Treatment for Problematic Internet Pornography Viewing
Often in the popular media, we hear people talk about things like "sex addiction" and "porn addiction." What may surprise the layperson is that these aren't diagnosable conditions. In the current DSM, the standard classification system for mental health problems in the US, there are no diagnoses even equivalent to something like a sexual addiction. We're not even sure if "addiction" is the right term. Some people have argued that excessive pornography use is akin to substance abuse, and others have suggested it may better characterized along the obsessive-compulsive spectrum. We're not even clear what "excessive" might mean!
Discussions about pornography tend to elicit strong feelings. On a professional listserv, a question about a teenager reading the men's magazine Maxim, which features sexy non-nude pictures of women, stirred up views that ranged from, "All pornography is a form of violence against women" to "What's the big deal?"
I'm not here to offer a definition of pornography or porn addiction. In my work as a clinical psychologist, my main concern is the treatment of a problem with which someone is struggling. Diagnosis is used to help move toward that goal. In a treatment study that came recently, the authors use the term "problematic Internet pornography viewing"-which they call "viewing" for short. The main researcher, Dr. Michael Twohig, a professor at Utah State University, sidesteps the debate of whether pornography use is an addiction or not. His main interest is how to treat something that is causing people difficulty in their lives. These problems may include personal feelings of shame or guilt, devoting more time to it than they'd like, and risky situations such as viewing pornography at work.
As a relatively new professor in a conservative state, Dr. Twohig, whose main research focus is disorder on the obsessive-compulsive spectrum, started to hear about problems with Internet pornography use in his new home state of Utah. This is supported by a recent study published in the Journal of Economics by Harvard Business School economics professor Dr. Benjamin Edelman. According to this study, Utah ranked highest among states in subscriptions to pornographic sites. (To download Dr. Edelman's article, click here.)
In his review of the research literature, Dr. Twohig found there were no published controlled experimental studies of treatment for problematic sexual behaviors. He found things written about problematic sexual behavior, but nothing using rigorous research techniques.
Dr. Twohig developed a small study treating pornography viewing using Acceptance and Commitment Therapy (ACT, said as one word "act"). ACT is a behavioral treatment that draws upon mindfulness. In eight 1½-hour sessions, Dr. Twohig treated six men who wanted to reduce their viewing.
What's really interesting about the treatment is that the clients were taught not to try to control their urges to view-which many they had already tried to do unsuccessfully-but instead to mindfully notice these urges and accept them. Clients learned to let go of the struggle with their pornography viewing. In addition, they were encouraged to commit to engaging in meaningful, valued activity (e.g., spend time with friends) between sessions.
At the end of the eight sessions, two had stopped viewing altogether and three were viewing significantly less than they were before treatment. Only one person was still viewing at comparable levels. The clients were contacted three months after treatment for a follow-up assessment, and the improvements appeared to be maintained for four of the five that had shown decreases in viewing. (I'd like to note that the goal of some clients was abstinence whereas the goal of others was to decrease the amount of time they spent viewing.)
There were other positive changes as well. Quality of life increased. Obsessive thoughts decreased. Even obsessive religious thoughts went down. As Dr. Steven Hayes, the creator of ACT, noted on a blog in the Huffington Post, viewing went down as people learned to treat themselves kinder and more compassionately, and as they moved towards activities that were important to them.
This is very different from the "tough" approach often advocated in the popular media to deal with problem behaviors.
In addition to being the first experimental study for dealing with problematic pornography viewing, Dr. Twohig's study also provides additional evidence that learning to treat our selves kindly is a useful remedy for making changes-even with something as culturally loaded as pornography viewing.
Editor's Note (10-18-10): We published a related article on Men, Women and Understanding Pornography written by Dr. Allan Schwartz back in May 2007. That article is still receiving comments from people who have been affected by a partner viewing pornography. For more detail on the devasting effect that this issue can have on relationships and to read comments from readers who have experienced it, please check out that article. Thanks!
guest - - Jan 10th 2011
I know that your aim is not to define pornography but is instead to discuss treatment for behavior that is causing someone a problem. But I'm just wondering if an individual who had a porn viewing problem eliminates porn from their life but then replaces it with obsessively fantasizing and masturbating about those immediately around them, could't that be the same "problem" just with a different focus? Aren't they just manifesting it in a different way...if they admit that they are imagining sex with these people around them or maybe if they're just calling up the inventory of porn images they have in their head to get as close to the same effect as actual porn viewing had for them, isn't it really the same problem? And if it is the same, can it be addressed with similar treatment techniques? I suppose society will never see just fantasizing and masturbating as a "problem" but it just seems that once you've had a porn viewing problem, it seems like it would make your fantasizing and masturbating rituals a little different.