What makes men seek treatment for porn use, and what the treatments tested so far did

What brings men to treatment

How much porn is too much? A 2016 study in Poland came at the question from the other end. Gola, Lewczuk and Skorko compared 132 men referred by psychotherapists after a first visit for problem porn use with 437 heterosexual men who were not in treatment¹. How often the men watched explained 1% of the difference between the two groups. The problems their use caused them explained 42%¹.

Frequency did go with seeking treatment, with a weak correlation of 0.21, and almost all of that link ran through the problems the use caused¹. A later paper on the same men found those in treatment watched 333 minutes a week on average, against 203 for the others². Only 89 of the 132 men in treatment reported their minutes, so that figure rests on a smaller group². The gap in symptoms was far wider. On a 0 to 20 scale, the men in treatment scored 13.55 and the others 5.41².

So the men who walked into a therapist's office came because of what porn was doing to them. The weekly tally mattered far less. Most people at high risk never get that far. A survey of 82,243 people in 42 countries ran in 2021 and 2022, and 57% of them were women, 40% men and 3% gender-diverse³. Only 13.7% of those at high risk of compulsive sexual behaviour had ever sought treatment³. Of the high-risk group, 31.7% had not sought help because they did not feel it was serious, and 18.5% because they would have felt uncomfortable or embarrassed³. That survey screened for compulsive sexual behaviour in general, not porn use alone, and a high score is not a diagnosis³.

What therapy did, on average

For those who do get help, the widest view comes from a 2025 review by López-Pinar, Esparza-Reig and Bőthe. It included 20 studies of psychotherapy for problematic porn use, published up to July 2024, with 2,021 people in all⁴. In the trials with a control group, therapy had large effects on problem severity, on how often and how long people watched, and on sexual compulsivity⁴. Each of those effect sizes came out just above 1, where 0.8 already counts as large⁴.

Craving was the exception. Five trials with 797 people measured it, and the pooled effect was 0.31, a small one, with the trials disagreeing a lot⁴. Against a control group, therapy changed what people did far more than how much they wanted it. Measured before and after in the same people, with no control group, the effect on craving was 1.18, larger than for any other outcome⁴. The other numbers need care too. The severity result rests on 3 trials and 98 people⁴. Every study in the review was rated at high risk of bias or with some concerns, and 84% of participants were men, mostly in Western countries⁴. Two of the five control groups were a waiting list⁴. The others were medication, a distraction task and transcranial stimulation alone⁴. CBT and ACT did not differ overall. On craving, CBT did better against controls and worse before and after⁴.

One small trial of ACT

ACT, short for acceptance and commitment therapy, trains people to make room for urges and thoughts without acting on them or fighting them, and to act on what they value⁵. The clearest trial of it for porn use is small. In 2016 Crosby and Twohig gave 28 men in the US either 12 weekly sessions of ACT or a place on a waiting list⁵. With therapy, weekly viewing fell from 6.1 hours to 0.4, a 93% drop. On the waiting list it went from 6.9 hours to 5.4 over 12 weeks, a 21% drop⁵.

After the wait, the waiting-list men had the therapy too. Across the 26 men treated, viewing fell 92% by the end and stayed 86% lower 3 months later⁵. 54% had stopped watching entirely by the end of treatment. At 3 months, 35% had⁵. Some of the gain wore off, and 3 months is as far as the follow-up went⁵.

Most of each one hour session went on making room for urges and loosening the grip of thoughts about viewing. The therapists did not challenge thoughts. They left out blockers, filters and moving the computer on purpose, and the authors suggest adding them⁵. These were not easy cases. The men averaged 29 years old and had struggled with porn for 13.6 years. All had tried to stop before, 13 of them with a therapist⁵.

An earlier study by the same team treated 6 men with 8 sessions of 90 minutes and found an 85% fall, held at 83% after 3 months⁶. Five of the six cut back sharply, and at 3 months one of those five was back where he started⁶. Six men is a very small number, and the 2016 trial has limits of its own. All but one of its 28 men were members of the Church of Jesus Christ of Latter-day Saints. Viewing was self-reported, and one therapist, the first author, treated 23 of the 28⁵. No one blind to the groups did the assessments, and the comparison was a waiting list, so it cannot show ACT beats other treatments⁵. Quality of life did not rise with therapy. It held steady while the waiting group got worse⁵.

An online course most people did not finish

A therapist means finding one and asking, and the 42-country survey showed how few people do. A self-help course online looks like a way round that. Bőthe and colleagues tested one called Hands-off in a randomised trial run in 2019 and 2020⁷. 264 people, 10 women and 254 men, most of them living in the US, England or Canada, were given the course or put on a 3 month waiting list⁷. The course had six weekly modules of 45 to 60 minutes, drawing on motivational interviewing, CBT and mindfulness, with a daily diary⁷.

Those who answered the 6 week check did well. Their average score on a 126 point problem scale fell from 85 to 64, below the high-risk line of 76⁷. The waiting list started at 80 and stayed there⁷. That result rests on 13 people⁷. Of the 123 given the course, 41 never finished a module and 12% finished the sixth⁷. 89% did not answer at 6 weeks⁷. Those who dropped out of the course had stronger cravings at the start than those who stayed⁷. The authors had planned to count everyone randomised, but so many dropped out that they counted only those who answered⁷.

The therapy review saw a smaller loss across all its studies. Of the 2,021 people they started with, 79% were in the results after treatment⁴. A 2024 trial of a different self-help method, imaginal retraining, with 274 people, had the same drop-out problem as Hands-off. It found a gain on its main measure among those who used the method each week and answered at the end, and counting everyone who was randomised, the gain was not significant⁸. The authors add that even the first result would not survive a correction for testing several measures⁸. Craving turns up again here. Against a control group it was the outcome therapy moved least in the review, and stronger craving at the start marked the people who left the course⁴⁷.

Medication

Pills are the other route, and the evidence is thinner still. In a double-blind trial in Warsaw, Lew-Starowicz, Draps, Kowalewska and colleagues gave 73 men with compulsive sexual behaviour disorder paroxetine, naltrexone or a dummy pill for 20 weeks⁹¹⁰. All of the men had problem porn use¹⁰. Neither they nor the doctors knew which pill they got⁹.

On the trial's main questionnaires all three groups improved, and the groups did not differ from each other. The same held for how often they watched porn⁹. The positive results came from single interview questions among many tested. Asked whether their problem sexual behaviour had become less frequent, 17 of 19 men on paroxetine said yes, against 13 of 19 on naltrexone and 11 of 23 on the dummy pill¹⁰. Paroxetine was also the only pill reported to lower craving rated each day on a phone⁹. Since craving is what therapy moved least against controls, that result deserves a bigger trial. One trial of 73 men cannot carry it⁴⁹.

The pills had side effects. Drowsiness hit 29% on paroxetine and 38% on naltrexone, and 5 of the 73 stopped because of side effects⁹. The trial had 73 men, ran at one clinic and took only white heterosexual men⁹¹⁰. Its results came out as a two page letter with tables online, and the letter and its tables disagree on how many on paroxetine had trouble reaching orgasm, 2.8% in the letter and 20.8% in the table⁹¹⁰. Both drugs need a prescription and a doctor's judgement. Nothing here is advice to take them⁹.

How they found it

• 132 men referred by psychotherapists after a first visit for problem porn use were compared with 437 men who were not in treatment. A 2021 to 2022 survey of 82,243 people in 42 countries asked who had sought treatment and why not.
• The 2025 review included 20 studies of psychotherapy for problematic porn use, published up to July 2024. The chart shows trials with a control group. Two of the five controls were a waiting list. The others were medication, a distraction task and transcranial stimulation alone.
• In the ACT trial, sessions were one hour a week. After the wait, the waiting-list men had the therapy too, so the combined figures cover 26 men.
• 264 people were randomly given the Hands-off course or put on a 3 month waiting list. On the waiting list, 55% answered at 6 weeks.
• 73 men with compulsive sexual behaviour disorder were randomly given paroxetine, naltrexone or a dummy pill. Neither they nor the doctors knew which.

What it cannot tell you

• Every trial here is small. The severity result in the review rests on 3 trials and 98 people, the ACT trial had 28 men, the online course result rests on 13 people who answered at 6 weeks and the medication trial had 73 men.
• Every study in the 2025 review was rated at high risk of bias or with some concerns. 84% of participants were men, mostly in Western countries.
• The ACT and online course trials compared against a waiting list, not another therapy, and use was self-reported. Follow-up in the ACT trial lasted 3 months.
• All but one of the 28 men in the ACT trial were members of the Church of Jesus Christ of Latter-day Saints, and one therapist treated 23 of them.
• The medication results came out as a two page letter with tables online, and the two disagree on how many on paroxetine had trouble reaching orgasm. Both drugs need a prescription and a doctor's judgement. Nothing here is advice to take them.
• The treatment-seeking study is a snapshot of heterosexual men in one country. The 42-country survey screened for compulsive sexual behaviour in general, not porn use alone, and a high score is not a diagnosis.

In P-Minus

P-Minus uses named CBT and ACT techniques, and each task says how strong the evidence behind it is. During the two-minute step on the P-Minus help button, one line asks you to watch the wanting as it moves and only notice, knowing God watches with mercy.

Sources

1. Gola M, Lewczuk K, Skorko M. What matters: quantity or quality of pornography use? Psychological and behavioral factors of seeking treatment for problematic pornography use. J Sex Med. 2016;13(5):815-24.
2. Lewczuk K, Leśniak J, Lew-Starowicz M, Gola M. Variability of pornographic content consumed and longest session of pornography use associated with treatment seeking and problematic sexual behavior symptoms. Sex Med. 2021;9(1):100276.
3. Bőthe B, Koós M, Nagy L, et al. Compulsive sexual behavior disorder in 42 countries: insights from the International Sex Survey and introduction of standardized assessment tools. J Behav Addict. 2023;12(2):393-407.
4. López-Pinar C, Esparza-Reig J, Bőthe B. Psychotherapy for problematic pornography use: a comprehensive meta-analysis. J Behav Addict. 2025;14(2):630-43.
5. Crosby JM, Twohig MP. Acceptance and commitment therapy for problematic internet pornography use: a randomized trial. Behav Ther. 2016;47(3):355-66.
6. Twohig MP, Crosby JM. Acceptance and commitment therapy as a treatment for problematic internet pornography viewing. Behav Ther. 2010;41(3):285-95.
7. Bőthe B, Baumgartner C, Schaub MP, Demetrovics Z, Orosz G. Hands-off: feasibility and preliminary results of a two-armed randomized controlled trial of a web-based self-help tool to reduce problematic pornography use. J Behav Addict. 2021;10(4):1015-35.
8. Baumeister A, Gehlenborg J, Schuurmans L, Moritz S, Briken P. Reducing problematic pornography use with imaginal retraining: a randomized controlled trial. J Behav Addict. 2024;13(2):622-34.
9. Lew-Starowicz M, Draps M, Kowalewska E, Obarska K, Kraus SW, Gola M. Tolerability and efficacy of paroxetine and naltrexone for treatment of compulsive sexual behaviour disorder. World Psychiatry. 2022;21(3):468-9.
10. Lew-Starowicz M, et al. Supplementary tables for the trial. OSF; 2022.

Sources checked October 2026.