The Best Treatment for Out-of-Control Sexual Behavior

Some people—overwhelmingly, men troubled by emotional stress—believe their sexual behavior is out of control. The chief sign of this is self-sexing while viewing pornography. What frequency of porn-fueled solo sex suggests being out of control? That’s debatable. Some say any self-pleasuring to any porn signifies a real problem. However, virtually all men engage in solo sex while watching porn: It’s a common way men self-soothe to cope with daily stresses. Canadian researchers wanted to compare the sexual attitudes of men who did or did not self-sex to porn, but they couldn’t find any who hadn’t.

Men disturbed by their porn habits often call themselves “sex addicts.” Quite often, their partners, and a small minority of mental health professionals, also use the term sex addict. But the large majority of psychologists and psychiatrists reject the very idea of sex addiction as poorly informed about sexuality. The latest edition of the bible of mental health conditions, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5, 2013) says there’s no such thing as sex addiction. The purported condition does not meet standard medical and psychological criteria for addiction. There is no professional consensus on its symptoms, diagnosis, and treatment. And quite frequently, men who label themselves sex addicts don’t watch any more porn than most other men; they just feel more distressed about it, usually because of upbringings in families and religious communities that demonized self-sexing and men’s favorite visual aid while having sex with themselves.

Sex addiction is fiction, but a substantial cottage industry has developed to treat it. Some residential facilities charge more than $30,000 a month—and health insurance rarely covers it. Evidently, there's a good deal of money to be made treating a condition most mental health professionals don’t even recognize as real.

Meanwhile, some men continue to feel absolutely convinced their sexual behavior is out of control. What should they do? A growing body of research shows that the most cost-effective approach is cognitive-behavioral therapy (CBT).

What Is CBT?

In Hamlet (II:2), Shakespeare summed up cognitive-behavioral therapy quite succinctly: “There is nothing either good or bad, but thinking makes it so.” “Cognitive” refers to thinking. CBT says that you may not be able to change the challenges life hands you, but you can change how you think about them. Changing the story you tell yourself allows you to correct false beliefs that cause torment, and detoxify how you react to life’s stresses.

Say you miss a plane. You might think: This is a disaster. My life is ruined. Or you might think: Oh, I missed my flight. What a drag. But there are others. I’ll rearrange my calendar. The “disaster” scenario evokes what CBT therapists call “catastrophizing"—overstating problems, and making mountains of molehills. Catastrophizing is associated with irritability, stress, anxiety, depression, insomnia, and increased blood pressure, a key risk factor for heart disease and stroke. The “molehill” perspective is the way to go. It’s more accurate, and it’s not linked to distress. CBT teaches how to recognize catastrophizing and correct the flawed thinking that produces it. This reduces anxiety and any associated acting out, including anxiety-fueled self-sexing to porn.

Sexual catastrophizing includes these mistaken ideas:

• Sexual thoughts and fantasies are wrong, harmful, or sinful.
• Only bad people self-pleasure.
• Porn is evil.

CBT therapists correct and de-catastrophize them:

• There’s nothing wrong with sexual thoughts and fantasies. Everyone has them. They’re perfectly normal. They’re a key element of great sex. So accept your thoughts and control your actions.
• Almost everyone self-sexes, particularly men who feel stressed. Unless it interferes with life responsibilities or partner lovemaking, there’s nothing wrong with it, even daily or more.

• Porn is not evil. It’s a cartoon version of men’s fantasies of effortless sexual abundance. Virtually every Internet-connected man on Earth has seen porn, hundreds of millions frequently, many daily. It’s okay to watch—with or without self-sexing.

The Biggest, Best Study Yet

Swedish researchers recruited 137 adult men who said their sexual behavior was out of control, and divided them into two groups. Half remained on a wait list. The other half participated in seven 2.5-hour CBT sessions over seven weeks (17.5 hours total). The CBT group learned that it’s fine to have sexual thoughts and fantasies, even several times a day. The therapists also informed them that it’s fine to engage in solo sex, even frequently, and that religious prohibitions against masturbation are not grounded in science. And they learned that men from all walks of life use porn to enhance self-pleasuring, which is almost always fine. The wait-list group reported slightly reduced sexual distress, while still considering themselves out of control. But in the CBT group, sexual anguish plummeted—and so did the men's anxiety-fueled porn-watching. It remained low six months later. And they no longer thought of themselves as out of control.

The Swedish report is the largest, most scientifically rigorous study to date of CBT for out-of-control sexuality. But it’s far from the only one:

• Other Swedish scientists used CBT to treat men for severe anxiety caused by self-sexing to porn. After seven sessions (17 hours total), their distress declined significantly. So did their porn viewing and their need for self-sexing. Both remained lower six months later.
• Utah State University researchers assessed the Internet porn viewing of adult men who said it had destroyed their quality of life. The men participated in eight 90-minute sessions of an offshoot of CBT: acceptance and commitment therapy (ACT; 12 hours total). Afterward, their anxiety decreased significantly and so did their viewing and self-pleasuring. Both remained low three months later.
• A Harvard researcher recruited 28 adult men in distress because of pornography viewing. Some were placed on a wait list. The rest received 12 sessions of ACT. The wait-list group showed scant change in porn viewing or solo sex, but the ACT group reported significant reductions in both.
• Creighton University investigators took 38 men convinced they were porn addicts to a rustic retreat center for eight days. They spent 32 hours in mindfulness meditation instruction and CBT. Their sexual anxiety, porn viewing, and self-sexing decreased significantly.

Now, some men hold deep religious convictions that demonize sexual thoughts, solo sex, and porn—and CBT may not help them. But for those open to scientific discussions of sexuality, CBT has a proven record of correcting false beliefs about sex and reducing behavior labeled out-of-control, hypersexual, or sex-addicted—usually for a small fraction of the cost of other therapies.

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