Devin Petersen and Tyler Pedersen, Counseling and Psychological Services
Online pornography use among college students is frequent and extensive. Studies indicate that roughly 90% of male college students access online pornography with nearly half doing so weekly or daily (Carroll, 2008). Although there is debate about the ultimate effects that frequent pornography viewing may have, some studies have found that heavy users (roughly 10% of viewers) can spend more than one hour per day accessing pornography with negative effects on mental health (depression, anxiety), social relationships, and work performance among others. Data available through BYU CAPS indicate that approximately 10% of all clients seeking mental health counseling at CAPS desire assistance with problematic pornography viewing and associated sexual concerns. This figure does not include those students who do not initially report a concern with pornography but that later arises as counseling proceeds. Regardless, compulsive pornography viewing and the accompanying perceived negative effects is a significant concern at BYU CAPS.
Unfortunately, BYU CAPS and other university counseling centers are unlikely to meet the needs of this segment of students. University counseling centers are experiencing unprecedented demand for counseling services (Reetz, Barr, & Krylowicz, 2013). A higher percentage of students are seeking mental health therapy now (12-15%) than at any time in the past and the severity of problems reported continues to intensify (Gallagher, 2012). At BYU, CAPS now provides counseling to 70% more students than it did 10 years ago (Cattani, Locke, Huebner, & Hart, 2014). This demand has created increased wait times for services, less frequent counseling visits, shorter sessions, and overall decreased effectiveness of services.
Due to increases in demand and limitations on resources, researchers and clinicians have developed online interventions to increase the efficiency and effectiveness of counseling. Several other online interventions exist to treat compulsive pornography use but they possess several flaws: 1) they are not grounded in proven empirical treatments 2) they are typically quite expensive and 3) they have no outcome data to support their efficacy. The goal of this project is to build an online treatment module/program based on empirically sound research, which will focus on compulsive pornography use. This will enable BYU CAPS to more effectively and efficiently help this segment of concerned students and if successful, the program can be easily scaled to reach many more students, clients, etc. from around the country and perhaps world.
In collaboration with Dr. Pedersen, I created an eight-lesson Acceptance and Commitment Therapy (ACT)-based online treatment program for students suffering from pornography addictions. This module followed the methods outlined in a published clinical trial of an effective 12-week ACT treatment for pornography addiction (Crosby, 2011). After an initial version of the protocol was developed, it was presented to the clinical management team (CMT) of CAPS, and other therapists in the counseling center who use ACT in therapy, and improvements were made based on their suggestions. The module will be administered via ChangeAlly, an online therapy platform similar to the broader platform currently used in the counseling center. An efficacy trial will begin once approval for the iOS mobile application is received. Intake paperwork will be scanned weekly for new incoming clients who had indicated pornography as a primary concern. The intake therapist will be contacted to inform them that the online module is available and they will be encouraged to use it with this particular client. Willing therapists will present the online module/program to clients and will enroll consenting clients in the program. Therapists will be encouraged to utilize the module as a support for insession therapy utilizing a blended approach. Clients will meet once with the therapist and then every 2-3 weeks while completing the online program for a total of four visits over 8-10 weeks.
We created a module, eight online lessons, for people experiencing compulsory pornography use. These lessons closely mirrored information on the use of ACT written by Steven Hayes, the creator of Acceptance and Commitment Therapy. Many of the original metaphors used to explain ACT were used, and others were created to target a younger population. In addition to the successful writing of the information to be used, we also created a website specifically for the use of these lessons as well as Android and iOS applications for mobile phones. We decided upon largely self-help based lessons due to the slow integration of a similar web-based platform by therapists. Multiple therapists have reviewed these lessons and revisions have been made with their suggestions.
The creation of the online lessons, and integration into web-based and mobile-based platforms has yielded promising evidence for the potential efficacy of these lessons. One of the most important lessons learned is the incredible time often required to create and test technology. Although the actual material has been long ready for use, the creation and approval of the mobile applications has been incredibly time consuming. Furthermore, the need for complete security due to privacy needs also creates additional complications. However, the use of videos, articles, psychological measures, and interactive lessons via phone and computer in preliminary testing is functional. Clients will be able to have unprecedented access to both helpful material as well as communication with a mental health professional through the mobile application. Once we have approval for our iOS to be used on the Apple store, treatment efficacy will begin. While we could have begun entering control and Android users into the study, we held off to avoid screening out iOS users and possibly introducing bias into the experimental design.
These lessons in particular, and online material in general, hold great promise for an increasingly tech savvy population needing psychological service. In particular, behavioral patterns oft associated with shame, will likely benefit from web-based self-help. Additionally, intake surveys at the counseling center suggest that many show interest in using web-based help to augment therapy. Preliminary testing of the lessons on Android phones indicate the usefulness of secure communication between client and therapist, administration of validated psychological measures, app notifications for assignments, and successful presentation of psychoeducational material such as web articles, videos, and audio files. Upon approval of our mobile application by the Apple Store, we will begin testing the efficacy of these lessons.