resources thin, while the at-risk minority gains the most.

What earlier research found

The first PROTECT trial

A 2022 trial in JAMA Network Open tested the same skills programme in 422 at-risk teenagers, against an assessment-only control group.

Over 12 months, symptoms fell by 39.8% in the programme group versus 27.7% in the control group.

Those teens were older, averaging 15. The programme group also showed a significantly bigger drop in procrastination than the control group.

What the new trial adds

The first trial used psychologists and a no-programme comparison. This one used everyday school staff and a matched active alternative, closer to how schools would actually run it.

How it fits together

Two trials now point the same way for at-risk teens. The evidence for giving everyone the programme is much weaker.

How much should you trust this?

Promising. It’s a large, well-designed trial, but with important caveats.

What makes it convincing

• A randomised trial in 44 schools with 1,793 students.
• A matched active comparison, not just a waiting list.
• 12-month follow-up and high fidelity to the programme.
• Consistent with an earlier trial of the same programme.

What makes me cautious

• Symptoms were self-reported; no clinical interviews were done.
• The effect showed up on one symptom scale, but not on three others.
• The lead author also led the earlier trial of the same programme.
• It took place in one German state.
• About one in five students had dropped out by 12 months.

What this means for you

• Most gaming isn’t a disorder. Watch for loss of control and harm to sleep, school or relationships.
• Ask your child’s school what it offers. Screening plus targeted support looks more effective than a talk for everyone.
• Skills matter more than lectures. Coping and emotion-control skills did more than information alone.
• Talk early. Ask about how gaming makes them feel and what they’d miss if they stopped.
• Seek help if it’s serious. A GP or school psychologist is a good first step.

The WHO’s questions and answers on gaming disorder explain the warning signs.

If you’re in crisis, please contact a person, not a chatbot.

In the US, call or text 988. In the UK and Ireland, you can call Samaritans on 116 123, any time.

Elsewhere, Find a Helpline lists free services. If someone is in immediate danger, call emergency services.

In this short Mayo Clinic video, a child psychiatrist shares three tips for parents worried about gaming:

What we still don’t know

1. Does it prevent diagnosed disorder? The trial measured symptoms, not diagnoses.
2. Does it last? Follow-up ended at 12 months.
3. Would it work elsewhere? It was tested in one German state.
4. Who should run it? Facilitator skill may affect results.
5. What about other online habits? Social media and phone use need their own trials.

My take: target, don’t blanket

What I like about this trial is its honest comparison. It pitted two real programmes against each other, not one programme against nothing.

I’m less convinced by headlines claiming schools can “prevent gaming addiction” for everyone. Across all students, there was no clear difference.

But for teens already showing warning signs, a short skills course did help. That’s a practical, affordable lesson for schools and parents.