Support Groups Sex Addicts Anonymous SAA is one such example of a support group whose purpose is to help others with sex addiction find recovery. Conclusions There is an ongoing discussion about the proper categorization of CSB. Conflict of interests Dr. Appendix DSM-5 proposed criteria for hypersexual disorder Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following five criteria: Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior.
The person is at least 18 years of age. References American Psychiatric Association. Diagnostic and statistical manual of mental disorders 5 th ed. Sex and love addicts anonymous. The Augustine Fellowship. Barth R. The mislabeling of sexual impulsivity. Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: Prevalence and predictors of high-risk behaviors. Addictive Behaviors , 24 6 , — Characteristics of 36 subjects reporting compulsive sexual behavior.
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Oakland, Canada: New Harbinger. New York: Oxford University Press. Learn from our sample or order a custom written research paper from Paper Masters. Text Us. Email Us. Research Papers on Sex Addiction Research papers on sex addiction from Paper Masters illustrate that it is an under-reported psychological phenomena that is common in society.
Sex Addiction as a Disorder? Common Characteristics of Sex Addiction: Frequently engaging in more sex and with more partners than intended. Being preoccupied with or persistently craving sex; wanting to cut down and unsuccessfully attempting to limit sexual activity. Thinking of sex to the detriment of other activities or continually engaging in excessive sexual practices despite a desire to stop. Spending considerable time in activities related to sex, such as cruising for partners or spending hours online visiting pornographic Web sites.
Neglecting obligations such as work, school or family in pursuit of sex. Continually engaging in the sexual behavior despite negative consequences, such as broken relationships or potential health risks. Escalating scope or frequency of sexual activity to achieve the desired effect, such as more frequent visits to prostitutes or more sex partners.
Feeling irritable when unable to engage in the desired behavior. Addiction Counseling research papers look into counseling as an important component and essential part in overcoming addictions such as drug addition Shopping Addiction Research Papers look at the views of shopping addiction, and if it is considered a character flaw or disease.
How to Write a Research Paper on Sex Addiction This page is designed to show you how to write a research project on the topic you see here. End your research paper worries in less than 5 Minutes! Order a custom research paper on ANY topic.
The user feels a strong sensation of inner heat and sensuality is exacerbated. The effect of the sniff lasts about 2 min. GHB is a very powerful anesthetic. In a liquid form, it can be drunk pure or mixed with non-alcoholic drinks.
The effects depend largely on the dosage but vary from euphoria, relaxation, somnolence, deep comatose sleep, and unconsciousness to the loss of inhibitions, an intensification of perception, a need to talk, or slight vertigo. In the organism, GBL turns into GHB; more dangerous; being more difficult to dose, it can provoke potentially fatal comas.
Insolent and seductive, risk taking allows one to leave behind the securized world in which one is immersed. Barebacking unprotected sex despite the risk of transmission of the HIV virus is more and more frequent among sex-addicts in the gay world. On top of the risks of HIV, this practice increases the risks of contamination of various other sexually transmitted diseases that can prove dangerous if they are not detected in time Syphilis, Hepatitis B. When he becomes interested in searching for stronger sensations, the sex-addict can direct his sexuality toward more hard-core practices fist-fucking, bondage, SM, urophilia, scatophilia, etc.
It is in these aspects that addictive sexuality can become a source of suffering, of isolation, and marginalization. The results of the studies by Peretti-Watel et al. Depression often constitutes the backdrop on which sexually addictive behavior is constituted and chronicized. The loss of belief in the positive effects of a relationship, the loss of hope in others, progressively makes one lose sight of the meaning of a life that has — despite the erogenous sensations that exhaust themselves in compulsive repetition — become sad and empty.
In this chapter, it is interesting to summarize some recent studies issued from cognitive neuroscience that investigated human male sexual behavior in general and, for some of them, its compulsive practice. Although using very different theoretical and experimental settings, sexual affiliation is for us one of the most promising context to articulate a dialog between neuroscience and psychoanalysis. Today, what do we know on the neural circuits involved in human male sexual arousal?
Is that possible to identify variations within these neural processes when sexual practice is becoming compulsive? Here are the two main questions of this section. From now several decades, the growing development of neuroimaging techniques shed light on brain processes with a new angle. It is now possible to record brain activity in a wide variety of perceptual, cognitive, or motor paradigms. In addition to a considerable increased knowledge of the brain circuits involved in general cognitive processes, two fields meet an exponential development: the so-called affective neuroscience Pankseep, , interested in the identification of brain networks involved in emotional and motivational informations processing and the so-called social neuroscience Insel and Fernald, crystallized around the cerebral correlates of the processing of social information.
These two approaches converge on questions such as the investigation of brain processing of emotional informations emitted by conspecifics. In this regard, recent studies have helped to highlight the connections between cognitive and neural systems involved in the production of the action and the perception of the action by a third party.
The above-developed perspective is now extending to the topic of emotions. For example, to be exposed to a disgusting flavor activates the same neural structures than to observe a disgust facial expression in another person see the example of the insula in Phillips et al. Insular lesions prevent both the experience of disgust and the recognition of social cues conveying disgust Calder et al. Comparably, the neural circuits of nociception are activated both by real pain and the representation of the affective state of someone in pain Morrison et al.
These results suggest that neural structures involved in emotional information processing also participate in the intersubjectivity of interacting people. However, the recovery between activated structures is not total. This suggests a certain amount of dissociation between regions involved in self-perception and those involved in other perception. Although a functional context such as empathy encompasses an intrinsic social component, relationships between individuals first obey to an intrinsic interattraction motivational component that can be either positive or negative.
However, this interattraction component can be studied within different functional contexts. Among these contexts, sexual behavior and its associated neural circuits has been more and more studied during last years, shedding light on interesting new results for socioaffective neuroscience.
Until the end of the 90s, the investigation of mental and neural representations associated to sexual behavior was poorly studied but is now exponentially emerging. However, it has to be noted that this is mostly investigated in human males. At the moment, an exponential number of scientific studies investigates the neural correlates of human male sexual arousal. Here, we would like to underline some recent results issued from socioaffective neuroscience studies that used sexual affiliation to study motivated social interactions and provided more general results.
Here, we will first focus on results obtained in healthy human males and secondly on very preliminary data from patients that could be involved in CSB occurrence. To understand the present assumptions of neuroscience on the neural networks that could be involved in sexual addiction, it is necessary to present some interesting recent results on the role of the brain on healthy human male sexual motivation. First, it has to be noted that functional magnetic resonance imaging fMRI , that is, the possibility to use MR imaging to identify brain activations thanks to local blood flow variations recording, was discovered in In this article, we present the main results from studies with two objectives: 1 when they were published, a preliminary exploration of the neural circuits involved in sexual visual information processing and 2 to use the high specificity of this behavior as a working model to identify the neural circuits involved generally in social relations with a motivational component.
Mainly, to explore the neural correlates of healthy human male sexual motivation, these studies used fMRI. Among other neuroimaging techniques, fMRI has a relatively good spatial resolution, but a quite poor temporal resolution around 1 second instead of milliseconds regarding the classical temporal unit of the cell functions.
Currently, an attempt that can be offered to try to overcome this pitfall is to try to unify the corresponding psychological and neural components in a neurobehavioral model. For healthy human male, a neurobehavioral model has been proposed Redoute et al.
Therefore, this is important to bring together a psychological process and a cerebral activation and to explain how these processes articulate with the other components of the model. Here, we sum up some data related to cognitive and physiological components of the neurobehavioral model. With several decades of studies of the neural correlates of healthy human male sexual arousal, the feasibility of this scientific approach has been widely demonstrated.
In other words, the presentation of decontextualized visual sexual stimuli within a scanner was valid. Although the experimental setting and procedures were not ecological to study sexual arousal, behavioral results indicate a possible induction of sexual attitudes. Regarding brain processes involved in visual sexual material processing, a good example is illustrated in Fig. In accordance with the hypotheses of the study, the recorded brain activations were interpreted as involved in the cognitive processes linked to motivational information processing Mouras et al.
For example, activations were identified in the inferior parietal lobules IPLs; Fig. Interestingly, these areas were known to be activated in monkeys during visual fixation episodes occurring during environmental exploration Lynch et al. For this region, an early activation was thought, for example, as being involved in enhancing attentional mechanisms toward motivationally relevant targets.
Through a more precise study of temporal activations for this part of the brain, we were able to demonstrate activations within the superior parietal lobules. In this study one of the first fMRI studies , these activations were nonetheless sustained not only during all visual sexual stimuli presentation period but also in the early as for IPLs. These results were in accordance with a very short categorization time for sexual stimuli Pizzagalli et al. Therefore, these activations were interpreted as the anatomical support of an early amplification of attentional processes directed toward visual sexual stimuli.
Brain areas activated in response to visual sexual stimuli as compared to neutral stimuli. Notes: A Right hemisphere: a parietooccipital sulcus; b superior parietal lobule; c postcentral gyrus; d precentral gyrus. B Left hemisphere: a superior occipital gyrus; b superior parietal lobule; c inferior parietal lobule; d precentral gyrus; e intraparietal sulcus. Figure from Mouras et al. Source: Adapted with permission from Mouras et al. Through published studies, a recurrent question is to know if the identified psychological and cerebral processes are specific to the functional context of sexual behavior.
Importantly, the male sexual function is characterized by a highly specific physiological response, that is, the genital response. For this purpose, a specific MR-compatible device able to record volumetric penile plethysmography concurrently to cerebral BOLD responses was manufactured.
This was applied in two recent studies Mouras et al. It allowed to precise the involvement of a specific neuronal system in the brain — the mirror neuron system — for visual sexual stimuli processing, which means visual stimuli with a high motivational relevance. Importantly, the mirror neuron system was first discovered in monkey as a specific category of motor neurons with an increasing firing rate either during the observation of an action or the mere realization of this action.
Today, the question of the involvement of this system within socioaffective information cerebral processing is one of the major debates for contemporary cognitive neurosciences. A recent study Carr et al. Consequently, it was important here to assess the degree of implication of these mirror neurons in the observation of sexual exchange.
Therefore, our hypotheses were that 1 in response to the presentation of sexual visual stimuli, the magnitude of activation of the brain networks involved in movement observation and motor imagery would predict the intensity of genital response and 2 the level of the erectile response would predict the amplitude of the BOLD response in primary and secondary somatosensory areas corresponding to the projection of the penis.
Three results are developed here see Fig. Parasagittal sections showing brain areas where the fMRI signal was correlated with the concurrent penile volumetric response. Notes: X refers to the distance in millimeters from the sagittal plane. Height threshold: pb. Correlation profiles between BOLD and plethysmographic signals as a function of the lag between the two signals. Notes: The vertical axis represents the Z statistic associated with the correlation coefficient between the two signals, and the horizontal axis the lag, which is the time interval seconds by which the correlated values are separated.
Positive lags are those where the plethysmographic response was correlated with subsequent values of the BOLD signal from Mouras et al. The first region in which the variations in BOLD signal were correlated to those of genital response was the left frontal operculum. On the other hand, the behavioral response was also recorded by physiological the erectile response and some of the efferences of the frontal operculum to the insula could be the corresponding anatomical support.
Therefore, these results place the physiological response at the center of the processes involved in social relations with a strong motivational component. These results are in accordance with those showing a possible anticipatory activation of this network, that is, before the observation of motor scenes Kilner et al.
For somatosensory areas, important results have been obtained. Everything happens as if the observation of sexual explicit scenes induced activation only in motor areas corresponding to the hand, but also in areas of the somatosensory cortex corresponding to the representation of the hand. Such processes may play a role in recognizing emotions in others by the observer Adolphs et al.
The exploration of the neural networks involved in healthy human sexual behavior through modern neuroimaging techniques remains recent, centered on healthy human male sexual motivation. Even if the number of studies on this topic is growing exponentially, there are still a lot of scientific questions to solve.
As shown by this article, the question of the neural circuits involved in addiction is an important topic. In the field of sexual addiction, different kinds of data are now available. Today, modern neuroimaging techniques such as MRI allow using different modalities to record during the same experimental session either data regarding the anatomical properties of the brain or its functional properties through neural activations recorded in any kind of behavior.
However, from one study to another, the evaluation method to assess and evaluate compulsive sexual behavior have been different. Recently, Miner et al. To recruit patients with a certain homogeneity, authors used as inclusion criterion the CSB syndrome. In , Coleman et al. As explained by authors, this syndrome shares criteria with other addictions such as bulimic behavior and pathological gambling.
Although this study was the first to present data on patients with a CSB, important hypotheses have been proposed through the report of single cases. The first one is the disruption of frontal brain areas that usually have an inhibitory effect on sexual behavior and that could induce an hypersexuality. Here, the recorded informations were only anatomical. With highly specific settings, diffusion tensor imaging DTI gives very precise information on cerebral white matter organization and integrity.
Therefore using DTI, authors compared cerebral microarchitecture in a group of patients with CSB and a group of appealed control participants. In parallel, informations were recorded from both groups through standardized questionnaires dealing with 1 intensity of symptoms of the CSB; 2 intensity of different traits related to impulsivity; and 3 skills regarding emotional regulation. In this task, they were asked to push a button when a given letter appeared on a screen, hereafter called the target letter.
This first version of the task was dedicated to evaluate the intensity of impulsivity. This second version of the task was dedicated to measure inattention of participants by measuring omission errors when they omit to left click on the mouse for a target letter occurrence.
The results of this study were very interesting. Regarding impulsivity, patients with higher impulsivity scores as measured by standardized questionnaires were more sensitive to negative emotions. Regarding anatomical data, two different types of analyses have been performed.
These results were changing a little bit when correlational analyses were performed between anatomical and cerebral data: a negative correlation was demonstrated between anatomical parameters and either impulsivity or negative emotion sensitivity for the inferior frontal cortex.
How to interpret these results? Firstly, these results demonstrate that CSB shares a lot of properties with other impulsivity control disorders such as kleptomania, pathological gambling, and alimentation disorders. Thanks to the Go-noGo behavioral task, a higher level of impulsivity was reported in patients with CSB than in control participants.
These results are in accordance with those demonstrated in patients with compulsive obsessional troubles as reported in a recent study using the same behavioral task in a group of patients depicting trichotillomania as compared to controlled participants Chamberlain et al. The cerebral side was also explored in terms of anatomy and processes. The anatomical data did not support the first hypotheses of the authors.
These results were different than those of previous studies reporting a disorganization of the inferior frontal cortex in other categories of impulsivity disorders Grant et al. Although no significant results were reported, some preliminary tendencies regarding anatomical data appeared.
DTI indexes variations were reported for the superior frontal lobe between patients and control participants that supports an alteration of axons within this region. For neuroimaging, a very interesting approach is to perform correlational analyses between neuroimaging and behavioral data. For this specific study, authors demonstrated a correlation between impulsivity measures and white matter troubles for the inferior frontal gyrus.
Similar results were demonstrated in studies dealing with compulsive obsessional disorders. As explained above and as postulated by Eli Coleman , CSB would be a partial response to negative affects such as depression or anxiety. Such an hypothesis is in accordance with responses reported in patients with higher ratings on a negative emotional scale and with behavioral and anatomical data recorded more generally in anxious troubles.
As mentioned above, anatomical data would support CSB more as an obsessional compulsive behavior than an impulsivity control disorder. Clinically, this type of addiction raises the problem of its screening. Indeed, to consult a therapist because of a too intense sexual like is not trivial. Moreover, the denial of the problems related to this kind of behavior, avoidance of suffering of depressive symptoms associated with a personal questioning do not help much these patients to consult a therapist.
When a therapeutic process begins, it will promote a flexible but robust therapeutic setting so that the patient gradually learns to keep a rhythm that is to say, also invest in the therapeutic relationship rather than to go from on therapist to zap from one therapist to another one as soon as frustration is felt.
Emotional reactions on edge, acts, or acting out often make it difficult to develop a good psychic elaboration. Carnes a , b was the first to develop a behavioral method based on the 12 steps of Anonymous Alcoholics that aims to rehabilitate these individuals.
The method is quite simple: it offers targeted groups complete abstinence regarding sexual behavior. Other authors such as Earl developed care programs in the same direction. Schneider highlighted the difficulty of these individuals to stop their behavior: the individual suffers from the same withdrawal symptoms as the one who continues to consume alcohol and drugs such as anxiety, insomnia, tremors, headache, and a depressive syndrome.
This simple idea has some merit to attract patients, who, desperate and alone, then have a new challenge to overcome. Indeed, abstinence will be able to afford to give, eventually, relief to a later love affair, which would — before — not resist to the temptation to change automatically because the other, that is, the partner, did not exist as such , but is the internal psychic structure really modified by this conditional abstinence?
The challenge for an analytical therapy is not to focus on the symptom. This type of care in the sense that such treatment will involve to be confronted to difficult life episodes, scarrying when it comes to open conflict and painful memories for consciousness. Moreover, as for some borderline states, the analytical cure for sex-addicts often reveals a great difficulty in remembering the past, which does not facilitate the elaboration processes. Behaviorally, which is implicitly aimed in the cure is learning a relationship with the other.
Within the model of the therapeutic relationship stable, rhythmic, challenging , the subject will learn a relational kind of consistency that he will be able to appreciate and incorporate the side of his emotional and sexual life. These psychotherapies may, depending on the intensity of pain experienced, be coupled with a medical care. On the pharmacological side, treatments are various and depend largely on their effect on the patient: anticonvulsant molecules, hormonal therapy-reducing libido, serotoninergic antidepressants clomipramine or selective inhibitors of serotonin reuptake , mood stabilizers and anxiolytics can be prescribed.
Inhibitory hormonal therapy often designed as castrating is usually reserved for a forensic use. A recent study by Gulsun et al. On the neurobiological side, as shown by the data discussed in this article, the investigation of the role of the brain in emotions and motivations remained for a long time out of the range of cognitive neuroscience. A fortiori, it took a decade after the discovery of an imaging technique such as functional MRI to see the first studies on male sexual behavior appear.
Although developing exponentially, the field remains largely unexplored for healthy sexual behavior. For sexual addiction, neuroscientists still have little data. However, these data are encouraging and suggest that the disorder observed on the behavioral side resonates with that observed on the neural side. The sexual affiliation model and its associated troubles could become one of the most second working model for the convergence and the dialog between psychoanalysis and neuroscience.
Clinical and scientific advances in this topic are of great interest for other fields sociology, anthropology, epidemiology, and public health in terms of their impact in reducing risk for HIV prevention. The authors have not received any funding or benefits from industry or elsewhere to write this review.
National Center for Biotechnology Information , U. Journal List Socioaffect Neurosci Psychol v. Socioaffect Neurosci Psychol. Published online Jan Author information Article notes Copyright and License information Disclaimer. Email: rf. Accepted Nov 4. This article has been cited by other articles in PMC. Abstract Sexual motivation is a fundamental behavior in human. Keywords: brain, fMRI, sexual affiliation. Elements of psychopathology Phenomenological psychopathology of addictive sexuality From the phase of searching up until the actual sexual activity, the subjects concerned may feel some benefits: reassurance, well-being, an almost manic excitement, a narcissistic shoring-up, and sensations of pleasure.
Time immobilized by the repetition compulsion From the point of view of temporality, the sex-addict suffers from a repetition compulsion, often giving him an impression of a stagnant temporality that is not open toward the future. How to live without belief? The space of the backrooms If addictive sexuality is a disorder that is easier to live with in big cities than in the countryside, this is in part due to the strong urban implantation of various venues dedicated to sexual encounters: clubs, bars, baths and saunas, cruising areas , prostitution zones, sex shops, and so on.
Denial Complementary to splitting and shored up by it, denial permits the exclusion of the field of consciousness and facilitates the isolation of those representations or affects that are not in keeping with the ideal self-image. Idealization, omnipotence, and devalorization The mechanism of idealization functions in a way that is complementary to splitting.
Anaclitic anxieties and their avoidance From a relationship point of view, addictive sexuality can be understood as a phobic strategy that allows one to avoid any real encounter with others. Comorbid disorders and risk taking Other dependencies During sexual activity, drugs may be used by the more dependent subjects: poppers, GHB, or Gamma Butyrolactone GBL , cocaine, crystal, hashish, and so on. Masked depression Depression often constitutes the backdrop on which sexually addictive behavior is constituted and chronicized.
Research in neurobiology In this chapter, it is interesting to summarize some recent studies issued from cognitive neuroscience that investigated human male sexual behavior in general and, for some of them, its compulsive practice.
Recent advances from neuroimaging studies From now several decades, the growing development of neuroimaging techniques shed light on brain processes with a new angle. Two emerging fields within cognitive neuroscience: affective and social neurosciences The above-developed perspective is now extending to the topic of emotions. Sexual affiliation: a functional context between affective and social neurosciences At the moment, an exponential number of scientific studies investigates the neural correlates of human male sexual arousal.
Contemporary data on healthy human male sexual function To understand the present assumptions of neuroscience on the neural networks that could be involved in sexual addiction, it is necessary to present some interesting recent results on the role of the brain on healthy human male sexual motivation. Open in a separate window. Exploratory data on CSB The exploration of the neural networks involved in healthy human sexual behavior through modern neuroimaging techniques remains recent, centered on healthy human male sexual motivation.
Therapeutic Clinical and therapeutic difficulties Clinically, this type of addiction raises the problem of its screening. Behavioral individual or group SAA therapies Carnes a , b was the first to develop a behavioral method based on the 12 steps of Anonymous Alcoholics that aims to rehabilitate these individuals.
Issues of psychodynamic therapies The challenge for an analytical therapy is not to focus on the symptom. Pharmacological aspects On the pharmacological side, treatments are various and depend largely on their effect on the patient: anticonvulsant molecules, hormonal therapy-reducing libido, serotoninergic antidepressants clomipramine or selective inhibitors of serotonin reuptake , mood stabilizers and anxiolytics can be prescribed.
Conclusion On the neurobiological side, as shown by the data discussed in this article, the investigation of the role of the brain in emotions and motivations remained for a long time out of the range of cognitive neuroscience. Conflict of interest and funding The authors have not received any funding or benefits from industry or elsewhere to write this review. A role for somatosensory cortices in the visual recognition of emotion as revealed by three-dimensional lesion mapping.
Journal of Neurosciences. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. Journal of Sex Research. The mislabeling of sexual impulsivity. Journal of Sex and Marital Therapy. Is empathy-induced helping due to selfother merging? Journal Personality Social Psychology.
Action observation activates premotor and parietal areas in a somatotopic manner: An fMRI study. European Journal of Neurosciences. Impaired recognition and experience of disgust following brain injury. Nature Neuroscience. The sexual addiction. Minneapolis: CompCare Publications; Contrary to love: Helping the sexual addict.
Center City, MN: Hazelden; a. Minesota: CompCare Publishers; b. New York: Bantam; Out of the shadows: Understanding sexual addiction. Center City, MN: Hazelden; C, Mazziotta J. C, Lenzi G. Neural mechanisms of empathy in humans: A relay from neural systems for imitation to limbic areas. R, Fineberg N. A, Blackwell A. D, Clark L, Robiins T. W, Shahkian B. The syntheses and selection process was performed by the first author. Studies that met the criteria were read twice to ensure accurate inclusion and topic relevance.
Uncertainty was resolved with the second author. After synthesis of full-text articles, nine studies that documented the treatment of OSA were identified see Fig. The measurement of compliance followed a two-point grading system, similar to the system used by King et al. In terms of the methodological approach for each study, the CONSORT checklist assessed whether any of the nine included studies reported i a structured summary of design, methods, and results; ii the eligibility criteria for participants; iii concise details of the intervention; and iv a justification for the sample size.
Although failure to report such details resulted in lower levels of compliance as highlighted in the CONSORT, the studies were not excluded. As noted above, nine studies that reported treatment outcomes for OSA were identified. The summaries of findings among the studies were reported using the ESRC synthesis guidebook for reviews with its prime focus on the effectiveness of the intervention [ 47 ].
Key characteristics of each included study are summarized in Table 1. Subgroup analysis involved the drawing up of clusters by identifying groups and relationships between emerging theme similarities. Findings were organized so heterogeneity and homogeneity between study variables could be examined more closely. This enabled the evaluative process of assessing the differential impacts of treatment for online sex addiction. More specifically, the subgroup analyses were undertaken so that interactions between treatment outcomes could be better explored and thus determining the efficacy of the intervention provided.
The four main differences between study variables included i type of design, ii assessment, iii definition and diagnosis, and iv types of treatment approaches. This was the primary reason for as to why meta-analysis was not performed. Often, specific inclusion criteria are sought at the initial stages of the review in order to reduce significant differences among studies. Given the limited number of studies implementing interventions for OSA, the approach to the current review was exploratory and was to generate as much evidence as possible prior to the refinement and exclusion process.
The main heterogeneous variables are outlined below. The total number of participants in the nine studies was four females. All studies used a range of self-report measures to assess for OSA and associated psychological distress. A self-report measure of consequences associated with compulsive pornography use was used in one of the studies [ 64 ]. All nine included studies referred to the negative consequences associated with OSA use in their introductory sections, but the operational definitions of OSA used to diagnose all varied to some degree.
Crosby used self-selected criteria to define compulsive pornography use that encompassed substance use disorders, impulse control, and obsessive-compulsive spectrum disorder. The variation of definitions adopted in each study could potentially have had an impact in the ways in which OSA was diagnosed.
Studies considered for the final analysis were based on the implementation and administration of a treatment intervention for OSA among the adult population. However, the types of treatment provided varied from study to study. For example, Bhatia et al.
Orzack and Ross [ 39 ] reported a number of therapeutic modalities i. The most occurring therapeutic treatment administered among the studies was CBT in various forms e. Further details on treatment interventions i. With regard to risk e. Treatment seekers were informed that a report is required in those cases in which clients might be at risk to both self and others i.
A number of trends were identified within recurring variables during the analysis process between the included studies. Grouping analyses allowed for identification of the most common and recurring variables across all nine studies. These were then grouped based on their similarities. Recurring outcome variables were categorized into psychological and behavioral outcomes to identify the studies based on whether they measured psychological factors, behavioral factors, or both, relating to the efficacy of treatment for OSA.
Significant improvements in overall psychological function following the implementation of a treatment intervention were reported in all studies. Orzack and Ross [ 39 ] and Sadiza et al. Orzack et al. Similarly, Crosby reported improvements in overall psyche and spirituality.
Two studies [ 58 , 61 ] also reported some reduction in obsessive thoughts alongside psychological distress associated with OSA. Eight studies reported significant reductions and preoccupations e. Additionally, Elmore [ 57 ] reported there was greater risk reduction i. Finally, Crosby, Orzack et al. Although the two studies did not assist in the reduction of online sexual behaviors, they did report symptom changes that accompanied the behaviors e.
While all studies outlined impacts of treatment, respectively, none of them identified specific treatment goals in psychological therapy. These analyses are summarized in Table 2. This present paper sets out to systematically explore current treatment interventions available for OSA identified and reported in the psychological literature. Participants across the studies were diagnosed with both online and offline sexual addiction along with other sub-types that included compulsive masturbation and online pornography use.
Those with OSA had undergone various treatment regimes in order to reduce symptoms that were associated with their sexually compulsive behaviors. In addition, it is essential to point out that OSA can be considered a genuine problem and this has been evidenced in the studies that implemented a treatment of some kind to those where it has had significant impact upon their lives. The main findings of this review provided significant support towards the need of the implementation of treatment interventions and empirically supported treatment models for adults that report with hypersexual behaviors online and the level of risk that is associated with it.
Only one of the studies that met the study inclusion criteria included a randomized control design. Most of the studies failed to describe adequate justification for their sample size and did not provide calendar dates of recruitment and intervention.
Interventions for OSA varied considerably across the included studies, with the majority of studies employing both pharmacological interventions and psychological therapy. However, none of the studies identified treatment goals, thus making it unclear as to whether what the overall target of therapeutic success was.
Psychotropic and therapeutic duration provided significant variance across each study. Furthermore, it must be noted that two out of nine studies were based on single cases that make it even more difficult to reach any definitive conclusions regarding efficacy. Carnes [ 67 ] highlighted that the first point of contact for treatment is typically with a physician.
This was evidenced in Bhatia et al. Treatment studies into OSA also highlighted that CBT—based on a very small number of studies—appears to be the most effective form of treatment for problematic habitual sex individually and in a group format in helping build awareness and aiding in reduction of online sexual behaviors. As highlighted by Weiss [ 68 ], a behavioral addiction warrants a behavioral treatment.
However, the two studies that employed ACT as a treatment method also highlighted that ACT can be as effective and future studies could feasibly compare both treatment methods with a control group to generate more evidence for OSA. Despite the lack of cohesiveness among researchers, all studies sought to explain OSA, and that treatment could be influenced in the way such a disorder is defined and therefore diagnosed.
Given that OSA can arguably be explained from two viewpoints i. This is one way in which treatment perhaps could be more strengthened. Furthermore, as highlighted by Hardy et al. However, participant perceptions of recovery and retrospective ratings of symptoms do have considerable validity as measures of important aspects of treatment efficacy and recovery [ 70 , 71 ].
The empirical research presented in the presented review provides a number of avenues for future treatment interventions to be designed in the area of OSA. The first concerns should address gender, although the present review identified only four women that sought treatment for OSA.
The previous literature [ 28 , 30 ] has reported that women, more likely than men, engage in such activities. Overall, the studies presented in this paper have highlighted that there are key differences among those who experience online sexual activities in a healthy manner than to those for which cybersex is becomes an addiction and consequently seek treatment.
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