COMBINING OUTDOOR EXPERIENTIAL THERAPY WITH CBT FOR THE NON-RESIDENTIAL TREATMENT OF YOUNG MALE INTERNET PORN ADDICTION

COMBINING OUTDOOR EXPERIENTIAL THERAPY WITH CBT FOR THE NON-RESIDENTIAL TREATMENT OF YOUNG MALE INTERNET PORN ADDICTION

Eric Walker, M.A.

The Chicago School of Professional Psychology

August 2010

Dr. Patti Britton, Ph.D., Internal Reader

 

Table of Contents

Chapter 1: Nature of the Study

Background to the Problem

Problem Statement

Research Questions

Application of Results

Theoretical Framework

Definitions

Outline of Remaining Chapters

Chapter 2: Review of the Literature

Theoretical Background

Online Pornography

Online Sexual Behavior

Male Compulsive Behavior

Review of Current Research Literature

Theories of Sexual Behavior

Internet Pornographic Addiction

Treatment of Addictive Behavior

Evaluation of Research Literature

Chapter Summary

Chapter 3: Research Design and Method

Chapter Overview

Problem Statement

Hypotheses and Their Rationales

Research Design

Pilot Studies

Participants

Instrumentation

 

 

Chapter 1:

Nature of the Study

BACKGROUND TO THE PROBLEM

Application of internet in various professional and social arenas has increased in last few decades. Internet which offered an effective mode of communication has become necessity of life of millions of internet users. This is affecting each sphere of the life of users from its role in communication to individual psychology and behavior. In the recent past, there has been growing concern over availability and use of pornographic materials on various websites. According to Cooper (2002) this emerging phenomenon has become an area of concern for the behavioral and psychological health clinicians. Terms like Internet-enabled sexual behavior (IESB referred by Greenfield, 2000 as cited by Cooper, 2002) and Online sexual activity have become one of the major areas of studies for dealing with this technology driven addiction known as online pornographic addiction or cybersex addiction.

Despite a great deal of debate in the field of research and psychology over whether or not internet pornography addiction exists, there has been extensive concern among the medical establishment, psychologists, Congress and The Supreme Court about the possible harms of youth being exposed to online pornography.

Brain research has shown that when sexual excitement occurs after viewing an image, the adrenal gland releases epinephrine into the bloodstream. The chemical then travels to the brain and locks in the image. The mind can then recall the image at any time, and trigger the same feelings of arousal. Other biochemical are also released such as serotonin, endorphins, adrenaline, and dopamine, which contribute to euphoric emotions, causing the person to want to experience the feeling again and again (Schneider, 1991). Accessibility and anonymity make it virtually impossible for a teenager to resist going back for more (Rambaree, 2004; Tareen, Nilsen and Stigum, 2006; Young, 2009).

Online pornography can be used for helping individuals and couples dealing with problems of having a normal sex life or willing to improve their sex life, have a narrow view of sexuality, stripped of the context of true intimacy, closeness, and the health and well being of oneself and partner. However, as a primary source of sex education, it is inaccurate and incomplete, creating feelings of confusion, anxiety, shame and guilt (Ross, Rosser, Mccurdy, & Feldman, 2007). As the compulsive behavior escalates, the teen becomes increasingly withdrawn and isolated. The internet, his drug of choice, does not require him to leave the room, spend money, or communicate with another human in order to maintain a constant supply (Hill & Beamish, 2007; Goldberg, Peterson, Rosen, & Sara, 2008).

Despite the rapidly increasing number of families seeking help for their teenage sons struggling with compulsive internet porn use, there are only two residential treatment centers in the United States specifically established and designed for the treatment of male, teenage internet pornography addiction. This is also a growing problem in adult young males.

Young (2007) studied the performance of CBT among the clients suffering from internet addiction. The findings of the study revealed that significant improvement was recorded in terms of motivation, time management for online uses, overall social relationships of the client and many others (Young, 2007).

There have been various studies on the Internet-enabled sexual behavior (IESB). In one of such studies by Orzack, Voluse, Wolf and Hennen (2006) revealed that the IESB had negative impact on the social relations of the individual, productivity at the workplace and academic success. This study was conducted among the middle aged men with problematic IESB. The therapy used in this study was combined therapy with CBT and Motivational Interventions (MI). This study revealed that the problem of IESB requires more studies and interventions (Orzack et al, 2006).

Both Oxbow Academy and Pine Creek Ranch have achieved 80-90% success rates using a holistic approach designed to help students recognize and deal with behavioral, emotional, and social problems that contribute to their sexual issues, using a combination of CBT along with an experiential model that is strength-based and emphasizes honesty, accountability, empathy and family re-unification.

Experiential therapy includes various types of experience programs that can be based on equine therapy, experiencing with dance, music, art and add on to the real life experience. Experiential therapy can be divided into two main categories: outdoor experiential therapy and indoor experiential therapy. Outdoor experiential therapy (OET) or Wilderness Therapy utilizes nature to help residents work through their problems and free themselves from dependency through the physical challenges offered in nature. There are various types of outdoor therapies used by different organizations for different problems. The theoretical aspect of any OET or wilderness therapy program consists of the perspectives like the perception of client by the program, theoretical setting of the program and approaches of the therapist for the program primarily. The two identified types of OET are expedition and base camp programs (Russell, Hendee and Phillips-Miller, 2000). According to Russel et al (2000) wilderness therapy process consists of three main phases of cleansing, personal and social responsibility phase and transition and aftercare phase. The cleansing phase is based on the fact that the client should be replaced from his/her destructive environment to a healthy environment with focus on physical and mental health being. This step is based on the natural consequences that lead to change an individual. At this stage, a slow start is needed. This is followed by the personal and social responsibility phase. This also depends on natural consequences. Addition to this peer interaction is used that helps individuals learning their personal and social responsibilities. Different environmental conditions and various natural aspects help in developing natural consequences for the real life of the individuals participating and lead them to understand how they are responsible for themselves. Russel et al (2000) focused on the approaches of the primary care staffs in the wilderness therapy approaches and concluded that these staffs have empathetic view for the clients. They nurture them and care about the clients in the camp and build a relationship of trust and friendship and help them dealing with their resistance and anger. However the role of staff had been questionable due to the deaths of teens during 1990s.

The experience of being out in the world reconnects a student to his world, and eventually helps him reconnect with the people who live in this world. While outdoor activities like living in camps with nature, expedition programs and others are beneficial for the social aspect of interacting with others. Research supports the use of experiential therapy for motivation and increased ability for social integration. Teens are typically less resistant to experiential therapy because it does not feel like therapy. Staff members are trained to process with each student, in the moment, the value of what is happening, helping them see parallels in their own lives. Experiential therapy is relationship based – building bonds between the student and his therapist, enabling the student to experience safe, healthy, supportive behavior within a family-styled structure. Various activities help students discover new interests to compete with their old patterns of sexual dependence. As their confidence grows, so does their determination to overcome their challenges by tapping into the thinking, emotions and senses of the student to help them internalize what they learn through the experience. Empirical studies show that experiential methods help clients achieve dramatic results in the areas of psychological symptom reduction.

Oxbow Academy in central Utah has six primary treatment objectives of disruption of negative behavior patterns, honesty and accountability, healthy perception of self and thinking, loving and validating relationships, skills for life, including social competency and personal integrity or relapse prevention.

Many clients utilizing the combination of CBT and experiential methods to help facilitate their recovery report less intensity of perceived distress fewer compulsive thoughts, impulses and actions, fewer feelings of inadequacy and inferiority,

fewer symptoms of depression, anxiety, fear, and anger, a greater orientation to the present, a tendency to be more independent and self-supportive, more flexibility,

more sensitivity to their own needs and feelings, a greater likelihood to express feelings and be themselves, an improved capacity to develop meaningful and warm interpersonal relationships with others.

PROBLEM STATEMENT

This study focuses on the potential benefits of combining weekly CBT with experiential therapy for the treatment of teenage male Internet porn addiction in a non-residential setting.

RESEARCH QUESTIONS

1. How therapists for young adult males (18-26 years) both healthy and unhealthy perceive a treatment plan combining CBT with Experiential therapy in an outdoor setting than CBT in an office setting.

2. What are the attitudes of therapists of young adult males for their supportiveness for combining CBT with Experiential therapy in an outdoor setting, than a group of young adult males of CBT in an office setting?

3. Do the therapists believe that young adult males will report a more favorable perception of their therapists consistency in a combining CBT with Experiential therapy in an outdoor setting, than a CBT in an office setting?

4. How important is therapist’s admirable traits for young males in CBT with Experiential therapy in an outdoor setting, than young adult males in CBT in an office setting?

5. To what extent qualitative results of the use of CBT and Outdoor Experiential therapy support the quantitative outcomes of positive change in the behavior of clients?

6. What are the patterns of long term impacts of the CBT and Experiential therapy treatment offered to the individuals with the addiction to online pornographic material?

RATIONALE:

Experiential therapy combined with CBT in an outdoor environment will help facilitate willingness and readiness for change instead of the typical adolescent resistive behavior. This study would provide the therapist perspectives to the overall treatment process in CBT in an outdoor environment and experiential therapy and how they perceive the combination of these two methods in order to helping the internet pornographic addicts. Therapists are the people working at the grassroots level of the problem. They are the implementers and they have experience of dealing with such problem at the practical level. Getting their perspective will help in understanding if the desired level of results will be achieved to help clients suffering from internet pornography addiction.

APPLICATION OF RESULTS

The results can be applicable in integrating the CBT and experiential therapy to get better and sustaining results for treating clients with internet pornography addiction problems. These results may help them in developing an effective treatment plan.

THEORETICAL FRAMEWORK

Online pornographic addiction is one of the merging problems leading to various physiological, psychological and behavioral problems among young males. This addiction can be treated under the online addiction as well as the sexual addition. This is unique and prevailing problem that has impact on the social relations of an individual. The current theories have different approaches for online pornography addiction (OPA) or problematic IESB or Cybersex addictions. All of these terms indicate almost the similar problems. The previous studies various treatments and their results have indicated that there are more research needed in the area of identifying a treatment approach that will help in achieving long term and sustainable results. There have been limited studies on the approach of therapists in achieving an effective approach for treatment of addicted clients.

 

Figure: Conceptual Framework

Source: Developed on the basis of available literature

 

 


DEFINITIONS

Addiction

“Compulsive, uncontrollable dependence on a substance, habit, or practice to such a degree that cessation causes severe emotional, mental, or physiological reactions”. Addiction is studied with models like disease models, genetic model, moral model and cultural model. Disease model has biological, psychological, social and spiritual dimensions (Rotgers, Morgenstern and Walters, 2006).

Cognitive Behavioral Therapies (CBT):

“Cognitive Behavioral Therapy (CBT) is the term used for a group of psychological treatments that are based on scientific evidence. These treatments have been proven to be effective in treating many psychological disorders.” (Association of Behavioral and Cognitive Therapies, 2010)

Experiential Outdoor Therapy

This therapy is based on the experience and challenges that an individual can find in nature which can help them grow and bring changes in their life. These therapies can be living in camp with nature.

Internet Addiction

There is no definition given for internet addiction. Young (2009) has compared internet addiction to any other addiction. This can be explained as an uncontrollable dependence on internet browsing for various purposes i.e. gaming, online surfing or cybersex that can cause severe emotional, mental and physiological problems.

Pornography

According to the Standford Encyclopedia of Philosophy, “Pornography is any material (either pictures or words) that is sexually explicit.”

Online sex/ Cyber sex

Cybersex allows users to get involved in pleasurable and exciting sexual activities through the web navigation. It has impact on various spheres of life of an individual from social to individual aspects of their life.

Online Sexual Activity (OSA)

“Online Sexual Activity (OSA) is defined as use of the Internet (including text, audio, graphic files) for any activity that involves sexuality, whether for purposes of recreation, entertainment, exploration, support, education, commerce, or finding and/or meeting sexual or romantic partners. OSA includes cyber sex (i.e., sexual activity via the net), Online Sexual Problems (OSP) (i.e., OSA has lead to difficulties, usually feeling out-of-control and/or having others complain about the activity), and Online Sexual Compulsivity (OCS) (i.e., an ongoing, out-of-control engagement with OSA).” (Cooper and Griffin-Shelley, 2001)

Sexual Addiction

Sexual addiction is related with the obsessive sexual activities that are related to loss of control and escalation, inability to stop, social, emotional, physical and legal consequences. This can lead to irritability, extreme defensiveness and anger in the individual (Weiss, 2008).

Sexually Explicit

This is an indexical term which depends on the culture and society it is applied. In some cultures showing any part of female body can count as sexually explicit i.e. Afghanistan and some Muslim dominated countries where modesty is determined with clothing and behavior. At the same time in some parts of the world sexually explicit material can be only the materials showing sexual acts and exposed sexual organs and related body parts. (The Stanford Encyclopedia for Philosophy, 2004)


OUTLINE OF REMAINING CHAPTERS

Chapter 2 Review of the Literature

This chapter provides review of the literature that covers the previous studies on internet pornography and sexuality on internet, psychological theories of sex addiction, internet pornography and compulsive behavior in men, healthy and unhealthy sexual habits and therapies used for the treatment of internet pornographic addiction. This chapter provides theoretical understanding of the topic of the study.

Chapter 3 Research Design and Methodology

Research design and research methodology is covered in this chapter. This chapter provides the details on the research methods available and used, research instrument, target respondents and limitations of research.

Chapter 4 Findings, Analysis and Discussion

This chapter is presentation of the research findings. Charts, graphs and tables will be used for the presentation of the data collected. Analysis and discussion sections cover the analysis of data collected and discussion of data with respect to the research questions and existing literature in order to reach to any conclusion and analyze the possibilities for the integrated therapy of CBT and Outdoor Experiential therapy.

Chapter 5 Conclusion and Recommendations

This chapter provide conclusion for the overall study. Here researcher develops recommendations for the prevailing problems of online pornographic addiction among young males.

 

CHAPTER 2

REVIEW OF THE LITERATURE

CHAPTER OVERVIEW

The chapter consists of the internet pornographic addiction concept through literature on 1) Internet pornography and sexuality on internet, 2) Psychological theories of sex addiction, 3) Internet pornography and compulsive behavior in men, 4) Healthy and unhealthy sexual behavior and 5) Therapies used for the treatment of internet pornographic addiction. The theoretical background will cover the etiology of online pornographic materials. The current literature will have focus in the direction of theoretical description online sexual behavior and male compulsive behavior, internet pornographic addiction and treatments from addictive behavior.

Theoretical Background

PORNOGRAPHY

According to Kendall (2007) pornography can be regarded as one of the oldest professions of the world. The term ‘porno’ is derived from the Greek term for a prostitute that is ‘pórni̱’. There are various debates over the impact of pornography in our society. Feminists have condemned pornography time to time for degrading women presentation and contributing to the crime. Liberals wants to have empirical support or evidence before declaring it harmful. Some researchers have argued on the significant link between pornography with crime (Dworkin, 1993) whereas some others find the relationship of pornography and criminal activities to be casual and similar to those who had spent years in religiously restricted environment (Marquit, 2010).  There are various advantages of pornography particularly for the couples who already have a sexual life. These couples can learn new position, get better sharing opportunity watching pornographic material, and fill the communication gap by communicating about their sexual preferences and dislikes. Watching other couple making love can release the hormones for excitement and sexual arousal and can help getting more intense orgasm. Sex plays significant role in relationship of a couple. This is highly private affair of two individuals. Pornographic materials help in understanding the performative norms and sexual meanings of various aspects of the sexuality of other individual (Attwood, 2002). Zillmann (2000) had emphasized on the need for a “re-conceptualization of harm from exposure to erotica.” According to ˇ Stulhofer, Busko and Landrepet (2010) sexually explicit materials (SEM) can contribute to the sexual well being of young men.

ONLINE PORNOGRAPHY

Internet in the present scenario is important in almost every walk of our life from communication to online shopping (Rambaree, 2004). There have been various studies in last one decade that identified use of internet in the area of sharing and accessing pornographic material and involving in sexual acts. According to Goldberg, Peterson, Rosen & Sara (2008) Nua Internet Surveys of 2001 indicated that sex is one of the most popular search terms over the internet.

“No truly random study has been conducted to determine the number of people accessing sexual Internet sites, some estimate that 31% of people online visit sites with sexual content, and of those, 5.5% of individuals exhibited compulsive behaviors and an additional 17% are “at risk” of becoming sexually addicted (Cooper, Delmonico, & Burg, 2000). Based on these estimates, as many as 69.7 million people are using the Internet for sexual purposes (cybersex), and as many as 11.8 million may be experiencing problems controlling their behaviors with cybersex.”

Cooper et al., 2000 explained the role of internet in changing the traditional mode of sexuality as “Sexuality is one aspect of human social behavior that is being dramatically impacted by the Internet” (as cited by Rambaree, 2004). Sherman (2003) explains reasons of the growing sexuality over the internet as internet offered a fast, quantity leap in distribution of pornographic materials, equips users with facilities of quick download, easily access and view, allows them to store various pornographic media files on their on their personal computers (Kendall, 2007).  Internet technology is advancing demand for pornography contents. Online sexual content and materials are sold and shared by huge community of people. This is a highly profitable and advanced business in the present scenario. This has created its place in the modern culture and society (Wondracek, Holz , Platzer, Kirda and Kruegel, 2010).

Pornographic materials available online can be targeted for variety of users from those who want to improve their regular sex activities to those who want to utilize this platform for sexual fantasies’ and desires. Rambaree (2004) explains that people coming and joining the chat rooms for interaction, enjoyment and exploring each others’ sexual properties. However at the same time the anonymity and interactivity allows them to communicate fearless and without being concerned of what other person would think (Rambaree, 2004).

Prior to the use of internet, people used to visit stores and shops for sexual or pornographic materials. Physical access was usually restricted to be sold to particular age group. However access to pornographic material has become easier for different age groups due to online access. This also ensure that their privacy is maintained (Kendall, 2007)


Types of Pornographic Material

Today internet created an opportunity for individuals to have access unlimited range of pornographic materials, still images and audio/video materials effortlessly. There is large availability of pornographic materials on internet. These materials can be classified in various ways on the basis of the nature of material like image, literotica (erotic literature), erotic images and erotic videos. On the other hand, in terms of type of content, it is classified as Erotica, Degrading and violent pornography.

Erotica:

Erotica generally carry sexual or erotic materials.  Erotica usually provides positive, loving human sexual interaction between willing individuals (Glascock, 2005). This can be used for the people suffering with sex related problems wherein they can understand and explore different perspectives of sexual pleasures and try with their partners. Erotica is usually free from any degrading and violent type of pornographic contents and sexual activities.

Non-violent or degrading pornography:

Non violent pornography is different from erotica type of pornography materials. It contains verbal abuse or it is portrait as having animal kind of characteristics. However it does not contain any type of physical violence. Non violent pornographic materials generally consist of man dominating over women and women representation in such content is objectified as a plaything responding to male sexual needs immediately (Glascock, 2005).

Violent pornographic materials:

These kinds of materials include pain and physically forced such as rape, bondage, discipline, bestiality, sadism and other forms of paraphilic linked sexual activities (Glascock, 2005). These materials are degrading and present violent sexual encounters. Dominant-submissive behavior can be seen between male to male, male to female, female to male or female to female or in groups.

There are various positive and negative aspects of online pornography. This area has attracted attention of feminists, social study researchers, psychologists, business and economics researchers and many others. There is an ongoing debate on the link of pornographic content and sexual crimes. There are two philosophical approaches for viewing pornography i.e. liberal and feminists. Feminists on one hand stress on the link between criminal activities based on sex and pornography where as liberals argue that there is no significant evidence that can prove this link. Most of the studies related to cybersex have been in the areas of understanding negative consequences of cybersex. Some researchers have argued on the positive implications of cybersex on some group of people like committed couples looking for expanding their sexual experiences, gay adolescents, people with difficulty in finding partners like physically or mentally challenged, unattractive and shy, women seeking to rejuvenating sexual knowledge with limited opportunity to do otherwise and others (Waskul, 2004 as cited by Philaretou, Mahfouz & Allen, 2005)

There are very limited studies conducted on the positive aspects or advantages of pornography. Even though it is identified as a tool for improving sexuality and pleasures with sexual acts among individuals and couples with the sexual behavioral problems, studies on the positive aspects are much lower than those of the negative aspects. Stone (2006) supports the use of young adult literature to help adolescents and young people understanding the physical as well as emotional aspects of the sexual behavior. These literatures can also be used for making them understand what acceptable and non-acceptable behavior is. According to SIECUS (2010) there are limited data available that can determine adolescent sexual behavior. The information available from different sources revealed that the average age for first intercourse among the youth was 17 years for males and 17.4 years for the females. The other sexual activities in which young people can be engaged are oral sex, kissing, fondling with genital and specific body parts, mutual masturbation and anal intercourse. Most of the time, involvement in any sexual activity is born with a natural curiosity among the youth.

Therefore pornographic material can offer a great tool for educating adolescent and allow them to understand role of respect, dignity and pleasure.

 

REVIEW OF CURRENT RESEARCH LITERATURE

Online Sexual Behavior

Online sexual behavior is one of the extensively researched areas. Goldberg et al, (2008) identified exponential growth of the adaptive and pathological use of sexual component over the internet. Cooper (2002) has identified three subcategories of the online sexual behavior of various individuals. These are “cybersex and its own subcategory of cybering, online sexual problems (OSPs) and online sexual compulsivity”.

Cybersex as cybering consists of the behaviors that gratify sexual behavior through various tools of pornography, chatting, erotic mails and live video chats through online camera and sharing same sexual fantasy. According to Delmonico (1997) cybersex has three basic forms i.e. online pornography exchange, real time sexual exchange and use of multimedia software for sexual fantasies. Cybersex can be explained through isolation, fantasy, anonymity and the low cost mode of entertainment (Delmonico, 1997). Bostwick and Bucci (2008) related internet sex with the brain malfunctioning and described the source of motivation to be the basic need of have sex. They studied the neurotransmitter Dopamine with relation to the addiction behavior and offered use of naltrexone as suppressing the addiction for internet pornography. OSPs consist of the problems people face or might face by using internet medium for their sexual desires. These problems can be individual, social or financial. Individual problems consist of guilt, shame, breach of trust, broken relationship, loss of respect, financial loss and others. Loss of family and friends, divorce and criminal charges for illegal activities can be other problems people might face. Online sexual compulsivity is part of OSP but signifies a state where an individual completely looses his control over daily activities and is dominated by the compulsion of online pornographic activities.

Goldberg et al (2008) used the term ‘cybersex addiction’ to cover pathological and compulsive behaviors that have negative impact on the user and his surroundings. Addiction or compulsion of cybersex is related to uncontrolled use of internet for sexual desires and impulsive control (Goldberg et al, 2008).  There have been various studies were in different symptoms of changes in behavior has been reported with the cybersex addiction such as lack of sleep, isolation, loss of productivity, loss of interest in other relationships, loss of interest in normal sex and fading sense of responsibilities (Schneider; 1991; Young, 1999; Boies, Cooper and Osborne, 2004; Goldberg et al, 2008). Indirect victims of the cybersex are primarily spouses who feel betrayal, rejection and other negative implications that might lead to ending up or distorting a healthy relationship. Children, family members and other social relations also suffer in such cases.

Sex addicts can exhibit ten types of sexual behavior (Carnes, 1991 as cited by Carnes and Adams, 2002). These are “fantasy sex, seductive role sex, and voyeuristic sex, exhibitionistic sex, paying for sex, trading sex, intrusive sex, anonymous sex, pain exchange sex and exploitive sex”. These sexual behaviors are encouraged and aroused online (Carnes and Adams, 2002).

Philaretou, Mahfouz & Allen (2005) have studied different forms of cybersex behavior. There are various aspects of online sexual behavior that includes wide range of online behaviors. Cooper (2002) listed various online sexual activities like “answering sexual personal ads; chat rooms/message boards; webcam sites; private member chat rooms; adult online sex shops and catalogs; e-mails; flirting and sexual innuendo; actual overt sex talk with the goal of arousal/orgasm; telephone sex; and actual, real time sexual encounters.”  According to Carnes (2001) Sexual addiction cycle consists of four-steps of preoccupation, ritualization, compulsive sexual behavior and despair. Preoccupation is the stage of sexual stimulation resulted from the thoughts of sex. This is followed by ritualization where addict seeks more arousal and excitement. Third stage individual loses his control to stop his obsessive behavior. Last stage of despair is helplessness and powerlessness. Carnes (2001) further explains,

The addictive system starts with a belief system containing faulty assumptions, myths, and values that support impaired thinking. The resulting delusional thought processes insulate the addiction cycle from reality….All the other support systems, including relationship, work, finance, and health become unmanageable.”(p 25)

 

Figure: The Addictive System (Carnes, 2001)

Weiss (2008) identified various areas of sexual addiction similar to those of other addictions. These are:

Loss of control and escalation in frequency of the sexual activity and/or content; Inability to stop the behavior despite previous agreements with self or others; Consequences directly related to the sexual behavior in areas such as social functioning, relationships, parenting, financial, career, emotional / physical health and legal; Significant loss of time and focus to the pursuit of or engagement in sexual activity to the detriment of other life goals or priorities.; Irritability, extreme defensiveness or anger when having to address, change or stop a particular sexual behavior.

Sexual addiction behavior falls in four categories of shameful, secret, abusive and void of relatedness (Carnes, 1978 as cited by Weiss, 2008).

Psychological symptoms Physical symptom
(a) experiencing a sense of well-being or euphoria while online,

(b) feeling unable or unwilling to stop online surfing,

(c) increasingly desiring and spending more and more time online,

(d) neglecting interpersonal relationships with intimate partners, friends, and family, (e) experiencing feelings of emptiness, distress, and irritability when prevented from pursuing online activities,

(f) lying to employers and family to cover up extent of online activities, and

(g) experiencing general problems with school or work responsibilities

a) carpal tunnel syndrome,

(b) dry eyes,

(c) migraine headaches,

(d) back aches,

(e) eating irregularities,

(f) neglect of personal hygiene, and

(g) sleep disturbances due to change in sleep patterns

Source: Developed on the basis of Orzack (2004 as cited by (Philaretou, Mahfouz & Allen, 2005).

 

Sexual Behavior of Young Males

Sexuality is regarded as integral part of human and worthy of dignity and respect (SIECUS, 2010). Facilitating development of healthy sexuality is considered an integral aspect of sex education. This kind of sexuality based on respect and equality will help developing healthy sexual behavior. At the same time some authors suggested development of the positive image based websites for the online pornography viewers where pleasure with sexuality, dignity and respect and help viewers realize the true pleasure related to sex rather than commercialized and fabricated experience.

Adolescents face various challenges due to their physical and physiological changes. The changing balance of hormones within their body results in mood swings and deviation of behavior between adult and child like behaviors. Sexually they become more independent from their parents and require lesser protection than their early years. Till this age, individuals get involved in self stimulation processes for sexual pleasure. This can be masturbation or fondling with their private parts. Level of curiosity to know more makes them explore new sources for information on sexual acts. Adolescents are divided in early, middle and late adolescence ages. The late adolescents are most independent and in various occasion their behavior and outlook would be similar to an adult. They develop their sexual identity by this stage and look for intimate relationships to satisfy their physical and emotional needs and probably get establish in their career and start their families.

It is evident from the previous studies that people come across with the pornographic material as early as the age of 11 years. The exposure turns to curiosity to know more. This is added to the physical and psychological changes these young people are undergoing. There are various implications of early exposure of pornographic and sexually explicit material among the teens and young adults listed by the magazine The Sex Educator. First of such implications is development of unrealistic image for genital organs among the young adults and teenagers (Des Deserts, 2002 as cited in The Sex Educator, 2007). This helps in normalizing of all types of sexual activities i.e. oral, vaginal and anal relations (Dagenais, 2005 as cited in The Sex Educator, 2007). According to Robert (2005 as cited in The Sex Educator, 2007) young minds tend to believe that every kind of sexual activity is possible, desirable and will be accepted which prepare them to try anything (Wold, 2003 as cited in The Sex Educator, 2007). The early age sexual exposure encourages them to involve in sexual acts in an early age (Dionne, 2005 as cited in The Sex Educator, 2007). Development of compulsive behaviors and unsafe sexual behaviors are some of the highest risk points (The Sex Educator, 2007).

Sˇtulhofer, Busˇko and Landrepet (2008) studied the behavior of young males (18-25 years) for understanding the effect of sexually explicit material on them. This study indicated that early exposure of SEM to young males can lead to affect their sexual satisfaction and level of intimacy with partner adversely.

Recently, Lynch (2009) studied the various sources of exposure to sex related information to the adolescents that revealed that media has been the primary source of information for more than two third of the total respondents studied (SIECUS, as cited by Lynch, 2009). Pattee (2006) has suggested that young adult literature should be added in sex education programs of the schools in order to give them realistic and needed information on different aspects of sex and sexual acts. Lynch (2009) points out the need for the private and safe place to try on new feelings of sexual desire as SEM are less risky than the sexual contact itself.

Fisher and Barak (2001) have explained the Sexual Behavior Sequence for individuals coming with contact of erotic content or material. This sequence starts with the contact with erotic stimuli that leads to physiological arousal. Individuals are more likely to involve in overt sexual behavior by looking for partners, opportunity to masturbate or online chat rooms. This stage is called preparatory sexual behavior. This stage leads to the actual sexual behavior (Fisher and Barak, 2001).

 

Figure: Sexual Behavior Sequence

Source: Developed on the basis of Fisher and Barak (2001)

Sexual Compulsive Behavior

Sexual compulsion is a stage of “uncontrollable urge to perform an irrational sexual act” with or without complete knowledge of negative consequences (Cooper 1998 as cited by Philaretou, Mahfouz & Allen 2005). Factors that can determine the compulsiveness of online pornographic addiction are frequency of sexual activities online, time spent on cybersex and its relation with the negative consequences of their lives, feeling of guilt and depression and obsession for particular pornographic material (Philaretou, Mahfouz & Allen, 2005).

Internet Pornographic Addiction

According to Cooper et al (2002) cybersex addicts are those individuals who spend more than eleven hours in a week in computer sex. This leads to lack of time for other important aspects of life like family, children and social circles. These individuals tend to avoid time needed for other things for cyber sex fun, prolonged hours of sitting in front of system and screen has negative implications on their physical and mental health. This also leads to isolation. Coombs (2004) argues that this heavy involvement affects the sexual activities with the primary partners. “Male sex addicts may be physically unable to have more sex after a session on the computer. A survey of partners of cybersex addicts found that among 68% of the couples, one or both had lost interest in relational sex; 51% of addicts had decreased interest in sex with their spouse as did 34% of partners”.

Coombs (2004) argues that these addicts tend to normalize the illegal or deviant sexual activities like bondage and submission, sex with minors, forced sex, fetish and various unimaginable sexual activities which are possible in the normal life. Cyber sex addicts tend to be using their nights without sleeps and diverted mind. As a result their productivity goes down and their professional lives get adversely affected. There has been increase in number of arrests for the illegal online sexual activities particularly for stalking, contacting or alluring minors for online sex.

Weiss (2004) lists impacts of cybersex affair on relationship of a couple and argues that the emotional impacts are similar to the offline affair that can result in damaging self-esteem, hurting the partner,

Betrayal, abandonment, loneliness, shame, isolation, jealousy and unrealistic comparison of partner’s psychical and traits and sexual performances to the fantasy partners, loss of interest in intimacy and mutual sexuality.”

Treatment of Sex Addictive Behavior

The sex addiction, particularly the cyber sex addiction is comparatively new disorder. This is the reason that this particular problem borrows treatment approaches of various other addiction treatments. In last one decade, it has been identified as a growing concern with different individual, social and psychological implications. 12-Step Programs (i.e. Sexaholics Anonymous), Cognitive-behavior Therapy (CBT), Interpersonal Therapy, Group Therapy and Medication are some of common sex addiction treatment programs (Herkov, 2006). According to Taintor (2005) addiction to online pornography needs to be treated like any other addiction. There are various ways clinicians and therapists can provide treatment such as online, face to face, medication, individual psychotherapy, group psychotherapy, self help groups, reimbursement and others (545).

Weiss (2004) focuses on the tools and principle for appropriate assessment of the addiction and mental health state of the client. This assessment should be used as the basic information for determining the overall approach of treatment. This can be cognitive-behavioral approach or integration of different therapies like Psychodrama, Art Therapy and EMDR. CBT and 12-step social support has been most effective and proven strategy to help addicts to develop healthy habits and cope up with the problems of sexual addictions (Weiss, 2004). Psychodrama, Art Therapy and EMDR help in stabilizing the sober behavior.

These therapies can help elicit subconscious motivations and concerns, often uncovering blocks to therapy and recovery.” (Weiss, 2004)

Carnes and Adams (2002) listed objectives of successful therapy. This consists of:

Establishing relationship of trust and empathy, promoting an understanding of the difference between emotion, feeling and affect; increasing awareness regarding impairments in attachment and bonding; facilitating awareness regarding impairments in attachment and bonding; facilitating awareness regarding the relationship between disrupted bonding and the inability to develop strategies to regulate affect, increasing skills helpful in the recognition, identification and modulation of affect; increasing awareness of environmental, emotional and situational stressors associated with dysregulated affect. (Carnes and Adams, 2002, p 85)

The treatment is individual approach for individual client based on the individual characteristics and severity of the problem (Goldberg et al, 2008).  There is no single therapy that has been developed for the treatment of the online pornographic addicted patients. The therapies used in the present scenario have been modified therapies that have been used for other addiction treatments like alcoholism, eating disorders and others (Goldberg, 2004; Goldberg, et al, 2008).

Therapist and Clinicians

Clinicians face various challenges when it comes to the dealing with sexually addicted clients such as preventing clients from sexually acting, fantasizing about clinicians, using sexually explicit language, creating physical proximity with the clinicians and try to develop sexual relationship with the clinicians. It is very challenging for the clinicians to handle their own biases. The boundary between appropriate and inappropriate can get easily blurred in lack of clear sense of therapeutic boundaries.

Most of the studies are focused on the sex addicted clients, social and psychological implications and others. There are limited studies that have covered issues of therapists and clinicians while dealing with internet pornography addicted clients. One of the initial studies in this area has been conducted by Young (1999) and covered incident rates, complaints at the primary level, psychiatric problems along with the addictions, attitude of therapists and their backgrounds. This study provided the therapists view of the internet addiction in overall and internet pornography was one part of this study. In this study therapists explained deceptive and illegal behavior of their patients like forced sex, bondage fantasies and others. However, there are very limited studies conducted in the area of understanding uniformity of etiology of online pornographic addiction among the therapists and clinicians (Young, 1999; Goldberg, 2004, Goldberg, Peterson, Rosen, & Sara, 2008).

According to Weiss (2004),

“Working with sexual addicts requires a new skill set- one that combines the empathy, insight and relational abilities of a good psychotherapist with the limited setting, confrontation and cognitive-behavioral strategies of an addiction specialist.” (p 234)

There are various aspects of challenges working with online pornography addicted clients for the health professionals. There were very limited studies conducted in this aspect till late 1990s. Young (1999) covered some aspects of the therapist perspectives in the internet addiction studies with one subset of cybersex. However, last one decade attracted attention of young researchers towards this aspect of the online pornography addiction therapies (Erickson, 2002; Goldberg, 2004; Weiss, 2004; Chiou, 2006; Goldberg et al, 2008).

Many chemical dependency counselors and mental health professionals, while expressing interest in furthering their understanding of such work, are under –standably anxious and uncomfortable at the thought of actually working with client issues such as compulsive masturbation, exhibitionism, anonymous sex, and the frequenting of strip clubs. (Weiss, 2004)

According to Cooper & Griffin-Shelley (2002) the knowledge of Triple-A-Engine helps clinicians to familiarize with different aspects of the sexual compulsive tendencies. Cooper and Griffin-Shelley (2002) argue that exposure of internet can disturb sexual life of people without any sexual problems and risks of developing range of sexual problems.

Therapists would be wise to stay current in this rapidly developing area through readings, workshops, and discussion and consultation with colleagues. Treatment for Online Sexual Problems and Online Sexual Compulsivity can include cognitive and behavioral interventions, individual, group, and couples therapies, medication, Twelve Step and online support groups and residential care. (Cooper, McCloughlin as cited by Cooper and Griffin-Shelley, 2002).

Weiss (2008) provides some insights on the client concerns regarding their treatment. This list was prepared on the basis of survey with the clients who took professional helps to deal with their sexual addiction problems. The problematic issues identified by various respondents were lack of understanding of the therapist about the power or intensity of the compulsion act, lack of knowledge of online and offline sexual activities, under-informed, lack of decision making, failure of insisting on eliminating self destructive sexual behavior, lack of understanding of the impact on the spouse or partner of the addict, adopting wrong approach to deal with spouse or include spouse in the treatment process and others. Weiss (2008) recommended that the therapists should be provided special training and awareness of the online sexual addiction and compulsive behavior in order to access and manage the challenges of addict successfully.


12 – STEPS PROGRAM

There are three ingredients such as knows the ways, goes the way and show the way. These ingredients are important to recognize a person to help with the intimidating task of recovery from a co-occurring mental health and substance use problem. “Sane is an excellent bridge to the remarkable and miraculous transformation that can take place through the fellowship and wisdom of the twelve step program of recovery” (Hornbacher, 2010).According to Hornbacher (2010) these steps help people with co-occurring disorders, making people understandable. Hornbacher (2010) explains recovery terminology with having mental health problems and makes it available to anyone.  There are many reasons for mental problems. The mental problems can be occurred may be by symptoms of avoidance, isolation, withdrawal, and negativity that can forestall action.

Rotgers, Morgenstern and Walters (2006) “12 –steps treatment refers to certain core concepts, implicit assumptions, informal hypothesis and explicit ideas that constitute one recognizable approach to addictions treatment and recovery.”

All twelve step recovery group are not open for people who have severe mental health issues. The clients who have these kinds of mental problems can be recovered by their social support, family support. The aim of the research is to create group that was comprehensive and accepting. That group should not be exclusive and judgmental. Luckily, most peer recovery support meetings keep the ambiance of acceptance and patience.  The primary purpose is to help people. The twelve steps program is important for living. Every step is important in its own way. The first step is to understand the mental health issue. Addicts usually develop an excellent skill for hiding their things and their habits so that their families, relatives, friends, employers and anyone can not get a hint of what they are doing. They believe that no one can see or find out about their preposterous ideas. This also helps them in hiding their actual conditions from many. In their minds they feel ashamed of and hide their illness from that judging world, from their friends, their family members and even themselves. This disorder completely takes over the individual taking control over all the activities of the life of an individual. These addicts realize that their lives have become unmanageable.

The second stage starts with the identification of People who have this mental illness are living under many coating of shame, cheating, refutation, and fear. These people generally prefer dark and lonely places where they can live and sit for longer time. They join company according to their choice with similar bent of minds. This creates imbalance in their lives. The twelve steps process helps such individuals to develop better way to live their lives. The addicts and mentally ill people are made realized that there is no future where they are walking and it is a right time to go back and set a new way for themselves.

Third Step deals with human brain and mental illness. It is very difficult to understand human brain and at that time mental illness it is much complicated and painful. Initially individuals have to deal with their own set of problems and these steps sound unbearable, scary over their addiction and over their life. People who suffer from mental illness and addiction are physically different from those without these problems. “The bodies of addicted person respond to certain substances and behaviors differently than do healthy, non-addicted bodies” (Hornbacher, 2010).                                                                                                                                          People receiving treatment for the addiction are also fall in the category of the mental illness of addiction in the fourth step. Due to this dual diagnosis takes place. In the first step, addicts feel powerlessness and loss of control for their lives. The first step does not feel them worried or out of control, but it is a better way to start the rest of the steps and their journey to a new life. People face their mental illness and do all the things they can to treat and manage this illness. They will try to be limited and harmed by this illness; until they honestly face their addiction and do all they can to recover from the illness, they will carry on to live in this situation of segregation, damaged dreams, hopelessness and despair. “This is a simple fact that by using drugs and alcohol makes mental illness worse and prevent their medication from having the necessary effects” (Hornbacher, 2010). When a person went to a twelve step meeting at first time then he taken heavy alcohol and used medication for several days. The client sitting in the meeting room and saw the twelve steps that hung on the wall. At that time, it was blindingly sunlit, the client felt that the floor was swimming and he was peering at the words.  The client read those steps but he does not understand what it means. The client read several times and finally focused on the first step. Every addicted person wants the magic bullet, the moment of surprise where the addicted person feel relax. Some clients have such kind of moment. In the first step, the client fighting the idea that he was powerless and felt that mental illness were bigger than he though it was, but he needs to take action to recover. This action is needed to survive, live life happily and respectfully. The clients have a series of actions they can take and receive in the company of others. It is very important for the addicted person to get support from his family members and social circle. These changes can not be brought in one day or overnight. Addicts are involved in series of different activities and motivated to develop good habits like reading books, doing various chores and be busy in some work or meetings. This helps them making war out of the isolation. Sharing of experience from others or those who succeeded in getting rid of the addiction problems is usually benefiting. The addicted person carries powerlessness lifts the burden of delusion. Every addicted person gets exhausted under this burden of delusion. They can achieve control over the material to which they are addicted. “These kinds of addicted person need serious action proportionate to the seriousness of the disease” (Hornbacher, 2010).

Outdoor Behavioral Healthcare programs

These behavioral healthcare programs are comparatively new and found effective in reducing behavioral and emotional symptoms of young clients particularly in the cases of substance abuse. There are limited studies that have covered to study the effectiveness of this approach.

Though several studies appear in the literature on outcomes associated with OBH programs (Hattie, Marsh, Neill, & Richards, 1997), few studies have specifically addressed the degree to which the treatment approach is effective in reducing symptoms associated with substance use and depression disorders.” (Russell, 2005)

OBH is also known as Wilderness therapy. Russell (2001) lists various terms used for this therapy such as “challenge courses,” “adventure– based therapy,” or “wilderness experience programs MEPs) or “wilderness therapy” and “boot camp”. Boot camp is the term giving negative impression of overall therapy which portrays it as a cruel process (Russell, 2006). Russell (2003) identified OBH as one of the widely accepted program for the individuals with mental health needs. OBH programs are run by licensed agencies who utilize services of licensed and non-licensed clinicians. Duration of OBH program varies from individual to individual. Individuals with similar needs can be grouped together (Russell, 2003).  The natural elements of the wilderness creates essential environment for the change in mental and psychological level. Personal learning and growth through the activities in the natural environment leads an individual to the third aspect of socialization (Russell, 2006).

 

Source: Russell, Hendee and Phillips-Miller, 2000 p211)

There are six components of any OBH program i.e. wilderness, eclectic therapeutic model that combines family systems theory, CBT, and experiential process, alone time, communication skills training, Native American reference and continuum of care (Russell, Hendee, & Phillips-Miller 2002; p. 211).

Evaluation of Research Literature

It is evident from the literature reviewed that internet provided an easy access to all kind of pornographic materials to the users that can be useful for him under very special circumstances but in most of the cases the overuse and dependence on these materials lead to addiction among the users. Addiction of internet pornography leads to the compulsive behavior among the users that can have serious psychological and physiological health implications. An individual suffering with online pornography addiction requires help to get back to a healthy routine of life. There are various therapies used for treatment of internet pornography addicts. These therapies are similar to the one used for the treatment of other addictions, with some modifications. The most common treatment approaches for the treatment of internet pornography addiction as identified in literature are 12-step programs, CBT and OBH.

It is evident that there have been limited efforts to identify the origin of sexual addition over internet, identifying the patterns of internet pornographic sexual addiction and effectiveness of treatments with respect to time taken to treat clients and their social and demographic backgrounds and history of repeated cybersex addiction problems.

However there has been gap in therapists’ understanding the etiology of internet pornography addiction, different aspects of client assessment and evaluation and therapists’ perspectives of online pornography addiction. CBT and OBH are growing in acceptance due to effectiveness.

 

CHAPTER SUMMARY

 

 


CHAPTER 3

RESEARCH DESIGN AND METHOD

 

CHAPTER OVERVIEW

This chapter provides detailed information on the procedures adopted for fulfill the objectives of the study to develop an appropriate treatment program for the online pornography addicted young males. Research design consists of research approach, methods used, and variables, types of measurements, instrument, and validity of research methods, data collection process and other aspects of the study.

PROBLEM STATEMENT

Current research indicates that there is a gap in the available treatment processes for the young males suffering from internet pornography addiction and compulsive behavior problems. This raises a question if available treatments for addictions are adequate enough to provide proper assistance to these young males to deal with their problems and get a sustaining treatment program that will prevent them from getting involved with the same addiction again. This is an attempt to explore the possibilities of combining different treatment methods to develop a treatment program that can deal with all the causes and problems of individuals with online pornography addiction and compulsive behavior problem.

 

 

HYPOTHESES AND THEIR RATIONALES

Ho1 Therapists have significant role in providing appropriate treatment to the clients with online pornographic addiction problems.

Ha1 Therapists do not have significant role in providing appropriate treatment to the clients with online pornographic addiction problems.

It is evident from the available research that the online pornography addiction problems have gained significant attention in the recent past but there are limited studies on the treatment plans and programs. Most of the studies focused only on the perspectives of teenagers and addicted people. The role of therapist involved in the treatment is an important area to focus on as the therapists are helping these individuals dealing with their problems and coming out as responsible individuals.

 

Ho2 Perception and attitude of therapists towards any treatment have important role in making it success or failure.

Ha2 Perception and attitude of therapists towards any treatment do not have important role in making it success or failure.

This is clear from the available literature that therapist are involved in every sphere of the life of the client during the treatment programs. They help them, nurture them and provide assistance to deal with their problems.

 

Ho3 CBT is an effective approach for providing treatment to the young males suffering from the online pornography addiction problem.

Ha3 CBT is not an effective approach for providing treatment to the young males suffering from the online pornography addiction problem.

It is evident from previous studies that CBT has been effective in treatment of various addiction programs. This is important to understand can be effective for the treatment of young males suffering from the online pornography addiction problems.

 

Ho4 Outdoor experiential therapy is an effective approach for providing treatment to the young males suffering from the online pornography addiction problem.

Ha4 Outdoor experiential therapy is not an effective approach for providing treatment to the young males suffering from the online pornography addiction problem

Similar to CBT outdoor experiential therapy is used for treatment for the addiction problems. This hypothesis will allow understanding the possibilities experiential therapy in the treatment of the young males suffering from the online pornography addiction problems.

 

Ho5 From the therapist point of views, combining CBT with Outdoor experiential therapy will provide a better approach for the treatment to the young males suffering from the online pornography addiction problem.

Ha5 From the therapist point of views, combining CBT with Outdoor experiential therapy will not provide a better approach for the treatment to the young males suffering from the online pornography addiction problem.

This hypothesis will help in understanding the possibilities of the combination of CBT and Outdoor Experiential therapy in treatment of the young males suffering from online pornography addiction.

Ho6 the quantitative and qualitative outcomes of use of CBT and Outdoor experiential therapy support each other.

Ha6 The quantitative and qualitative outcomes of use of CBT and Outdoor experiential therapy do not support each other.

RESEARCH DESIGN

The research design for this research is based on phenomenological study that aims at exploring experiences of the therapist in order to understand the essence of the treatment program outcomes for the OPA among the young males. The research paradigm is based on ‘pragmatism’ whereas the consequences of action will are explored in the real world practices for the treatment of OPA. The research methods used for this study are based on the mixed method approach.

Qualitative study

The focus of this study will be to understand the core of the treatment methods used by the therapists and its implications on the clients from their perspectives. Data will be collected on the basis of long interviews. Respondents would be asked set of open ended questions related to online pornography addiction treatment programs for young males.

Quantitative study

This will be based on survey where in prospective respondents will be requested to participate in an online survey. This survey will provide the attitude and perception of young male respondents regarding the treatment programs and therapists roles. This will be based on structured questionnaires with the set of bipolar or scale based questions.

Pilot Study

The questionnaire will be tested for its effectiveness and identifying any practical problem in language, sequence and understanding of questions. The sample size for pilot study will be thirty and the participants participating in pilot studies will be excluded from the final study.

 

PARTICIPANTS

Qualitative

Therapists and staff working with clients suffering with online addiction, sexual addiction and cybersex addiction are the primary respondents for the interview purpose. This will help in understanding the overall phenomenon of online pornographic addiction, factors impacting it and the therapist perspectives for the same. The sample size for the interviews will be n=10.

Quantitative

Quantitative data will be collected from the young males who have participation in any addiction treatment program. This will help in determining the programs that have been effective for them, their perception and attitude regarding the therapists helping them dealing with their addiction. The sample size n=100.

INSTRUMENTATION

The instrument for the interviews will be questionnaire with open ended questions allowing participants to the freedom of sharing their experiences. Researcher will use probes pertaining to every question so that more inputs can be collected.

The survey will be based on structured questionnaire. The questions will be closed ended where in each respondent will have choices available to select the most appropriate response (see appendix A and B).

Researcher intends to use the instrument used by Widyanto and McMurran (2004) for the study of “The Psychometric Properties of the Internet Addiction” with some modifications according to the present study.

VALIDITY AND RELIABILITY

Degree of measure is determined with the validity for this study (Creswell, 2003). Consistency of a study is provides the reliability for the study of the phenomenon. The survey questionnaire has fixed responses. Survey data has been collected without researcher bias and involvement. Due to the fixed responses, there is almost no scope for the deviation from the previously determined research outline.

ETHICAL ISSUES

All the respondents will be informed regarding the purpose of the research. Researcher will not use any identifier for the respondents. Due to the sensitivity and vulnerability of the information related to sexual behavior, the consent of each respondent participating would be taken.

All the respondents will be clearly informed that they have right to retract their participation at any point of time of in filing the survey form.

 

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Appendix A Qualitative Research Questions

Job Related Information:

  1. How long you have been working in the current position?
  2. How long you have been working with online pornography addicts?
  3. Are you clinically licensed to work with addicts?
  4. Do you receive any clinical supervision? Is your clinical supervisor is clinically licensed?
  5. Which of the therapy programs best describes your work environment?
  6. How many and what kind of clients do you deal with at a given point of time?
  7. What kind of challenges you face while working with online pornography addicts?
  8. How you measure the severity of addiction for online pornography addicts? Is it same as the measures of other addiction problems?
  9. Based on your experience, what do you think is best for the treatment of online pornography addicts?
  10. How you would rate the success of treatment programs for the online pornography addicts?
  11. Do you feel there is any better way to provide treatment to online pornography addicts?
  12. What do you think about the combination of Cognitive behavior therapy (CBT) and Outdoor Behavioral programs (Wilderness therapy) for the online pornography addicts? Kindly explain.

 

Thank you

Probes for question 5

    1. Wilderness Therapy-Base camp
    2. Wilderness Therapy- Expedition
    3. Both a and b
    4. 12 Step Program
    5. Cognitive Behavioral therapy

 

Appendix B Quantitative Survey Questionnaire

Hi, I am ………………conducting a study on the title “combining outdoor experiential therapy with CBT for the non-residential treatment of young male internet porn addiction”.

Kindly fill the following survey form. All the information and identity related information will be treated as confidential. There is no identifier used for any survey feedback questionnaire in order to maintain the anonymity of the participant. Your information would be valuable for this study.

  1. Demographic information

Age group:

  • 17-19 years
  • 20 to 23 years
  • 24 to 26 years

Kindly tick the most appropriate. You are:

  • White Non Hispanic
  • White Hispanic
  • Native American,
  • Asian
  • Black Hispanic
  • Black non Hispanic
  • Less than one hours
  • Two to five hours
  • Five to Ten hours
  • Eleven hours and above
  • Communication (Chatting and e-mails)
  • Instant messaging (friends)
  • Instant messaging (Anyone)
  • Pornographic websites
  • Online shopping
  • School/College Assignments
  • Entertainment (Movies, music, news and gossip)
  • Social networking website
    • Yes
    • No
  1. How much time on an average you used to spend on online activities everyday before your treatment?
  1. Which was the primary purpose of spending time online?
  1. I have received treatment for my online pornographic addiction.

 

  1. Kindly select from the available options (1 for least applicable, 5 for most applicable):
Questions 1 2 3 4 5
I used to spend more time virtually than spending that time with others in reality.          
I used to feel bad when I am able to do any online activity any day.          
I could not imagine my life without internet.          
I used to visit pornographic websites everyday.          
I used to download pornographic materials everyday.          
I usually forgot everything when I am on pornographic websites.          
I used to think about pornographic contents even when I was not in front of my system.          
I used to feel bad about my online sexual activity every time.          
I used to find myself helpless to deal with that situation.          
My family members and friends used to complain about my more involvement online.          
I used to find internet more exciting that my real partner for sexual activities.          
My performance in class/workplace suffered due to this habit.          
My experience in the treatment process was good.          
I think treatment was well designed and suited to deal with my problem          

 

  1. Do you think you have received the best treatment?
  • Yes
  • No
  • Can not say
  • Cognitive therapy based
  • Outdoor therapy based
  • I do not know.
  • Yes
  • No
  1. Your treatment was:
  1. Do you think this treatment would have been better?
  1. Can you please elaborate on your response to the previous question?

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Thank you for your participation.

 

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