HELPING ADULTS DEALING WITH COMPULSIVE PORNOGRAPHY USE COPING

HELPING ADULTS DEALING WITH COMPULSIVE PORNOGRAPHY USE COPING. US Training Program on Pornography #3 from Pornography Intervention at: http: //coping. us/pornographyintervention. html Prepared and Presented by: Jim Messina, Ph. D. , CCMHC, NCC, DCMHS-T

Pornography Intervention for Adults (3 rd of 4 Programs on Pornography Intervention) Resource for Course on Coping. us: http: //www. coping. us/pornographyintervention. html and http: //www. coping. us/seasmanual. html Description of Program: This program takes an intervention orientation to an emerging epidemic of internet pornography which threatens adults who have become addicted compulsive pornography users. There is a need to train mental health professionals to learn how to assist adults who are dealing with the grips of compulsive pornography use in their lives. Also, therapists need to learn how to conduct community wide educational programming to awaken citizens to this crisis and to help them develop strategies on how to deal with it in their communities. Helping adults grapple with this new challenge to their mental health and happiness can result in renewed commitment and conviction to fight this issue to regain complete recovery and wellness in their lives. Therapists need help on what to say, how to say it and how not to use shame, guilting and outing to get the adults to come to grips with this issues in their lives. Learning Objectives 1. To learn about the impact of Compulsive pornography use on Adults in America today with an exploration of what types of pornography are out there and on what platforms they are present. 2. To learn about the neuroscience of watching pornography by adults which leads to the compulsive need for more pornography to satisfy the mesolimbic reward centers of the brain. 3. To learn techniques which adults can use to lessen the impact of compulsive pornography in their lives and to help them learn how to grow stronger, committed to strengthened personal growth and recovery despite what challenges come their way. 4. To learn about the resources to supplement the treatment of adults coping with compulsive pornography use, which can be incorporated into all types of institutions in the community churches, civic organizations and social media.

IMPACT OF PORNOGRAPHY ON ADULTS

Why Now? ■ In 2006 with the introduction of High Speed Internet systems the world has been turned upside down when it come to Pornography and the ease of its accessibility ■ No one dreamed of this problem which is now at epidemic proportions ■ In 2010 the Professional Literature began to be crowded with research on the impact of internet pornography or cybersex ■ Today there is enough documentation to convince mental health professionals, pastoral leaders, school officials and governmental agencies that there is a whole new study out there about the prevention of compulsive pornography use by children, teens, young adults, and married partners ■ The time has come to deal with this issue seriously and for this reason Coping. US Training Programs has 4 distinct programs on Pornography Intervention ■ They are: – Pornography Prevention Program Strategies for parents with children and teens – Pornography Intervention for Couples – Pornography Intervention for Adults – Pornography Therapeutic Interventions for Mental Health Professionals

Impact of Pornography on Adults in America ■ A 2016 study identified that men’s sexual difficulties and the sharp rise in erectile dysfunction, delayed ejaculation, decreased sexual satisfaction, and diminished libido during partnered sex in men under 40 is directly related to overuse of internet pornography. The study concluded that alterations to the brain's motivational system are the etiology underlying pornography-related sexual dysfunctions (Park et al. , 2016). Their explanation is that the characteristics of internet pornography may be potent enough to condition sexual arousal that do not readily transition to real life partners. These characteristics include: ■ Limitless novelty ■ Potential for easy escalation to more extreme material ■ Video formats ■ The result of the impact of internet pornography is that ■ sex with desired partners may not register as meeting expectation and arousal declines. ■ Clinical reports suggest: ■ Terminating internet pornography use is sometimes sufficient to reverse negative effects. (Park et al. , 2016).

Self-Perceived Pornography Addiction ■ By 2016, an estimated 40 million adults in the U. S. regularly view Internet pornography ■ 10 percent of whom admit to having an addiction to Internet pornography ■ Self-perceived pornography addiction (SPPA) has increasingly emerged as a concept in research & popular culture. ■ “Pornography or porn addiction” is not a formally recognized disorder & there is disagreement among researchers regarding its definition or even its existence however there are reliable findings about its impact ■ How Compulsive Pornography Use is operationalized often varies & this influences conclusions made about the impact of Compulsive Pornography Use ■ Compulsive Pornography Use is most frequently operationalized as excessive pornography use with negative consequences ■ Compulsive Pornography Use is reported to affect users & their partners in similar ways, such as increased feelings of isolation & relationship breakdowns ■ There still exist a debate regarding the definition & etiology of Self-Perceived Pornography Addiction as distinct from self-perceived sex addiction (Health & Medicine, 2016).

Psychological Distress Directly Related to Compulsive Pornography Use A 2015 study examined how the notion of perceived addiction to Internet pornography might be related to other domains of psychological functioning The study demonstrated that: ■ The notion of perceived addiction to Internet pornography is very robustly related to various measures of psychological distress ■ The relation between psychological distress & perceived addiction to Internet pornography persisted, even when other potential contributors (neuroticism, selfcontrol, amount of time, spent viewing pornography) were controlled for statistically (Grubbs, Volk, Exline & Pargament, 2015).

Impact of Online Pornography on Sexist Attitudes of Males In 2014 a study investigated how the sexist attitudes of young adult males were affected when they were inadvertently exposed to online pornography & the role of the sense of anonymity in subsequent selection by these individuals of sexually explicit material Results of this study showed that: ■ Participants were more likely to pursue extreme pornography when they felt anonymous, as compared with situations in which they did not feel anonymous ■ This tendency was especially apparent for those exposed for 10 seconds to sexual online pop-up commercials that include pornographic content ■ The results also showed that inadvertent exposure to such sexual online pop-up commercials, coupled with feelings of anonymity, could increase participants’ sexist attitudes toward women (Shim & Paul, 2014).

Impact on Gender Role & Attachment Styles from Compulsive Male Porn Use A 2014 study examined, gender role conflict & attachment styles & consequences of poorer relationship quality & sexual satisfaction of men’s pornography use among adult heterosexual men - Findings revealed that: Both frequency of pornography use & problematic pornography use were related to: ■ greater gender role conflict ■ more avoidant & anxious attachment styles ■ poorer relationship quality ■ less sexual satisfaction ■ In addition, the findings provided support for a theorized mediated model in which gender role conflict was linked to relational outcomes both directly & indirectly via attachment styles & pornography use (Szymanski & Stewart-Richardson, 2014).

Pornography’s Use Impact on Relationships A 2013 study examined: ■ associations among pornography use ■ the meaning people attach to its use ■ sexual quality ■ relationship satisfaction ■ factors that discriminate between those who use pornography & those who do not Participants were couples who were either married or cohabiting at the time the data were gathered. Overall results from this study indicated substantial gender differences in terms of use profiles, as well as pornography’s association with relationship factors. Findings: ■ male pornography use was negatively associated with both male & female sexual quality ■ Female pornography use was positively associated with female sexual quality ■ Meaning explained a relatively small part of the relationship between pornography use & sexual quality (Poulsen, Busby & Galovan, 2013).

Impact Exposure of Pornography on Young Adult Development In 2012 a study of the role of exposure to pornography during adolescence in predicting intimacy among young adults was conducted with college students (aged 18– 25 years) who were surveyed online. Respondents provided information about: ■ pornography use at ages 14 & 17 ■ perceived realism of pornographic depictions of sexual activities ■ attitudes towards recreational sex & relationship intimacy ■ significant gender differences in pornography exposure ■ perceived realism of pornographic contents ■ attitudes towards recreational sex ■ No direct relationship was found between adolescent exposure to pornography & relationship intimacy in young adulthood ■ The realism of pornography was related both to exposure & intimacy, but only among female participants ■ The association between the appraisal of pornographic realism & intimacy was shown to be mediated by attitudes towards recreational sex

Pornography Use Weakens Commitment in Relationships A 2012 analysis of five different studies examined the correction between pornography consumption & commitment to romantic relationships with the expectation that higher levels of pornography consumption would correspond to weakened commitment in young adult romantic relationships. ■ Study 1: found that higher pornography consumption was related to lower commitment ■ Study 2: replicated this finding using observational data ■ Study 3: participants were randomly assigned to either refrain from viewing pornography or to a self-control task. those who continued using pornography reported lower levels of commitment than control participants ■ Study 4: participants consuming higher levels of pornography flirted more with an extradyadic partner during an online chat ■ Study 5: found that pornography consumption was positively related to infidelity & this association was mediated by commitment. ■ Overall: a consistent pattern of results was found using a variety of approaches with the conclusion that more pornography consumption is associated with a more weakened commitment to one’s relationship partner (Lambert, Negash, Stillman, Olmstead & Fincham,

Differences from Male & Female Use of Pornography In studying the differences between male and female use of pornography researchers found that males indicated: ■ a younger age of first exposure to pornography ■ higher total number of times pornography was viewed ■ more frequently viewing pornography within the last year compared to female participants ■ Although men viewed more pornography more frequently than women, both male & female participants reported similar reasons for viewing pornography ■ “Wanted the sexual excitement" was frequently indicated as a reason for viewing pornography ■ However, a higher percentage of women reported "never looking for pornography on purpose" than did men ■ The difference between "wanted the sexual excitement" and "never looking at pornography on purpose" was only 3%, suggesting that there is great discrepancy within reasons for viewing pornography among female participants. The discrepancy suggests that there is not a "typical" relation between women & pornography (Butler, Holm & Ferraro, 2011).

Earlier Studies Show Impact of Pornography on Young Adults In 2009, a survey of 29, 000 individuals at North American universities found that: ■ 51% of male students & 32% of female students first viewed pornography before their teenage years (12 & younger) ■ 35% of all students’ first exposure was Internet or computer-based (compared to 32% from magazines, 13% from VHS or DVD &18% from Cable or pay-perview) ■ 64% of college men & 18% of college women spend time online for Internet sex every week ■ 42% of male students & 20% of women said they regularly read romance novels, sexually explicit magazines, or regularly visited sexually explicit websites or chat rooms (Leahy, 2009)

Impact of Compulsive Online Pornography Use on Adults Research from 2005, indicated pornography consumption was associated with the following six trends, among others: 1. Increased marital distress & risk of separation & divorce 2. Decreased marital intimacy & sexual satisfaction 3. Infidelity 4. Increased appetite for more graphic types of pornography & sexual activity associated with abusive, illegal or unsafe practices 5. Devaluation of monogamy, marriage & child rearing 6. An increasing number of people struggling with compulsive & addictive sexual behavior (Manning, 2005).

Emerging Impact of Internet Pornography Identified Back in 2002 In 2002, the American Academy of Matrimonial Lawyers reported the following as the most salient factors present in divorce cases: ■ 68% of the divorces involved one party meeting a new lover the Internet ■ 56% involved one party having “an obsessive interest in pornographic websites” ■ 47% involved spending excessive time on the computer ■ 33% involved excessive time spent speaking in chat rooms (Dedmon, 2002)

Impact of Pornography Begins in Adolescence A 2000 study found prolonged exposure to pornography impacts adolescents and young adults’ attitudes toward marriage including: ■ ■ ■ ■ An exaggerated perception of sexual activity in society Diminished trust between intimate couples The abandonment of the hope of sexual monogamy Belief that promiscuity is the natural state Belief that abstinence and sexual inactivity are unhealthy Cynicism about love or the need for affection between sexual partners Belief that marriage is sexually confining Lack of attraction to family & child-raising (Zillmann, 2000).

What Did We Find Out? Over the Years the Impact of Online Pornography & Compulsive Use of this Pornography has become a major issue for Adults Being able to stop Compulsive Use of Pornography is complicated due to the Neuroscience behind the Use of Pornography

NEUROSCIENCE OF PORNOGRAPHY

Mesolimbic System: Pleasure/Reward Pathways Impacted by Pornography ■ Addiction occurs when pleasure/reward pathways are hijacked by exogenous drugs such as cocaine or opioids, or by natural processes essential and inherent to survival such as food and sex in the mesolimbic reward centers of the brain. ■ The pleasure/reward pathways and the other limbic regions mediate, at least in part, the acute positive emotional effects of natural rewards, such as food, sex and social interactions. These same regions have also been implicated in the so-called ‘natural addictions’ (that is, compulsive consumption for natural rewards) such as pathological overeating, pathological gambling, and sexual addictions. Preliminary findings suggest that shared pathways may be involved: (an example is) cross sensitization that occurs between natural rewards and drugs of abuse (Hilton & Watts, 2011).

Ventral Striatal Reward Pathway This circuit starts and ends in the brainstem with the release of dopamine. Activating these “reward cells” with stimulation (e. g. , pornography, sex, drugs, food, etc. , causes them to transmit dopamine to other regions in the cortex and subcortex such as the striatum. This reinforces the drive for future reward seeking behaviors. These signals converge to a set of cells in the nucleus accumbens, which is essential for determining the motivational significance of the reward stimulus, causing the person to think, “Mmmmm that was fun; I’ll do that again. ” In cases of extreme compulsive pornography use, simply showing still pictures to the compulsive pornography user will engage this reward circuit. The same is true for people addicted to eating: showing them pictures of food can reengage the same (Hilton & Watts,

Impact of Pornography Use on Brain Matter In 2014 the first-ever brain-scan study of online porn users, was conducted at the Max Planck Institute for Human Development in Berlin, researchers found that the hours and years of porn use were correlated with decreased grey matter in regions of the brain associated with reward sensitivity, as well as reduced responsiveness to erotic still photos with: ■ Significant negative association between reported pornography hours per week & gray matter volume in the right caudate ■ Reduced functional activity during a sexual cue–reactivity paradigm in the left putamen ■ Functional connectivity of the right caudate to the left dorsolateral prefrontal cortex was negatively associated with hours of pornography consumption ■ The negative association of self-reported pornography consumption with the right striatum (caudate) volume, left striatum (putamen) activation during cue reactivity, and lower functional connectivity of the right caudate to the left dorsolateral prefrontal cortex could reflect change in neural plasticity as a consequence of an intense stimulation of the reward system, together with a lower top-down modulation of prefrontal cortical areas ■ Alternatively, it could be a precondition that makes pornography consumption more rewarding (Kuhn & Gallinat, 2014)

The Brain’s Neurochemicals Impacted by Compulsive Pornography Use A Summary from Covenant Eye’s: The Porn Circuit: Understand Your Brain and Break Porn Habits in 90 Days by Sam Black, 2013. Dopamine: ■ Focuses one’s attention on whatever task is at hand ■ Motivates person forward ■ Activates or enhances rewards circuitry that makes one feel good ■ Plays a major role in memory ■ Helps people recall what is important in environment & remember appropriate response to the stimulus ■ Fuels the tension & craving for meeting a need ■ Is released in response to all drugs of addiction & plays a role in many disorders affecting motivation & attention such as obsessive-compulsive disorder & behavioral addictions. ■ Helps brain remember what is interesting & how to respond to it. ■ Focuses the mind on a specific task while other concerns are ignored

The Brain’s Neurochemicals Impacted by Compulsive Pornography Use Delta. Fos. B ■ Has been implicated as a critical factor in the development of virtually all forms of behavioral & drug addictions ■ In the nucleus accumbens, Delta. Fos. B functions as a "sustained molecular switch" & "master control protein" in the development of an addiction ■ Once "turned on" (sufficiently overexpressed) Delta. Fos. B triggers a series of events that ultimately produce an addictive state (i. e. , compulsive reward-seeking involving a particular stimulus) ■ This state is sustained for months after cessation of drug of choice use (including pornography) due to the abnormal & exceptionally long half-life of Delta. Fos. B ■ Delta. Fos. B in the nucleus accumbens medium spiny neurons directly & positively regulates drug self-administration & reward sensitization through positive reinforcement while decreasing sensitivity to aversion.

The Brain’s Neurochemicals Impacted by Compulsive Pornography Use Norepinephrine ■ A neurotransmitter often associated with stress & the fight-or-flight response, helping people to be more alert ■ Acts as a hormone for sexual arousal & sexual memory ■ Helps people burn emotional experiences in their minds ■ Whether it’s a wonderful sexual experience with one’s spouse or a provocative sexual image, the information is stored for easy recall with the help of norepinephrine.

The Brain’s Neurochemicals Impacted by Compulsive Pornography Use Oxytocin ■ Often referred to as the bonding hormone because big releases arrive when mothers & fathers hold their newborn babies ■ Often called the cuddle hormone because oxytocin levels rise when a couple snuggles, hold hands, or express other forms of intimacy ■ Is one reason a kiss is so powerful ■ Plays a big role in sexual bonding to one’s partner and triggers the contractions during male orgasm ■ It is for this reason that married couples are encouraged to enjoy face-to-face sex that provides as much skin contact as possible for the greatest release of the bonding chemical ■ Because oxytocin is also released in climax, it can have a negative impact for the porn user: Instead of bonding to a real mate, the porn viewer’s brain bonds to the image, video, or

The Brain’s Neurochemicals Impacted by Compulsive Pornography Use Vasopressin ■ Working in concert with oxytocin, encourages the feelings of bonding and is slowly released during sexual activity and at climax ■ The release of vasopressin during porn viewing and masturbation works to cement a person’s attachment to this behavior Endogenous Opiates ■ People were designed to have an amazing sexual experience. The body produces natural or endogenous opiates, which during climax provide pain relief and a sense of transcendence and euphoria-It is for this reason that many say Pornography Addiction is PMO: Pornography leads to Masturbation which leads to Organism which produces these addictive endogenous opioids ■ This is an opium like substance, naturally produced by the body Serotonin ■ Serotonin is released after climax and brings feelings of calm, wellbeing, and satisfaction. ■ High serotonin levels also decrease sexual motivation: These factors help explain why men are often accused of being ready for a nap after sex

The Brain’s Neurochemicals Impacted by Compulsive Pornography Use Testosterone ■ Often cited as the male hormone (although women have it in lesser amounts), testosterone dramatically increases sexual arousal and desire ■ Is released in men throughout the day, but when sexual cues are picked up by the brain the testes increase production ■ Pornography (and the mental fantasizing that it enables) crafts a brain that constantly generates testosterone and heightens sexual desire. With this ever-present sexual desire, the brain is ready to interpret any signal (external or internal) and ramp up the perceived need for sexual activity. ■ Men with strong feelings of commitment to their spouse tend to have lower testosterone levels. This may be a reason why these men may be less likely to commit adultery. ■ Because testosterone is slow to dissipate, men who habitually view pornography cause their own chemical imbalance. ■ This high testosterone level increases their sexual awareness far above normal ■ Sexual fantasies are sparked by everyday objects & even modestly dressed women are seen as provocative.

Neuroplasticity Impacted by Pornography Brain plasticity or neuroplasticity: ■ Lifelong ability of the brain to wire and rewire its neurocircuitry ■ Brain can increase or decrease the strength and number of synapses that communicate an emotion or feeling allowing information or memories to flow more or less quickly ■ Operates under a dynamic of “use it or lose it” - Do an activity more often and the brain will create neural pathways that make an activity easier to think about and complete. In creating neural pathways of porn use, repetition matters ■ Sexual activity launches major excitation in peoples’ brains, so it takes less repetition to build these porn pathways than it would to engrain cravings for other activities ■ Because porn provides a state of arousal, the brain also creates pathways that make initial arousal easier ■ Suddenly, porn & sex with a partner aren’t the only experiences that are arousing: Since as porn pathways deepen, people in everyday life become objects of sexualized fantasy & inanimate objects, clothing & situations not designed for sex become sexually charged

The Processes involved in the Neuroplasticity of the Brain A Summary from Covenant Eye’s, The Porn Circuit: Understand Your Brain and Break Porn Habits in 90 Days by Sam Black, 2013 Sensitization ■ A person who uses a pornographic image or story and masturbates for the first time begins a learning process of how to respond to porn in the future ■ With repetition the brain responds not only to the initial stimulus, but also to related stimuli. ■ After a person becomes sensitized, very little is needed to trigger a response ■ A superhighway is connected to the rewards circuitry ■ This superhighway has many entrance ramps ■ Sexual cues are seen everywhere and sexual fantasizing comes easy.

The Processes involved in the Neuroplasticity of the Brain Triggers: ■ Cigarette smokers can name a list of activities that spark a physical & mental desire for a smoke: drinking a cup of coffee, finishing a meal, sipping alcohol. These cues are called triggers & when presented the brain gets a shot of dopamine that motivates a person to smoke, ingest nicotine & fire the rewards circuitry of the brain Triggers also surface for porn & masturbation & these sensitization cues can vary greatly from person to person depending on their gender, marital status, & types of porn & activities they use: ■ Simply being home alone is enough to prompt many people to rush to their computer in search of porn ■ Some people lie awake at night, taunted with thoughts of getting up to view porn online & masturbate while the family sleeps. Why? Because they hold not only memories of using the computer for porn, but also of opportunities of secrecy & even of getting up or staying up for a late-night fix. These compulsive feelings are engrained from repetitive & powerful experiences: Dopamine flows easily in response to the learned pornographic trigger driving a person to act out & the sensitized neural pathway leads easily to the rewards circuitry where opiates fire.

The Processes involved in the Neuroplasticity of the Brain Desensitization ■ Though not true for everyone, many porn users find they need a greater amount or more intense porn to activate a state of arousal ■ Their brains had decided after multiple porn excursions that this amount of dopamine is excessive. So, it had reduced the amount of dopamine in response to porn, and it had reduced the number of dopamine receptors for the neural circuits associated with porn use. ■ To escape this desensitization, people & men especially, expand their pornographic tastes to more novel stimuli: What was once considered hardcore — a heterosexual couple engaged in intercourse — is now considered mundane, and varied forms of sex mixed with force, violence, and humiliation are now fused into today’s pornographic scripts

The Processes involved in the Neuroplasticity of the Brain Hypofrontality: ■ Compulsiveness is a good descriptor of hypofrontality ■ Many porn users feel focused on getting to porn and masturbating even when a big part of them is saying, “Don’t do this” ■ Even when negative consequences seem imminent, impulse control is too weak to battle the cravings.

Summary of Neuroplasticity Processes ■ When a man sees his partner or pornography and is sexually stimulated, including imagination, his arousal is increased &h is thoughts are focused through dopamine, testosterone & norepinephrine. ■ If sex or self-sex is pursued, these chemicals further focus his brain’s attention & narrow his thoughts on the sexual experience ■ These and other chemicals are also active in women during arousal, but in addition, perceptions, feelings, lengthy memories & cognitive choices play a larger role ■ During sex or masturbation, people get the sexual version of tunnel vision as more of these initial chemicals are combined with the slow release of oxytocin and vasopressin ■ Worries & concerns often fall away & the mind focuses on sexual release ■ The contractions of orgasm are connected to the brain’s release of endogenous opiates ■ These opiates & dopamine shut off the portions of the brain responsible for anxiety, adding to the euphoria & the removal of fear ■ Then the brain receives serotonin, adding feelings of wellbeing & satisfaction ■ All of those hormones and neurotransmitters are actually interacting with the physical brain & its neural connections.

■ Summary of Neuroplasticity Through this process of learning, the neural circuits for a porn habit are sensitized, becoming Processes broad superhighways with multiple on-ramps ■ These on-ramps are the direct result of a sensitivity to sexual cues that are seen in a growing variety of stimuli ■ The pornographic brain sees cues for arousal everywhere & because porn is part of the regular diet, testosterone keeps men especially on high alert ■ When sexual cues are strong enough, dopamine spurs the pornography user to act out, which releases more of the neural chemicals that focus attention ■ In men, the neural pathway for masturbation leads to a quick release of opiates during ejaculation. ■ Meanwhile, as this highway grows more engrained, often people become desensitized to the pornography they have been using and seek more images or porn that are more novel ■ As this tolerance expands, people often become disgusted with their own pornographic pursuits…but do it anyway, broadening the cues that lead to arousal. ■ When pornography users boast they are pushing the envelope by introducing new, harder themes, what they don’t say is they must, because they have been building up tolerance to their usual content, So when temporary escape has passed, many look at themselves & see

How Compulsive Pornography Use Mimics Other Addictions in the Brain Video on How Compulsive Pornography Use Mimics Other Addictions in the Brain Here is a Ted Talk Video which explains this process: The great porn experiment (2012) | Gary Wilson | TEDx. Glasgo https: //www. youtube. com/watch? v=w. SF 82 Aw. SDi. U

Is Compulsive Pornography Use an Addiction? The American Society of Addiction Medicine (ASAM) formally expanded their definition of addiction in 2011 to include both behaviors and substances: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. There is a Three Stage Model of Addiction which includes: 1. Binge/intoxication 2. Withdrawal/negative affect 3. Preoccupation/anticipation (Love, Laier, Brand, Hatch & Hajela, 2015)

Three Stage Model of Addiction Stage 1: Binge/intoxication ■ Different classes of drugs activate the reward system through different means, however, the universal result is a flood of dopamine in the Mesolimbic System: Pleasure/Reward Pathways ■ This results in acute positive reinforcement of the behavior that initiated the flood ■ In this impulsive stage, this positive reinforcement results in addictive related learning associations ■ Neuroplastic changes begin to occur, however, as the continued release of dopamine in the Pleasure/Reward Pathways leads to an increase in dynorphin levels ■ Dynorphin, in turn, decreases the dopaminergic function of the reward system, resulting in a decrease of the reward threshold an increase in tolerance.

Three Stage Model of Addiction Stage 2: Withdrawal/negative affect ■ The dopamine flood has run its course, and there is activation of the extended amygdala, an area associated with pain processing and fear conditioning ■ The resulting negative emotional state leads to activation of brain stress systems and dysregulation of anti-stress systems ■ This leads to a decreased sensitivity to rewards and an increase in the reward threshold, which is called tolerance ■ This further progresses to negative reinforcement as the individual continues to engage in the addictive behaviors to avoid the negative affect associated withdrawal ■ A second component of the reward system comes into play here: the mesocortical dopamine pathway responsible for key components of cognition and executive function, inhibition & emotional response ■ Taken together, the mesocortical dopamine pathway affects the cognitive component of reward processing

Three Stage Model of Addiction Stage 3: Preoccupation/anticipation (craving) ■ The neuroplastic impairments expand beyond the mesocortical dopamine pathway into other regions of the prefrontal cortex responsible for motivation, self-regulation/selfcontrol, delayed reward discounting, and other cognitive and executive functions ■ This leaves the individual vulnerable to reinstatement of the behavior ■ Two primary mechanisms have been identified; cue-induced reinstatement and stress induced reinstatement ■ Numerous neuroimaging studies substantiate this model, and these impairments are the source behind the “chronic relapsing disorder” element of the medical definition of addiction (Love, Laier, Brand, Hatch & Hajela, 2015)

INTERVENING WITH ADULT COMPULSIVE PORNOGRAPHY USERS

Immediately Have Clients Make Their Homes Safe from Pornography & Other Negative Materials on Internet Have Adult Clients make their home safe from cybersex invasion through the use of Monitoring & Filtering systems such as Covenant Eyes which are listed below: Circle with Disney: https: //meetcircle. com/circle/ Covenant Eyes: http: //www. covenanteyes. com/ K 9 Web Protection: http: //www 1. k 9 webprotection. com/ Mc. Afee Family Protection system: http: //www. mcafeefamilyprotection. com/a/index. php/featureswebsites/ Mobicip Internet Filter: http: //www. mobicip. com/ Net Nanny: https: //www. netnanny. com/ Norton: Keep Your Family Safe: https: //us. norton. com/family-resources/ Qustodio Family System: https: //www. qustodio. com/en/ Surfblocker: https: //www. surfblocker. com/parents. php

Strategies When Working with Adults with Compulsive Pornography Use In planning your Intervention with an Adult with Compulsive pornography/sex use you want to follow the steps recommend by Delboy (2015): Step 1. Client Background and Case Conceptualization A. Complete an Initial Clinical Assessment and Treatment Plan B. Use of Self-Assessment or Professional Assessment Instruments to determine if the client is a compulsive pornography/sex user C. Delineate the Symptoms which are signs of the problem D. Do a complete Psychosocial History & include assessment of ACE Factors (Adverse Childhood Experiences) E. Provide a complete diagnosis for the client including Principal, Provisional & Other Conditions That May Be a Focus of Clinical Attention Step 2. Literature and Research Review Step 3. Appraisal of Existing Literature Step 4. Treatment Plan Development Step 5. Implementation Considerations

Step 1. Client Background and Case Conceptualization A. Complete an Initial Clinical Assessment and Treatment Plan ■ You want to be sure you complete an Initial Clinical Assessment and Treatment Plan http: //coping. us/cliniciantreatmenttools/clinicalassessmentplan. html

Step 1. Client Background and Case B. Assessments Conceptualization (http: //www. coping. us/pornographyintervention/strategieswithadults. html) Self-Assessment for assessing Compulsive Pornography/Cybersex Use ■ Self-Assessment: Am I addicted to Internet Sex? ■ Cybersex Addiction Self-Assessment Screening ■ Am I a Sex Addict Self Assessment ■ PATHOS Screening Tool for Compulsive Pornography Use Professional Assessments to Assess Compulsive Pornography/Cybersex Use ■ Hypersexual Behaviors Inventory (HBI) with Scoring ■ The Hypersexual Disorder Screening Inventory (HDSI) ■ Love Addiction Screening Test (LAST) ■ Sex Addiction Screening Test (SAST) ■ 4 -self-tests- Sexual Addiction, Sexual Anorexia, Binge-Purge, Collateral indicators ■ Sexual Compulsivity Scale

Step 1. Client Background and Case C. Delineate the Symptoms which are signs of the problem Conceptualization D. Do a complete Psychosocial History and include assessment of ACE Factors (Adverse Childhood Experiences) explained at: Adverse Childhood Experiences (ACE) Factors Assessment at: http: //coping. us/cliniciantreatmenttools/acefactors. html E. Provide a complete diagnosis for the client including Principal, Provisional and Other Conditions That May Be a Focus of Clinical Attention. Remembering that hypersexual, compulsive pornography/sex use are not diagnosable, so utilize a mental health disorder Co-Morbidities of Depression (F 34. 1 Persistent Depressive Disorder (Dysthymia) (DSM-5, 2013, p. 168) or Anxiety (F 41. 1 Generalized Anxiety Disorder (DSM-5, 2013, p. 222)

Step 2. Literature and Research Review Read the following: Introduction to the Issue of Pornography at: http: //coping. us/pornographyintervention/introtopornography. html Neuroscience of Pornography at: http: //coping. us/pornographyintervention/neuroscienceofpornography. html Impact of Pornography on Children and Teens at: http: //coping. us/pornographyintervention/impactchildrenteens. html Impact of Pornography on Young Adults at: http: //coping. us/pornographyintervention/impactyoungadults. html Impact of Pornography on Marriage and Family Life at: http: //coping. us/pornographyintervention/impactmarriagefamily. html

Step 3. Appraisal of Existing Literature Read the following: Treatment of Compulsive Pornography Use by Adults at: http: //coping. us/pornographyintervention/treatmentofadults. html

Step 4. Treatment Plan Development Recognizing the treating of Compulsive pornography/sex use is similar to Addictions in the Alcohol and Substance Use Disorder Treatment Protocols so utilize the tools available for you in: ■ Tools for Coping Books at: http: //coping. us/toolsforcopingseries. html ■ Marriage Workout: A Marital Enrichment Online Workbook at: http: //coping. us/marriageworkout. html ■ Tools for a Balanced Lifestyle: A Manual for a Guilt Free System of Healthy Living at: http: //coping. us/balancedlifestyle. html

Step 5. Implementation Considerations Consider implementing an Alternative 12 -Step Program which will not set up resistance due to the fear of stigmatization. A readily available program is ■ The Self-Esteem Seekers Anonymous (SEA’s) Program at: http: //coping. us/seasmanual. html ■ Feel free to utilize any and all of the units in the Online Books on Coping. us.

Addressing Adults' Specific Issues Related to Compulsive Pornography/Sex Use Years of data have shown that individuals who are engaged in compulsive pornography/sex use are typically: 1. Victims of abuse (sexual, physical, emotional) 2. Come from rigidly disengaged families 3. See themselves as shameful, bad, unworthy persons 4. Are codependent & believe no one will love them as they are 5. See sexual activity as the most important way of taking care of their emotional needs 6. Engage in a variety of sexual behaviors (Levert. 2007)

Addressing Adults' Specific Issues Related to Compulsive ■ “Shame-based” is self-message most often experienced by adults with sexual related Pornography/Sex Use addiction. Efforts in treatment to reduce this shame is a goal (Wilson, 2000). ■ Problematic Internet Use behaviors may lead to decreased offline social activities & increased depression and loneliness over the course of several years. (Brezing, Derevensky & Potenza, 2010) ■ A 2017 report demonstrated that both insecure attachment styles & shame based or punishment-based religious beliefs were related to college students’ addictive sexual behaviors (Giordano, Cashwell, Lankford, King & Henson, 2017) ■ Given these needs, therapists can utilize the REBT and CBT modules from six books on coping. us (Laying the Foundation, Tools for Personal Growth, Tools for Relationships, Tools for Anger Workout, Tools for Handling Control Issues and Growing Down: Tools for Healing the Inner Child) to help their clients address these needs

1. Victims of abuse (sexual, physical, emotional) ACE Factors: ■ Adverse Childhood Experiences (ACE Factors) Assessment and Resilience Stress/ Questionnaire: http: //coping. us/cliniciantreatmenttools/acefactors. html ■ Laying the Foundation: http: //coping. us/layingthefoundation. html ■ Understanding Self-Esteem: http: //coping. us/toolsforpersonalgrowth/understandingselfesteem. html ■ “Little Child within”: http: //coping. us/toolsforpersonalgrowth/littlechildwithin. html ■ Inner Child Needing Growing Down: http: //www. coping. us/growingdown/innerchild. html ■ Re-Parenting Your Inner Child: http: //www. coping. us/growingdown/reparening. html ■ Handling Resentment: http: //www. coping. us/toolsforangerworkout/handlingresentment. html ■ Overcoming Silent Withdrawal: http: //www. coping. us/toolsforangerworkout/silentwithdrawal. html ■ Stop Self-Destructive Anger Responses: http: //www. coping. us/toolsforangerworkout/selfdestructiveangerresponses. html

2. Come from rigidly disengaged families: ■ Handling Insecurity: http: //coping. us/toolsforpersonalgrowth/handlinginsecurity. html ■ Building Trust: http: //coping. us/toolsforpersonalgrowth/buildingtrust. html ■ Getting in Touch With Feelings: http: //www. coping. us/growingdown/getintouchwithfeelings. html ■ Handling the Need to Control: http: //www. coping. us/toolsforhandlingcontrol/handlingneedtocontrol. html ■ Tempering Survival Behaviors: http: //coping. us/toolsforhandlingcontrol/temperingsurvivalbehaviors. html ■ Handling Depression: http: //www. coping. us/toolsforangerworkout/handlingdepression. html ■ Overcoming Pessimism and Negativity: http: //www. coping. us/toolsforangerworkout/pessimismandnegativity. html

3. See themselves as shameful, bad, unworthy persons ■ Letting Go of Shame and Guilt: http: //www. coping. us/growingdown/letgoshameandguilt. html ■ Self-Forgiveness: http: //www. coping. us/growingdown/selfforgiveness. html ■ Handling Guilt: http: //coping. us/toolsforpersonalgrowth/handlingguilt. html ■ Unconditional Self-Acceptance and Self-Love: http: //www. coping. us/growingdown/selfacceptancelove. html ■ Handling Irrational Beliefs: http: //coping. us/toolsforpersonalgrowth/handlingirrationalbeliefs. html ■ Self-Affirmations that Work: http: //coping. us/toolsforpersonalgrowth/selfaffirmationsthatwork. html ■ Handling Fear of Success: http: //coping. us/toolsforpersonalgrowth/handlingfearofsuccess. html ■ Stop Jumping to Negative Assumptions:

4. Are codependent and believe no one will love them as they are ■ Handling the Need for Approval: http: //coping. us/toolsforrelationships/handlingneedforapproval. html ■ Handling the Fear of Rejection: http: //coping. us/toolsforrelationships/handlingfearofrejection. html ■ Overcoming Fears: http: //coping. us/toolsforpersonalgrowth/overcomingfears. html ■ Becoming Vulnerable: http: //coping. us/toolsforpersonalgrowth/becomingvulnerable. html ■ On Becoming a Risk Taker: http: //coping. us/toolsforpersonalgrowth/onbecomingarisktaker. html ■ Unconditional Acceptance and Love: http: //www. coping. us/toolsforhandlingcontrol/unconditionalacceptanceandlove. html ■ Overcoming Helplessness: http: //coping. us/toolsforhandlingcontrol/overcomehelplessness. html

5. See sexual activity as the most important way of taking care of their emotional needs ■ Accepting Powerlessness: http: //www. coping. us/toolsforhandlingcontrol/acceptingpowerlessness. html ■ Handling Pride: http: //coping. us/toolsforpersonalgrowth/handlingpride. html ■ Overcoming Perfectionism: http: //coping. us/toolsforpersonalgrowth/overcomingperfectionism. html ■ Developing Patience: http: //coping. us/toolsforpersonalgrowth/developingpatience. html ■ Visualizations for Growing Down: http: //www. coping. us/growingdownvisualizations. html ■ Developing Self-Control: http: //coping. us/toolsforhandlingcontrol/developingselfcontrol. html ■ Eliminating Passive-Aggressiveness: http: //www. coping. us/toolsforangerworkout/passiveaggressiveness. html

6. Engage in a variety of sexual behaviors ■ Letting Go of the Uncontrollables and Unchangeables: http: //www. coping. us/toolsforhandlingcontrol/letgouncontrollablesunchangeables. html ■ Accepting Personal Responsibility: http: //coping. us/toolsforpersonalgrowth/acceptingpersonalresponsibility. html ■ Spirituality: http: //coping. us/toolsforpersonalgrowth/spirituality. html ■ Overcoming Invisibility: http: //www. coping. us/growingdown/overcomeinvisibility. html ■ Establishing Healthy Boundaries: http: //www. coping. us/growingdown/healthyboundaries. html ■ Eliminate Revenge: http: //www. coping. us/toolsforangerworkout/eliminatingrevenge. html

Dealing with Relapse in Recovery from Compulsive Pornography/Sex Use ■ Relapse is a common experience among sex addicts, and the disclosure of relapse has a range of consequences for addicts and their relationships, however, voluntary disclosure of relapse (rather than the partner discovering relapses independently) has been found to be associated with positive relational outcomes (Corley, Pollard, Hook & Schneider, 2013). ■ Relapse is an everyday reality in recovery from any addiction and it is important for therapists to be armed with tools to share with their clients to help them get back on the way when relapse happens, figure out why it happened and do specific things to reducing the change of relapse in the future.

Tool Box for clients to use as they deal with ■ Relapse ■ Time Management for Recovery: http: //coping. us/seaslifestylestools/timeforrecovery. html Goal Setting in Recovery: http: //coping. us/seaslifestylestools/timeforrecovery. html ■ Handling Anti-Recovery Thinking: http: //coping. us/seaslifestylestools/recoverythinking. html ■ Overcoming Perfectionism in Recovery: http: //coping. us/seaslifestylestools/overcomeperfectionism. html ■ The Emotional/Behavioral Connection in Recovery: http: //coping. us/seaslifestylestools/emotionsbehaviors. html ■ Social Support in Recovery: http: //coping. us/seaslifestylestools/socialsupportinrecovery. html ■ Coping with Stress in Recovery: http: //coping. us/seaslifestylestools/copingwithstress. html ■ Thought Stopping for Recovery: http: //coping. us/seaslifestylestools/thoughtstopping. html ■ Problem Solving in Recovery: http: //coping. us/seaslifestylestools/recoveryproblemsolving. html ■ Cues for Anti-Recovery: http: //coping. us/seaslifestylestools/antirecoverycues. html ■ Use of Behavioral Chains in Recovery: http: //coping. us/seaslifestylestools/behavioralchains. html ■ Handling Binging, Compulsive and Addictive Behaviors: http: //coping. us/seaslifestylestools/handlecompulsions. html ■ Handling Relapse-Inducing Factors: http: //coping. us/seaslifestylestools/lowerriskofrelapse. html ■ Mental Imagery in Recovery: http: //coping. us/seaslifestylestools/mentalimagery. html ■ Self-Image in Recovery: http: //coping. us/seaslifestylestools/selfimageinrecovery. html ■ Handling Feedback in Recovery: http: //coping. us/seaslifestylestools/handlingfeedback. html ■ Testing Motivation in Recovery: http: //coping. us/seaslifestylestools/motivationinrecovery. html ■ Exercise Program in Recovery: http: //coping. us/seaslifestylestools/exerciseforrecovery. html ■ SEA's Tools for Recovery: http: //coping. us/seastoolsforrecovery. html

12 -Step Program for Adults with Compulsive Pornography/Sex Use Supportive communication received through 12 -step processes may enable pornography/sex addicts to change their behavior or motivated pornography/sex addicts who change their behavior diligently attend 12 -step processes, either way such programs appear to be highly productive (Wright, 2010). It is for this reason that we highly recommend that therapists initiate a 12 Step Program known as the Self-Esteem Anonymous-SEA’s Program which is non-stigmatizing since there is no mention of Pornography or Sex Addiction in the program’s Title or Programs: ■ Outline of Setting up SEA's Program and Meetings: http: //coping. us/seasmanual/introductiontoseas. html ■ SEA's Tools for Recovery: http: //coping. us/seastoolsforrecovery. html ■ The SEA's 12 Steps Workbook: http: //coping. us/seas 12 stepworkbook. html

Online Recovery Programs for Adult Compulsive Pornography Users ■ Reclaim Sexual Health: (An online recovery program to overcome pornography sponsored by the Catholic Church) https: //reclaimsexualhealth. com/ ■ Exodus 90; Fight for Your Freedom Program from Those Catholic Men: https: //exodus 90. com/ ■ Porn Kills Love - Fight the New Drug: http: //pornkillslove. com/ ■ The app from Fight the New Drug at: https: //itunes. apple. com/us/app/fighterapp/id 1159929565 ■ Fortify - A Step Toward Recovery - an online recovery program at: https: //fortifyprogram. org/

RESOURCES TO USE WITH ADULTS

Websites Specific For Compulsive Porn ■ Users Integrity Restored: http: //integrityrestored. com/ ■ Fight the new drug: http: //fightthenewdrug. org/ ■ Those Catholic Men: http: //thosecatholicmen. com/ ■ Fight for Your Freedom Program from Those Catholic Men: https: //exodus 90. com/ ■ Reclaim Sexual Health: https: //reclaimsexualhealth. com/ (An online recovery program to overcome pornography sponsored by the Catholic Church) ■ Freedom from Pornography of the Lincoln, Nebraska Diocese: http: //www. lincolndiocese. org/internet-protection-pornography ■ Overcoming Pornography A website of the Mormon Church: https: //www. overcomingpornography. org/? lang=eng

A Video Series for Adults Covenant Eyes – Porn Harms Your Heart and Soul at: https: //www. youtube. com/user/Covenant. Eyes/featured This organization which is related to Integrity Restored has developed a series of videos which are listed with organized topical play lists at: https: //www. youtube. com/user/Covenant. Eyes/playlists The Topical Playlists are: ■ Accountable Lifestyle ■ Tutorials for installing and use of the Covenant Eye Internet Security System ■ Parenting for the Internet Generation ■ What is lust and pornography? ■ Recovery from porn ■ IProtect: App and Device Education

Videos: Scriptural Approach to Overcoming Compulsive Pornography Use from Covenant Eyes The Catholic Church and Pornography: 4 Quick Insights from the U. S. Bishops: https: //www. youtube. com/watch? v=3 vckjb 0 GI_s Is Pornography a Problem in the Church? Introduction to the Cycle of Pornography Series (2016): https: //www. youtube. com/watch? v=ag. S_Rjex. Ek. Y The Cycle of Porn Addiction (2016): https: //www. youtube. com/watch? v=0 ypfdm 7 GOXY How to Deal with Guilt and Shame After Looking at Pornography (2016): https: //www. youtube. com/watch? v=D 2 Hy. V_sr 5 no Idols of the Heart Part 1 (2016): https: //www. youtube. com/watch? v=lzzxz. JTMb. A 8 Idols of the Heart Part 2 (2016): https: //www. youtube. com/watch? v=j. Qe. Ns 5 q 48 wg Reclaim Sexual Health Video Series https: //reclaimsexualhealth. com/videos. html

More Videos ■ 5 Lies Culture Tells Christian Singles: https: //www. youtube. com/watch? v=Xl. CLsf. NJJ 10 ■ The Porn Effect: http: //theporneffect. com/ This site is a spinoff of Integrity Restored has loads of helpful ways to overcome use of pornography including excellent videos ■ 5 Research Findings From University Porn Experiment- The Great Porn Experiment: https: //www. youtube. com/watch? v=FXhro. Pv. QPBU ■ Men are quitting Internet Porn: https: //www. youtube. com/watch? v=Hb-B 9 pc. R_y 8 ■ 3 Reasons Anime Porn is Really Bad for You: https: //www. youtube. com/watch? v=p. S 7 s. G 8 n. PQ 4 E ■ 4 Ways Porn Warps the Male Brain: https: //www. youtube. com/watch? v=JNs. Ed. EZXhd. E ■ Does Porn Impact the Brain? https: //www. youtube. com/watch? v=bk-C 5 LTougs ■ What Are the Practical Steps to Quitting Porn? https: //www. youtube. com/watch? v=N 8 BJf-QCb. Pw ■ Elevate Recovery: Get High on Life This site has a series of video’s which are self-help motivational presentations for Men or for Women who are suffering from addicted pornography use: https: //www. youtube. com/channel/UCbqa. PKei. NW 6 R 6 LECHw. Qk. Rug/videos ■ How Porn Destroys Your Manhood https: //www. youtube. com/watch? v=hfs. Bb. F 4 ABg 4 ■ 10 Mistakes You Make When Quitting Porn https: //www. youtube. com/watch? v=UWJCKQw. CXR 4&t=7 s ■ How To Stop Watching Porn by using other Addictions! https: //www. youtube. com/watch? v=uz. Pf. Uu. T 9 S 4 M ■ Overcoming Pornography Addiction: The Healing Power of Jesus Christ: https: //www. youtube. com/watch? v=i. XXQp. Tg. SSD 8

TED Talks For Adults ■ The great porn experiment (2012) | Gary Wilson | TEDx. Glasgo https: //www. youtube. com/watch? v=w. SF 82 Aw. SDi. U ■ Pornography Isn't Your Problem (2016) | Jason Mahr | TEDx. Cincinnati: https: //www. youtube. com/watch? v=v. Ig. WMzdgwe. I ■ No Sex Marriage – Masturbation, Loneliness, Cheating and Shame (2016) | Maureen Mc. Grath | TEDx. Stanley. Park: https: //www. youtube. com/watch? v=LVgz. Oy. HVcj 4 ■ The Sex-Starved Marriage (2013) | Michele Weiner-Davis | TEDx. CU: https: //www. youtube. com/watch? v=Ep 2 MAx 95 m 20

Bibliography on Treatment for Compulsive Pornography Use ■ Bradshaw, J. (2005). Healing the shame that binds you. Deerfield Beach, FL: Health Communications, Inc. ■ Brandenburg, B. (2013). Power over pornography: The breakthrough formula for overcoming pornography addiction. North Charleston, SC: Create. Space Independent Publishing Platform. ■ Carnes, P. (1997). The betrayal bond: Breaking free of exploitive relationships. Deerfield Beach, FL: Health Communications, Inc. ■ Carnes, P. (2012). A gentle path through the twelve steps: The classic guide for all people in the process of recovery. Center City, MN: Hazelden. ■ 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. New York, NY: Routledge. ■ Hall, P. (2016), Sex addiction: The partner’s perspective: A comprehensive guide to understanding and surviving sex addiction for partners and those who want to help them. New York, NY: Routledge.

Bibliography on Treatment for Compulsive Pornography Use ■ Laaser, M. R. (2009). Healing the wounds of sexual addiction. Grand Rapids, MI: Zondervan. ■ Palmer, V. T. (2016). Moving beyond betrayal: The 5 -step boundary solution for partners of sex addicts. Las Vegas, Nevada: Central Recovery Press. ■ Trotter, D. L. (2016). A different kind of strong. Salt Lake City, UT: Intellectual Reserve ■ Weiss, R. & Schneider. (2015). Always turned on: Sex addiction in the digital age. Carefree, Arizona: Gentle Path Press. ■ Williams, R. E. & Kraft, J. S. (2012). The mindfulness workbook for addiction: A guide to coping with grief, stress and anger that trigger addictive behaviors. Oakland, CA: New Harbinger Publications. ■ Wilson, G. (2014). Your brain on porn: Internet pornography and the emerging science of addiction. London: Commonwealth Publishing.

References (1): Black, S. (2013). The porn circuit: Understand your brain and break the porn habits in 90 days. Owosso, MI: Covenant Eyes, Inc. Butler, M. E. , Holm, J. E. & Ferraro, F. R. (2011). Pornography's immediate effect on relationship satisfaction. PSI CHI Journal of Undergraduate Research, 16(3), 113 -122. Corley, M. D. , Pollard, S. E. , Hook, J. N. & Schneider, J. P. (2013). Impact of disclosure of relapse for selfidentified sexual addicts. Sexual Addiction & Compulsivity, 20, 157 -170. DOI: 10. 1080/10720162. 2013. 786659 Dedmon, J. (2002). Is the internet bad for your marriage? Online affairs, pornographic sites playing greater role in divorces. Press Release from The Dilenschneider Group, Inc. , Nov. 14, 2002. Retrieved at: http: //www. prnewswire. com/news-releases/is-the-internetbad-for your-marriage-online-affairspornographic-sites-playing-greater-role-in-divorces 76826727. html Delboy, S. (2015). Evidence-based practice for sex addiction: A clinical case illustration. Sexual Addiction & Compulsivity, 22, 273 -289. DOI: 10. 1080/10720162. 2015. 1072487 Grubbs, J. B. , Volk, F. , Exline, J. J. & Pargament, K. I. (2015). Internet pornography use: Perceived addiction, psychological distress, and the validation of a brief measure. Journal of Sex & Marital Therapy, 41(1), 83 -106. DOI: 10. 1080/0092623 X. 2013. 842192 Health and Medicine (2016). Findings from University of Nottingham in sexual and reproductive health reported (Pornography addiction in adults: A systematic review of definitions and reported impact). Health & Medicine Week, 1716. Retrieved from https: //search. proquest. com/docview/1832847718? accountid=38769 Hilton, D. L. & Watts, C. (2011). Pornography addiction: A neuroscience perspective. Surgical Neurology International, 2, 19.

References (2): Lambert, N. M. , Negash, S. , Stillman, T. F. , Olmstead, S. B. & Fincham, F. D. (2012). A love that doesn’t last: Pornography consumption and weakened commitment to one’s romantic partner. Journal of Social and Clinical Psychology 31(4), 410 -438. Leahy, M. (2009). Porn university: What college students are really saying about sex on campus. Chicago: Northfield Publishing. Levert, N. P. (2007). A comparison of Christian and Non-Christian males, authoritarianism, and their relationship to internet pornography addiction/compulsion. Sexual Addiction & Compulsivity, 145 -166. DOI: 10. 1080/10720160701354771 Love, T. , Laier, C. , Brand, M. , Hatch, L. & Hajela, R. (2015). Neuroscience of internet pornography addiction: A review and update. Behavioral Science, 5, 388 -433. doi: 10. 3390/bs 5030388 Manning, J. (2005). Hearing on pornography’s impact on marriage & the family, U. S. Senate Hearing: Subcommittee on the Constitution, Civil Rights and Property Rights, Committee on Judiciary, Nov. 10, 2005. Retrieved at: http: //www. judiciary. senate. gov/hearings/testimony. cfm? id=e 655 f 9 e 2809 e 5476862 f 735 da 10 c 87 dc& wit_id=e 655 f 9 e 280 e 5476862 f 735 da 10 c 87 dc-1 -3 Park, B. Y. , Wilson, G. , Berger, J. , Christman, M. , Reina, B. , Bishop, F. , Klam, W. P. & Doan, A. F. (2016). Is internet pornography causing sexual dysfunction? A review with clinical reports. Behavioral Sciences, 6. doi: 10. 3390/bs 6030017

References (3): Poulsen, F. O. , Busby, D. M. & Galovan, A. M. (2013). Pornography use: Who uses it and how it is associated with couple outcomes. Journal of Sex Research, 50(1), 72 -83. DOI: 10. 1080/00224499. 2011. 648027 Shim, J. W. & Paul, B. M. (2014). The role of anonymity in the effects of inadvertent exporsure to online pornography among young adult males. Social, Behavior and Personality, 42(5), 823 -834. doi. org/10. 2224/sbp. 2014. 42. 5. 823 Štulhofera, A. , Buškob, V. & Schmidtc, G. (2012). Adolescent exposure to pornography and relationship intimacy in young adulthood. Psychology & Sexuality, 3(2), 95– 107 doi. org/10. 1080/19419899. 2010. 537367 Szymanski, D. M. & Stewart-Richardson, D. N. (2014). Psychological, relational, and sexual correlates of pornography use on young adult heterosexual men in romantic relationships. The Journal of Men’s Studies, 22(1), 64 -82. DOI: 10. 3149/jms. 2201. 64 Wilson, G. (2012). The great porn experiment. TEDx. Glasgohttps: //www. youtube. com/watch? v=w. SF 82 Aw. SDi. U Wright, P. J. (2010). Sexual compulsivity and 12 -Step peer and sponsor supportive communication: A cross-legged panel analysis. Sexual Addiction & Compulsivity, 17, 154 -169. DOI: 10. 1080/10720161003796123 Zillmann, D. (2000). Influence of unrestrained access to erotica on adolescents’ and young adults’