Sexual Addiction & Compulsivity

The Journal of Treatment & Prevention

ISSN: 1072-0162 (Print) 1532-5318 (Online) Journal homepage: www.tandfonline.com/journals/usac20

Addiction and Mindfulness; Pornography

Addiction and Mindfulness-Based Therapy ACT

Julie Fraumeni-McBride

To cite this article: Julie Fraumeni-McBride (2019) Addiction and Mindfulness; Pornography
Addiction and Mindfulness-Based Therapy ACT, Sexual Addiction & Compulsivity, 26:1-2, 42-53,
DOI: 10.1080/10720162.2019.1576560

To link to this article: https://doi.org/10.1080/10720162.2019.1576560

Published online: 21 Mar 2019.

Submit your article to this journal

Article views: 6762

View related articles

View Crossmark data

Citing articles: 6 View citing articles

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=usac21
SEXUAL ADDICTION & COMPULSIVITY
2019, VOL. 26, NOS. 1–2, 42–53
https://doi.org/10.1080/10720162.2019.1576560

Addiction and Mindfulness; Pornography Addiction

and Mindfulness-Based Therapy ACT
Julie Fraumeni-McBride
Chapman University, Orange, California, USA

ABSTRACT
Mindfulness, more specifically acceptance and commitment
therapy (ACT) may be the most optimal form of therapy to be
used in treating problematic pornography use—use that may
qualify as addiction, which falls within the realm of sex addic-
tion. ACT would be beneficial to apply in a clinical setting for
1-on-1 therapy, coaching and sexuality workshops using the
ACT model. Though some ambiguity exists on whether porn-
ography addiction falls within the realm of sex addiction,
there is sufficient theoretical framework to apply addiction
identifiers to problematic pornography use, which further has
implications to the benefits of using ACT in treating perceived
problematic or addictive pornography use.

Introduction to mindfulness, addiction, and problematic pornography

use and/or addiction
Mental illness has been medicalized in the Diagnostic and Statistical
Manual of Mental Disorders (DSM) and has developed rigid and stigma-
tized labels that inevitably classify human beings as specimens of medicine
as opposed to human beings with a certain set of difficulties that are in
need of attention and healing (Jacobs, 2014). Traditional forms of psycho-
therapy such as cognitive behavioral therapy (CBT; Young, 2007) tend to
treat symptoms and behaviors or feelings that are deemed problematic
(American Psychological Association, 2017a). Mindfulness-based therapies
tend to holistically view a client aside from particular diagnoses and work
with the feelings experienced to defuse judgement and introduce self-com-
passion (American Psychological Association, 2017b).
Mindfulness-based therapies for addiction (Black, 1998) have emerged
recently as validated forms of clinical therapy comparable to and in certain
situations or cases superior to traditional forms of therapy such as CBT
(Spears et al., 2017). Evidence suggests that the metacognitive psychological
skills acquired in mindfulness-based therapies can serve as a basis for

CONTACT Julie Fraumeni-McBride [email protected] Chapman University, Orange,

California, USA.
ß 2019 Taylor & Francis Group, LLC
 SEXUAL ADDICTION & COMPULSIVITY 43

managing and countering habitual avoidance and regulate dysphoric affect

in addiction in ways that support recovery (Bieling et al., 2012).
Mindfulness, more specifically acceptance and commitment therapy
(ACT; Woods & Twohig, 2008), may be the optimal form of therapy in
treating problematic pornography use—use that may qualify as addiction
(Kor et al., 2014), which falls within the realm of sex addiction (Hayes
et al., 2011; Kuzma & Black, 2008). ACT would be beneficial to apply in a
clinical setting for one-on-one therapy, coaching, and sexuality workshops
using the ACT model (Hayes et al., 2011). Though some ambiguity exists
on whether pornography addiction falls within the realm of sexual addic-
tion and compulsivity (Schwartz & Southern, 2017) or the existence of sex
addiction itself (Duffy, Dawson & das Nair, 2016; Kraus, Voon & Potenza,
2016), there is sufficient theoretical framework available to apply addiction
identifiers to problematic pornography use (Kor et al., 2014), which further
has implications to the benefits of using ACT in treating perceived prob-
lematic or addictive pornography use (Hayes et al., 2011; Twohig &
Levin, 2017).

What is addiction? What is sex-Pornography addiction?

Clinical addiction
In clinical psychology, addiction is defined as a process by which behavior
can have multiple functions: “to produce pleasure and to provide escape
from internal discomfort is used in a pattern characterized by (1) recurrent
failure to control the behavior (powerlessness) and (2) continuation of the
behavior despite significant negative consequences (unmanageability)”
(Goodman, 1990).

The DSM III lists the following criteria to identify addiction

The DSM III lists the following criteria to identify addiction:
Addictive Disorder (or Addiction) (A) Recurrent failure to resist
impulses to engage in a specified behavior. (B) Increasing sense of tension
immediately prior to initiating the behavior. (C) Pleasure or relief at the
time of engaging in the behavior. (D) A feeling of lack of control while
engaging in the behavior. (E) At least five of the following: (1) frequent
preoccupation with the behavior or with activity that is preparatory to the
behavior (2) frequent engaging in the behavior to a greater extent or over a
longer period than intended (3) repeated efforts to reduce, control or stop
the behavior (4) a great deal of time spent in activities necessary for the
behavior, engaging in the behavior or recovering from its effects (5) fre-
quent engaging in the behavior when expected to fulfill occupational,
44 J. FRAUMENI-MCBRIDE

academic, domestic or social obligations (6) important social, occupational

or recreational activities given up or reduced because of the behavior (7)
continuation of the behavior despite knowledge of having a persistent or
recurrent social, financial, psychological or physical problem that is caused
or exacerbated by the behavior (8) tolerance: need to increase the intensity
or frequency of the behavior in order to achieve the desired effect or
diminished effect with continued behavior of the same intensity (9) rest-
lessness or irritability if unable to engage in the behavior (F) Some symp-
toms of the disturbance have persisted for at least 1 month, or have
occurred repeatedly over a longer period of time. (Goodman, 1990)

Sex addiction and pornography

More specifically to the realm of sex addiction (Schneider, 1994), sexual
addiction includes behaviors such as compulsive pornography use, cyber-
sex, compulsive masturbation, voyeurism, exhibitionism, etc. (Del Giudice
& Kutinsky, 2007; Kalichman & Rompa, 1995; Roller, 2004). Sexual addic-
tion and compulsivity results in cognitive, behavioral, and emotion dysre-
gulation consequences that impair an individual’s capacity for intimacy
(Schwartz & Southern, 2017). When an individual’s capacity for intimacy is
reduced or eliminated repairs need to be made in order to have a healthy
sexual relationship with a future or current partner and overall sexual
health and wellbeing (Schwartz & Southern, 2017). In a sexual addiction,
extensive therapy to reconstruct healthy erotic templates or love maps to
reduce objectification and compulsions need to be reestablished for not
only sexual health but also mental, emotional, and physical health, which
are all interconnected to sexuality (Schwartz & Southern, 2017).
People tend to use addiction as a means of avoiding or replacing private
experiences such as thoughts, emotions, and physical sensations (Hayes &
Levin, 2012). Though there are instances when pornography use is agreed
upon by couples to heighten sexual interaction (Grant & Potenza, 2007) or
attraction (Bergner & Bridges, 2002), pornography use is not always
prompted simply by curiosity—it is often prompted by some level of dis-
tress, experiential avoidance, relational withdrawal, or inability to connect,
especially by users or partners who identify the use as problematic
(Coleman, 1991; Hayes et al., 2011, p. 306; Kor et al., 2014; Rachman,
Thordarson, Shafran, & Woody, 1995).
Pornography addiction (Cooper, Delmonico & Burg, 2000; Cooper,
Putnam, Planchon & Boies, 1999; Kor et al., 2014; Twohig & Levin, 2017)
involves the inability to regulate use of pornography in a way that is incon-
sistent with deliberate value based decision making, whereas problematic
pornography use is often reported to be unwanted by the user, where the
 SEXUAL ADDICTION & COMPULSIVITY 45

user lacks the ability to limit or disengage from use despite the desire to do
so (Hayes et al., 2011; Kor et al., 2014; Twohig & Levin, 2017; Twohig
et al., 2009).

Negative outcomes resulting from problematic pornography use

Typically, pornography use is labeled unwanted and problematic when an
individual lacks the ability to regulate use or experiences negative outcomes
as a result of use (Kor et al., 2014; McBride, Reece & Sanders, 2008; Mick
& Hollander, 2006). Pornography use is problematic to the extent that it
leads to problematic emotional, cognitive, or behavioral outcomes (Kor
et al., 2014; Twohig et al., 2009).
Some negative outcomes of problematic pornography use have been
linked to depression, social isolation, damaged relationships (Manning,
2006), including decreased interest in sexual activity between affected part-
ners (Schneider, 2003), marital separation (Reid & Woolley, 2006) and
divorce (Schneider, 2000b), career loss or decreased productivity, financial
consequences (Schneider, 2000a), anxiety, shame, guilt, potential legal prob-
lems, loneliness, and self-blame and increased need for mental health sup-
port (Cooper, Griffin-Shelley, Delmonico & Mathy, 2001; McBride
et al., 2008).
Additionally, pornography use has been linked to increased risk of sexual
deviancy (Oddone-Paolucci, Genuis & Violato, 2000), negative and sexist
attitudes (Orzack & Ross, 2000) and behavior towards women (Garcia,
1986), extramarital affairs and participation in prostitution (Stack,
Wasserman, & Kern, 2004), and a correlation between pornography use
and behavioral aggression (Allen, D’Alessio, & Brezgel, 1995).
With the given evidence to negative outcomes associated with problem-
atic or addictive pornography use (Kor et al., 2014), it is important to con-
sider the best practices and models for treating, managing, and recovery
from unwanted problematic pornography use (Ford, Durtschi, & Franklin,
2012). Additionally, there may be unnoticed negative effects of pornog-
raphy use that may be considered using the ACT model for identification
of unwanted, non-value based compulsions (Twohig & Levin, 2017).

A mindfulness ACT model for pornography addiction recovery

Traditional methods of therapy such as CBT that involve though suppres-
sion or distraction may actually be less productive to addressing problem-
atic pornography use (Abramowitz, Tolin & Street, 2001; Twohig & Levin,
2017). Increased focus on suppressing thoughts may lead to an increase in
private thoughts and experience, which will lead to urges and undesired
46 J. FRAUMENI-MCBRIDE

pornography use (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Because
ACT targets processes that aim to decrease experiential avoidance, it may
be more effective than other available therapies for managing and resolving
problematic pornography use and/or addiction (Hayes et al., 2011; Twohig
& Levin, 2017).
There are six core processes targeted in ACT: present-moment aware-
ness, acceptance, defusion, self-as-context, values clarification, and commit-
ted action (Hayes & Levin, 2012; Twohig & Levin, 2017).

Present-Moment-Awareness
Present-moment-awareness seeks to foster a nonjudgmental relationship to
private experiences or thoughts as they occur—it is a way to become aware
of thoughts and feelings without having to place a judgment on one’s self
for experiencing thoughts and feelings that are part of the typical human
experience (Harris, 2009; Hayes & Levin, 2012; Twohig & Levin, 2017).

Acceptance
Acceptance in ACT is used to help the participant come to a realization
that experiencing thoughts, feelings, or urges is normal and that one does
not have to act on these experiences but simply acknowledge that they are
occurring. This component of ACT seeks to conceptualize that one can
have little to no control over thoughts and feelings, but can control actions,
and in this case, encourages participants not to act, only experience the
feelings and thoughts in a state of acknowledgement (Harris, 2009; Hayes
& Levin, 2012; Twohig & Levin, 2017). In this way, acceptance is the
opposite of avoidance.

Defusion
Defusion is the deliberate act of separating judgement from thoughts and
actions. It is the process by which a participant learns that placing subject-
ive judgement is unnecessary to addressing and acknowledging thoughts
and feelings and that value-based decision making is actually more pro-
ductive when judgement is removed from thoughts and feelings (Harris,
2009; Hayes & Levin, 2012; Twohig & Levin, 2017). This is different than
acceptance because acceptance is that process of relinquishing control over
thoughts and feelings, and defusion is the active separation of judgements
from thoughts and feelings (Harris, 2009; Hayes & Levin, 2012; Twohig &
Levin, 2017).
 SEXUAL ADDICTION & COMPULSIVITY 47

Self-As-Context
Self-as-context seeks to take away definitions and labels an individual pla-
ces on themselves as a result of judgement of undesirable or desirable
thoughts and feelings, which an individual has little or no control over. In
this component of ACT, an individual is redefined as a holistic human ves-
sel that uncontrollable thoughts and feelings pass through that do not
define an individual based on thoughts, feelings, or urges (Harris, 2009;
Hayes & Levin, 2012; Twohig & Levin, 2017).

Values clarification
In values clarification, ACT seeks to help individuals who act undesirably
based on, perhaps, unwanted thoughts, feelings, and urges, to identify how
they want to act based on values that derive from their desired way of liv-
ing. This is different than goals, which have an attainment and definitive
end, whereas values are governors for unending actions (Harris, 2009;
Hayes & Levin, 2012; Twohig & Levin, 2017). By these identified values,
individuals then learn to act according to these values versus being com-
pelled by a thought, emotion, or urge to act.

Committed action
Committed action is a resolve and result of value identification. This is
where an individual learns to act on values rather than impulses derived
from thoughts, feelings, or urges and is able to deliberately act based on a
premeditated and deliberate set of values and actions (Harris, 2009; Hayes
& Levin, 2012; Twohig & Levin, 2017).
Though no formal books have used an ACT model specifically for
addictive and problematic pornography use, Hayes and Levin (2012) have
developed an adaptive table (Table 1), which serves to accommodate porn-
ography specific material to the ACT model, which is divided according to
a recommended 12 session program for recovery from problematic pornog-
raphy use.

Evaluation and limitations

The ACT model has already been shown to improve outcomes for
unwanted addictive behaviors (Harris, 2009; Twohig & Levin, 2017). There
has also been some research that has examined the effectiveness of ACT
for pornography addiction (Crosby, 2011; Crosby & Twohig, 2009; Twohig
& Crosby 2010; Twohig & Levin, 2017). More research and evaluation are
needed to test the efficacy of a pornography specific ACT model.
Currently, most problematic pornography research has focused on males
and particular religious groups such as members of The Church of Jesus
48 J. FRAUMENI-MCBRIDE

Table 1. ACT Protocol for Pornography Addiction (Adapted from Hayes & Levin, 2012).
Session Treatment Components Session Content
1 Values  Identify treatment goals and link to values
 Support client goals of either no viewing or reducing and con-
trolled amounts of viewing
Acceptance  Identify the distinction between viewing and urges to view
2 Acceptance  Discuss short-term versus long term effectiveness of attempts to
control urges
 Identify the negative impacts of attempts to control urges
 Highlight the paradoxical nature of attempts to control urges
using the Person in the Hole metaphor.
3 Acceptance  Reinforce the futility of attempts to control urges
 Identify attempts to control urges as part of the problem using
the Polygraph metaphor and the Chocolate Cake and What Are
the Numbers? Exercises.
 Discuss the social contexts that support regulation of private
events using the Rule of Mental Events dialog
 Introduce acceptance as an alternative to control using the Tug-
of-War with a Monster metaphor
4 Acceptance  Review acceptance by demonstrating that the willingness to
experience urges is a chosen behavior and an alternative to con-
trol using the Tug-of-War with a Monster metaphor
 Identify the decrease in effort required to willingly experi-
ence urges
Values  Briefly discuss client values to give purpose and meaning
to acceptance
 Discuss what could be gained by letting go of the con-
trol agenda
Committed Action  Make behavioral commitments to gradually reduce viewing
 Make behavioral commitments to engage in values-based activ-
ities instead of attempting to control urges
5–8 Defusion  Teach the limits of language and its role in suffering
 Undermine cognitive fusion using the Passengers on the
Bus metaphor
Self-as-Context  Identify the self as the context where inner experiences occur
using the Chessboard metaphor
 Explain that the client can’t choose what inner experiences occur
but can choose what to do with them
Present-Moment-Awareness  Help the client be present with inner experiences
 Identify the importance of being present while not being heavily
attached to inner experiences
Acceptance  Identify opportunities for acceptance from out-of-session practice
 Encourage acceptance of any problematic inner experiences
Committed Action  Make behavioral commitments to continue to reduce viewing
 Make behavioral commitments to engage in values-based activ-
ities instead of attempting to control urges
9–10 Values  Define the concept of Values
 Clarify the client’s values and assess the consistency of his or her
behavior with those values using the Value
Assessment worksheet
Committed Action  Make behavioral commitments to continue reducing viewing
 Increase behavioral commitments to engage in valued living
based on recent values work
 Discuss relapse management using ACT skills
11–12 Termination  Review any processes that still need attention
 Summarize the treatment using the Joe the Bum metaphor
 Apply ACT processes to termination
 Suggest a self-help workbook for continued progress

Christ of Latter-day Saints. More work is needed to test ACT in relation to

a broader spectrum of populations such as women, LGBTQ, ethnic minor-
ities, and a wider range of religious preferences or absence thereof.
 SEXUAL ADDICTION & COMPULSIVITY 49

Another limitation would be that there is limited research to support porn-

ography addiction. Pornography addiction is not recognized in the DSM
and much of the literature on pornography addiction is theoretical,
although there is a large market for treatment (Duffy, Dawson & das Nair,
2016; Hayes & Levin, 2012; Kraus, Voon & Potenza, 2016). Additional limi-
tations for implementing ACT may occur in highly religious populations
that have a deeply fused relationship with judgement placed on thoughts,
feelings, and urges (MacInnis & Hodson, 2016). This can be alleviated with
introductory work to defusing less triggering thoughts and feelings from
judgements and then explaining the difference between automatic thoughts
and thinking as a chosen behavior (Hayes & Levin, 2012).
More research and clinical trials assessing the program evaluation of
ACT in regard to unwanted and addictive pornography use are important
to further understand the complexities associated with use and the benefits
of ACT as a model for treating unwanted pornography use.

Conclusion
Addiction is the repetition or engagement of behavior that has rewarding
effects despite negative consequences. The individual involved with addict-
ive symptoms and behavior has little to no control over behavior and con-
tinues to perform the behavior despite its negative effects (Goodman,
1990). Similarly, sex addiction as it relates to pornography addiction has
similar patterns of addictive behavior and unfavorable outcomes (Roller,
2004). Pornography use becomes unwanted and problematic when an indi-
vidual shows a lack of ability to manage urges despite having the desire to
refrain or limit use (McBride et al., 2008). Pornography addiction is linked
with problematic emotional, cognitive, and behavioral outcomes (Twohig
et al., 2009); depression; social isolation; damaged relationships (Manning,
2006), including decreased interest in sexual activity between affected part-
ners (Schneider, 2003) and marital separation and divorce (Schneider,
2000b); career loss or decreased productivity; financial consequences
(Schneider, 2000a); anxiety; shame; guilt; potential legal problems; loneli-
ness; and self-blame; and increased need for mental health support
(Cooper, Griffin-Shelley, Delmonico, & Mathy, 2001; McBride et al., 2008).
Due to the evidence related to negative outcomes with problematic and
often addictive pornography use, interventions are needed to manage
unwanted compulsions. Traditional methods (Wegner, 1994) such as CBT
may be less productive because they focus on suppressing behavior and
alleviating symptoms that may lead to an increase in pornography use,
urges, and compulsions (Hayes, Luoma, Bond, Masuda, & Lillis, 2006).
Mindfulness or acceptance and commitment therapy (ACT) may be the
50 J. FRAUMENI-MCBRIDE

optimal therapy to treat pornography addiction (Hayes et al., 2011; Twohig

& Levin, 2017) because its aim is directed at overall processes and function-
ing (Ruiz, 2012). The components of ACT help individuals to gain aware-
ness over his/her thoughts, emotions, bodily sensation, and behavior, which
allows individuals to relate to experiences in a different way that recon-
structs previously held beliefs and judgements that may have perpetuated
unwanted behavior (Twohig & Levin, 2017). Because CBT focuses on
symptom reduction and ACT focuses on functioning overall, ACT has
shown to have more favorable outcomes related to depression, quality of
life, and post treatment sustainability, and greater impact on its putative
processes of change, making ACT a stronger choice in eliminating addic-
tions and maintaining recovery post-treatment (Ruiz, 2012).

References
Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought sup-
pression: A meta-analysis of controlled studies. Clinical Psychology Review, 21(5),
683–703. doi:10.1016/S0272-7358(00)00057-X
Allen, M. I. K. E., D’Alessio, D. A. V. E., & Brezgel, K. E. R. I. (1995). A meta-analysis
summarizing the effects of pornography II: Aggression after exposure. Human
Communication Research, 22(2), 258–283. doi:10.1111/j.1468-2958.1995.tb00368.x
American Psychological Association, APA, (2017a) www.apa.org/monitor/2015/03/cover-
mindfulness.aspx. Accessed 24 Oct. 2018.
American Psychological Association, APA, (2017b) www.apa.org/ptsd-guideline/patients-
and-families/cognitive-behavioral.aspx. Accessed 24 Oct. 2018.
Bergner, R. M., & Bridges, A. J. (2002). The significance of heavy pornography involvement
for romantic partners: Research and clinical implications. Journal of Sex and Marital
Therapy, 28(3), 193–206. doi:10.1080/009262302760328235
Bieling, P. J., Hawley, L. L., Bloch, R. T., Corcoran, K. M., Levitan, R. D., Young, L. T., …
Segal, Z. V. (2012). Treatment-specific changes in decentering following mindfulness-
based cognitive therapy versus antidepressant medication or placebo for prevention of
depressive relapse. Journal of Consulting and Clinical Psychology, 80(3), 365–372. doi:
10.1037/a0027483
Black, D. W. (1998). Recognition and treatment of obsessive-compulsive spectrum disor-
ders. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds.), Obsessive-
compulsive disorder: Theory, research and treatment. New York: Guilford Press.
Coleman, E. (1991). Compulsive sexual behavior: New concepts and treatments. Journal of
Psychology and Human Sexuality, 4(2), 37–52. doi:10.1300/J056v04n02_04
Cooper, A., Delmonico, D. L., & Burg, R. (2000). Cybersex users, abusers, and compulsives:
New findings and implications. Sexual Addiction and Compulsivity, 7(1-2), 5–29. doi:
10.1080/10720160008400205
Cooper, A., Griffin-Shelley, E., Delmonico, D. L., & Mathy, R. M. (2001). Online sexual
problems: Assessment and predictive variables. Sexual Addiction and Compulsivity, 8(3-
4), 267–285. doi:10.1080/107201601753459964
Cooper, A., Putnam, D. E., Planchon, L. A., & Boies, S. C. (1999). Online sexual compulsiv-
ity: Getting tangled in the net. Sexual Addiction and Compulsivity, 6(2), 79–104.
 SEXUAL ADDICTION & COMPULSIVITY 51

Crosby, J. M. (2011). Acceptance and commitment therapy for the treatment of compulsive
pornography use: A randomized clinical trial. Doctoral dissertation, Utah State
University.
Crosby, J. M., & Twohig, M. P. (2009). Acceptance and commitment therapy for the treat-
ment of problematic pornography use: A case series of low behavioral rates. Poster pre-
sented at the annual convention of the Association for Behavioral and Cognitive
Therapies, New York, N. Y.
Del Giudice, M. J., & Kutinsky, J. (2007). Applying motivational interviewing to the treat-
ment of sexual compulsivity and addiction. Sexual Addiction and Compulsivity, 14,
303–319. doi:10.1080/10720160701710634
Duffy, A., Dawson, D. L., & das Nair, R. (2016). Pornography addiction in adults: A sys-
tematic review of definitions and reported impact. Journal of Sexual Medicine, 12(5),
760–777. doi:10.1016/j.jsxm.2016.03.002
Ford, J. J., Durtschi, J. A., & Franklin, D. L. (2012). Structural Therapy With a Couple
Battling Pornography Addiction. The American Journal of Family Therapy, 40(4),
336–348. doi:10.1080/01926187.2012.685003
Garcia, L. T. (1986). Exposure to pornography and attitudes about women and rape: A cor-
relational study. Journal of Sex Research, 22(3), 378–285. doi:10.1080/00224498609551316
Goodman, A. (1990). Addiction: Definition and implications. British Journal of Addiction,
85(11), 1403–1408. doi:10.1111/j.1360-0443.1990.tb01620.x
Grant, J. E., & Potenza, M. N. (2007). Impulse control disorders. In J. E. Grant & M. N.
Potenza (Eds.), Textbook of men’s mental health. Arlington, VA: American Psychiatric
Publishing.
Harris, R. (2009). ACT Made Simple: An Easy-To-Read Primer on Acceptance and
Commitment Therapy. Oakland, CA: New Harbinger.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and
commitment therapy: Model, processes, and outcomes. Behavior Research and Therapy,
44(1), 1–25. doi:10.1016/j.brat.2005.06.006
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy:
The process and practice of mindful change (2nd ed.). New York: Guilford Press.
Hayes, S. C., & Levin, M. E. (Eds.). (2012). Mindfulness and Acceptance for Addictive
Behaviors: Applying Contextual CBT to Substance Abuse and Behavioral Addictions (1st
ed.). Oakland, CA: Context Press.
Jacobs, D. H. (2014). Mental disorder or “Normal Life Variation”? Why it matters.
Research on Social Work Practice, 24(1), 152–157. doi:10.1177/1049731513502397
Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity
scales: Reliability, validity, and predicating HIV risk behavior. Journal of Personality
Assessment, 65(3), 586–601. doi:10.1207/s15327752jpa6503_16
Kor, A., Zilcha-Mano, S., Fogel, Y. A., Mikulincer, M., Reid, R. C., & Potenza, M. N.
(2014). Psychometric development of the Problematic Pornography Use Scale. Addictive
Behaviors, 39(5), 861–868. doi:10.1016/j.addbeh.2014.01.027
Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be
considered an addiction?. Addiction, 11(12), 2097–2106. doi:10.1111/add.13297
Kuzma, J. M., & Black, D. W. (2008). Epidemiology, prevalence, and natural history of
compulsive sexual behavior. Psychiatric Clinics of North America, 31(4), 603–611. doi:
10.1016/j.psc.2008.06.005
MacInnis, C. C., & Hodson, G. (2016). Surfing for sexual sin: Relations between religious-
ness and viewing sexual content online. Sexual Addiction & Compulsivity, 23(2-3),
196–210. doi:10.1080/10720162.2015.1130000
52 J. FRAUMENI-MCBRIDE

Manning, J. C. (2006). The impact of internet pornography on marriage and the family: A
review of the research. Sexual Addiction and Compulsivity, 13(2-3), 131–165. doi:
10.1080/10720160600870711
McBride, K. R., Reece, M., & Sanders, S. A. (2008). Predicting negative outcomes of sexual-
ity using the Compulsive Sexual Behavior Inventory. International Journal of Sexual
Health, 19(4), 51–62. doi:10.1300/J514v19n04_06
Mick, T. M., & Hollander, E. (2006). Impulsive-compulsive sexual behavior. CNS
Spectrums, 11(12), 944–955.
Oddone-Paolucci, E., Genius, M., & Violato, C. (2000). A meta-analysis of the published
research on the effects of pornography. In C. Violato, E. Oddone-Paolucci, & M. Genius
(Eds.), The changing family and child development. Aldershot, UK: Ashgate.
Orzack, M. H., & Ross, C. J. (2000). Should virtual sex be treated like other sex addictions?.
Sexual Addiction and Compulsivity, 7(1-2), 113–125. doi:10.1080/10720160008400210
Rachman, S., Thordarson, D. S., Shafran, R., & Woody, S. R. (1995). Perceived responsibil-
ity: Structure and significance. Behavior Research and Therapy, 33(7), 779–784. doi:
10.1016/0005-7967(95)00016-Q
Reid, R. C., & Woolley, S. R. (2006). Using emotionally focused therapy for couples to
resolve attachment ruptures created by hypersexual behavior. Sexual Addiction and
Compulsivity, 13(2-3), 219–239. doi:10.1080/10720160600870786
Roller, C. G. (2004). Sex addiction and women: A nursing issue. Journal of Addictions
Nursing, 15(2), 53–61. doi:10.1080/10884600490450263
Ruiz, F. J. (2012). Acceptance and commitment therapy versus traditional cognitive behav-
ioral therapy: A systematic review and meta-analysis of current empirical evidence.
International Journal of Psychology & Psychological Therapy, 12(3), 333–357.
Schneider, J. P. (1994). Sex addiction: Controversy within mainstream addiction medicine,
diagnosis based on the DSM-III-R, and physician case histories. Sexual Addiction and
Compulsivity, 1(1), 19–44. doi:10.1080/10720169408400025
Schneider, J. P. (2000). A qualitative study of cybersex participants: Gender differences,
recovery issues, and implications for therapists. Sexual Addiction and Compulsivity, 7(4),
249–278. doi:10.1080/10720160008403700
Schneider, J. P. (2000). Effects of cybersex addiction on the family: Results of a survey.
Sexual Addiciton and Compulsivity, 7(1-2), 31–58. doi:10.1080/10720160008400206
Schneider, J. P. (2003). The impact of compulsive cybersex behaviors on the family. Sexual
and Relationship Therapy, 18(3), 329–354. doi:10.1080/146819903100153946
Schwartz, M. F., & Southern, S. (2017). Recovery from sexual compulsivity. Sexual
Addiction & Compulsivity, 24(3), 224–240. doi:10.1080/10720162.2017.1350229
Spears, C. A., Hedeker, D., Li, L., Wu, C., Anderson, N. K., Houchins, S. C., & Wetter,
D. W. (2017). Mechanisms Underlying Mindfulness-Based Addiction Treatment Versus
Cognitive Behavioral Therapy and Usual Care for Smoking Cessation. Journal of
Consulting and Clinical Psychology, 85(11), 1029–1040. doi:10.1037/ccp0000229
Stack, S., Wasserman, I., & Kern, R. (2004). Adult social bonds and use of the Internet
pornography. Social Science Quarterly, 85(1), 75–88. doi:10.1111/j.0038-4941.2004.
08501006.x
Twohig, M. P., & Levin, M. E. (2017). Acceptance and commitment therapy as a treatment
for anxiety and depression: A review. Psychiatric Clinics of North America, 40(4),
751–770. doi:10.1016/j.psc.2017.08.009
Twohig, M. P., & Crosby, J. M. (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
 SEXUAL ADDICTION & COMPULSIVITY 53

Wegner, D. M. (1994). Ironic processes of mental control. Psychological Review, 101(16),

253–266.
Woods, D. W., & Twohig, M. (2008). Trichotillomania: An ACT-enhanced therapy
approach. New York: Oxford University Press.
Young, K. S. (2007). Cognitive behavior therpay with Internet addicts: Treatment outcomes
and implications. CyberPsychology and Behavior, 10(5), 671–679. doi:10.1089/
cpb.2007.9971