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Jiang X, Wu Y, Zhang K, Bőthe B, Hong Y, Chen L. Symptoms of problematic pornography use among help-seeking male adolescents: Latent profile and network analysis. J Behav Addict 2022; 11:912-927. [PMID: 36067020 PMCID: PMC9872529 DOI: 10.1556/2006.2022.00065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/13/2022] [Accepted: 08/14/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIMS Little data exist on exploring the subgroups and characteristics of problematic pornography use (PPU) in help-seeking adolescents. The aims of the study were to classify the subgroups among help-seeking male adolescents, explore their similarities and differences, and uncover their core symptoms. METHODS A total of 3,468 Chinese male adolescents (Mage = 16.64 years, SD = 1.24) who were distressed about their pornography use were recruited. The Problematic Pornography Consumption Scale, the Brief Pornography Screen Scale, and Moral Disapproval of Pornography Use were used to classify them. The General Health Questionnaire, the Pornography Craving Questionnaire, and the Sexual Compulsivity Scale were used to investigate participants' negative consequence related to their pornography use; and the Online Sexual Activity Questionnaire (OSAs) and time spent on pornography use every week were considered as quantitative indicators. RESULTS Help-seeking male adolescents could be divided into 3 profiles, namely, self-perceived problematic (SP, n = 755), impaired control (IC, n = 1,656), and problematic use groups (PPU, n = 1,057). Frequency of OSAs was important for the identification of SP individuals, while negative consequences were more effective in identifying individuals with objective dysregulated behavior. Salience and mood modification were shared by all groups; however, in addition to this, the SP and PPU groups also showed withdrawal symptoms. DISCUSSION AND CONCLUSION This study's results provide support for the presence of different profiles of help-seeking individuals and information on potential intervention targets among adolescents which is lacking in the literature.
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Affiliation(s)
- Xiaoliu Jiang
- Department of Psychology, School of Humanities and Social Sciences, Fuzhou University, Fujian, China
| | - Yudi Wu
- Department of Psychology, School of Humanities and Social Sciences, Fuzhou University, Fujian, China
| | - Kuo Zhang
- Department of Social Psychology, Nankai University, Tianjin, China
| | - Beáta Bőthe
- Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada,Département de Psychologie, Université de Montréal, Montréal, Canada,Corresponding author. E-mail:
| | - Youjuan Hong
- School of Nursing, Fujian Medical University, Fujian, China
| | - Lijun Chen
- Department of Psychology, School of Humanities and Social Sciences, Fuzhou University, Fujian, China,Corresponding author. Tel.: +86-59122866562. E-mail:
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Stark R, Markert C, Kruse O, Walter B, Strahler J, Klein S. Individual cortisol response to acute stress influences neural processing of sexual cues. J Behav Addict 2022; 11:506-519. [PMID: 35895611 PMCID: PMC9295234 DOI: 10.1556/2006.2022.00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/28/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIMS Problematic pornography use can be conceptualized as an impulse control disorder or alternatively as a behavioral addiction. Stress is an important trigger in addiction, but less is known about the neural effect of stress in problematic pornography use. Therefore, we aimed at investigating the effect of stress during the anticipation and viewing of sexually explicit material while considering person characteristics related to potentially being at risk for developing problematic pornography use. METHODS In an fMRI study (n = 157 men, age: mean = 25.46, SD = 4.11) we used a sexual incentive delay task. A social stress test was used to induce stress in half of the participants. Salivary cortisol was repeatedly measured and person characteristics were considered moderating the effects of cortisol response. RESULTS We found no group differences in the neural responses during the anticipation phase, but a higher reactivity to sexual stimuli in the dACC in the stress group. Acute stress activated a pronounced cortisol response, which positively correlated with neural activations in the reward system (NAcc, dACC) to sexual cues. Further, the individual time spent on pornography use moderated the effect of cortisol in some regions of the reward system (dACC, mOFC). DISCUSSION AND CONCLUSIONS Our results suggest that acute stress related increases in cortisol can enhance the incentive value of cues announcing sexual stimuli. This might explain why acute stress is considered a trigger of pornography use and relapse and why individual stress response might be a risk factor for developing a problematic pornography use.
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Affiliation(s)
- Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany,Corresponding author. E-mail:
| | - Charlotte Markert
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| | - Onno Kruse
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany
| | - Bertram Walter
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| | - Jana Strahler
- Sportpsychology, Institute of Sport and Sport Sciences, University of Freiburg, Germany
| | - Sanja Klein
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany,Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany,Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
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3
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Efrati Y, Gola M. Adolescents' compulsive sexual behavior: The role of parental competence, parents' psychopathology, and quality of parent-child communication about sex. J Behav Addict 2019; 8:420-431. [PMID: 31328954 PMCID: PMC7044617 DOI: 10.1556/2006.8.2019.33] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/23/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Compulsive sexual behavior (CSB) has implications for clinical and non-clinical adult populations. Disposition to CSB has been shown to influence adolescence sexual behaviors, but the development of adolescents' disposition toward CSB has yet to be examined in the family context. In this study, we investigated whether parent-adolescent communication mediates the links between parental characteristics and adolescents' CSB. METHODS The sample included 275 Israeli families [triad of mothers (age = 34-63 years, M = 45.48, SD = 5.46), fathers (age = 36-83 years, M = 48.33, SD = 6.63), and one adolescent (48.2% boys, 51.1% girls; age = 14-18 years, M = 16.23, SD = 1.18)]. Parents completed measures of psychopathology, parental self-esteem, and parental self-efficacy, and adolescents completed measures of quality of sex-related communication and CSB. RESULTS The results indicate that, for girls, higher maternal self-esteem and lower psychopathology were linked with better sex-related communication and so with lower CSB. For boys, only parental religiosity was linked with the quality of sex-related communication and CSB, with religious parents having better communication than secular ones. DISCUSSION The findings provide an opportunity for researchers to gain a better insight into the dynamics of familial factors in the development of CSB among adolescents.
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Affiliation(s)
- Yaniv Efrati
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
- Faculty of Education and Society and Culture, Beit-Berl College, Kefar Sava, Israel
| | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, CA, USA
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Stark R, Klein S, Kruse O, Weygandt M, Leufgens LK, Schweckendiek J, Strahler J. No Sex Difference Found: Cues of Sexual Stimuli Activate the Reward System in both Sexes. Neuroscience 2019; 416:63-73. [PMID: 31394197 DOI: 10.1016/j.neuroscience.2019.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/27/2023]
Abstract
Sexually explicit material (SEM) is increasingly used in western societies. One reason for this high usage might be the rewarding property of SEM demonstrated in many brain imaging studies showing an activation of the reward system during the presentation of SEM. It is not yet well understood why women use SEM to a remarkably lesser extent than men. Maybe men react stronger to stimuli - so called SEM cues -, which signal the presentation of SEM and are therefore more vulnerable to use SEM than women. Therefore, the present study aimed at investigating the sex specific neural correlates towards SEM and SEM cues. We were further interested in whether person characteristics as trait sexual motivation, extent of SEM use in the last month, and age at onset of goal-oriented SEM use affect the neural responses to SEM and SEM cues. The trials of the fMRI experiment consisted of an expectation phase with SEM or neutral cues and a presentation phase with SEM or neutral stimuli, respectively. Analyses showed that the reward circuitry was activated by SEM, but also by SEM cues. There were some sex differences in hemodynamic responses to SEM during the presentation phase, but not during the expectation phase to SEM cues in any of the regions of interest. The influence of the investigated person characteristics was only small if existent. The results suggest that sex specific cue processing cannot explain sex differences in the use of SEM.
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Affiliation(s)
- Rudolf Stark
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany; Bender Institute of Neuroimaging, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany; Center of Mind, Brain and Behavior, Universities of Marburg and Gießen, Hans-Meerwein-Straße 6, 35032 Marburg, Germany.
| | - Sanja Klein
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany; Bender Institute of Neuroimaging, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany.
| | - Onno Kruse
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany; Department of Clinical Psychology, University of Siegen, Adolf-Reichwein-Str. 2a, 57076 Siegen, Germany.
| | - Martin Weygandt
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Excellence Cluster NeuroCure, 10117 Berlin, Germany.
| | - Lisa K Leufgens
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany.
| | - Jan Schweckendiek
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany
| | - Jana Strahler
- Department of Psychotherapy and Systems Neuroscience, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany; Bender Institute of Neuroimaging, Justus-Liebig-Universität Giessen, Otto-Behaghel-Str. 10H, 35394 Giessen, Germany.
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de Alarcón R, de la Iglesia JI, Casado NM, Montejo AL. Online Porn Addiction: What We Know and What We Don't-A Systematic Review. J Clin Med 2019; 8:E91. [PMID: 30650522 PMCID: PMC6352245 DOI: 10.3390/jcm8010091] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 01/09/2023] Open
Abstract
In the last few years, there has been a wave of articles related to behavioral addictions; some of them have a focus on online pornography addiction. However, despite all efforts, we are still unable to profile when engaging in this behavior becomes pathological. Common problems include: sample bias, the search for diagnostic instrumentals, opposing approximations to the matter, and the fact that this entity may be encompassed inside a greater pathology (i.e., sex addiction) that may present itself with very diverse symptomatology. Behavioral addictions form a largely unexplored field of study, and usually exhibit a problematic consumption model: loss of control, impairment, and risky use. Hypersexual disorder fits this model and may be composed of several sexual behaviors, like problematic use of online pornography (POPU). Online pornography use is on the rise, with a potential for addiction considering the "triple A" influence (accessibility, affordability, anonymity). This problematic use might have adverse effects in sexual development and sexual functioning, especially among the young population. We aim to gather existing knowledge on problematic online pornography use as a pathological entity. Here we try to summarize what we know about this entity and outline some areas worthy of further research.
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Affiliation(s)
- Rubén de Alarcón
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Javier I de la Iglesia
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Nerea M Casado
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
| | - Angel L Montejo
- Psychiatry Service, Hospital Clínico Universitario de Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain.
- University of Salamanca, EUEF, 37007 Salamanca, Spain.
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Lee EB, Homan KJ, Morrison KL, Ong CW, Levin ME, Twohig MP. Acceptance and Commitment Therapy for Trichotillomania: A Randomized Controlled Trial of Adults and Adolescents. Behav Modif 2018; 44:70-91. [DOI: 10.1177/0145445518794366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).
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Abstract
Background and aims Sexuality is natural to human life and inseparable from it, yet some individuals develop compulsive sexual behavior (CSB). Many individuals with CSB seek treatment in free self-support groups based on the twelve-step program. This program was extensively studied in substance abuse disorders (e.g., Alcoholics Anonymous), but little is known about its efficiency in CSB. Methods We "assesed" questionnaire data on sociodemographical-, psychological-, and recovery-related factors from 97 male participants of Sexaholics Anonymous (SA) programs in Israel. Results Our results indicated that advancement in the SA program, measured as a current step of the program, is significantly related to lower levels of sexual-related overall sense of helplessness, avoidant help-seeking, self-control, overall CSB, and sexual suppression. It is also related to the higher well-being. Discussion This is the first study to examine psychological factors of CSB recovery process in twelve-step groups, and future research is needed to replicate our results within a longitudinal study.
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Affiliation(s)
- Yaniv Efrati
- Faculty of Education and Society and Culture, Beit-Berl College, Kfar Saba, Israel,Corresponding author: Yaniv Efrati, PhD; Faculty of Education and Society and Culture, Beit-Berl College, Kfar Saba 4490500, Israel; Phone: +972 545 800 094; E-mail:
| | - Mateusz Gola
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, San Diego, CA, USA
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9
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Grubbs JB, Wilt JA, Exline JJ, Pargament KI, Kraus SW. Moral disapproval and perceived addiction to internet pornography: a longitudinal examination. Addiction 2018; 113:496-506. [PMID: 28833800 DOI: 10.1111/add.14007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/18/2017] [Accepted: 08/14/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Internet pornography use is an increasingly common, yet controversial, behavior. Whereas mental health communities are divided about potentially problematic use patterns, many lay people identify as feeling dysregulated or compulsive in their use. Prior work has labeled this tendency perceived addiction to internet pornography (PA). This study's aims were to (1) assess the association between PA at baseline and other factors, including actual levels of average daily pornography use and personality factors and (2) assess the associations between baseline variables and PA 1 year later. DESIGN Two large-scale community samples were assessed using online survey methods, with subsets of each sample being recruited for follow-up surveys 1 year later. SETTING United States. PARTICIPANTS Participants were adults who had used pornography within the past 6 months recruited in two samples. Sample 1 (n = 1507) involved undergraduate students from three US universities and sample 2 (n = 782) involved web-using adults. Subsets of each sample (sample 1, n = 146; sample 2, n = 211) were surveyed again 1 year later. MEASUREMENTS At baseline, we assessed average daily pornography use, PA and relevant predictors (e.g. trait neuroticism, trait self-control, trait entitlement, religiousness, moral disapproval of pornography use). One year later, we assessed PA. FINDINGS Cross-sectionally, PA was correlated strongly with moral disapproval of pornography use [sample 1, Pearson's correlation: r = 0.68 (0.65, 0.70); sample 2, r = 0.58 (0.53, 0.63)]. Baseline moral disapproval [sample 1, r = 0.46 (0.33, 0.56); sample 2, r = 0.61 (0.51, 0.69)] and perceived addiction demonstrated relationships with perceived addiction 1 year later. We found inconclusive evidence of a substantial or significant association between pornography use and perceived addiction over time [sample 1, r = 0.13 (-0.02, 0.28); sample 2, r = 0.11 (-0.04, 0.25)]. CONCLUSIONS Perceived addiction to internet pornography appears to be related strongly to moral scruples around pornography use, both concurrently and over time, rather than with the amount of daily pornography use itself.
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Affiliation(s)
- Joshua B Grubbs
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Joshua A Wilt
- Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Julie J Exline
- Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Kenneth I Pargament
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Shane W Kraus
- VISN 1 MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
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Kraus SW, Voon V, Kor A, Potenza MN. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction. Addiction 2016; 111:2113-2114. [PMID: 27470127 DOI: 10.1111/add.13499] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/14/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Shane W Kraus
- VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, Massachusetts, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ariel Kor
- Department of Psychology, Teachers College, Columbia University, New York, USA
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Neurobiology, Child Study Center, the National Center on Addiction and Substance Abuse and Connecticut Mental Health Center, Yale University School of Medicine, New Haven, Connecticut, USA
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