Hands-off: Feasibility and preliminary results of a two-armed randomized controlled trial of a web-based self-help tool to reduce problematic pornography use

Abstract

Background and Aims Despite problematic pornography use (PPU) being prevalent, no previous study has examined the effectiveness of evidence-based interventions for PPU, using rigorous methods. Using a two-armed randomized controlled trial study design, we examined the feasibility and initial effectiveness of a six-week online PPU intervention. Methods We recruited 264 participants (3.8% women, M age = 33.2, SD = 10.6) who were randomized and assigned to either the self-help intervention (n = 123) or waitlist control condition (n = 141), and completed self-report questionnaires at baseline and after the end of the intervention (six-week follow-up). Multivariable linear regression models were generated and tested on a complete case basis to investigate possible treatment effects. Participants provided quantitative and qualitative feedback regarding the intervention’s content and appearance. Results Participants evaluated all modules positively in the intervention in general. There were differential dropout rates (89.4% in intervention vs. 44.7% in control group) with an overall follow-up rate of 34.5%. The intervention group reported significantly lower levels of PPU (P < 0.001, d = 1.32) at the six-week follow-up. Moreover, they reported lower pornography use frequency (P < 0.001, d = 1.65), self-perceived pornography addiction (P = 0.01, d = 0.85), pornography craving (P = 0.02, d = 0.40), and higher pornography avoidance self-efficacy (P = 0.001, d = 0.87) at the six-week follow-up. Discussion and Conclusions The present study was only a first step in rigorous treatment studies for PPU, but the findings are promising and suggest that online interventions for PPU might help reduce PPU in some cases, even without the guidance of therapists, by reducing treatment barriers.

Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review

“…There were 2 studies for internet reduction that reported an average of 5.5 hours of screen time per day [ 52 , 53 ]. The average frequency of engagement was 6 times per week [ 20 , 45 , 46 ], with 2 studies involving gamblers reporting a frequency of 13 times a month for internet gambling [ 54 ] and another study reporting 62 sessions a month for online poker [ 55 ].…”

“…Eight studies (ten arms) reported the delivery of cognitive restructuring [ 45 , 51 , 54 , 55 ], cognitive bias modification (CBM) [ 47 , 50 ], exposure therapy [ 49 ], or mindfulness [ 53 ]. Cognitive restructuring prompted participants to identify, challenge, and replace automatic negative thoughts associated with gaming, gambling, pornography, and nonspecified internet use.…”

“…Six studies (eight arms) delivered problem solving [ 45 , 48 , 52 ], relapse prevention [ 45 , 48 , 51 , 55 ], or social skills training [ 54 ]. Problem solving prompted participants to identify high-risk situations or triggers that were barriers to sustained behavior change.…”

“…Five studies (five arms) reported the delivery of stimulus control [ 46 , 53 , 56 ], behavioral substitution [ 45 ], or self-monitoring [ 45 , 48 ], and five studies (five arms) delivered social support [ 45 , 48 , 52 , 54 , 55 ]. Stimulus control involved periods of exclusion from online gambling venues or reducing prompts, inclusive of removing notifications, placing the phone out of sight, or turning it off and establishing phone-free periods during the day (eg, before sleep).…”

Internet-based interventions for behavioral addictions: A systematic review

“…Pornography use disorder. For pornography use disorder, Bőthe, Baumgartner, Schaub, Demetrovics, and Orosz (2021) assessed one internet-based intervention, which consisted of CBT in combination with MI. The intervention provided participants with modules targeting the identification of risk situations, behavioral activation, identification of triggers, and challenging automatic negative thoughts.…”