Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet

The Impact of a Public Health Campaign to Deter Viewing of Child Sexual Abuse Images Online: A Case Study of the UK Stop It Now! Campaign

Public campaigns offer an opportunity to prevent child sexual abuse by raising awareness and promoting help available to bystanders, victims, and those at risk of perpetrating the abuse. This paper explores the impact of The Lucy Faithfull Foundation's 'Stop It Now!' campaign in the UK (2015-2018) on help-seeking. Helpline calls (11,190 unique callers), website analytics (109,432 new website visitors) and three website-hosted surveys (N = 252) provided data on help-seeking, awareness, and self-reported behavior. Results indicated that there were more visitors to the help website during active campaigning periods, and helpline callers and website visitors were more likely to seek help after viewing campaign materials during active than non-active campaign periods. Help-seekers were predominantly men concerned about their own behavior. Survey 2 respondents concerned about their own behavior (n = 53) indicated that their awareness of the law (75.5%), and legal and personal consequences (67.9%) had changed after hearing about the campaign, and 66% reported a change in behavior. Public health campaigns may be an effective way to promote help-seeking and prevent abuse.

A randomized controlled add-on trial of fluoxetine and cognitive behavioral therapy for help-seeking men with a sexual interest in children: presentation of the PARACHUTES trial protocol and initial feasibility data

Background

Sexual Interest in Children (SIC) is a major risk factor for sexual offending, yet clinical trials are sparse. The present protocol outlines a randomized controlled trial (RCT) that aims to investigate the effectiveness of fluoxetine and Cognitive Behavioral Therapy (CBT) in help-seeking men with SIC.

Methods

Adult men contacting the Swedish telephone helpline PrevenTell are screened for inclusion and invited to further assessment on site. One hundred and eleven men with SIC (defined as DSM-5 pedophilic disorder or hebephilia) will be randomized (1:1:1 ratio) to receive one of three interventions for 14 weeks: (1) an internet-administered psychoeducational program (iPP), (2) iPP and the addition of fluoxetine 20-40 mg or (3) iPP and the addition of internet-administered CBT (iCBT). Exclusion criteria include severe psychiatric illness, contraindicating treatment and an elevated risk of committing hands-on sexual offences. Symptom intensity is assessed at baseline, pre-treatment, every other week for 12 weeks, and post treatment. The primary outcome measure is the Sexual Interest in Children: Current Assessment Scale (SIC: CAS) that quantifies sexual behaviors associated with SIC as well as perceived distress and impairment. Secondary outcomes include measures of dynamic risk-factors for committing sexual offences.

Results

The data collected during the initial 20 months of recruitment were analyzed to predict the required number of individuals to be screened and estimate the probable length of the data collection phase. As of March 2022 to November 2023, 146 men have called PrevenTell and disclosed a sexual interest in minors. Following pre-screening, 110 men were excluded from participation in the trial. Current SSRI therapy was the primary reason for exclusion (n = 24; 22%), followed by an elevated risk of committing hands-on sexual offences (n = 14; 13%). Among the 31 men who underwent the screening procedure on site, 26 were allocated to either iPP, iPP+fluoxetine, or iPP+iCBT. The recruitment rate indicates that the trial will be concluded within the pre-estimated timeframe.

Discussion

This is the first RCT of treatment with SSRI and iCBT in a population of help-seeking men with SIC. The significance of this trial and its methodological strengths and limitations are discussed.

Public perception of individuals who commit Child Sexual Abuse Material offences: Exploring the impact of demographic variables and cross-national differences

BACKGROUND

Lay perceptions of persons who download and distribute Child Sexual Abuse Material (CSAM) is an underexplored subject. There is a need for understanding the factors that influence perceptions as the public perceptions have implications for endorsement of sex offender rehabilitation that in turn can influence the availability of treatment programs and stigma for help-seeking.

OBJECTIVE

To explore public perceptions of individuals that commit child sexual abuse offences, to compare the results to those obtained in a large US sample, and to explore associations between demographic variables, general perceptions and endorsement of imprisonment and treatment for individuals that commit CSAM offences.

PARTICIPANTS AND SETTING

An online survey were distributed in Norway in February 2023. 618 individuals responded, 76 % were female, mean age 34.99 (SD = 14.23), the majority (>70 %) had higher education, and 44 % had children.

RESULTS

Consistent with prior research, the public perceptions overestimated the risk of future contact offences and recidivism. Women overestimated the percentage of risk of contact offences and pedophilic interest more than men. The overestimation was significantly less in this sample compared to the US sample (d = 0.39-0.96). Those working with online child abuse had perceptions of persons committing CSAM offences that were more aligned with empirical findings. Demographic variables were only marginally associated with endorsement for treatment and imprisonment, except for having children, which was associated with endorsement of imprisonment. Perceived risk of contact offences, pedophilic preference, and assumed childhood sexual victimization were associated with perceptions of individuals committing CSAM offences as different than those committing physical sexual abuse and both endorsement of treatment and imprisonment.

CONCLUSIONS

The perceptions of those who commit CSAM offences showed a stronger association with endorsement for treatment and imprisonment than demographic variables.

Evaluating Child Sexual Abuse Perpetration Prevention Efforts: A Systematic Review

Many child sexual abuse prevention efforts focus on the prevention of victimization, through education of children and parents, bystander training, and policies and practices in youth-serving organizations (e.g. requiring criminal record checks). However, there has been growing attention to child sexual abuse perpetration prevention, targeted at individuals who are at risk of perpetration. We conducted a systematic review of studies reporting outcomes for child sexual abuse perpetration prevention interventions. Only seven studies were identified in our review, with five intended for adults and two intended for children. Four of the five adult studies had significant methodological concerns, precluding strong conclusions from these studies. We concluded that higher-quality evaluations of perpetration prevention efforts are greatly needed. We also identified intrafamilial perpetration prevention, particularly interventions for parents or caregivers, as a critical gap in the literature. Suggestions for child sexual abuse perpetration intervention evaluation and delivery are discussed.

Investigating child sexual abuse material availability, searches, and users on the anonymous Tor network for a public health intervention strategy

Tor is widely used for staying anonymous online and accessing onion websites; unfortunately, Tor is popular for distributing and viewing illicit child sexual abuse material (CSAM). From 2018 to 2023, we analyse 176,683 onion domains and find that one-fifth share CSAM. We find that CSAM is easily available using 21 out of the 26 most-used Tor search engines. We analyse 110,133,715 search sessions from the Ahmia.fi search engine and discover that 11.1% seek CSAM. When searching CSAM by age, 40.5% search for 11-year-olds and younger; 11.0% for 12-year-olds; 8.2% for 13-year-olds; 11.6% for 14-year-olds; 10.9% for 15-year-olds; and 12.7% for 16-year-olds. We demonstrate accurate filtering for search engines, introduce intervention, show a questionnaire for CSAM users, and analyse 11,470 responses. 65.3% of CSAM users first saw the material when they were children themselves, and half of the respondents first saw the material accidentally, demonstrating the availability of CSAM. 48.1% want to stop using CSAM. Some seek help through Tor, and self-help websites are popular. Our survey finds commonalities between CSAM use and addiction. Help-seeking correlates with increasing viewing duration and frequency, depression, anxiety, self-harming thoughts, guilt, and shame. Yet, 73.9% of help seekers have not been able to receive it.

Web-Based Initiatives to Prevent Sexual Offense Perpetration: A Systematic Review

PURPOSE OF REVIEW

Web-based programs to prevent sexual offense perpetration could provide an opportunity that avoids many of the barriers associated with in-person treatment. The aim of this systematic review is to give an overview of the literature on web-based initiatives aimed at sexual offense perpetration prevention published during the last 10 years (2013-2023) and to report data on the efficacy as well as issues of the discussed initiatives.

RECENT FINDINGS

We included 18 empirical studies discussing web-based perpetration prevention initiatives, of which six are randomized controlled trials. Among the articles, four cover programs focusing on prevention of sexual reoffending and 14 discuss programs aimed at preventing initial sexual offenses. Evaluations and observations of web-based initiatives aimed at preventing sexual offense perpetration show overall promising results and are well-appreciated. However, evaluation studies are scarce and more randomized controlled trials replicating this effect are warranted.

Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study

BACKGROUND

Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown.

OBJECTIVE

For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry.

METHODS

This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline.

RESULTS

Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants' belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect.

CONCLUSIONS

For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants' attitudes toward web-based interventions were important in predicting acceptance.

TRIAL REGISTRATION

German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256.

The public's knowledge about child sexual abuse influences its perceptions of prevention and associated policies

BACKGROUND

Child sexual abuse (CSA) prevention requires efforts from all members of society.

OBJECTIVE

The current study aimed to examine factors associated with (1) perceptions of CSA as unpreventable and (2) support for policies to prevent CSA and to punish people who perpetrated CSA. We focused on the roles of knowledge and misperceptions about child sexual abuse.

PARTICIPANTS AND SETTING

We collected survey data online from a large (N = 5068), nationally representative sample of adults in the United States.

RESULTS

Analyses revealed factors promoting perceptions of CSA as unpreventable. Support for or against policies that aim to prevent CSA or to punish perpetrators of CSA were associated with individual factors such as older age (B = 0.08, -0.13), Republican political affiliation (B = 0.10, 0.07), and misperceptions about CSA (B = 0.15, 0.06).

CONCLUSIONS

Findings highlight malleable factors that could be targeted to collectivize calls for CSA prevention and to promote support for effective policies to prevent CSA. In particular, ensuring accurate knowledge about CSA, and collective responsibility and government efficacy specific to CSA prevention, were identified as helping shape views of CSA as preventable.