The evidence we rely on

Every source used across the site, with the type of study it is and a line on what it does and does not show.

16 sources

1. Randomised controlled trial Fernandez DP, Kuss DJ, Justice LV, Fernandez EF, Griffiths MD (2023). Effects of a 7-Day Pornography Abstinence Period on Withdrawal-Related Symptoms in Regular Pornography Users: A Randomized Controlled Study. Archives of Sexual Behavior, 52(4), 1819–1840. doi:10.1007/s10508-022-02455-9 The strongest single piece of evidence on abstinence "withdrawal", and it found NO significant difference between abstaining and control groups on craving, affect or withdrawal symptoms over seven days. An exploratory analysis found craving rose only in people with BOTH high problematic use and daily-or-more frequency. Seven days is short and the sample was undergraduates — it does not settle the question, but nothing stronger currently exists. Cited in: Is there really such a thing as withdrawal? · The flatline: a real experience with no research behind it · Stages of change, 12 steps, and which is which
2. Randomised controlled trial Twohig MP, Crosby JM (2010). Acceptance and Commitment Therapy as a Treatment for Problematic Internet Pornography Viewing. Behavior Therapy, 41(3), 285–295. doi:10.1016/j.beth.2009.06.002 A small early trial of ACT with a large reported reduction in viewing, maintained at three months. Six participants and no control group in the original design — encouraging and much too small to generalise from, which is roughly the state of the whole treatment literature. Cited in: Stages of change, 12 steps, and which is which
3. Review Grubbs JB, Perry SL, Wilt JA, Reid RC (2019). Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis. Archives of Sexual Behavior, 48(2), 397–415. doi:10.1007/s10508-018-1248-x The finding that matters most for a religious or conservative readership: how much somebody feels addicted is predicted better by the clash between their behaviour and their moral beliefs than by how much they actually use. It does not mean the distress is fake — it means distress and frequency are two different things and need separating. Cited in: When the distress is about the conflict, not the amount
4. Review Sniewski L, Farvid P, Carter P (2018). The assessment and treatment of adult heterosexual men with self-perceived problematic pornography use: A review. Addictive Behaviors, 77, 217–224. doi:10.1016/j.addbeh.2017.10.010 Reviewed the treatment literature and found it thin: mostly case reports and uncontrolled studies, with very few randomised trials. Approaches with the most support are CBT, ACT and mindfulness-based work — support that is promising rather than established. Cited in: Stages of change, 12 steps, and which is which
5. Review Torre JB, Lieberman MD (2018). Putting Feelings Into Words: Affect Labeling as Implicit Emotion Regulation. Emotion Review, 10(2), 116–124. doi:10.1177/1754073917742706 Naming an emotion measurably reduces its intensity, without the person intending to regulate anything. This is the mechanism behind asking someone to pick a word for what they are feeling rather than asking them to calm down. Cited in: Naming what you feel, and why it lowers the volume
6. Review Berridge KC, Robinson TE (2016). Liking, Wanting, and the Incentive-Sensitization Theory of Addiction. American Psychologist, 71(8), 670–679. doi:10.1037/amp0000059 The work that separated "wanting" from "liking". Dopamine tracks wanting — the pull toward a cue — and not pleasure. It explains the common experience of intensely pursuing something you do not enjoy when you get it, and it is the single most useful correction to popular dopamine talk. Cited in: What dopamine actually does — and what it does not · Is there really such a thing as withdrawal? · The flatline: a real experience with no research behind it · The model researchers actually use
7. Review Kashdan TB, Barrett LF, McKnight PE (2015). Unpacking Emotion Differentiation: Transforming Unpleasant Experience by Perceiving Distinctions in Negativity. Current Directions in Psychological Science, 24(1), 10–16. doi:10.1177/0963721414550708 People who distinguish finely between unpleasant feelings ("restless" vs "lonely" vs "ashamed") regulate them better and are less likely to reach for drinking, aggression or self-harm under distress. Cited in: Naming what you feel, and why it lowers the volume
8. Neuroimaging study Prause N, Steele VR, Staley C, Sabatinelli D, Hajcak G (2015). Modulation of late positive potentials by sexual images in problem users and controls inconsistent with "porn addiction". Biological Psychology, 109, 192–199. doi:10.1016/j.biopsycho.2015.06.005 The main published result pointing AWAY from the addiction model: brain responses to sexual images did not follow the pattern seen with drug cues in substance addiction. Included here deliberately — a bibliography that only holds studies agreeing with the site is not a bibliography. Cited in: What dopamine actually does — and what it does not · The flatline: a real experience with no research behind it
9. Neuroimaging study Kühn S, Gallinat J (2014). Brain Structure and Functional Connectivity Associated With Pornography Consumption: The Brain on Porn. JAMA Psychiatry, 71(7), 827–834. doi:10.1001/jamapsychiatry.2014.93 The most-cited imaging study here. 64 healthy men; more reported hours correlated with smaller right striatal grey matter and weaker connectivity between the striatum and the prefrontal cortex. CROSS-SECTIONAL — it cannot say whether use caused the difference or people with those differences use more. The authors say so themselves. Cited in: What dopamine actually does — and what it does not · The braking system: why self-control fails at 1am
10. Neuroimaging study Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. (2014). Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS ONE, 9(7), e102419. doi:10.1371/journal.pone.0102419 The main published result pointing TOWARD the addiction model: cue reactivity in men with compulsive sexual behaviour resembled the pattern seen in substance addiction. Read alongside Prause et al. — the two are the clearest illustration that this question is not settled. Cited in: What dopamine actually does — and what it does not · The flatline: a real experience with no research behind it
11. Observational study Bőthe B, Tóth-Király I, Potenza MN, Orosz G, Demetrovics Z (2020). High-Frequency Pornography Use May Not Always Be Problematic. The Journal of Sexual Medicine, 17(4), 793–811. doi:10.1016/j.jsxm.2020.01.007 Frequency and problems come apart. A sizeable group used very often without reporting problems, and others reported serious problems at moderate frequency. The useful question is what it is costing you, not how many times. Cited in: When the distress is about the conflict, not the amount
12. Observational study Grubbs JB, Lee BN, Hoagland KC, Kraus SW, Perry SL (2020). Addiction or Transgression? Moral Incongruence and Self-Reported Problematic Pornography Use in a Nationally Representative Sample. Clinical Psychological Science, 8(5), 936–946. doi:10.1177/2167702620922966 Nationally representative US sample. Self-perceived addiction was higher in people who were younger, more religious, more morally conflicted about their use, male, and used more often — with moral conflict a stronger predictor than frequency. Cited in: When the distress is about the conflict, not the amount
13. Official classification World Health Organization (2019). ICD-11 for Mortality and Morbidity Statistics: 6C72 Compulsive sexual behaviour disorder. World Health Organization. Link The official classification. Places compulsive sexual behaviour under impulse-control disorders, NOT under addictive behaviours, and states that distress arising entirely from moral judgement about sexual impulses is not sufficient for the diagnosis. Cited in: Is this actually an addiction? · When the distress is about the conflict, not the amount
14. Theoretical model Brand M, Wegmann E, Stark R, Müller A, Wölfling K, Robbins TW, Potenza MN (2019). The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors. Neuroscience & Biobehavioral Reviews, 104, 1–10. doi:10.1016/j.neubiorev.2019.06.032 The framework most researchers in this area actually use. Treats the behaviour as an interaction between predisposing traits, a trigger, the affective and cognitive response to it, and executive control — rather than as a substance acting on a brain. A model, not a finding. Cited in: The braking system: why self-control fails at 1am · The model researchers actually use
15. Theoretical model Prochaska JO, Velicer WF (1997). The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion, 12(1), 38–48. doi:10.4278/0890-1171-12.1.38 The stages-of-change model: precontemplation, contemplation, preparation, action, maintenance. Widely used and widely criticised — the stages describe people usefully but the evidence that stage-matched interventions outperform good generic ones is weak. Cited in: Stages of change, 12 steps, and which is which
16. Commentary or critique Kraus SW, Krueger RB, Briken P, First MB, Stein DJ, Kaplan MS, et al. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109–110. doi:10.1002/wps.20499 The working group explaining WHY it was classified as impulse-control rather than addiction: they judged the evidence for an addiction model insufficient at the time of writing. Cited in: Is this actually an addiction? · When the distress is about the conflict, not the amount