Acceptance and Commitment Therapy for the Treatment of Compulsive Pornography Use: A Randomized Clinical Trial

Compulsive pornography use (CPU) is generally defined by the inability to control the use of pornography and the resulting negative effects on quality of life or general functioning including damaged relationships, loss of productivity, impaired performance at work or school, job loss, financial expenses, guilt/shame, and personal distress. Statistics indicate that CPU may be as common as other psychological disorders and that the effects of the behavior can be just as severe. It is estimated that 1.5% to 3% of the adult population of the United States meets the criteria for compulsive pornography use. A review of the literature found no randomized controlled investigations of psychosocial treatments for this problem. This study reports the results of a randomized clinical trial of acceptance and commitment therapy (ACT) for the treatment of compulsive pornography use comparing an active treatment condition (n = 14) with a waitlist control (n = 14). The results showed a significant 93% decrease in self-reported hours viewed per week from pretreatment to posttreatment compared to the control condition, which experienced a 21% decrease. In a 20-week follow-up assessment, the treatment group did not change significantly from posttreatment to follow-up with an 84% decrease, indicating relative maintenance of the treatment gains. The control condition received the active treatment after the waiting period and was combined with the treatment group to calculate an overall effect size from pretreatment to posttreatment of 1.86. This is supported by clinical effectiveness data that shows 54% of the participants completely stopped viewing at posttreatment and another 39% of participants reduced viewing by at least 70% of pretreatment levels by posttreatment. Additional measures of quality of life, sexual compulsivity, and negative outcomes of sexual behavior were also completed and support the behavioral self-report results. These results are significant because they provide the first randomized group evidence of an effective treatment for compulsive pornography use. Implications and future directions are discussed