8 - (3-MIN 1) Psychological Treatments for out of Control Sexual Behavior: A Systematic Review

This PRISMA systematic review contemplates empirically evidenced psychological treatments for Out of Control Sexual Behavior, including conditions such as Compulsive Sexual Behavior Disorder, Sex Addiction, Hypersexuality, Problematic Pornography Use, and other online manifestations. Data on the studies’ definition of the condition, sample characteristics, experimental design, methodology, administration, assessment, satisfaction, procedural elements, and follow-up was collected. This is the first review that we know of to include treatment satisfaction and procedural indicators. The terms "sex addiction," "cybersex addiction," "porn* addiction," "problematic pornography use," “PPU,” “hypersexual*,” "compulsive sexual behavior," and "sexual compulsivity," along with “treatment,” “intervention,” “program,” “trial,” “therap*,”; as well as “efficacy,” “evaluation,” “results,” and “assessment,” were searched in the databases Proquest, PsycInfo, PubMed, Scopus, and Web of Science. After screening, 22 studies were included. Over 50% (n=12) of studies were published in 2019 or later, the year of the ICD-11 inclusion of Compulsive Sexual Behavior Disorder, the first time this condition was defined in a diagnostic manual. Only 27% (n=6) of studies were randomized controlled trials. Across the included studies, there was substantial heterogeneity in the measures used to evaluate these conditions, with 24 unique outcome measures. 41% of studies (n=9) assessed satisfaction, while 27% (n=6) measured processual indicators. The most common treatment approaches were second and third wave cognitive behavioral therapy, with 50% (n=11) studies applying CBT (n=9) or other cognitive or behavioral methods (n=2) and 18% (n=4) utilizing ACT. 45% of studies (n=10) reported follow-up outcome measures at 3 months or less, 23% (n=5) at 6 months, one study at one year, and the remaining (n=6) did not include follow-up measures.
This review has implications for both research and clinical practice. In research, controlled trials are also needed to evaluate treatment effectiveness. In clinical practice, we can learn from the effective treatment methodologies, such as the use of second- and third-wave cognitive behavioral therapies. Most importantly, there are various takeaways at the intersection of research and clinical practice. First, it is crucial to evaluate patient satisfaction with treatment received, as it influences treatment adherence and outcome. Next, further evaluation of procedural elements and processual elements of treatment should be made a priority to understand why different treatments work, and what underlying mechanisms of change are occurring.

Funding: Spanish Ministry of Science and Technology (PID2021-127353OB-I00).