Sex Addiction Treatment

The term sex addiction is a topic of debate among clinicians worldwide. The International Classification of Diseases of the World Health Organisation (WHO) called this condition Compulsive Sexual Behaviour Disorder (CSBD) and recognised it as an impulse control disorder. Meanwhile, the term Hypersexual Disorder appears in the proposed previous revisions of the Diagnostic and Statistical Manual for Mental Disorders (DSM) of the American Psychiatric Association (APA).

Regardless of the term, most professionals agree that sex addiction is a behavioural problem characterised by persistent and excessive patterns of sexual thoughts, fantasies, urges, and behaviours that lead to the point of distress, impairment, or negative consequences in personal, occupational, or social areas of functioning. People with sex addiction may engage in various sexual activities, such as watching pornography or explicit content, masturbation, paying for sex, and having multiple partners.

Cognitive Behavioural Therapy (CBT) is a form of talk therapy that helps you explore how your thoughts interact with the way you feel and act. It is a highly structured and goal-driven approach that focuses on identifying irrational thoughts and maladaptive behaviours that cause and maintain distress. These faulty thoughts and behaviours are challenged, modified, and replaced with healthier ones. Some of the techniques used by CBT therapists to help individuals with sex addiction include:

• Psychoeducation: The first few sessions of CBT focus on educating the individual about sex addiction as a psychological condition. The therapist discusses the typical symptoms, prognosis, treatment options, and therapy goals.
• Thought Record: One of the key features of CBT is the ability to recognise faulty patterns of thought. The therapist assists the individual in identifying these distorted thoughts associated with sexual urges and behaviours through journaling. A CBT worksheet is provided where the situation, thoughts, emotions, evidence to support the thought, and alternative thoughts are written and assessed.
• Cognitive Restructuring: Once the cognitive distortions about sexual urges and compulsive behaviours are recognised, the therapist’s primary objective is to help individuals reconstruct them by challenging those thoughts and replacing them with rational ones.
• Relaxation Techniques: People with sex addiction often use compulsive sexual behaviours to deal with daily stressors. CBT therapists replace these maladaptive coping strategies with healthier ones, such as progressive muscle relaxation and deep breathing, to name a few.

Another useful therapeutic intervention for sex addiction is Dialectical Behaviour Therapy (DBT). It is a structured and evidence-based programme with strong educational components designed to equip individuals with skills in managing intense emotions and improving interpersonal relationships related to compulsive sexual urges and behaviours. DBT places strong significance on making the individual aware of the present moment so they can react to healthy sexual urges without being impulsive and compulsive. DBT incorporates four core modules to treat people with sex addiction such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

There is growing evidence that trauma can lead to unhealthy coping mechanisms, such as compulsive sexual behaviours. Trauma, particularly sexual abuse, can create unhealthy sexual development that interferes with the individual’s physical, emotional, and psychological processes conducive to healthy sexual behaviour. Hence, Eye Movement Desensitisation and Reprocessing (EMDR) as a gold standard treatment for stress- and trauma-related conditions can be a useful approach to treating individuals with sex addiction.

EMDR works by helping the individual identify and recall memories, thoughts, or sensations related to trauma while engaging in bilateral movements such as eye movement, auditory cues, and tapping. This process allows both hemispheres of the brain to communicate with each other, enabling individuals to process traumatic memories safely. Throughout the EMDR procedures, the therapist systematically follows eight phases: history-taking and treatment planning, preparation, assessment, desensitisation, installation, body scan, closure, and re-evaluation.

Motivational Interviewing (MI) is an emphatic and client-centred intervention that focuses on providing collaborative conversation to empower the individual’s internal motivation for change by resolving ambivalent feelings. The therapist emphasised the fact that individuals do not lack resources to change but rather motivation to change problem behaviours such as uncontrolled sexual activities. Throughout the process of MI, the therapist elicits the individual’s reason for changing sexual behaviours, rolls with any resistance to change, and builds the individual’s confidence in the ability to change. Typically, the process of change comes in five stages:

• Precontemplation: The individual has no intention of changing the unhealthy sexual behaviour in the foreseeable future. There is also no awareness about the problem or the need for a change.
• Contemplation: At this stage, problems are identified, and the individual is assessing whether there is a need to take action by weighing the pros and cons of continuing the compulsive sexual behaviours.
• Preparation: The individual begins to plan the change and starts to commit to changing the unhelpful sexual behaviours.
• Action: At this stage, the individual transforms the plan for changing compulsive sexual behaviour into action.
• Maintenance: To prevent relapse, the individual consolidates the gains achieved during the previous stages.