Internet-Administered Cognitive Behavioral Therapy for Hypersexual Disorder, with or Without Paraphilia(s) or Paraphilic Disorder(s) in Men: A Pilot Study

Abstract

Background Hypersexual disorder (HD) is a condition in which the individual experiences loss of control over engagement in sexual behaviors, leading to negative effects on various areas of life. Paraphilias often present concomitantly with HD, and although cognitive behavioral therapy (CBT) has been proven to reduce engagement in hypersexual behavior, no studies have investigated the effects of Internet-administered CBT (ICBT) on HD, with or without paraphilia(s) or paraphilic disorder(s). Aim To investigate the effects of Internet-administered CBT on HD, with or without paraphilia(s) or paraphilic disorder(s). Methods Male participants (n = 36) evaluated positive according to the proposed diagnostic HD criteria, with or without paraphilia(s) or paraphilic disorder(s), received 12 weeks of ICBT. Measures were administered weekly over the treatment period, with an additional follow-up measurement 3 months after completion of treatment. An assessment interview was performed 2 weeks after treatment. Outcomes The primary outcome was the Hypersexual Behavior Inventory (HBI-19), and secondary outcomes were the Hypersexual Disorder: Current Assessment Scale (HD:CAS), the Sexual Compulsivity Scale (SCS), as well as a tentative composite of 6 Severity Self-rating Measures, for Paraphilic Disorders and depression (Montgomery-Åsberg Depression Rating Scale [MADRS-S]), psychological distress (Clinical Outcomes in Routine Evaluation Outcome Measure [CORE-OM]), and treatment satisfaction (CSQ-8). Results Large, significant decreases in HD symptoms and sexual compulsivity were found, as well as moderate improvements in psychiatric well-being and paraphilic symptoms. These effects remained stable 3 months after treatment. Clinical Implications ICBT can ameliorate HD symptoms, psychiatric distress, and paraphilic symptoms, which suggests that the ICBT for HD, with or without paraphilia(s) or paraphilic disorder(s), may constitute a valuable addition of treatment options in clinical settings. Strengths and Limitations This is the first study evaluating the efficacy of ICBT on a sample of men suffering from HD. In addition, a proportion of the sample reported concomitant paraphilic interests and disorders, thus mirroring an everyday clinical practice in the field of sexual medicine. No control group was assigned, and some of the outcome measures are still to be validated. The long-term effects of ICBT and its efficacy in hypersexual women are unknown. Conclusions This study gives support for ICBT as an effective treatment option for HD. Future evaluations of the treatment program should include women and larger samples in randomized controlled procedures and investigate the long-term effects.

Emerging experience with selected new categories in the ICD‐11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

“…In terms of treatment of the disorder, there have been several relevant advances since earlier reviews on the topic 280,281 . Randomized controlled trials have been conducted using a 7-week CBT group intervention 282 as well as Internet-administered CBT 283 , both of which showed significant reductions in symptoms as compared to waitlist control groups. Individuals treated with acceptance and commitment therapy reduced their Internet pornography use as compared to a waitlist control 284 , as did participants in a CBT-based self-help intervention 285 .…”

“…Since the inclusion of compulsive sexual behaviour disorder in the ICD‐11 was proposed, there has been a major expansion of research in this area 227 . A good deal of the early research was based on a conceptualization of “sex addiction” 242 , that later began to shift to a discussion of compulsive sexual behaviour, that does not entirely map to ICD‐11 compulsive sexual behaviour disorder 291,258‐297 , or simply “problematic sexual behaviours” 298 or “problematic pornography use” 299 . A good deal of the research in the past several years has focused on “hypersexuality” e.g., 301,302 , although this has only occasionally been operationalized as hypersexual disorder as it had been proposed for DSM‐5.…”

A Literature Review of Sexual Deviation

“…Terdapat beberapa cara yang dapat dilakukan untuk menangani sexual deviation beberapa diantaranya adalah melalui penanganan berbasis behavioristik seperti Cognitive Behavior Therapy (Hallberg et al, 2020, Harrison et al, 2020, satiation, covert sensitization, odor aversion dan bentuk lain seperti family therapy atau secara medis seperti SSRI (Andrasik, 2006). Menurut Harrison et al (2020 salah satu bentuk penanganan yang paling efektif untuk menangani perilaku pelanggar seksual adalah melalui CBT (Cognitive Behavior Therapy).…”

“…Penanganan CBT harus memperhatikan aspek kognisi dan perilaku yang berbeda-beda pada masing-masing individu agar individu dapat ditangani secara sesuai dan hasilnya efektif. Lebih lanjut, Hallberg et al (2020) menunjukkan bahwa ICBT (Internet-Administered Cognitive Behavioral Therapy) dapat menurunkan gejala hypersexual disorder (HD) dengan atau tanpa parafilia. ICBT sama seperti CBT dengan tujuan untuk merekonstruksi pikiran-pikiran yang menyimpang dan menenangkan pikiran dengan melakukan mindfulness.…”

Zwanghaftes Sexualverhalten – Welche Rolle spielen sexuelle Grenzverletzungen und Paraphilien

“…Grundlegend für den Therapieerfolg ist daher eine offene, nichtverurteilende Haltung der Therapierenden auch bezüglich der Inhalte sexueller Fantasien und Verhaltensweisen. Grund zur Hoffnung auf eine erfolgreiche Behandlung besteht spätestens, nachdem erste Ergebnisse eine Reduzierung von ZS und paraphiler Problematik nach onlinebasierter kognitiver Verhaltenstherapie zeigen (Hallberg et al 2020).…”