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Treatment Approaches for Problematic Pornography Use: A Systematic Review

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Abstract

Problematic pornography use (PPU) is an emerging condition associated with several negative psychological and sexual outcomes. This study aimed to systematically review treatment approaches for PPU. Potentially eligible studies were searched for in PubMed/MEDLINE, Embase, PsycINFO, and Web of Science up to April 1, 2023. The quality of the evidence was assessed with the use of the Joanna Briggs Institute’s checklists, the Cochrane risk-of-bias tools, and the GRADE approach. A total of 8936 references were retrieved, and 28 studies were included in the systematic review (n = 500 participants). Included studies were case reports (k = 16), case series (k = 1), quasi-experimental investigations (k = 7), and randomized clinical trials (k = 4). The majority of included studies presented overall low quality and significant risk of bias, with all interventions receiving a low or very low rating according to the GRADE approach. Most studies investigated psychological interventions, with the predominance of second and third wave cognitive behavioral therapy interventions. Pharmacological treatments included opioid antagonists (naltrexone in most cases) and antidepressants, while one study investigated a protocol that included rTMS. Several investigations described the combination of psychological and pharmacological approaches. Most studies did not report on side effects, with online and self-help interventions presenting significant issues in terms of treatment adherence. Even though there are promising options that may have efficacy for the treatment of patients with PPU, the literature in the topic still presents significant limitations that compromise the reaching of more definitive conclusions.

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Acknowledgements

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001.

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Authors and Affiliations

  1. Department of Psychiatry, Universidade Federal do Paraná, Rua Padre Camargo, 280, Curitiba, PR, CEP: 80060-240, Brazil

    Thiago Henrique Roza & Raffael Massuda

  2. Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental and Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

    Thiago Henrique Roza, Lucas Tavares Noronha, Augusto Ossamu Shintani & Ives Cavalcante Passos

  3. Graduate Program in Psychiatry and Behavioral Sciences, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Thiago Henrique Roza, Augusto Ossamu Shintani, Maria Inês Rodrigues Lobato, Felix Henrique Paim Kessler & Ives Cavalcante Passos

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Contributions

THR had the idea for the article. THR, LTN and AOS participated in the literature search and data extraction. THR drafted the first version of the manuscript. RM, MIRL, FHPK, and ICP critically revised the work.

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Correspondence to Thiago Henrique Roza.

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Conflict of interest

ICP is CNPq research fellow and supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil and by FIPE (Fundo de Incentivo à Pesquisa e Eventos) from Hospital de Clínicas de Porto Alegre, Brazil. ICP receives authorship royalties from Springer Nature and ArtMed. ICP has served as consultant, advisor, or speaker for the following entities: Janssen, LundBeck, Libbs, Daiichi Sankyo, EMS and Pfizer. RM reported personal fees from Janssen and Daiichi Sankyo. All other authors declare that they do not have any conflicts of interest in relation to this work.

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Roza, T.H., Noronha, L.T., Shintani, A.O. et al. Treatment Approaches for Problematic Pornography Use: A Systematic Review. Arch Sex Behav 53, 645–672 (2024). https://doi.org/10.1007/s10508-023-02699-z

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