Tuesday, September 28, 2010

Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing

In a post a few weeks ago, I blogged about a blog post by Dr. Steven Hayes on a study using Acceptance and Commitment Therapy (ACT), a mindfulness- and acceptance-based treatment, for problematic Internet pornography viewing. I’ve since had a chance to track down and read the study, and I thought I’d write about it today.

Dr. Michael Twohig, a professor at Utah State University, is a pioneer in the use of ACT for obsessive-compulsive disorder. In a talk I saw him give on OCD at a conference in June, I recall him saying he expanded into problematic pornography viewing after he moved to Utah and found it was a big problem there.

Although this study has a small sample—six men—it’s a big step in that it’s not only the first controlled study of the treatment of Internet pornography viewing using ACT, but it’s the first controlled study of any treatment for Internet pornography viewing! According to Twohig and his co-author Jesse Crosby, there are studies of problematic sexual behaviors with treatments such as cognitive behavior therapy and motivational interviewing, but none of these are experimental.

It’s worth noting that although the media uses terms such as “sex addiction” or “porn addiction,” these aren’t technical diagnostic terms. There’s no official diagnosis for someone engaging in excessive pornography viewing. In fact there’s no consensus on how to classify it: some see it as a compulsion similar to OCD, whereas others see it as akin to substance abuse. Twohig and Crosby define “problematic pornography viewing” as: 1.) “viewing pornography more than 3 times per week on some weeks; and 2.) “the viewing causes difficulty in general life functioning.” Although we could quibble with this criteria—why 3 times a week?—it serves the purpose of the study.

Serving as the therapist for all six men, Dr. Twohig treated each with a flexible protocol of 8 weekly, 1.5 hour sessions. Sessions addressed the major ACT processes. Participants practiced mindful awareness and acceptance of inner experiences such as urges and arousal. Between sessions, they committed to engaging in activities in accordance with their values.

At the end of the last treatment session, five of the six showed significant reductions in viewing pornography. At a follow-up three months after treatment ended, two people weren’t viewing pornography at all and three were viewing at significantly reduced levels. (It’s worth noting that the goal of some was abstinence and that of others was reduced viewing.) Only one of the six participants was viewing pornography as often as he was prior to treatment. Overall, participants exhibited an increase in quality of life and decrease in obsessive features and religious-based obsessive thoughts.

One thing I really like about this article is the modesty around some of the conclusions. The authors humbly note although the study did not use behavior therapy or contingency managements, nor did it draw from some of the other interventions that have been associated with pornography viewing (e.g., CBT, MI), these may also be useful. (A major reason the researchers did not draw upon other tools was that they wanted to rely on ACT-specific processes--a bold move in my opinion.) Results do suggest that focusing on mindful acceptance of urges and movement towards meaningful activity may be helpful in reducing pornography viewing. This is the really cool part--rather than focusing not looking at pornography, treatment focused on mindful acceptance of urges and engagement in meaningful activities outside session.

Although larger randomized controlled trials are a next step towards examining the efficacy of ACT in treating problematic pornography viewing, this study is a really important first step in two ways: 1) It's the first controlled experimental study of a treatment for viewing; 2) It suggests that mindful acceptance of one’s experiences may be more helpful in changing behavior than trying to control one’s urges.

For those who are a member of ACBS, the main umbrella organization for ACT, a pre-publication PDF of the article can be downloaded here.

For the full citation:

Twohig, M. P., & Crosby, J. M. (2010). Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing. Behavior Therapy, 41(3), 285-295.

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