The Scope of Cybersex and Problematic Internet-Enabled Sexual Behavior

Cybersex is the third largest economic sector on the Web — only exceeded by software and computer sites. Carnes (2003) has identified a host of physical and psychological problems associated with what Orzack, Voluse, Wolf, and Hennen (2006) call Problematic IESB (internet-enabled sexual behavior).

These problems include sexually transmitted diseases, damage to genitals, unwanted pregnancies, compulsive masturbation, affairs, voyeurism, exhibitionism, sexual harassment, depression, suicide, self-harm, disruption of the family, battering, sexual abuse, financial distress, and a high probability of other addictive behavior like alcoholism, drug abuse, and pathologic gambling.

Distinguishing Addiction From Maladaptive Behavior

However, the discovery of something sexual in a client’s behavior does not make an addictive illness. Diagnosing someone with a sexual addiction is complicated by the fact that the term “sexual addiction” does not appear in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), nor does the word “addiction.”

So how does a therapist or clinician determine the difference between an addiction and a maladaptive behavior? Carnes (2003) explains that a person with a sexual addiction will experience each of the following symptoms: (1) a loss of control; (2) a continuation of the behavior even in the face of adverse consequences; and (3) a great deal of preoccupation with the behavior.

A long-term affair, exploitive or violent behavior, for example, might be a problem for a spouse, but not necessarily a sexual addictive illness. On the other hand, if a young man indicates that he wants to quit looking at pornography, but finds himself looking at pornography every time he has an opportunity (even though he knows it damages his relationship with his girlfriend and is contributing heavy financial and legal problems), and is obsessed with pornographic thoughts, the therapist might consider this behavior as a possible addiction.

The Neurology Behind Compulsive Sexual Behavior

Reisman (2004) describes visual pornography as an “endogenous drug” that permanently, yet unconsciously, restructures the brain, mind, memory, and conduct of the user. James Olds (1956), a pioneer in understanding addiction, explained that the Midbrain or Limbic System’s main function is that of survival.

It doesn’t think or reason — it just creates strong craving towards anything that will sustain survival. The Limbic System unconsciously dictates the bodily functions of oxygen, water, food, sleep, sex, etc. This instinctive part of our brain operates separately and independent of the Pre-Frontal Lobe (the conscious, moral, reasoning part of our brain).

Because the Limbic System views sexuality as part of our survival, Nestler (2001) explained that pornography and other sexually stimulating activities can become unconscious cravings, and if given enough stimulation, can partially disengage the Pre-frontal Cortex — to differing degrees or another — and cut the addict off from their feelings, emotions, moral reasoning, and consequences with little apparent concern for long-term effects of certain behaviors.

What the Research Says About Treatment

Considering this school of thought regarding the involvement of the Limbic System in the brain and its unconscious impact on behavior, Orzack, Voluse, Wolf, and Hennen (2006), Young (1999), Schwartz (1995), Line and Cooper (2000) all posit the notion that one of the most effective treatments for sexual addictions is a combination of personal and group therapy, using a Cognitive Behavioral Theoretical orientation.

This setting allows members to slowly decrease their shame, guilt, and isolation and, at the same time, discuss their symptoms and suffering openly in a supportive, nurturing, and non-judgmental environment. Orzack, Voluse, Wolf, and Hennen (2006), Line and Cooper (2000) have coupled CBT with ancillary theories of Readiness to Change (RtC) and Motivational Interviewing (MI).

In spite of all we know about sexual addiction, empirical documentation of successful treatment plans for sexual addictions is almost non-existent. Although professionals are documenting and investigating the negative impact of sexual addictions, Orzack, Voluse, Wolf, and Hennen (2006) insist that there are many questions still remaining on how to effectively treat the addiction, and that more information on effective intervention is “sorely needed.” They call for future studies focused on treatment, rather than the addiction itself.

Seven Key Factors in Successful Recovery

Carnes (2003) has identified key factors in the management of a successful sexual addiction recovery program. They include:

A good addiction-oriented primary therapist for a three to five year period — the first two being very intense.
A 12-step group experience for sexual addiction. Regular attendance is essential. The probability of relapse is extremely high if the client does not attend meetings.
A 12-step group program for other addictions. It is common for the addict to have other addictions as well. The probability of recovery is higher if the other addictions are resolved as well.
A sponsor or mentor who attends the same meetings and has had previous experience with the recovery program. The relationship with, and support of, a consolidated sponsor has been proven to be helpful in the recovery process.
Completion of work, assignments, and homework — not just attendance. A recent outcome study indicated that only 23 percent of the clients completed the 12-step assignments. Among those who did complete all 12 steps, recidivism was rare.
Early family involvement. Family participation in the patient’s therapy improves the chance for success.
Spiritual support — and/or belief in a higher power. Addicts report that the spiritual work initiated in their 12-step communities and continued in their spiritual communities was critical to the changes they needed to make.
Exercise, good nutrition, and a healthy lifestyle — all help to reduce stress and are associated with better recovery prognosis.

What Clients in Recovery Say Helped Most

Carnes (2000) interviewed 190 people who have had success in their sexual addiction recovery programs. They were asked what had helped them most. The following is a list of treatments that were most helpful — from the most influential to the least:

A higher power (87 percent)
Couples 12-step group experience on sexual addictions (85 percent)
A friend’s support (69 percent)
Individual therapy (65 percent)
A celibacy period (64 percent)
A sponsor (61 percent)
Exercise/nutrition (58 percent)
A 12-step group experience based on other addictions (55 percent)
Partner support (36 percent)
Inpatient treatment (35 percent)
Outpatient group (27 percent)
Family therapy (11 percent)
Hospital after care (9 percent)

Our Approach at Atium Health

Our approach to the treatment of sexual addiction at Atium Health is quite similar and inclusive of many of these critical factors documented in this research. In our individual therapy, we use a hybrid 4-phase approach:

Understanding the neurology of what it is the client is trying to manage — to establish a solid foundation of neuroscience.
Automating a powerful trilogy of three emotional regulation skills — that exponentially increase the power of each other, when used consistently.
Identifying and healing the emotional bruises and cognitive distortions that often undergird the intense desire for overstimulation.
Enhancing a felt sense of safety and connection in all important relationships.

Learn more about our Sexual Compulsive Behavior & CSBD Treatment program and how we support recovery with in-person care at our Pleasant Grove, Utah clinic and telehealth across Utah and Arizona.

References

Carroll, M.R. & Wiggins, J. (1990). Elements of group counseling: back to the basics. Denver, CO: Love Publishing Co.

Carnes, P. (2003). Understanding sexual addiction. Siecus Report, 31, 5-10.

Corey, G. (2004). Theory and practice of group counseling. Belmont, CA: Brooks/Cole-Thomson Learning.

Dyer, W.W. & Vriend, J. (1988). Counseling techniques that work. USA: American Association for Counseling and Development.

Gladding, S.T. (2003). Group work: a counseling specialty. Upper Saddle River, NJ: Pearson Education.

Line, B. and Cooper, A. (2000). Group therapy: essential component for success with sexually acting out problems. Unpublished manuscript.

Nestler, E. (2001). Molecular neurobiology of addiction. American Academy of Addiction Psychiatry, 10, 201-217.

Olds, J. (1956). Pleasure center in the brain. Science America, 195: 105-16.

Orzack, M., Voluse, B., Wolf, D., & Hennen, J. (2006). An ongoing study of group treatment for men involved in problematic internet-enabled sexual behavior. CyberPsychology & Behavior, 9, 348-360.

Orzack, M. H. (1998). Computer addiction: what is it? Psychiatric Times, 8:32-33.

Orzack, M. H. (1999). How to recognize and treat computer.com addictions. Directions in Clinical and Counseling Psychology. Lesson 2, Vol. 9. New York: The Hatherleigh Co., 13-26.

Reisman, J. (2004). The brain science behind pornography addiction and the effects of addiction on families and communities. Testimony before the United States Senate, Subcommittee on Science, Technology, and Space of the Committee on Commerce, Science, and Transportation.

Schwartz, B. (1995). Group therapy. The Sex Offender: Corrections, Treatment, and Legal Practice. Kingston, NJ: Civic Research Institute, 14-15.

Yalom, I. (1995). The theory and practice of group psychotherapy. New York, NY: BasicBooks.

Young, K. (1999). Evaluation and treatment of internet addiction. Innovations in Clinical Practice: A Source Book. Sarasota, FL: Professional Resource Press, 19-31.

Toward a Better Understanding of Sexual Addiction Treatment