Some people—overwhelmingly, men troubled by emotional stress—believe their sexual behavior is out of control. The chief sign of this is self-sexing while viewing pornography. What frequency of porn-fueled solo sex suggests being out of control? That’s debatable. Some say any self-pleasuring to any porn signifies a real problem. However, virtually all men engage in solo sex while watching porn: It’s a common way men self-soothe to cope with daily stresses. Canadian researchers wanted to compare the sexual attitudes of men who did or did not self-sex to porn, but they couldn’t find any who hadn’t.
Men disturbed by their porn habits often call themselves “sex addicts.” Quite often, their partners, and a small minority of mental health professionals, also use the term sex addict. But the large majority of psychologists and psychiatrists reject the very idea of sex addiction as poorly informed about sexuality. The latest edition of the bible of mental health conditions, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5, 2013) says there’s no such thing as sex addiction. The purported condition does not meet standard medical and psychological criteria for addiction. There is no professional consensus on its symptoms, diagnosis, and treatment. And quite frequently, men who label themselves sex addicts don’t watch any more porn than most other men; they just feel more distressed about it, usually because of upbringings in families and religious communities that demonized self-sexing and men’s favorite visual aid while having sex with themselves.
Sex addiction is fiction, but a substantial cottage industry has developed to treat it. Some residential facilities charge more than $30,000 a month—and health insurance rarely covers it. Evidently, there's a good deal of money to be made treating a condition most mental health professionals don’t even recognize as real.
Meanwhile, some men continue to feel absolutely convinced their sexual behavior is out of control. What should they do? A growing body of research shows that the most cost-effective approach is cognitive-behavioral therapy (CBT).
In Hamlet (II:2), Shakespeare summed up cognitive-behavioral therapy quite succinctly: “There is nothing either good or bad, but thinking makes it so.” “Cognitive” refers to thinking. CBT says that you may not be able to change the challenges life hands you, but you can change how you think about them. Changing the story you tell yourself allows you to correct false beliefs that cause torment, and detoxify how you react to life’s stresses.
Say you miss a plane. You might think: This is a disaster. My life is ruined. Or you might think: Oh, I missed my flight. What a drag. But there are others. I’ll rearrange my calendar. The “disaster” scenario evokes what CBT therapists call “catastrophizing"—overstating problems, and making mountains of molehills. Catastrophizing is associated with irritability, stress, anxiety, depression, insomnia, and increased blood pressure, a key risk factor for heart disease and stroke. The “molehill” perspective is the way to go. It’s more accurate, and it’s not linked to distress. CBT teaches how to recognize catastrophizing and correct the flawed thinking that produces it. This reduces anxiety and any associated acting out, including anxiety-fueled self-sexing to porn.
Sexual catastrophizing includes these mistaken ideas:
CBT therapists correct and de-catastrophize them:
Swedish researchers recruited 137 adult men who said their sexual behavior was out of control, and divided them into two groups. Half remained on a wait list. The other half participated in seven 2.5-hour CBT sessions over seven weeks (17.5 hours total). The CBT group learned that it’s fine to have sexual thoughts and fantasies, even several times a day. The therapists also informed them that it’s fine to engage in solo sex, even frequently, and that religious prohibitions against masturbation are not grounded in science. And they learned that men from all walks of life use porn to enhance self-pleasuring, which is almost always fine. The wait-list group reported slightly reduced sexual distress, while still considering themselves out of control. But in the CBT group, sexual anguish plummeted—and so did the men's anxiety-fueled porn-watching. It remained low six months later. And they no longer thought of themselves as out of control.
THE BASICSThe Swedish report is the largest, most scientifically rigorous study to date of CBT for out-of-control sexuality. But it’s far from the only one:
Now, some men hold deep religious convictions that demonize sexual thoughts, solo sex, and porn—and CBT may not help them. But for those open to scientific discussions of sexuality, CBT has a proven record of correcting false beliefs about sex and reducing behavior labeled out-of-control, hypersexual, or sex-addicted—usually for a small fraction of the cost of other therapies.