Matthias Brand is the head of the department General Psychology: Cognition at the University of Duisburg-Essen (Brand’s team of researchers). Listed below are the neurological studies on porn users, and reviews of the literature/commentaries on porn use/addiction, that Brand and his team have published:
1) Watching Pornographic Pictures on the Internet: Role of Sexual Arousal Ratings and Psychological-Psychiatric Symptoms for Using Internet Sex Sites Excessively (Brand et al., 2011) – [greater cravings/sensitization and poorer executive function] – An excerpt:
Results indicate that self-reported problems in daily life linked to online sexual activities were predicted by subjective sexual arousal ratings of the pornographic material, global severity of psychological symptoms, and the number of sex applications used when being on Internet sex sites in daily life, while the time spent on Internet sex sites (minutes per day) did not significantly contribute to explanation of variance in IATsex score. We see some parallels between cognitive and brain mechanisms potentially contributing to the maintenance of excessive cybersex and those described for individuals with substance dependence.
2) Pornographic Picture Processing Interferes with Working Memory Performance (Laier et al., 2013) – [greater cravings/sensitization and poorer executive function] – An excerpt:
Some individuals report problems during and after Internet sex engagement, such as missing sleep and forgetting appointments, which are associated with negative life consequences. One mechanism potentially leading to these kinds of problems is that sexual arousal during Internet sex might interfere with working memory (WM) capacity, resulting in a neglect of relevant environmental information and therefore disadvantageous decision making. Results revealed worse WM performance in the pornographic picture condition of the 4-back task compared with the three remaining picture conditions. Findings are discussed with respect to Internet addiction because WM interference by addiction-related cues is well known from substance dependencies.
3) Sexual Picture Processing Interferes with Decision-Making Under Ambiguity (Laier et al., 2013) – [greater cravings/sensitization and poorer executive function] – An excerpt:
Decision-making performance was worse when sexual pictures were associated with disadvantageous card decks compared to performance when the sexual pictures were linked to the advantageous decks. Subjective sexual arousal moderated the relationship between task condition and decision-making performance. This study emphasized that sexual arousal interfered with decision-making, which may explain why some individuals experience negative consequences in the context of cybersex use.
4) Cybersex addiction: Experienced sexual arousal when watching pornography and not real-life sexual contacts makes the difference (Laier et al., 2013) – [greater cravings/sensitization and poorer executive function] – An excerpt:
The results show that indicators of sexual arousal and craving to Internet pornographic cues predicted tendencies towards cybersex addiction in the first study. Moreover, it was shown that problematic cybersex users report greater sexual arousal and craving reactions resulting from pornographic cue presentation. In both studies, the number and the quality with real-life sexual contacts were not associated to cybersex addiction. The results support the gratification hypothesis, which assumes reinforcement, learning mechanisms, and craving to be relevant processes in the development and maintenance of cybersex addiction. Poor or unsatisfying sexual real life contacts cannot sufficiently explain cybersex addiction.
5) Cybersex addiction in heterosexual female users of internet pornography can be explained by gratification hypothesis (Laier et al., 2014) – [greater cravings/sensitization] – An excerpt:
We examined 51 female IPU and 51 female non-Internet pornography users (NIPU). Using questionnaires, we assessed the severity of cybersex addiction in general, as well as propensity for sexual excitation, general problematic sexual behavior, and severity of psychological symptoms. Additionally, an experimental paradigm, including a subjective arousal rating of 100 pornographic pictures, as well as indicators of craving, was conducted. Results indicated that IPU rated pornographic pictures as more arousing and reported greater craving due to pornographic picture presentation compared with NIPU. Moreover, craving, sexual arousal rating of pictures, sensitivity to sexual excitation, problematic sexual behavior, and severity of psychological symptoms predicted tendencies toward cybersex addiction in IPU. Being in a relationship, number of sexual contacts, satisfaction with sexual contacts, and use of interactive cybersex were not associated with cybersex addiction. These results are in line with those reported for heterosexual males in previous studies. Findings regarding the reinforcing nature of sexual arousal, the mechanisms of learning, and the role of cue reactivity and craving in the development of cybersex addiction in IPU need to be discussed.
6) Empirical Evidence and Theoretical Considerations on Factors Contributing to Cybersex Addiction From a Cognitive Behavioral View (Laier et al., 2014) – [greater cravings/sensitization] – An excerpt:
The nature of a phenomenon often called cybersex addiction (CA) and its mechanisms of development are discussed. Previous work suggests that some individuals might be vulnerable to CA, while positive reinforcement and cue-reactivity are considered to be core mechanisms of CA development. In this study, 155 heterosexual males rated 100 pornographic pictures and indicated their increase of sexual arousal. Moreover, tendencies towards CA, sensitivity to sexual excitation, and dysfunctional use of sex in general were assessed. The results of the study show that there are factors of vulnerability to CA and provide evidence for the role of sexual gratification and dysfunctional coping in the development of CA.
7) Cybersex Addiction (Brand & Laier, 2015). Excerpts:
Many individuals use cybersex applications, particularly Internet pornography. Some individuals experience a loss of control over their cybersex use and report that they cannot regulate their cybersex use even if they experienced negative consequences. In recent articles, cybersex addiction is considered a specific type of Internet addiction. Some current studies investigated parallels between cybersex addiction and other behavioral addictions, such as Internet Gaming Disorder. Cue-reactivity and craving are considered to play a major role in cybersex addiction. Also, neurocognitive mechanisms of development and maintenance of cybersex addiction primarily involve impairments in decision making and executive functions. Neuroimaging studies support the assumption of meaningful commonalities between cybersex addiction and other behavioral addictions as well as substance dependency.
8) Neuroscience of Internet Pornography Addiction: A Review and Update (Love et al., 2015). A thorough review of the neuroscience literature related to Internet addiction sub-types, with special focus on internet porn addiction. The review also critiques two recent headline-grabbing EEG studies by teams headed by Nicole Prause (who falsely claims the findings cast doubt on porn addiction). Excerpts:
Many recognize that several behaviors potentially affecting the reward circuitry in human brains lead to a loss of control and other symptoms of addiction in at least some individuals. Regarding Internet addiction, neuroscientific research supports the assumption that underlying neural processes are similar to substance addiction… Within this review, we give a summary of the concepts proposed underlying addiction and give an overview about neuroscientific studies on Internet addiction and Internet gaming disorder. Moreover, we reviewed available neuroscientific literature on Internet pornography addiction and connect the results to the addiction model. The review leads to the conclusion that Internet pornography addiction fits into the addiction framework and shares similar basic mechanisms with substance addiction.
9) Integrating Psychological and Neurobiological Considerations Regarding The Development and Maintenance of Specific Internet-Use Disorders: An Interaction of Person-Affect-Cognition-Execution model (Brand et al., 2016). A review of the mechanisms underlying the development and maintenance of specific Internet-use disorders, including “Internet-pornography-viewing disorder”. The authors suggest that pornography addiction (and cybersex addiction) be classified as internet use disorders and placed with other behavioral addictions under substance-use disorders as addictive behaviors. Excerpts:
Although the DSM-5 focuses on Internet gaming, a meaningful number of authors indicate that treatment-seeking individuals may also use other Internet applications or sites addictively….
From the current state of research, we suggest to include Internet-use disorders in the upcoming ICD-11. It is important to note that beyond Internet-gaming disorder, other types of applications are also used problematically. One approach could involve the introduction of a general term of Internet-use disorder, which could then be specified considering the first-choice application that is used (for example Internet-gaming disorder, Internet-gambling disorder, Internet-pornography-use disorder, Internet-communication disorder, and Internet-shopping disorder).
10) Prefrontal control and internet addiction: a theoretical model and review of neuropsychological and neuroimaging findings (Brand et al., 2015) – [dysfunctional prefrontal circuits/poorer executive function and sensitization] – Excerpt:
Consistent with this, results from functional neuroimaging and other neuropsychological studies demonstrate that cue-reactivity, craving, and decision making are important concepts for understanding Internet addiction. The findings on reductions in executive control are consistent with other behavioral addictions, such as pathological gambling. They also emphasize the classification of the phenomenon as an addiction, because there are also several similarities with findings in substance dependency. Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
11) Implicit associations in cybersex addiction: Adaption of an Implicit Association Test with pornographic pictures (Snagkowski et al., 2015) – [greater cravings/sensitization] – Excerpt:
Recent studies show similarities between cybersex addiction and substance dependencies and argue to classify cybersex addiction as a behavioral addiction. In substance dependency, implicit associations are known to play a crucial role, and such implicit associations have not been studied in cybersex addiction, so far. In this experimental study, 128 heterosexual male participants completed an Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) modified with pornographic pictures. Further, problematic sexual behavior, sensitivity towards sexual excitation, tendencies towards cybersex addiction, and subjective craving due to watching pornographic pictures were assessed. Results show positive relationships between implicit associations of pornographic pictures with positive emotions and tendencies towards cybersex addiction, problematic sexual behavior, sensitivity towards sexual excitation as well as subjective craving. Moreover, a moderated regression analysis revealed that individuals who reported high subjective craving and showed positive implicit associations of pornographic pictures with positive emotions, particularly tended towards cybersex addiction. The findings suggest a potential role of positive implicit associations with pornographic pictures in the development and maintenance of cybersex addiction. Moreover, the results of the current study are comparable to findings from substance dependency research and emphasize analogies between cybersex addiction and substance dependencies or other behavioral addictions.
12) Symptoms of cybersex addiction can be linked to both approaching and avoiding pornographic stimuli: results from an analog sample of regular cybersex users (Snagkowski, et al., 2015) – [greater cravings/sensitization] – Excerpt:
Some approaches point toward similarities to substance dependencies for which approach/avoidance tendencies are crucial mechanisms. Several researchers have argued that within an addiction-related decision situation, individuals might either show tendencies to approach or avoid addiction-related stimuli. In the current study 123 heterosexual males completed an Approach-Avoidance-Task (AAT; Rinck and Becker, 2007) modified with pornographic pictures. During the AAT participants either had to push pornographic stimuli away or pull them toward themselves with a joystick. Sensitivity toward sexual excitation, problematic sexual behavior, and tendencies toward cybersex addiction were assessed with questionnaires.
Results showed that individuals with tendencies toward cybersex addiction tended to either approach or avoid pornographic stimuli. Additionally, moderated regression analyses revealed that individuals with high sexual excitation and problematic sexual behavior who showed high approach/avoidance tendencies, reported higher symptoms of cybersex addiction. Analogous to substance dependencies, results suggest that both approach and avoidance tendencies might play a role in cybersex addiction. Moreover, an interaction with sensitivity toward sexual excitation and problematic sexual behavior could have an accumulating effect on the severity of subjective complaints in everyday life due to cybersex use. The findings provide further empirical evidence for similarities between cybersex addiction and substance dependencies. Such similarities could be retraced to a comparable neural processing of cybersex- and drug-related cues.
13) Getting stuck with pornography? Overuse or neglect of cybersex cues in a multitasking situation is related to symptoms of cybersex addiction (Schiebener et al., 2015) – [greater cravings/sensitization and poorer executive control] – Excerpt:
Some individuals consume cybersex contents, such as pornographic material, in an addictive manner, which leads to severe negative consequences in private life or work. One mechanism leading to negative consequences may be reduced executive control over cognition and behavior that may be necessary to realize goal-oriented switching between cybersex use and other tasks and obligations of life. To address this aspect, we investigated 104 male participants with an executive multitasking paradigm with two sets: One set consisted of pictures of persons, the other set consisted of pornographic pictures. In both sets the pictures had to be classified according to certain criteria. The explicit goal was to work on all classification tasks to equal amounts, by switching between the sets and classification tasks in a balanced manner.
We found that less balanced performance in this multitasking paradigm was associated with a higher tendency towards cybersex addiction. Persons with this tendency often either overused or neglected working on the pornographic pictures. The results indicate that reduced executive control over multitasking performance, when being confronted with pornographic material, may contribute to dysfunctional behaviors and negative consequences resulting from cybersex addiction. However, individuals with tendencies towards cybersex addiction seem to have either an inclination to avoid or to approach the pornographic material, as discussed in motivational models of addiction.
14) Sexual Excitability and Dysfunctional Coping Determine Cybersex Addiction in Homosexual Males (Laier et al., 2015) – [greater cravings/sensitization] – Excerpt:
Recent findings have demonstrated an association between CyberSex Addiction (CA) severity and indicators of sexual excitability, and that coping by sexual behaviors mediated the relationship between sexual excitability and CA symptoms. The aim of this study was to test this mediation in a sample of homosexual males. Questionnaires assessed symptoms of CA, sensitivity to sexual excitation, pornography use motivation, problematic sexual behavior, psychological symptoms, and sexual behaviors in real life and online. Moreover, participants viewed pornographic videos and indicated their sexual arousal before and after the video presentation. Results showed strong correlations between CA symptoms and indicators of sexual arousal and sexual excitability, coping by sexual behaviors, and psychological symptoms. CA was not associated with offline sexual behaviors and weekly cybersex use time. Coping by sexual behaviors partially mediated the relationship between sexual excitability and CA. The results are comparable with those reported for heterosexual males and females in previous studies and are discussed against the background of theoretical assumptions of CA, which highlight the role of positive and negative reinforcement due to cybersex use.
15) Ventral Striatum Activity When Watching Preferred Pornographic Pictures is Correlated With Symptoms of Internet Pornography Addiction (Brand et al., 2016) – [greater cue reactivity/sensitization] – A German fMRI study. Finding #1: Reward center activity (ventral striatum) was higher for preferred pornographic pictures. Finding #2: Ventral striatum reactivity correlated with the internet sex addiction score. Both findings indicate sensitization and align with the addiction model. The authors state that the “Neural basis of Internet pornography addiction is comparable to other addictions.” An excerpt:
One type of Internet addiction is excessive pornography consumption, also referred to as cybersex or Internet pornography addiction. Neuroimaging studies found ventral striatum activity when participants watched explicit sexual stimuli compared to non-explicit sexual/erotic material. We now hypothesized that the ventral striatum should respond to preferred pornographic compared to non-preferred pornographic pictures and that the ventral striatum activity in this contrast should be correlated with subjective symptoms of Internet pornography addiction. We studied 19 heterosexual male participants with a picture paradigm including preferred and non-preferred pornographic material.
Pictures from the preferred category were rated as more arousing, less unpleasant, and closer to ideal. Ventral striatum response was stronger for the preferred condition compared to non-preferred pictures. Ventral striatum activity in this contrast was correlated with the self-reported symptoms of Internet pornography addiction. The subjective symptom severity was also the only significant predictor in a regression analysis with ventral striatum response as dependent variable and subjective symptoms of Internet pornography addiction, general sexual excitability, hypersexual behavior, depression, interpersonal sensitivity, and sexual behavior in the last days as predictors. The results support the role for the ventral striatum in processing reward anticipation and gratification linked to subjectively preferred pornographic material. Mechanisms for reward anticipation in ventral striatum may contribute to a neural explanation of why individuals with certain preferences and sexual fantasies are at-risk for losing their control over Internet pornography consumption.
16) Subjective Craving for Pornography and Associative Learning Predict Tendencies Towards Cybersex Addiction in a Sample of Regular Cybersex Users (Snagkowski et al., 2016) – [greater cue reactivity/sensitization, enhanced conditioned responses] – This unique study conditioned subjects to formerly neutral shapes, which predicted the appearance of a pornographic image. Excerpts:
There is no consensus regarding the diagnostic criteria of cybersex addiction. Some approaches postulate similarities to substance dependencies, for which associative learning is a crucial mechanism. In this study, 86 heterosexual males completed a Standard Pavlovian to Instrumental Transfer Task modified with pornographic pictures to investigate associative learning in cybersex addiction. Additionally, subjective craving due to watching pornographic pictures and tendencies towards cybersex addiction were assessed. Results showed an effect of subjective craving on tendencies towards cybersex addiction, moderated by associative learning. Overall, these findings point towards a crucial role of associative learning for the development of cybersex addiction, while providing further empirical evidence for similarities between substance dependencies and cybersex addiction. In summary, the results of the current study suggest that associative learning might play a crucial role regarding the development of cybersex addiction. Our findings provide further evidence for similarities between cybersex addiction and substance dependencies since influences of subjective craving and associative learning were shown.
17) Mood changes after watching pornography on the Internet are linked to symptoms of Internet-pornography-viewing disorder (Laier & Brand, 2016) – [greater cravings/sensitization, less liking] – Excerpts:
The main results of the study are that tendencies towards Internet Pornography Disorder (IPD) were associated negatively with feeling generally good, awake, and calm as well as positively with perceived stress in daily life and the motivation to use Internet pornography in terms of excitation seeking and emotional avoidance. Furthermore, tendencies towards IPD were negatively related to mood before and after watching Internet pornography as well as an actual increase of good and calm mood. The relationship between tendencies towards IPD and excitement seeking due to Internet-pornography use was moderated by the evaluation of the experienced orgasm’s satisfaction. Generally, the results of the study are in line with the hypothesis that IPD is linked to the motivation to find sexual gratification and to avoid or to cope with aversive emotions as well as with the assumption that mood changes following pornography consumption are linked to IPD (Cooper et al., 1999 and Laier and Brand, 2014).
18) Predictors for (Problematic) Use of Internet Sexually Explicit Material: Role of Trait Sexual Motivation and Implicit Approach Tendencies Towards Sexually Explicit Material (Stark et al., 2017) – [greater cue reactivity/sensitization/cravings] – Excerpts:
The present study investigated whether trait sexual motivation and implicit approach tendencies toward sexual material are predictors of problematic SEM use and of the daily time spent watching SEM. In a behavioral experiment, we used the Approach-Avoidance Task (AAT) for measuring implicit approach tendencies towards sexual material. A positive correlation between implicit approach tendency towards SEM and the daily time spent on watching SEM might be explained by attentional effects: A high implicit approach tendency can be interpreted as an attentional bias towards SEM. A subject with this attentional bias might be more attracted to sexual cues on the Internet resulting in higher amounts of time spent on SEM sites.
19) Tendencies toward Internet-pornography-use disorder: Differences in men and women regarding attentional biases to pornographic stimuli (2018) – [greater cue reactivity/sensitization, enhanced cravings]. Excerpts
Several authors consider Internet-pornography-use disorder (IPD) as addictive disorder. One of the mechanisms that has been intensively studied in substance- and non-substance-use disorders is an enhanced attentional bias toward addiction-related cues. Attentional biases are described as cognitive processes of individual’s perception affected by the addiction-related cues caused by the conditioned incentive salience of the cue itself. It is assumed in the I-PACE model that in individuals prone to develop IPD symptoms implicit cognitions as well as cue-reactivity and craving arise and increase within the addiction process. To investigate the role of attentional biases in the development of IPD, we investigated a sample of 174 male and female participants. Attentional bias was measured with the Visual Probe Task, in which participants had to react on arrows appearing after pornographic or neutral pictures. In addition, participants had to indicate their sexual arousal induced by pornographic pictures. Furthermore, tendencies toward IPD were measured using the short-Internetsex Addiction Test. The results of this study showed a relationship between attentional bias and symptom severity of IPD partially mediated by indicators for cue-reactivity and craving. While men and women generally differ in reaction times due to pornographic pictures, a moderated regression analysis revealed that attentional biases occur independently of sex in the context of IPD symptoms. The results support theoretical assumptions of the I-PACE model regarding the incentive salience of addiction-related cues and are consistent with studies addressing cue-reactivity and craving in substance-use disorders.
20) Trait and state impulsivity in males with tendency towards Internet-pornography-use disorder (Antons & Brand, 2018) – [enhanced cravings, greater state & trait impulsivity]. Excerpts:
Results indicate that trait impulsivity was associated with higher symptom severity of Internet-pornography-use disorder (IPD). Especially those males with higher trait impulsivity and state impulsivity in the pornographic condition of the stop-signal task as well as those with high craving reactions showed severe symptoms of IPD.
The results indicate that both trait and state impulsivity play a crucial role in the development of IPD. In accordance with dual-process models of addiction, the results may be indicative of an imbalance between the impulsive and reflective systems which might be triggered by pornographic material. This may result in loss of control over the Internet-pornography use albeit experiencing negative consequences.
We agree with “perceived addiction” not being the ideal term and potentially highly problematic. The use of the CPUI-9 total score to define “perceived addiction” does not seem appropriate given that the three subscales incompletely assess various aspects of addiction. For example, craving is not sufficiently considered (see above), addiction is not defined by quantity/frequency measures (these may vary widely in substance-use disorders; see also discussion of quantity/frequency measures as related to CPUI-9 scores in Fernandez et al., 2017), and many other aspects relevant to addictions are not adequately considered (e.g., interference in relationships, occupation, school). Many of the CPUI-9 questions, such as those related to emotional distress and derived from measures linked to moral/religious conceptions, do not correlate well with the two more strongly correlated CPUI-9 subscales related to compulsivity and access (Grubbs et al., 2015a). For this reason, some researchers (e.g., Fernandez et al., 2017) have stated, “our findings cast doubts on the suitability of the Emotional Distress subscale as part of the CPUI-9,” particularly as it is the Emotional Distress component that consistently does not show a relationship to quantity of pornography use. Further, the inclusion of these items in a scale that defines “perceived addiction” may skew findings diminishing the contribution from perceived compulsive use and inflating the contribution of perceived moral incongruence (Grubbs et al., 2015a). While these data may provide support for the separation of these items from the others in the scale (potentially in support of the proposed model), the items focus only on feeling sick, shame, or depressed when viewing pornography. These negative feelings represent only a possible subset of negative consequences related to Internet-pornography use, and ones that are arguably linked to specific aspects of specific religious beliefs. To disentangle addictive use and PPMI, it is very important to consider not only the PPMI side, but also potential interactions between mechanisms of addictive or dysregulated use and those contributing to PPMI in order to better understand the two conditions and whether they are, indeed, separate. Grubbs et al. (2018) argue (in the section: “What about a third pathway?”) that there might be an additional pathway of problems related to pornography use, which could be the combination of experiencing “objective dysregulation” and PPMI simultaneously. We argue that a combination of both pathways may not be a third one, but possibly a mechanism underlying “both” problems with pornography use. In other words, we posit that some of addiction-related processes and motivational factors may operate across PPMI and “dysregulated use.” These similarities may exist even if the time spent viewing pornography may differ with respect to generating distress or impairment in PPMI and “dysregulated use.” In “both conditions,” pornography is used more than intended, which may result in negative consequences and distress, and pornography use is continued despite negative consequences. The psychological processes underlying such use may be similar, and these should be investigated in more detail.
22) Facets of impulsivity and related aspects differentiate among recreational and unregulated use of Internet pornography (Stephanie et al., 2019) – [enhanced cravings, greater delayed discounting (hypofrontality), habituation]. Excerpts:
Because of its primarily rewarding nature, Internet pornography (IP) is a predestinated target for addictive behaviors. Impulsivity-related constructs have been identified as promoters of addictive behaviors. In this study, we investigated impulsive tendencies (trait impulsivity, delay discounting, and cognitive style), craving toward IP, attitude regarding IP, and coping styles in individuals with recreational–occasional, recreational–frequent, and unregulated IP use. Groups of individuals with recreational–occasional use (n = 333), recreational–frequent use (n = 394), and unregulated use (n = 225) of IP were identified by screening instruments.
Individuals with unregulated use showed the highest scores for craving, attentional impulsivity, delay discounting, and dysfunctional coping, and lowest scores for functional coping and need for cognition. The results indicate that some facets of impulsivity and related factors such as craving and a more negative attitude are specific for unregulated IP users. The results are also consistent with models on specific Internet use disorders and addictive behaviors…. Furthermore, individuals with unregulated IP use had a more negative attitude toward IP compared to the recreational–frequent users. This result might suggest that individuals with unregulated IP use have a high motivation or urge to use IP, although they may have developed a negative attitude toward IP use, perhaps because they have already experienced negative consequences linked to their IP use pattern. This is consistent with the incentive-sensitization theory of addiction (Berridge & Robinson, 2016), which proposes a shift from liking to wanting during addiction.
A further interesting result is that the effect size for post-hoc tests duration in minutes per session, when comparing unregulated users with recreational–frequent users, was higher in comparison to the frequency per week. This might indicate that individuals with unregulated IP use especially have difficulties to stop watching IP during a session or need longer time to achieve the desired reward, which might be comparable with a form of tolerance in substance use disorders. This is consistent with the results from a diary assessment, which revealed that pornographic binges are one of the most characteristic behaviors in treatment-seeking males with compulsive sexual behaviors (Wordecha et al., 2018).
Unregulated Internet-pornography (IP) use is characterized by diminished control over IP use and the continued use albeit negative consequences. There is evidence that craving mediates the effect of symptom severity of unregulated IP use on the amount of IP use. Functional coping styles may help individuals to regain control over their behavior by better dealing with craving. This raises the question whether the effect of craving on IP use is moderated by functional coping styles in individuals with varying degree of unregulated IP use.
Overall, 1498 heterosexual, male IP users participated in this online survey. Participants indicated their amount of IP use, symptom severity of unregulated IP use, functional coping styles, and their craving towards IP.
A moderated mediation revealed that symptom severity of unregulated IP use in heterosexual males was positively related to IP use. This effect was partially mediated by craving and the effect of craving on IP use was moderated by functional coping styles.
24) Theories, prevention, and treatment of pornography-use disorder (2019)
Introduction Compulsive sexual behavior disorder, including problematic pornography use, has been included in the ICD-11 as impulse control disorder. The diagnostic criteria for this disorder, however, are very similar to the criteria for disorders due to addictive behaviors, for example repetitive sexual activities becoming a central focus of the personʼs life, unsuccessful efforts to significantly reduce repetitive sexual behaviors and continued repetitive sexual behaviors despite experiencing negative consequences (WHO, 2019). Many researchers and clinicians also argue that problematic pornography use can be considered a behavioral addiction.
Methods Based on theoretical considerations, empirical studies are evaluated considering the question if the main characteristics and processes involved in addictive behaviors can also be observed in problematic pornography use.
Results Cue-reactivity and craving in combination with reduced inhibitory control, implicit cognitions (e.g. approach tendencies) and experiencing gratification and compensation linked to pornography use have been demonstrated in individuals with symptoms of pornography-use disorder. Neuroscientific studies confirm the involvement of addiction-related brain circuits, including the ventral striatum and other parts of fronto-striatal loops, in the development and maintenance of problematic pornography use. Case reports and proof-of-concept studies suggest the efficacy of pharmacological interventions, for example the opioid antagonist naltrexone, for treating individuals with pornography-use disorder and compulsive sexual behavior disorder. Randomized placebo-controlled clinical trials are needed to demonstrate the potential long-term effects of pharmacological interventions. Systematic studies on the efficacy of prevention methods for problematic pornography use are still missing, but a very important topic for future research and practice.
Conclusion Theoretical considerations and empirical evidence suggest that the psychological and neurobiological mechanisms involved in addictive disorders are also valid for pornography-use disorder. Systematic studies addressing potential intervention strategies are one of the main challenges for future research providing data for evidence-based prevention and treatment of pornography-use disorder.
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