Defining a Framework for Those with Compulsive Sexual Behavior Disorder: A Narrative Synthesis

Figures & data

Figure 1. PRISMA flow chart.

Table 1. Complete summary of all papers included in the present review.

Author (Year)	Study Method	Classification	Therapeutic Approach	Main Findings
Benfeld (2018).	Qualitative. Experiences of 6 sex addiction therapists.	Sex Addiction. Sexual Addiction. Sexual Compulsivity.	Attachment Informed. Biopsychosocial model, OAT (Opportunity, Attachment and Trauma) model. Mindfulness being in the present. Group Therapy.	Assessment: Adult Attachment Interview (AAI) Causes: Emotional deregulation. Client’s model of intimacy. Insecure attachment styles. Trauma. Treatment: Attachment focused approach.
Coleman, Dickenson, Girard, Rider. Candelario-Perez, Becker-Warner, Kovic, and Munns (2018).	Qualitative.	Impulsive/ Compulsive Sexual Behavior.	Integrated Biopsychosocial model, OAT (Opportunity, Attachment and Trauma) model, Sex Positive Model and attachment theory. Psychoeducation. Solution focused. Self-awareness. Mindfulness. Family systems. Social learning. Attachment and interpersonal theories. Basic sexological principles and therapies. Group Therapy.	Assessment: Integrative Biopsychosocial and Sex Positive Model of impulsive/compulsive sexual behavior (ICSB) Causes: Trauma. Emotional deregulation. Faulty development of positive identity and healthy intimacy functioning. Treatment: Group Therapy (intensive and long-term). Individualized treatment.
Droubay, Shafer, and Butters (2020).	Quantitative. Adults (n = 559).	Problematic Pornography Use.	Acceptance and Commitment Therapy. Client-Informed Approach.	Assessment: Person-in-environment assessment. Causes: Dysregulation. Treatment: Therapeutic goals. Self-Awareness. Holistic care. Shame reduction.
Garcia, Assumpcao, Malloy-Diniz, De Freitas, Delavenne, and Thibaut (2016).	Qualitative.	Sexual Addiction.	Group therapy. Family therapy. Individual therapy. Cognitive Behavioral Therapy. Mindfulness. Gestalt therapy. Task-oriented approach program. Out-of-Control Sexual Behavior treatment protocol (OCSB). The Psychotherapeutic Stage Model (PSM).	Assessment: Clinical interview. Causes: Childhood trauma. Treatment: Importance of the relationship with the therapist and members of the therapy group. Boundary management. Self-Awareness. Shame reduction. Accountability.
Giugliano (2006).	Qualitative. Adult men (n = 14).	Out-of-Control Sexual Behavior. Problematic Sexual Behavior.	Trauma Informed Therapy.	Assessment: There is a need for training in assessment tools. Causes: Childhood trauma. Treatments: Should go beyond addressing overt sexual behaviors.
Hall (2011).	Qualitative.	Sex Addiction. Sexual Addiction.	Biopsychosocial Model. Attachment Theory. Systems Theory. Couples Therapy.	Assessment: Biopsychosocial. Causes: Childhood trauma. Insecure attachment styles. Treatment: Importance of the relationship with the therapist and members of the therapy group. Shame reduction. Empathy. Developing a behavior management plan.
Hall (2013b).	Expert Review Paper.	Sexual Addiction.	Biopsychosocial model, OAT (Opportunity, Attachment and Trauma) model and attachment theory. Mindfulness Group Therapy.	Assessment: Client’s history. OAT model used in the assessment process. Causes: Childhood trauma. Insecure attachment styles. Treatment: Understanding of the societal influence of opportunity.
Hall and Larkin (2020).	Qualitative. n = 19 recovering sex and porn addicts.	Sexual Addiction.	Biopsychosocial model, OAT (Opportunity, Attachment and Trauma) model and attachment theory. Psychoeducation. One-to-One therapy. Group therapy.	Assessment: OAT model used in the assessment process. Causes: Childhood trauma. Insecure attachment styles. Treatment: Relationship building. Communication skills. Boundary management. Shame reduction. Accountability.
Herring (2017).	Expert Review Paper.	Problematic Sexual Behavior.	As a theory-neutral framework it can be utilized to support models and methodologies representing many different perspectives.	Establishes commitment violations, values conflicts, diminished self-control, negative consequences, and inadequate sexual responsibility as independent and equally sufficient determinants of problematic sexual behavior.
Holas et al. (2020).	Quantitative. n = 13 adult males with a diagnosis of CSBD.	Compulsive Sexual Behavior Disorder.	Mindfulness-based relapse prevention (MBRP).	Assessment: A web-based baseline assessment. Brief Pornography Screener (BPS). Treatment: Meditation, experiential exercises, inquiry, psychoeducation and discussion.
Hook et al. (2008).	Expert Review Paper.	Sexual Addiction. Disorder of Intimacy.	Mindfulness. Group therapy.	Causes: Childhood trauma. Insecure attachment styles. Treatment: Long-term group therapy.
Kotera and Rhodes (2019).	Quantitative.	Sexual Addiction. Sex Addiction.	Relation-based interventions Mindfulness-based interventions	Assessment: Preoccupied, Ashamed, Treatment, Hurt others, Out of control and Sad (PATHOS). Causes: Adverse childhood experience. Childhood trauma. Neurological disorder. Insecure attachment style. Treatment: Relation-based or mindfulness-based interventions
Lundy (1994).	Mixed Method.	Sexual Addiction.		Assessment and classification are essential components of understanding and providing adequate treatment.
Reid et al. (2014).	Quantitative. Hypersexual patients (n = 40) and control subjects (n = 30).	Hypersexuality. Hypersexual Disorder.	Mindfulness.	Assessment: Structured diagnostic interview. Hypersexual Behavior Inventory (HBI). NEO Personality Inventory-Revised (NEO-PI-R). Inverse relationship of mindfulness to hypersexuality associations with emotional regulation, impulsivity, and stress proneness.
Reid et al. (2009).	Quantitative. Hypersexual patients (n = 59) control group of non-hypersexual individuals (n = 55).	Hypersexuality.	The Symptoms Checklist-90-Revised (SCL-90-R).	Assessment: Hypersexual Behavioral Inventory (HBI). SCL.90-R. Compulsive Sexual Behavior Inventory. Sexual Addiction Screening Test. Causes: Emotional deregulation. Trauma.
Sanches and John (2019).	Systematic Review Paper.	Love Addiction.	Psychotherapy. Group Therapy.	Treatment: Therapeutic Alliance.
Sussman (2010).	Narrative Review Paper.	Love Addiction.	Sex Love Addicts Anonymous (SLAA). 12 Steps program. Group Therapy.	Likely to manifest by adolescence, and functions similarly to substance abuse disorders.
Woehler et al. (2018).	Narrative Review Paper.	Sexual Addiction.	Relational Depth Therapy. Mindfulness. Maintaining a present moment focus. Group Therapy. 12 Step program.	Assessment: Motivational Interviewing. Treatment: Therapeutic alliance. Boundary management. Awareness. Empathy.

Droubay, B. A., Shafer, K., & Butters, R. P. (2020). Sexual desire and subjective distress among pornography consumers. Journal of Sex & Marital Therapy, 46(8), 773–792. doi:10.1080/0092623X.2020.1822483

 PubMed Web of Science ®Google Scholar

Garcia, F. D., Assumpção, A. A., Malloy-Diniz, L., De Freitas, A. A. C., Delavenne, H., & Thibaut, F. (2016). A comprehensive review of psychotherapeutic treatment of sexual addiction. Journal of Groups in Addiction & Recovery, 11(1), 59–71. doi:10.1080/1556035X.2015.1066726

 Web of Science ®Google Scholar

Giugliano, J. (2006). Out of control sexual behavior: A qualitative investigation. Sexual Addiction & Compulsivity, 13(4), 361–375. doi:10.1080/10720160601011273

 Google Scholar

Hall, P. (2011). A biopsychosocial view of sex addiction. Sexual and Relationship Therapy, 26(3), 217–228. doi:10.1080/14681994.2011.628310

 Web of Science ®Google Scholar

Hall, P. (2013b). A new classification model for sex addiction. Sexual Addiction & Compulsivity, 20(4), 279–291. doi:10.1080/10720162.2013.807484

 Google Scholar

Hall, P., & Larkin, J. (2020). A thematic analysis of clients’ reflections on the qualities of group work for sex and pornography addiction. Sexual Addiction & Compulsivity, 27(1–2), 1–11. doi:10.1080/10720162.2020.1751360

 Web of Science ®Google Scholar

Herring, B. (2017). A framework for categorizing chronically problematic sexual behavior. Sexual Addiction & Compulsivity, 24(4), 242–247. doi:10.1080/10720162.2017.1394947

 Web of Science ®Google Scholar

Holas, P., Draps, M., Kowalewska, E., Lewczuk, K., & Gola, M. (2020). A pilot study of mindfulness-based relapse prevention for compulsive sexual behaviour disorder. Journal of Behavioral Addictions, 9(4), 1088–1092. doi:10.1556/2006.2020.00075

 PubMed Web of Science ®Google Scholar

Hook, J. N., Hook, J. P., & Hines, S. (2008). Reach out or act out: Long-term group therapy for sexual addiction. Sexual Addiction & Compulsivity, 15(3), 217–232. doi:10.1080/10720160802288829

 Google Scholar

Kotera, Y., & Rhodes, C. (2019). Pathways to sex addiction: Relationships with adverse childhood experience, attachment, narcissism, self-compassion and motivation in a gender-balanced sample. Sexual Addiction & Compulsivity, 26(1-2), 54–76. doi:10.1080/10720162.2019.1615585

 Web of Science ®Google Scholar

Lundy, J. P. (1994). Behavior patterns that comprise sexual addiction as identified by mental health professionals. Sexual Addiction & Compulsivity, 1(1), 46–56. APA doi:10.1080/10720169408400027

 Google Scholar

Reid, R. C., Bramen, J. E., Anderson, A., & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients: Mindfulness and hypersexuality. Journal of Clinical Psychology, 70(4), 313–321. doi:10.1002/jclp.22027

 PubMed Web of Science ®Google Scholar

Reid, R. C., Carpenter, B. N., & Lloyd, T. Q. (2009). Assessing psychological symptom patterns of patients seeking help for hypersexual behavior. Sexual and Relationship Therapy, 24(1), 47–63. doi:10.1080/14681990802702141

 Web of Science ®Google Scholar

Sanches, M., & John, V. P. (2019). Treatment of love addiction: Current status and perspectives. The European Journal of Psychiatry, 33(1), 38–44. doi:10.1016/j.ejpsy.2018.07.002

 Web of Science ®Google Scholar

Sussman, S. (2010). Love addiction: Definition, etiology, treatment. Sexual Addiction & Compulsivity, 17(1), 31–45. doi:10.1080/10720161003604095

 Google Scholar

Woehler, E. S., Giordano, A. L., & Hagedorn, W. B. (2018). Moments of relational depth in sex addiction treatment. Sexual Addiction & Compulsivity, 25(2–3), 153–169. doi:10.1080/10720162.2018.1476943

 Google Scholar