Treating Compulsive/Addictive Porn Use and Simultaneous Issues/Disorders

Compulsive and addicted users of pornography often arrive in treatment with co-occurring issues – unresolved early-life trauma,[i] another addiction,[ii] a depressive or anxiety disorder, [iii] shame and self-hatred,[iv] etc. Unfortunately, the often-symbiotic relationship between porn usage and these coexisting problems is not always clearly assessed or addressed in treatment. In fact, it used to be that when compulsive/addicted porn users sought treatment for their addiction, they got that and nothing else. This occurred for two main reasons:

  1. Until very recently it was believed that before a compulsive/addicted porn user got sober, little else could happen on the therapeutic front. After all, if we understand that porn compulsivity and addiction are (or become over time) maladaptive attempts to self-soothe and self-medicate and that the basis of traditional psychotherapy is recognizing, experiencing, and processing past and present emotional discomfort, then logic dictates clients can’t grow past their emotional challenges (their early-life trauma, for instance) while they are simultaneously self-medicating away the resulting anxiety, emotional instability and depression they experience.
  2. Most clinicians are trained to (and prefer to) work using specific approaches. Addiction specialists, for instance, tend to use highly directive forms of behavioral therapy such as CBT and DBT. This works great when dealing with behavior modification, but not so well with trauma, depression, anxiety, and the like. Meanwhile, trauma specialists tend to use various exposure and/or desensitization techniques like PE (prolonged exposure) and EMDR (eye movement desensitization and reprocessing).[v] These work great with trauma, but they’re not overly useful when it comes to establishing sobriety. Similarly, specialists in depression, anxiety, and other disorders have their preferred methodologies, and these typically are not the best ways to address an early recovery from addiction. Thus, a clinician’s lack of comfort with certain techniques sometimes creates a “treatment box” that is not easily escaped.

Unfortunately, for some porn addicts this means that coexisting issues are never effectively addressed. At times, these problems are never even identified and acknowledged. As such, recovering porn addicts are sometimes turned loose on the world post-treatment without any understanding of why and how their addiction developed and became so powerful, or why their addiction seems to reappear without obvious external reasons.

In response to this issue, over the course of the last several years Dr. Rob Weiss has developed, both individually and in conjunction with his esteemed colleague, Dr. Christine Courtois, a three-stage methodology for integrated treatment of compulsivity/addiction and related co-occurring issues. This approach is based heavily on their own observations, experiences, and theories, though it incorporates (often quite heavily) the well-developed work of many other clinicians. This new approach recognizes the interconnected nature of addiction and other disorders and the fact that they often have a negative synergistic impact.

The belief here is that if both addiction and interrelated issues are not treated in an integrated fashion and people don’t heal from their multiple conditions simultaneously, they may not fully heal from any of those issues. This thought is well-supported by research that shows compulsives and addicts (of all types) with extensive trauma histories and/or co-occurring psychological disorders like depression and anxiety have a much harder time maintaining long-term sobriety than addicts without such histories.[vi] A very simplified version of Dr. Rob’s three-stage model is as follows:

  • Stage One: This stage is devoted to client safety and early sobriety. Emphasis is on crisis management, along with extensive psychoeducation about the compulsivity/addiction, coexisting issue(s), and their interaction. The goal is to eliminate shame and consequence-producing behaviors while helping the client develop basic coping skills that he or she can use to deal with triggers and the desire to use pornography.
  • Stage Two: This stage is more focused on the simultaneous issue. For instance, trauma survivors may be asked to work on the re-experiencing and processing of past trauma(s) in the safety of the therapeutic setting, learning coping mechanisms that can be used outside the therapy room to lessen trauma’s impact. Over time, this emotional and cognitive processing of past trauma (or depression, anxiety, and anything else a particular client is dealing with) results in a lessening of symptoms and, in turn, an easier time maintaining sobriety.
  • Stage Three: In this stage, treatment focuses on the client’s newfound ability to make life choices based not on his or her history of compulsivity/addiction and coexisting issues, but on freedom from those bonds and a newly developed sense of self-worth and personal empowerment.

Although the treatment stages are presented above in linear format, they are fluid in their application, with clients engaging in the different treatment tasks and moving back and forth between the stages as needed. For example, if a client reports feeling unsafe and overwhelmed during the formal trauma (or depression, anxiety, etc.) work that takes place in stage two, he or she will (with the guidance of the therapist) return to stage one’s more cognitive safety planning and skill-building to restabilize and to practice healthy coping skills. Once stabilization and skills are reestablished, the work of stage two resumes. Furthermore, stage three is often implemented even though stage two is ongoing (and may continue to be ongoing for quite some time).

Throughout the stages there is planning for backslides and relapse, with setbacks treated as problems to be solved rather than personal failures. At all stages, clients are encouraged to take risks with self-exploration in a safe and supportive environment, and to engage in new behaviors based on their newly acquired perspective and skills.

At all times, it is important to understand that there is no cure for compulsivity and addiction. Similarly, there is no cure for complex trauma, depression, or anxiety. Treatment for these issues does not make them go away, never to return. Instead, treatment provides clients with knowledge, skills, and tools that can reduce the power and impact of compulsive/addictive behaviors and simultaneous issues and disorders, helping the client live a healthier, happier, more connected, and more emotionally fulfilling life.

References

[i] Earle, R. H., Earle, M. R., & Osborn, K. (1995). Sex addiction: Case studies and management. Brunner/Mazel; Zapf, J. L., Greiner, J., & Carroll, J. (2008). Attachment styles and male sex addiction. Sexual Addiction & Compulsivity, 15(2), 158-175.

[ii] Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. Journal of sex research, 47(2-3), 181-198; Carnes, P. (2001). Facing the shadow: Starting sexual and relationship recovery. Hazelden Publishing & Educational Services; Hall, P. (2013). Understanding and treating sex addiction: A comprehensive guide for people who struggle with sex addiction and those who want to help them. London: Routledge; among others.

[iii] John Bancroft. (2009). Human sexuality and its problems. Elsevier Health Sciences; and Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. Journal of sex research, 47(2-3), 181-198.

[iv] Kaplan, M. S., & Krueger, R. B. (2010). Diagnosis, assessment, and treatment of hypersexuality. Journal of sex research, 47(2-3), 181-198; and Reid, R. C., Harper, J. M., & Anderson, E. H. (2009). Coping strategies used by hypersexual patients to defend against the painful effects of shame. Clinical Psychology & Psychotherapy, 16(2), 125-138.

[v] Courtois, C. (2014). It’s not you, it’s what happened to you, p 5. Long Beach, CA: Elements Behavioral Health.

[vi] Farley, M., Golding, J. M., Young, G., Mulligan, M., & Minkoff, J. R. (2004). Trauma history and relapse probability among patients seeking substance abuse treatment. Journal of Substance Abuse Treatment, 27(2), 161-167; Brown, S. A., Vik, P. W., Patterson, T. L., Grant, I., & Schuckit, M. A. (1995). Stress, vulnerability and adult alcohol relapse. Journal of Studies on Alcohol and Drugs, 56(5), 538; among other studies.