Mental Health
Cognitive behavioral therapy-based interventions for problematic pornography use: A scoping review.
Open Access: No.
Abstract
Introduction
Problematic pornography use (PPU) has attracted increasing interest due to its reported associations with psychological distress, sexual difficulties, and relationship concerns in a subset of users. Several psychotherapeutic interventions have been proposed. Still, there is no widely accepted, evidence-based, standardized protocol for its treatment.
Objective
This scoping review aimed to identify and synthesize intervention protocols based on cognitive behavioral therapy (CBT) for the treatment of PPU, published between 2019 and 2024.
Methods
A systematic search was conducted in the PubMed, Scopus, and PsycINFO databases, using predefined terms such as “cognitive behavioral therapy,” “pornography,” “PPU,” and “problematic pornography use.” Empirical studies presenting CBT-based protocols for PPU, published in English, Portuguese, or Spanish between 2019 and 2024, were included. Two independent reviewers conducted double-blind screening of the studies, with discrepancies resolved by consensus. Extracted data included participant characteristics, study design, intervention components, session structure, and outcomes.
Results
The initial search identified 437 studies. After removing duplicates and full-text screening, 11 studies met the inclusion criteria. Interventions varied in therapeutic approach, including CBT alone, ACT, mindfulness-based practices, and hybrid protocols, integrating CBT techniques with ACT-based or mindfulness-based strategies. Delivery modalities included in-person (n = 5), online (n = 5), and mixed (n = 1). Most protocols addressed emotional regulation, cognitive restructuring, craving management, and relapse prevention. Although all studies reported reductions in the frequency of PPU and associated symptoms, interventions that combined CBT with other techniques tended to report larger effect sizes. No studies reported complete abstinence, and there were high dropout rates in self-guided interventions.
Conclusions
Despite promising findings, current CBT-based protocols for treating PPU lack standardization and methodological rigor. The field would benefit from consensus on diagnostic criteria, therapeutic goals, outcome measures, and additional randomized clinical trials that integrate mental health and sexual health.
Relevance
The evidence from these studies showed that cognitive behavioral therapy showed reductions in pornography use, craving, and psychological distress (e.g., guilt, shame, depressive symptoms, anxiety) as well as improvement in emotional regulation, self-efficacy, and indicators of well-being.
Mindfulness-based treatment components (e.g., observation of thoughts and sensations, non-reactive awareness, acceptance strategies) were reported by several studies to improve emotional regulation, shame reduction, and decreases in guilt and rumination. “These findings are consistent with the broader literature highlighting the role of emotion-regulation difficulties and internal experiences of distress in PPU severity.” Additionally, “interventions integrating multiple techniques tended to report more robust effects. Programs combining CBT components (eg, cognitive restructuring, stimulus control, relapse-prevention skills) with acceptance- or mindfulness based strategies yielded moderate-to-large effect sizes.”
Citation
Zwielewski, G., Machado, V., Fiamoncini, A. A., Quinta-Gomes, A. L., & Cruz, R. M.. (2026). Cognitive behavioral therapy-based interventions for problematic pornography use: A scoping review. Sexual Medicine Review, 14(2), Article qeag027. https://doi.org/10.1093/sxmrev/qeag027
