Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms in Regular Pornography Users: A Randomized Controlled Study

Differences in cross-sectional and daily diary problematic pornography use correlates

Background

Most problematic pornography use (PPU) research relies on cross-sectional designs. Ecological momentary assessment (EMA) studies are needed to better understand PPU correlates. We evaluated how daily PPU and pornography use ratings were correlated with baseline PPU, pornography use frequency (over 12-months), alcohol problems, and depression in a community sample of men living in the United States.

Design

Participants (n = 113, mean age 37.95 [11.09]) completed a baseline survey battery followed by daily EMAs over 14 days (k = 1,240 observations). Data were gathered on the Prolific panel.

Findings

Screener thresholds suggested 32%, 25%, and 24% of sample were at-risk for PPU, depression, and alcohol use problems respectively. Baseline estimates suggested PPU to be weakly correlated with depression (r = 0.29) and past 12-month pornography use (r = 0.27), but not alcohol problems (r = 0.08). Multilevel modeling indicated aggregated pornography use amount as a robust correlate of aggregated pornography control problems over the observation period. Baseline PPU and pornography use indicators were significant predictors of aggregated control problems and pornography use amount respectively. Baseline depression and alcohol problem predictors were non-significant. Past 12-month pornography use frequency and depression scores exacerbated the relationships between daily pornography use amount and aggregated control problems. Sensitivity analyses specific to only those who used pornography across all observations were consistent with full model results (though effect strength changed).

Conclusions

With exception to the PPU and pornography use indicators, cross-sectional baseline estimates (e.g., alcohol problems and depression) were generally not predictive of aggregated pornography use and control problems in the following 14 days.

Investigating mood-modification, withdrawal, and sensitization in compulsive sexual behaviour

Background and aims

Compulsive Sexual Behaviour (CSB), defined as a persistent failure to control repetitive sexual impulses, has been discussed as a pathological phenomenon for centuries. Various terms, such as excessive sexual behaviour, hyper-sexuality, compulsive sexual behaviour disorder (CSBD), or sexual addiction (SA), have been used to describe it, contributing to ongoing debates about its theoretical framework. The following three studies aim to empirically assess whether CSB exhibits key elements of behavioural addiction (mood-modification, sensitization/tolerance, and withdrawal).

Method

Three studies, involving participants with and without CSB, were conducted. The mood-modification hypothesis was tested by exposing participants to short films inducing positive, negative, and emotionally neutral moods, followed by an evaluation of their craving for pornography. To test the sensitization hypothesis, participants viewed short films with varying levels of explicit sexual stimuli, and their level of actual wanting and liking were assessed through self-reports. For the withdrawal hypothesis, participants underwent a 10-day sexual abstinence, with self-reports of various symptoms, collected on pre-intervention, 3rd, 7th, and 10th days.

Results

Contrary to previous studies of addiction, CSB participants didn't show increased craving to mood induction and negative mood actually decreased craving for pornography. Secondly, they showed wanting to explicit sexual stimuli although it was not increased with explicitness. Finally, they demonstrated reduced withdrawal symptom during abstinence.

Conclusion

The results of this study provide conflicting results concerning the model of behavioural addiction. There is supporting evidence for wanting in response to explicit pornography stimuli although it was not associated with increased explicitness. There is also evidence for reduced withdrawal during abstinence. Finally, there was no evidence that mood modification increases craving for pornography, negative mood actually decreased craving. Further research is needed to test the various models of CSB.

Withdrawal-like Symptoms in Problematic Pornography Use: A Scoping Review

OBJECTIVES

There is still debate whether problematic pornography use (PPU) can be understood as an addictive disorder, and little is known about withdrawal-like symptoms in these patients. Therefore, our aim was to summarize the existing scientific literature about this topic in the format of a scoping review.

METHODS

Potentially eligible references were retrieved from 6 databases (MEDLINE/PubMed, Web of Science, Embase, PsycINFO, LILACS, and SciELO) up to February 7, 2023. Studies were included if they reported original data about withdrawal-like symptoms in individuals with PPU. Studies investigating child pornography use, or in which it was not possible to extract data of interest were excluded. Data extracted from included studies and their quality assessment were described narratively.

RESULTS

A total of 937 references were retrieved, and 14 studies were included (n = 31,009 participants). According to our results, cravings were intense in most cases and frequent reasons for relapse. The proportion of participants experiencing other withdrawal-like symptoms (mental, sexual, and physical symptoms) reached up to 72.2% in the cross-sectional studies with this information available. Severity of withdrawal symptoms was associated with severity of PPU and frequency of pornography use. In some studies, measures of withdrawal symptoms were considered central symptoms of PPU and were significantly higher in individuals considering treatment. Masturbation was reported to alleviate withdrawal-like symptoms in some cases.

CONCLUSIONS

There is preliminary evidence for the existence of withdrawal-like symptoms in PPU. Future studies should investigate onset, characteristics, duration, and proportion of withdrawal-like symptoms in PPU with robust methodology, also investigating potential confounding variables.

Clarifying and extending our understanding of problematic pornography use through descriptions of the lived experience

Problematic pornography use (PPU) is a complex and growing area of research. However, knowledge of the PPU lived experience is limited. To address this gap, we conducted an online qualitative study with 67 individuals who self-identified as having problematic pornography use (76% male; Mage = 24.70 years, SD = 8.54). Results indicated several dimensions that have not been fully explored in the literature. These included various mental and physical complaints following periods of heavy pornography use, sexual functioning deficits with real partners, and a subjectively altered state of sexual arousal while using pornography. Moreover, we expanded on current knowledge regarding the inner conflict associated with PPU and clarified the ways that users can progress to increasingly intensified patterns of pornography use, such as tolerance/escalation and pornographic binges. Our study highlights the complex and nuanced nature of PPU and provides suggestions for future research and clinical practice.