Essential Tools for Recovery from Pornography and Sex Addiction

Hey there everybody, and welcome to this video on the porn trap, based in part on the book by Wendy and Larry Maltz. I'm your host, Dr. Donnellice Snipes. In this video, we're going to explore the prevalence of pornography use, reasons people watch porn, and the hidden power of porn, the consequences of porn, 10 action steps that you might use if you are having a problem with porn. Then we're going to talk about handling relapses and identifying strategies for healing as a couple. So let's start out with what is porn? Pornography. A lot of people automatically think of pornhub or video based porn, but pornography is any sexually explicit or erotic video, audio, pictures or prose. And when we talk about pro prose, Lady Chatterley's Lover comes to mind. This is a book that was released decades ago, but when it was released, it was considered quite racy for the time. The definition of what pornography is does not rely on how graphic it is, but the person's relationship to it. That is, does it sexually arouse the individual and involve them in a fantasy or in a relationship with it. Pornography use is actually relatively common. And it's important to note here that in this video, I'm not saying that all pornography use is bad. That is a decision that an individual has to make. What we're talking about in this video is how pornography use can become problematic and the effects of compulsive or problematic pornography use. In any event, a lot of people engage in the use of porn and most of the studies really look at video based porn. They're not considering the text based. They're not considering the images like Playboy magazine or Penthouse or Hustler, if those even still exist. And they're not considering pros. So what we're really talking about is video. 36% of men and 16% of women aged 18 to 39 years report having consumed pornography in the prior week. Now we know that 36% of men and 16% of women are not having problems with pornography, are not, quote, addicted to, to pornography. So it's important to recognize that like a lot of other things, there is recreational use and then there is compulsive or problematic use. Another study found that 94.2% of college students had viewed pornography before starting college. Now people start college 17, 18, 19 years old, which means they were viewing it in high school, in early adolescence. And we're going to talk about how that can be problematic because the adolescent brain is so much more malleable and susceptible to neuronal changes and damage as the result of addictive behaviors. So why do people watch porn? Well, there's a lot of reasons and remember I said pornography use in and of itself is not necessarily bad. And that is a personal moral judgment call that each individual has to make. And we're going to talk, I'm going to try to present a fair and balanced view, if you will, of pornography in this video. Some people watch pornography to enhance their sexual arousal and, or facilitate masturbation through fantasy. Sometimes couples watch together to enhance their sexual arousal and then they end up in having sexual relations. Sometimes people enhance their sexual arousal in order to facilitate masturbation because they cannot access their significant other for some reason, or maybe they don't have a significant other at that point in time and, and they don't want to just hook up with anybody. Some people watch porn to learn the mechanics of sex and increase their sense of sexual competence. There is the talk that some parents have with their children. Not all parents have the talk with their kids, but there is the talk that some have with their kids. But a lot of times it does not get into the nitty gritty of the. The mechanics of what's going on. So some people explore for curiosity, reasons to learn in order to enhance their sense of competence so they feel more confident going into sexual relationships. Some people watch it because they enjoy it. Some watch it to improve their relationships. Maybe they want to add some spice to the bedroom and they don't know exactly where to find information about it or different techniques, or maybe it's something that their partner wants to do with them. There are a lot of reasons some people watch porn to relieve loneliness. There are some studies out there that have looked at people who watch porn, especially people who develop a problematic relationship with it. And it can be used when somebody does not feel self confident enough or their self esteem is too low to engage with another person. Whether, whether it's because they have body image issues or because they have concerns about their prowess in the bedroom. There are a lot of different reasons, but there's a lot of pressure for people when you're in a real life sexual encounter. And so some people that anxiety is too much so they engage in fantasy relationships with the pornography. As I mentioned, some people watch porn because their partner wants them to. It's a mutually agreeable act. And the only time they watch it is when they watch it together. Some people watch porn to relieve boredom, some watch it to decrease shame. They look for pornography that highlights activities that they like to do, that highlights things that are, well, things that they like to do or that represent them more in order to decrease shame, in order to feel like, hey, there's other people out there that do this to improve mood. When people watch pornography, it creates a tension within them. It creates the release of a lot of different neurochemicals that we're going to talk about in a minute. But that can improve mood, it can improve energy in some people. And the release of dopamine and other endogenous opioids and other things when a person masturbates also improves mood. So people may be using porn as a tool or as a self medication strategy. As I mentioned, some people watch porn to see people like themselves represented, Especially if they have are self conscious about themselves for some reason, then they may seek out porn that represents them. Some studies indicate that people watch porn to confirm their sexual orientation. They watch porn to figure out what is it that excites me, what types of people excite me. And some people just watch it out of habit. That's what they've done and it's what they will continue to do. Unfortunately, porn can have a hidden power, and one of the powers is called the Coolidge effect. Our brains are programmed, our primitive brains are programmed to tires of one partner or stimulus, but have a powerful automatic response to novelty. So people, for example, that have been married for 50 years and have been in a monogamous relationship for 50 years, may have difficulty getting as excited about each other, but they have a powerful stimulatory response to novelty, to pornography. The brain, interestingly enough, doesn't differentiate very much between 2D, what a person sees on the screen, and 3D partners. So video based porn can be, especially video based porn can be particularly stimulating for people and trigger that sexual arousal. The desire and motivation to pursue sex arises largely from dopamine, which motivates you to do things that further your survival and the survival of the species. Remember, dopamine is not actually a pleasure chemical. It's a motivation. I want to do that again, I want more of that chemical. When you do that again, when you want more of that, then there's a release of serotonin and norepinephrine and endogenous opioids and all kinds of other pleasure chemicals. And the brain goes, oh yeah, let's get the dopamine out. So to encourage us to do that again, Sexual stimulation offers the biggest natural blast of dopamine available to your reward circuitry. Now, when we say natural blast, that means things that you can do without ingesting chemicals or herbs. Or something, something that is endogenous. You're using your own internal chemicals. Porn can give people the illusion of power and control. They can envision themselves in this fantasy with another person. They can visualize themselves being more competent or well competent in the bedroom. And interestingly, with porn, there's something called a variable ratio schedule of reward. And that is one of the hardest schedules to extinguish. Because if you get a reward every single time you do something, then if that reward disappears, you quickly kind of lose interest in it, basically. But variable ratio means that you don't exactly know when you're going to find that video that does it for you, that stimulates your arousal. So you may watch three and then find a really good video, and then five and find a good video. And then one, you, you know, the very next one is another great video. So it keeps people pressing the button, pressing the lever, so to speak, in order to get that hit of dopamine in order to get that arousal. Video porn is far more arousing than static porn because it involves more senses and is more lifelike. Video porn, you've got audio, you've got visual that's going on as well as when people start to get excited, they start to secrete pheromones, so they're smelling their own pheromones. And so you start to get this trifecta to increase sexual arousal and raise declining dopamine. People can instantly switch genres. So like Internet gaming, that goes on and sometimes there's no actual end to a game, and there's always constantly new novelty. Same thing with porn. If one thing starts to get boring, then you can switch to something else. Unfortunately, with porn, one of the things that they have found in the research is that people often go from more normative pornography to things that are less normative, harder core, and potentially more problematic. Porn videos have been shown to replace people's imagination and may shape their sexual tastes, behavior and trajectory, especially in adolescence. And it's important to recognize that watching porn, you know, it kind of hijacks your brain. So you may remember what you saw in the video, but it removes people's sense of imagination in real life, where you're thinking about in this situation, at this context and in, at this time, what could I do? How could I improve this situation? Porn often just takes you to that place where you're like, I want to recreate that vision. So it's much more disconnected, much more role oriented, as opposed to intimacy oriented. It can also shape sexual tastes. If you see, if A person sees something a lot, they may think it's far more common than it really is. Or if they see something that seems to produce a lot of pleasure or produces pleasure in themselves, then that intense rush of neurochemicals they get may encode that as something that they want to do in real life. Pornography is stored in your brain. Once you've seen it, you kind of can't unsee it, which allows you to recall it anytime you need a hit. Unlike food and drugs, for which there is a limit to consumption, you can eat only so much before your stomach bursts. You can use drugs only so much before you overdose. There are no physical limitations to Internet porn consumption. The brain's natural satiation mechanisms are not activated unless one climaxes. So you can keep watching porn for, you know, hours or longer. The satiation mechanism doesn't kick in until the person climaxes. But even if they climax after a trajectory, a refractory period, then they're able to resume their, resume the behavior. So it is important to recognize that porn is something that can end up taking up a whole lot of time. So how does porn actually affect the brain? Let's just talk about some neurochemistry because you all know that that's one of my favorite topics. Your endogenous opioids are the main reward chemical, your pleasure chemicals. Interestingly, some studies have found that naltrexone is effective for blocking the endogenous opioids and reducing the reward and may stimulate testosterone. Dopamine is the main motivation chemical. So remember I said your endogenous opioids are the pleasure chemical. But dopamine says, oh, I want to go get more of that. Dopamine is all about seeking and searching for rewards, the anticipation and the wanting. So dopamine goes up as tension builds. When the person achieves the reward, then they get that release feeling. Dopamine provides the motivation and drive to pursue potential rewards or long term goals. Interestingly, we think about dopamine as, again, something that says we want to continue to do that. But dopamine is a perseverance chemical. It's a motivation chemical that motivates us to survive. It's not just for pleasure, it's for survival. So dopamine is released to encourage us to seek novelty food, sex, and safety. Anything that violates expectations, that produces shock, surprise, or more than we could have imagined will often trigger the release of dopamine. If it's shock or surprise, the dopamine may be released so we can seek and search for safety. If it is novelty or more than we could imagine, and it's just thrilling. Then dopamine is released because it says, oh, I want more of that. Strong emotions that can be elicited by porn, which include desire, guilt, disgust, embarrassment, anxiety, or fear, all can elicit dopamine for different reasons. Strong emotions elevate dopamine and boost norepinephrine and cortisol that increase excitement and amplify dopamine's effects. So dopamine itself is pretty powerful. But then when you add cortisol and other excitatory neurochemicals, then you've got motivation and energy, and they amplify one another. Now, obviously, when we have positive emotions like desire, then dopamine is going to say, I want more of that. When we have other strong emotions like guilt, disgust, embarrassment, anxiety, or fear, dopamine may be released in order to encourage us to seek safety. But if, when those strong emotions are released and that HPA axis, your stress response system is triggered, cortisol, norepinephrine, excitatory neurochemicals are released. Your brain has difficulty differentiating. Is this good dopamine or is this bad dopamine? It's dopamine. It says, I want more of that. Over time, a porn user's brain can mistake feelings of anxiety or fear for feelings of sexual arousal. So that feeling they get if they feel guilty about what they're doing, but it's paired with a opioid rush, it's paired with that release, with that feeling of pleasure, then that feeling of anxiety may start to be coupled or lead the person to expect pleasure. That feeling of anxiety may trigger reminders of porn, which lead to viewing porn and masturbation and pleasure. Internet porn can alter brain circuitry for sexuality, especially during adolescence, when the brain is highly malleable, programmed to learn all about sex. During adolescence, there are a lot of physiological changes, hormonal changes, as well as neurological changes that are taking place that are designed to increase people's awareness of their sexuality. You know, a 2, 3, 4 year old often doesn't think about sex. A 12, 13, 14 year old does. And that's partly because of just normal physiological changes, where the brain saying, okay, puberty's hit. You can reproduce now, so let's get interested in perpetuating the species. So I mentioned that porn use in and of itself is not necessarily problematic. And some people could argue that the way it shapes people's expectations about, about sex can be problematic. We're not debating that here. What we're talking about is when pornography becomes a compulsive behavior or an addiction. The American Society of Addiction Medicine Defined addiction as addiction by saying. Addiction is a primary chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic brain, biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and or relief by using a substance or other behavior. So they change their definition of addiction to include behavioral or process addictions. Now, the ICD 11, which is the alternative to the DSM 5TR, added compulsive sexual behavior disorder as code 6C 72. But it goes on to really break down the criteria. For diagnosing pornography addiction or compulsive sexual behavior disorder. Now, compulsive sexual behavior disorder Applies to sex as well as pornography. In order to be diagnosed, the person only has to have a persistent failure. To control intense, repetitive sexual impulses or urges. That includes watching porn, masturbation, sex for at least six months. As evidenced by one or more of the following. So the threshold is pretty low here. Significant health and personal care or other interests, activities or responsibilities are given up. So the person can engage in sex, Porn, masturbation, Unsuccessful efforts to control or significantly reduce the repetitive sexual behavior. The person continues to engage in repetitive sexual behavior despite despite adverse consequences. So a person who is able to stop when they start experiencing adverse consequences. Would probably not qualify for this particular diagnosis. Continues to engage in repetitive sexual behavior. Even when they derive little or no satisfaction from it. So that's a really broad definition. And since the person only needs to meet one or more criteria for at least six months. It means that it's really pretty easily applied. To people who are presenting for treatment. So from a reimbursement standpoint, that can be a good thing. Additionally, compulsive sexual behavior disorder Must not be explained by another mental disorder. For example, mania or hypomania. When people are in a manic or hypomanic episode, they may display hypersexuality. There are other mental health issues that may also be displayed as hypersexuality. We also want to examine whether it's due to another medical condition. Traumatic brain injury in the right places can potentially trigger hypersexuality. Or due to the effects of a substance or medication. That triggers hypersexual desire. Or in the case of addiction to another substance. Some people may engage in sexual behavior in order to get their substance of choice. They're engaging it even though they derive very little pleasure from it. But it is a means to an end. The behavior results in marked distress or significant impairment in one or more areas of functioning. The ICD11 does indicate that individuals who make or are concerned about religious or moral judgments about their own sexual behavior may describe themselves as sex addicts or describe their behavior as compulsive. The clinician is advised to consider whether such perceptions are due to internal or external judgments or whether there's evidence that impaired control over sexual impulses, urges or behaviors exist. Now that's a nice little note, but if you go back to the diagnostic criteria, The person may meet criteria based on cultural prohibitions against sex. But remember, the first criteria, the main criteria is a persistent failure to control intense, repetitive sexual impulses or urges for at least six months. So let's talk about the relationship with porn. What do we mean relationship? Well, people are likely to become emotionally and physically attached to something that they regularly turn to for emotional comfort. So if somebody is using this in order to alleviate feelings of depression, anxiety, boredom, what have you, then when they can't access it, those feelings may become completely overwhelming, so they turn to that and they are emotionally attached to it. We already talked about physical attachment. We're going to talk about it a little bit more in a minute. Because there are brain changes that result when the brain is regularly flooded with dopamine. There are hormonal changes that take place when the brain is regularly flooded with dopamine and when that HPA axis or that stress response synthesis system is regularly activated. So what is this physiological conditioning? Excess masturbation can be the signal to your primitive brain that you have hit the evolutionary jackpot. It's like, hey, there's a lot to go around and I'm spreading the. I'm perpetuating the species in a big way. With regular over consumption, high levels of dopamine trigger the production of delta phos B, which initiates several brain changes, including sensitization. So you may be thinking, well, I was thinking about tolerance. Well, we'll get to tolerance in a minute. Sensitization is when the brain wires together sensory stimuli. So the computer, the room you're in, the whatever, a sensory stimuli, what you see, what you smell, what you hear, emotions, how you're feeling when you're doing it, and memories associated with a big reward. So if there's a big reward, your brain says, oh, I want to remember how that happened. So I'm going to take in all of these stimuli and all of these associated triggers and I'm going to lump them all together. So next time I encounter that trigger or any of those Triggers, I remember how to get that reward again. So they create a pathway to the reward center that can be activated by cues or triggers which create cravings. Which is why we see in people who start to develop compulsive sexual behavior disorder that things as benign as computers or Internet access or a particular time of day can trigger these urges and cravings that feel extremely powerful. Desensitization or decoupling of those triggers with that stimuli occurs when stimuli become old and the person needs novel stimuli. So remember we talked about the Coolidge effect. If they keep watching the same thing, then it's not going to produce as big of a reward. And, and when that reward gets bland enough, then the person may start seeking out something else. Now I did mention the adolescent brain. And you know, I'm passionate about the adolescent brain because it is, and I've used the analogy before, a clay pot. Think about making a clay pot before it has been fired, before it has gone into the kiln, how malleable it is. And that is the adolescent brain. It's really easy to break it, to modify it, to morph it. Once it goes into the kiln, then you know, it's, it's either solid or it's broken. The adolescent brain is malleable like that. They have an immature prefrontal cortex, which is where we have impulse control, executive functioning, over responsive limbic or emotional circuits, an overactive dopamine system. The adolescent, instead of going, yeah, that sounds like something I might want to do, is it's either I'm not interested or I'm all in. There isn't the, there aren't the degrees that we see in people who have a fully developed brain. They have a more pronounced HPA axis or stress response because of their over responsive limbic circuits. When their HPA axis kicks off, it kicks off more intensely. They have a greater flood of excitatory neurochemicals. So you see what sometimes we call more emotional dysregulation in the adolescent, which can be for positive things like in response to sex and masturbation, as well as dysphoric things like anger, anxiety, depression, which sometimes are self medicated with porn and masturbation. And there are also in male, biologically male adolescents, augmented levels of testosterone. What are the negative consequences of compulsive sexual behavior disorder when the person cannot access their drug of choice? When their dopamine levels start to drop, they may become easily irritated, depressed. They may isolate or objectify people when they start using pornography regularly because they are regularly in this world where these things are normal and typical. And then when they are in in real life, the expected behaviors may be somewhat different. So we may start to see a change in how people perceive their partners and perceive other people. Even without compulsive sexual behavior behavior, they may neglect important life areas. There may be sexual dysfunction. People who regularly engage with pornography because vanilla sex or mainstream sex may be old hat. That Coolidge effect is kicking in. So it may be harder to get aroused by what is more mainstream in real life. Likewise, they may, since they've been exposed to so many different partners through pornography, they may have difficulty getting aroused by their real life partner. They may experience relationship issues because they start objectifying their significant other because of sexual dysfunction, because of loss of interest in real life sex, because of disagreements about whether porn is appropriate or not. There are a lot of reasons. And I have another video called Love, you hate the porn that is based on a book called Love you hate the porn that talks about some of the psychological effects of pornography use on the non porn using partner. But that's a whole different presentation. Pornography use can cause shame and guilt in some people. Some people have no problems with it. Other people do. It may include escalation into risky areas. And that can mean online risky areas, or it can mean trying to experiment with some of the things that they see in porn in real life, which may be pushing some boundaries. And it can lead to physiological and psychological craving or need for pornography. Risk factors for the development of compulsive sexual behavior disorder porn addiction include associating porn with pleasure or relief of dysphoria. If this is one of the only ways somebody can feel relief or experience pleasure, then that's a risk factor. If they are dealing with untenable stress, anxiety or depression, they may be self medicating in order to increase their dopamine, serotonin and opioid levels. If they have a lack of social supports, then that can contribute to feeling untenable stress, anxiety, depression or loneliness, which again can make them more at risk. Unrestricted access to porn. Now again, a lot of people are on the Internet. A lot of people theoretically could have unrestricted access to porn. However, especially for adolescents that have more difficulty with that impulse control and for people who've started to develop problems with it, then unrestricted access can be more problematic. Or for example, when there were all of the quarantines, a lot of people were locked in their house by themselves and they weren't able to go to work. They weren't able to interact in real Life with other people. So we did see more engagement with online pornography. People who had early access to porn in childhood and early adolescence experience brain changes that make them more can make them more susceptible to problematic pornography use. The frequent use of porn with masturbation makes them more at risk. If porn is used by itself and then they engage in sexual activity with a partner, that's less of a risk. But if the porn use is associated with masturbation, then it can become more problematic because it doesn't rely on that other person being there. So we start having more unrestricted access to release. People who have difficulty with intimacy, including trust, abandonment and communication, are also at greater risk. As I mentioned, some people will engage in fantasy relationships with the people that they're watching in porn because it is too stressful to engage with people in real life. And then people who have non traditional sexual interests may seek out validation, may seek out stimulation through pornography, because that is not something that they are able to find in in real life. Protective factors include disliking porn, having limited contact with porn, especially before age 25, which is when that prefrontal cortex solidifies, matures, feeling sexually secure and satisfied in real life, wanting to experience emotional intimacy, high self esteem, confidence and a sense of personal experience, efficacy or competence in life as well as in the bedroom, and secure attachment relationships in childhood that help the person develop emotional intelligence or the ability to identify and modulate their own emotions and form a solid sense of self and self esteem. They have started looking at pornography literacy programs, Recognizing that pornography is probably not going anywhere. Pornography literacy programs attempt to mitigate the negative impact of porn by helping people think more critically about the pornography they viewed, Increasing their awareness that porn tends to be somewhat unrealistic in a number of ways, including heteronormative themes, sexual behaviors, and even the kinds of bodies that are depicted in the in the pornography. So let's talk about recovery strategies. First, the person has to want to quit. They've got to want to alter their behaviors. And for people who've developed compulsive sexual behavior disorder, a lot of times it's recommended that they abstain from pornography for a period of time at least. And I make the analogy of somebody who drinks, somebody who's an alcoholic would likely not try to recover by using controlled drinking. That is a very hot button topic. Pornography is not essential to life. So developing a motivation to be willing to give up pornography for a period of time is one of the first steps. So have people create a vision board of their rich and meaningful Life. What people, things, activities and values are important to them. And I do have a video on the YouTube channel that talks about how to create a vision board for a rich and meaningful life. If you want to go into details on that. Once the person has the vision board so they can see what's important in their rich and meaningful life, they've actually gone to the trouble of thinking about it and creating a visual representation. Then having them regularly ask themselves when they start having a craving. Does using porn help me get closer to those people, things, activities and values that are important to me, or does it move me away? Does it use my energy in a way that doesn't nurture those things I. Or worse yet, harms those things? You can also use a decisional balance exercise. And this is a very common activity that's used in motivational interviewing. You create a chart that looks like this. You have benefits and drawbacks on the far column. And then across the top row, stop using porn or keep using porn. Why do we have keep using porn? Because there are benefits. People that were using it were using it for a reason. They were getting a reward. So it's important that we acknowledge those benefits and potentially figure out alternate ways to meet those needs other than porn. So in the first quadrant, the benefits to stopping using porn, how is it going to make me feel better emotionally? That can be. They may feel less guilty, they may feel more relieved. We don't know. And that's up to each individual person for emotional benefits of keeping. Continuing to use porn could be relief from depression, boredom, and anxiety. So that's one of those functions that porn is serving that in therapy needs to be a treatment target. How can we help people meet those emotional needs? How can we help them feel happy even without using porn? Mental benefits to stop using porn, how does it make logical sense? How will it improve their attitude and their ability to concentrate and focus? Well, you know what, if they're not obsessing about porn all the time, then they may have some more mental clarity. Mentally, the cravings that happen when they're not using may be a benefit to continuing to use porn. So we want to look at how can we help people deal with those obsessive thoughts, ruminations, cravings, whatever you want to call them. Physically, the benefits to stop using porn can include increased energy, it may include increased sexual functioning. Benefits to continuing to use porn physically. Some people will say that using porn and masturbation helps them relax and go to sleep. Again, that's a treatment target. There's a lot of ways to help people get better sleep. Besides pornography, interpersonally, what are the benefits to stopping using porn and what are the benefits to continuing to use porn then financially and legally? You look at both sides and then you go down to the drawbacks. And some of these are going to be repetitive from what we just went through. But it's still helpful to get very granular with people to help them identify their motivations to quit as well as their obstacles or apprehensions to quitting. So what are the drawbacks, emotional drawbacks to stopping porn? Well, anxiety and feeling overwhelmed maybe. What are the mental drawbacks? Physical, interpersonal, financial and legal. So you can go through all of those with the person, write it down. Don't just sit there and talk about it like we did, but actually have them write it down so they can go back and they can look at it when they start having cravings. They can see see the reasons that they want to use. They can see the alternatives to achieve the benefits of pornography. Next steps, Tell somebody about the problem. Now, this is easier said than done. For a lot of people it's like, well, who do I tell? A lot of people start out by telling a doctor or a therapist, maybe a sponsor, a coach or a significant other and then establish 24 hour accountability. Now obviously with a doctor and a therapist, they're not going to be there to hold you accountable 24 hours a day. So somebody that is outside of that realm is going to be important. But you need to reach out for support. If you've already tried to quit, that's pretty of the diagnosis and have been unsuccessful, then you're going to need to add some additional tools to your toolbox. Create a porn free environment. You can use a family oriented Internet service provider or cable. Change your email so you're not getting flooded with pornography or triggering emails. Likewise, I know I get tons of spam that is completely inappropriate for what I want to see in my inbox, but I have set my spam filters very very high and I have my spam folder automatically delete. Mine is every 30 days. But my guess is you can set it to delete at the end of every day. Install what I call netnany programs. These are programs that are on all of your digital devices that report to someone else when you're going to an unapproved website. So that way you can't go to the library or to a coffee shop or somewhere and get on somebody else's wi fi. But with your mobile device. Call ahead to hotels and have porn movies not available. On your particular television. So none of those pay per view things. Don't drive by adult stores, don't drive by places that are triggering for you and add competing stimuli. If, as most of us do, you spend a fair amount of time on the computer or on your mobile device because of work or because that's how you communicate with your friends, there can be some very benign reasons for doing that. If you pair it so it's an uncomfortable situation to watch porn or masturbate, then that will help decouple that particular stimulus. So on your mobile device, you know, obviously you have a net nanny program, but then you can also have on your lock screen a picture of your kid or a picture of your mom, have pictures on your desk and around your computer that really kind of take the motivation for porn away. Whether it are, whether it's religious icons or family or something else that can be helpful. It's not going to do everything, but it does tend to sort of dampen the mood. Get involved in treatment or self help programs. In these programs you're going to need to identify and address your vulnerabilities. And those are some things that you may have identified if you went through the decisional balance exercise with somebody. But identify and address your vulnerabilities. What physical or emotional states, what times of day, what environments, what relationships might make you more vulnerable to being triggered might make you more. There's just not another word I can find vulnerable to triggers in your environment. Sometimes, for example, you can be in front of a computer and not be triggered. You're not vulnerable at that point, maybe because you've got pictures of your family all around it or something. But other times the environment, you're more vulnerable in the environment because you're by yourself and there are not those competing stimuli around. So identify and address your vulnerabilities. And a lot of those are probably going to be time of day, mood and access. And then triggers what things or emotional states or physical states trigger your desire to use, trigger your cravings when you're already vulnerable and then all of a sudden you see a particular store or you're in a particular environment, then you may be triggered or your compulsion, compulsive thoughts may be triggered. Explore the function of pornography or compulsive sexual behavior in your life? What purpose is it serving and what are alternative ways to meet those needs? Address underlying physical, psychological and relationship issues. Physical issues. We do need to look at those. Make sure a person gets a physical to assess whether their testosterone levels are within range, whether there are Other gonadal hormones are in range, whether there is thyroid dysfunction, whether there is anything else going on physiologically that might be contributing either to hypersexuality or to depression and anxiety. If somebody is has hypothyroid, they may feel, they may label it as depression and they may be trying to self medicate with pornography and masturbation. So we want to address the underlying physiological issues that are contributing to, not only directly to the porn use, but to the reasons people want to use porn. Address underlying psychological and relationship issues, including communication and start healing your sexuality. Well, what I mean by this in start healing your sexuality is start defining what a healthy sexual relationship looks like for you. And what does it mean? Does it mean caring for somebody, sharing a genuine connection with a partner, healthy communication with that person? Now, not all people are enthralled by what is sometimes termed vanilla sex. It is more mainstream sex. There are people that also embrace kink, embrace bdsm, but all of that involves communication, healthy communication. And in the kink community there's a saying, safe, sane and consensual. So it's important that people, no matter whether they're engaging in, quote, vanilla sex or very traditional sexual behaviors or things that are more non traditional, that they are communicating with one another and respecting each other's boundaries and that these sexual encounters enhance each person and their self esteem. We don't want people leaving sexual encounters feeling bad about themselves or ashamed about themselves. In terms of relapse, relapse prevention is a lot like what you addressed in treatment, but it's just kind of making sure that you don't end up going back down that road. There are five different types of relapse. Physical or behavioral relapse occurs when you start engaging in the behavior again and triggering those tsunamis of neurochemicals. Affective or emotional relapse is when you start experiencing depression or anxiety or other emotions that may have triggered the or be associated with pornography use. And that pornography use may be to alleviate the feelings of boredom or depression or anxiety. Cognitive or mental relapse is when you start justifying, well, I can watch a little, or I can watch it with my partner, or I can watch it in this particular situation. When you start justifying, minimizing and denying, then that can be a road to relapse. Environmental relapse is when you start taking away any of those things in the environment that prevent you from accessing the porn or remind you not to access the porn. So you get rid of the net nanny apps, you take away the firewalls, you start going to sites online, so you're bringing that porn into your environment. And relational relapse can be, for example, starting to engage in more non intimate sexual behaviors, engaging in more masturbation and fantasy relationships, or engaging in more one night stands, one offs and unemotional sexual encounters. For relapse prevention, you need to know your triggers and how to prevent them when possible, or when the triggers exist, how to mitigate them. So if you go somewhere, like maybe you're staying at your family's house or a friend's house and they have the Internet and computers there and you know how to get on their Internet or computer, they may not have the firewalls. So how do you mitigate that trigger so you're not obsessing about getting on that computer and viewing porn. One of those ways may be to have them password protect their computer and not give you the password. But it's important to know if I encounter this trigger, this thing that makes me start thinking about and craving porn, how can I mitigate it? How can I keep it from hopefully triggering those cravings? Develop healthy alternatives to viewing porn or masturbation. So when you do start having those cravings, what else can you do that can help you feel pleasure, that can distract you, that can help you, quote, ride the wave? Learn distress tolerance skills. I talk about this as the bee theory. When you have a bee on your arm, it's kind of like having a craving. Your urge is to swat that bee away. You know you don't want that be there. Well, with cravings, you don't want to feel the way you're feeling. You want to make that feeling go away. Well, if you swat the bee, it's likely going to sting you. If you give in to your urges, it's likely going to end up with negative consequences. Practice mindfulness. The more mindful you are, the earlier you're going to notice. Early warning signs of relapse. Prevent and mitigate your vulnerabilities, physical vulnerabilities. Maybe you tend to be more vulnerable to being triggered when you're tired, or environmental vulnerabilities. Maybe you tend to be more vulnerable to being triggered when you're at home alone. So figure out how you can address those things. Add in pleasure to your life. Do other things to increase your dopamine, whether that's exercise or, or playing with your dog or flying a kite or rock climbing or whatever it is. Develop a support system and an emergency plan. When you start feeling urges or cravings, what are some steps that you can take in order to manage that situation in terms of healing as a couple. An intimacy oriented approach to sex involves creating ground rules regarding emotional and physical safety. You know, how can we reconnect in a safe way? Engage in courtship with one another and I encourage you to watch the video on love languages and figure out how to communicate love for your significant other in a way that is using their love language. And I also have another video on increasing intimacy in order to help improve the relationship. Practice looking at each other with love. Just gaze into each other's eyes and see how that impacts you. Become more mindful when you're with your partner. Stay focused on the sensations, the sights, the smells, the sounds, the non verbals of your partner when you are with your partner, not just in sex, but anytime in order to start becoming more aware of the moment and not have your thoughts out there. Talk with your partner about sexual likes, dislikes, needs, etc. And you can go online and search for something called a yes, no, maybe list. And there are a lot of them out there, some more detailed than others, but this can serve as a opening way to initiate this conversation where you can both fill it out and exchange it and then you can talk about it. Explore the realm of sensual pleasure with your significant other. It doesn't necessarily need to lead to sex initially, but start out by just getting back to basics. Holding hands, foot back, head massages, sitting in a hot tub together, experiencing aromatherapy, or practicing different forms of touch like feathers or massage balls. Pornography is everywhere. Unfortunately, it can hijack people's primitive drives for survival and reproduction. Although it doesn't always do that, pornography is not always bad to begin to change the process. If pornography has started to become problematic for somebody, it's important to describe how they envision a rich and meaningful life, the effects pornography has had on them, and how it keeps them from achieving their rich and meaningful life. Identifying triggers and vulnerabilities for use and preventing or mitigating them as much as possible. Identifying needs that porn fulfills and alternate methods for meeting those needs. Practicing mindfulness and getting support.