"New" therapy program for CSAM viewers

bro…chemical castration. It’s in the name.

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Chemical castration is castration via anaphrodisiac drugs, whether to reduce libido and sexual activity, to treat cancer, or otherwise. Unlike surgical castration, where the gonads are removed through an incision in the body,[1] chemical castration does not remove organs, nor is it a form of sterilization.[2]

That isn’t whats happening you idiot? We were experimenting different THERAPIES, not medical experiments. try harder.

And you’re the one calling ME an idiot? Fuckin’ lol

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Looking at their public information page, I found this:

Sexuality as an identity

Some people we meet have created a strong identity around their attraction to children, which they can find comforting both in having a way to define themselves, and in the community.

It can be scary to do something different or learn to change your ideas about yourself and who you are, but it can also be a very positive transformation. It gives you the opportunity to ask yourself, what kind of person do I want to be, and what kinds of things does that person do?

Some people find ways to live without putting too much effort or energy into their sexuality, some allow themselves to be open to signals and attractions but consciously choose not to actively act on it. Finding other meaningful areas to explore, allowing focus on sexuality to rest for a while, becomes positive for some over time. The need for a sexual outlet varies depending on the individual, and also changes with time.

To me that sounds very condescending, as if people who have accepted their pedophilia and incorporated into their identity are somehow wrong and just “too afraid” of new things. It also needlessly pathologizes people who have found comfort in their identity as pedophiles.

This does make it sound as if their goal was for people to try to change or suppress their sexual attractions and to view it as something negative that they should try to ignore as much as possible. Which to me sounds like an approach that could be very detrimental to one’s mental wellbeing.

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Very bizarre stuff, so apparently pedophiles need to suppress their pedophilic thoughts, while at the the same time magnifying their thoughts about their own pedophilia and presumably how disgusting they are for it.

This isn’t a therapeutic strategy, this is just spite

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Chemical castration is really just suppressing testosterone production. Historically this has been done just been cutting off the testicles, but now there are certain medications that can do this as well.

Radically suppressing someone’s testosterone production as you can imagine has a myriad of effects on the mind and body beyond simple sex drive, and so I completely understand why people would be resistant to what is essentially subtractive HRT.

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I’ve been taking part in the Prevent It program since stumbling on it on this forum. I’ve begun a series of modules. What’re y’all’s opinion on this? I know that many folks around here have negative feelings towards Prevent It (most notably @LoliShadow’s thread here: Cancel Prevent It

We want to thank you for being here. It can be difficult to reach out for help. You should feel proud of yourself!

You have registered for this treatment because you are concerned about your sexual urges involving children and want to develop healthier ways of living with your sexuality. Congratulations for making the first important step on this journey to taking more control over your urges and living a life aligned with your values.

One common reflection people who start treatment have is that they have felt guilt or shame about their attraction for a long time, but have not been able to talk with anyone about their difficulties and struggles. It can be difficult to reach out for help for such stigmatized attractions and behaviors, so you should be proud of yourself for taking the first step by joining a program specifically developed for persons who have concerns about their sexual urges, thoughts or behaviors involving children. It is brave to recognize that you have a problem, want to change it, and then take active steps toward this goal.

This treatment targets urges and behaviors which can be different for different participants depending on if you have current ongoing problematic behavior, if you have had them in the past, or if you have never acted on your urges but are worried about doing so in the future.

This treatment program is based on cognitive behavioral therapy - CBT. A CBT treatment is goal-oriented, to help you change something that is not optimal in your life. We do this by helping you to explore your behaviors, thoughts, feelings, and bodily reactions. Your thoughts, feelings and behaviors are interconnected, and while you might not be able to control your thoughts, you can focus on what you can control: your actions. This can help you to influence your thoughts and feelings over time. Our goal is to assist you in finding effective strategies in gaining more control over your sexual urges involving children.

We want to put an emphasis on increasing activities and behaviors that are in line with your values and goals, and not on taking away something. Try to focus on how you want to be and how you want to live, rather than just what you want to stop doing. Have you thought about your values and goals before? By signing up for this program you have made a step toward feeling in control over your sexual behaviors and more confident about handling your urges in a way that reflects your values and goals for yourself.

Prevent It

This program is self guided with therapist support. This means that you will go through the modules by yourself whenever and wherever you want. We suggest a pace of one module per week, but you can do them a little faster or slower depending on the module. Each module is broken down into sections so you can watch the video, read through the text, work on any exercises, and then fill in the worksheets. These worksheets will help you to engage with the module’s content, reflect on your situation, and write about your experiences with the exercises. After you have submitted the worksheets your assigned therapist will read through your work and send feedback, possibly asking a few follow up questions. If you ever have any questions or concerns regarding a module you can always contact your therapist using the “Messenger” function on your homepage.

The first step is to chart out your risk situations, which are the situations where you are most likely to act on your urges. For example, for some individuals a risk situation would be going on forums where child sexual abuse material (CSAM) is shared, while for others it could be approaching contact, online or offline, with children. Identifying the specific thoughts, and feelings in these risk situations will help you to better understand what function the behavior would serve for you.

The next step is to find alternative ways to handle these situations based on the functions you identified, and figure out what is most effective for you. This also includes going through some different exercises such as mindfulness meditations that you can test for yourself.

Lastly we will work on strengthening your “protective factors,” or factors that make it easier for you to act in a way that is in line with your values. We will create a maintenance plan together to help you with your continued work after this program has ended.

Sexuality

We often get questions about sexuality at the start of this program, and because of this we want to start out with some information on this topic.

Human sexuality involves many different feelings, thoughts and behaviors to experience and express one’s sexuality. Sexuality is both diverse and flexible, and can be something that brings a lot of excitement and satisfaction, or something that can cause problems.

Our previous experience from patients in this treatment program have shown that for some, their sexual attraction to children is a pattern that they noticed early in life, while others notice that their attraction no longer ages with them after a certain point, or that they notice this later in life. The reasons people start seeking out child sexual abuse material can vary. Some individuals write that they did not reflect on how the material was illegal, for example by originally wanting to look at same-age peers when they themselves were children. However, others describe a pattern of seeking out more and more extreme material until they start using CSAM. The reasons people continue to use CSAM also vary. This can be seen as an interest in different power dynamics (in taking either role), due to feeling that this is the only way to satisfy their sexuality, or even as a substitute for adult relationships.

A question we often receive is “Why have I developed a sexual attraction to children?” This is a difficult question because everyone’s situation and experiences are unique, and based on current research there is no one answer that is correct. We encourage you to not focus as much on the “why” and instead focus on charting your behaviors, thoughts, and feelings connected with your current problems. This is something we will get into more in another module, but you can already begin thinking about this now. An important thing to keep in mind is that while you can’t control your thoughts and attractions, you can control your behavior and how you react to sexual urges.

Compulsive Sexual Behavior Disorder (CSBD)

This treatment is aimed at people with sexual attraction to children, however one common problem people who reach out to us have is a preoccupation with sexual thoughts and behaviors. This preoccupation can be, in the latest version of the WHO (World Health Organization) classification system for different diagnoses (ICD-11), diagnosed as Compulsive Sexual Behavior Disorder (CSBD).

CSBD, sometimes called hyper sexuality or sexual addiction, is the preoccupation of sexual thoughts, fantasies, urges, behaviors, or feelings. This preoccupation can cause feelings of a loss of control, distress, and/or negatively affect your day-to-day life.

It is important to notice the balance in your behavior. Many sexual behaviors can be healthy, but if you engage in them compulsively or way too often they can become a problem. This could include watching pornography, masturbating, engaging in online chats about sex, having sex with new partners, etc. These are activities that can be part of a healthy legal sexuality, but if done too much, in a compulsive or obsessive way, they can start to cause distress due to loss of control or other problems.

Another common problem people tend to reflect on is having difficulty being present in everyday life due to spending too much time on their sexual thoughts, planning around sexual activities, watching pornography or fantasizing. The free time that was previously spent on hobbies, social activities, or family may instead be used to think about or to engage in sex.

This leads to a deficit in non-sexual related behaviors, which can cause other problems such as a decrease in meaningful relationships. In Module 3 we will discuss behaviors and thoughts done in excess or not enough, so if this is something that you can relate to we can start working on a way to help you find more balance.

Cont. below :arrow_down:

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So what can your next steps be if you have used CSAM?

Signing up for this program was the very first important step on your journey towards a more satisfying life where you feel in control of your urges. What can your next step be?

  1. Inhope (INHOPE | Home) is a website where you can anonymously report illegal content online. A positive step you could take is to upload any CSAM you may have downloaded to this link (https://www.inhope.org/EN#hotlineReferral) in order to help protect the child.

  2. The next step is to delete any and all CSAM you might have. This can be a really big step for a lot of people, and many describe that it is hard for them to part with their collections. If this is true for you it probably means that you have spent a lot of time and effort on it. Unfortunately, keeping that collection might be holding you back from your goals and the changes you are trying to make.

  3. If you have recognized that you spend large amounts of time online, it can be helpful to decrease this use in order to increase activity in your daily life and decrease your triggers for using CSAM. You should think about how much time you consider to be reasonable for each day. Some people work from a computer, which is harder to change, but you can focus on your “free time” and how you are spending it. In the next module we will begin looking at your values and goals, with an emphasis on increasing activities you want to spend more time on. However, it is still a good idea to begin thinking about this now. General tips for decreasing computer time: track how much time you spend on the computer, set alarms to limit your use and stick to them, limit where you use your computer (for example, only allowing yourself to use it at your desk/table/office), engage in non-computer related activities (hobbies, reading, socializing, cooking, etc) instead.

  4. Lastly, many find that blocking themselves from the sites or apps they would visit or deleting their profiles are ways to set up barriers that can help them think twice before resorting to old habits and using CSAM.

Some past participants have made the observation that engaging in treatment can be a trigger for increased urges. This could be because it forces them to think about situations in which their urges arise, or because they are using the TOR browser to view the treatment which is what they normally only use when they are looking for CSAM or chat forums for minor attracted persons. If you find this is the case for you, start being mindful of these urges! One suggestion is to set a dedicated amount of time to work on the module, and then have an activity to do directly after, such as take a walk. It is a good idea to not sit with the thoughts too long each day. If you are struggling with this, please let your therapist know!

Weekly reflections and exercises

When completing the following exercises, please click “SAVE” for every box!

Some people feel that they won’t be able to resist their urges, but by making it just a little harder to access the material some find that they are less tempted since it would mean that they would need to actively take down the barriers. It gives you an extra moment to think about if it is actually worth it.

Have you tried setting barriers for your problematic behavior before? If so, what happened?

My answer:

I haven’t set up barriers because I don’t go actively looking for CSAM (not currently, anyhow). I usually stumble upon it on other sites. When I do, I usually click on it and take a quick look before reporting the offending material. It wasn’t always this way, but that’s how it is currently.

Next question:

Do you have any questions about Prevent It or starting a program for unwanted sexual thoughts, feelings and behavior?

My answer:

None that come to mind.

Next segment:

Things to keep in mind: Throughout this treatment you will be experimenting with alternative ways to handle your urges. It is good to keep a list of what you have tried, if it worked, and what the outcome was. This is so that you can learn what works for you.

Remember to be gentle with yourself and that if you make a mistake you should just keep going! The fact that you are more conscious of your behavior and more careful about your habits, shows that you are making a huge effort! Some people think that if they make a mistake, they should give up because their previous effort doesn’t feel like it matters anymore, and that they are back to square one. Don’t discredit your previous work, try to focus on the progrss you have made. The best way to handle a mistake is to acknowledge that you engaged in a problematic behavior which was not in line with your goals, could have hurt others, and was potentially illegal, and then recognize that it is important to keep moving forward. These lapses in judgment are known risk factors for further relapse, so how you handle and learn from these situations is crucial for your future success.

Behavioral change is possible – you can learn to take control over your own behavior and change your actions for the better.


Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

My answer:

Yes

:heavy_check_mark:No

Were there any aspects of this module that you did not find useful?

My answer:

Yes

:heavy_check_mark:No

Were there any lessons or strategies from Module 1: Introduction to CBT that you found particularly confusing?

My answer:

Yes

:heavy_check_mark:No


In the next module, we will begin mapping your values and goals. This will be an important module as it lays the foundation for your continued work.

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I have some serious concerns about Priotab’s (the group behind Prevent It) past research, which I stated in the thread you linked. However, I believe in this specific case they put themselves in a position where their ability to cause harm is significantly limited, since they can’t prescribe medication or gain access to participant’s information. For that reason, I generally support their approach here, and while I can’t vouch for its effectiveness as I’m not a participant, I do recommend it to people in conversation and on my website.

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Second Module:

Part A: Ambivalence

Thoughts and feelings about changing your behavior
The fact that you’ve started this treatment program proves that you want to make a change in your life. There are different thoughts and feelings that might hold you back from taking steps towards change. Today you will learn about thoughts and feelings from a psychotherapeutic perspective. How they might influence our behavior and how we can relate to them differently. Then, you will get a chance to explore the thoughts and feelings of ambivalence you might have towards making a change.

Thoughts and feelings as your guides
Thoughts and feelings can be viewed as the guides of our behaviors. Often, they help us to make the right decision, but sometimes they need to be challenged. Thoughts and feelings are important tools for us to understand the world and ourselves. However, if they are too rigid and overly generalized, they get dysfunctional and make us inflexible in the way we cope with the inevitable setbacks of life. Some examples of such negative thoughts are: “I’m a failure no matter what I do”, "I’m not meant to be a responsible person, that’s not who I’m destined to be’', or “I will never succeed, there’s no need to even try”.

You might not be consciously aware of such important negative thoughts you have. But you can become aware of them with some practice. The more conscious we are, the better we understand why we act the way we do, and the easier it is to take control of our behavior.

Feelings, on the other hand, are crucial for basic survival, as they inform how we tend to react in different situations and guide our everyday lives. Most feelings are unstable: they only stay for a short moment. But during this time, they give impulses, to drive and push your choices. For example, when fear and anxiety strike, they make you want to escape or avoid what might be threatening. While positive feelings, such as hope and lust, make you want to engage more.

An important feeling in this treatment context is shame. Shame often triggers an impulse to interrupt behaviors, hide or escape, especially in social situations when you think you’re doing wrong. Shame can also stop you from seeking help if you’re afraid of what the other person might say. And it’s typical to express shame when entering treatment.

Feelings of shame reflect an attribution of bad behavior to the person, such as “I am a bad person”. Guilt, on the other hand, reflects an attribution of bad behavior to poor decision-making, such as “I am capable of good behavior but I made a poor choice”. It is an important distinction between shame and guilt. It might be good to consider this when reflecting on your motivation to change your problematic behaviors.

Feelings might be very hard to handle. But remember they are not dangerous or toxic; if you don’t follow the urges they give rise to, sooner or later the feeling and the impulses will fade away. Feelings are feelings, they are not behavior. You do not have to act on them. One common misconception is that an urge will continue to get worse and worse until you give in, but from research, we see this isn’t the case and that if you can allow yourself to get through these intense urges without reinforcing them they will weaken over time. If you can accept having feelings that cause you distress in the moment without acting on them, your ability to develop and to try new behaviors will increase. This will make you more flexible in how you deal with negative feelings by creating some distance between your feelings and impulses and your reactions.

This idea of reinforcing or giving attention to behaviors we want to increase is something we will come back to in later modules.

Ambivalence for change
Because you are just starting out in this program, we want you to explore your uncertainty and motivations. It can be important to recognize both the positive and negative thoughts you are having about making change, and by identifying these you can strengthen your goals by seeing why, in the long run, you want to keep going.

Part A Exercise: Exploring ambivalence

Explore your ambivalence for change in the worksheet. Start with the upper left box, benefits of not working towards a change, and then disadvantages of not working towards change. Continue with the benefits and disadvantages of working towards a change.

Their questions and my answers:

1. Benefits of NOT working towards change 3. Disadvantages of working towards change
No stress, no shame, no guilt. The freedom to do what comes naturally to me. Requires a strong will/spine, a powerful mental fortitude. Facing my fears and doubts head-on. Feeling worse before I feel better (could result in suicide).
2. Disadvantages of NOT working towards change 4. Benefits of working towards change
Refusing to change may catch up with me and land me in serious trouble. Or at least have me do something I’ll regret/feel remorse for. The reduction/removal of problematic beliefs and/or behaviors.

Reflection: Now that you have explored your ambivalence, do you have any reflections about your answers or changing your behavior?

My answer:

I have immense fear of myself, what I’m capable of. My thoughts consume me. What if I’m too weak to beat this? What if I fail miserably, even after completing this project? What if deep down I’m not as willing to change as I think? Or even outright incapable of change? Perhaps it would be better to spare myself the disappointment and kill myself. Doing so would also spare any potential victims. I do not believe this is an illogical thought pattern or course of action.

Part B: Values

What is truly important in your life?
Values ​​are chosen, basic beliefs about what is important in your life and what kind of person you want to be. Values concern issues such as, What does the life I really want to live look like? How do I want to act towards myself and others? How do I want to be as a human being?

Values​​ differ from goals in that goals can be achieved, but values are something that you always carry with you. An example of a value is “being a loving person” and an example of a goal related to that value would be a loving act, like helping a friend. If you state your values, they can act as a kind of compass that you can act in accordance to and use to set a valued direction for how you want your life to progress. Reflect on your basic values and use the Bull’s eye worksheet.

Exercise: Bullseye worksheet
This worksheet consists of a dartboard, in which you rate how much you are living in accordance with values in different areas of your life. The bulls eye in the middle of the board is your optimal condition. Put four X’s on the dartboard, one for each of the following life areas:

  • Work and education
  • Leisure
  • Personal growth and health
  • Relationships

The dartboard is supposed to represent what your situation looks like right now. An X in the bull’s eye indicates that you’re living completely in accordance with your values within that specific area. And an X far away from the bull’s eye indicates that you’re far away from where you want to be within that area.

Goals
It’s now time to think about what goals you would like to work towards and we’ll do this based on your stated values as well as behaviors you engage in too much or too little. When formulating your goals, there are a few things that may be useful to keep in mind. Unlike your values, goals ​​should be concrete and measurable, so that you’re able to evaluate them once you have achieved them.

During psychotherapy, many people state that their goal is to “get more self-confident”. To find concrete goals, you can ask yourself: How would I notice that I am self-confident? Perhaps it would mean giving a speech at a dinner party, expressing desires and needs in your relationship, or saying no to an assignment you don’t feel comfortable doing.

Keep in mind that thoughts and feelings are hard to control, your goals should be stated in terms of behaviors. Notice the difference between the following goals:

"Don’t be afraid to start a discussion at work” – That’s a goal stating what to feel

Start a discussion at work despite feeling afraid" – That’s a goal stating what to do

By stating a goal in terms of behaviors we are able to make concrete steps towards change. We can’t influence our feelings directly, but over time we can change them through our actions.

Intermediate goals and rewards
It may be helpful to think about the steps you can take on your way towards your end goal - in other words your intermediate goals.

In the future, when you’ve reached an intermediate goal or an end goal you’ve set for yourself, don’t forget to reward yourself with something you enjoy. For example a warm bath, a dinner with friends, or buying something that you’ve wanted for a long time.

Remember, the reward should not be of a sexual nature.

Part B: Exercises

Now you can formulate and start to work with your goals within the four different life areas in your bulls’ eye. Start with the most important one for you.

   	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 		 	 	 	 	 	 	 	 		 	 		 	 	 	 	 	 	 	 	 	 		 	 	 	 		 	 	 	 	 	 	 	 		 	 	 		 	 	 		 	 	 	 	 	 		 	 	 	 	 		 	 	 	 		 	 	 	 		 	 	 	 	 	 	 	 	 	 	 		 	 		 	 	 	 	 	 	 	 	 	 	 	 	 			 	 	 	 	 	 	 		 	 	 	 	 	 			 	 	 	 	 	 	 	 	 		 	 	 	 	 		 	 		 	 	 	 	 	 	 	 	 	 		 	 	 	 		 	 	 	 	 		 	 	 		 	 	 	 	 	 		 	 	 	 		 	 		 	 	 	 	 	 	 	 		 	 	 		 	 	 	 	 	 	 	 	 	 		 	 	 		 	 	 	 	 	 	 	 	 	 	 	 		 	 	 	 		 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	>Reflect on each area, why they align with where you want them to be, or why they don’t. Have you noticed any effects or consequences from this?
  • Work/education
  • Leisure/hobbies
  • Personal growth/health
  • Relationships (family, friends, partners)

Now you can begin developing your goals within the four different life areas in your bulls’ eye. Start with the most important one for you.

You can use the list below to help you identify your main values in each area. Once you have this, you can start to develop goals that bring you more in line with your values. Try to pick at least one value and goal for each area, and you can of course write multiples for each. Think about what goals you would like to work towards, based on your stated values as well as behaviors you want to increase or decrease.

Unlike your values, goals ​​should be concrete and measurable, so that you’re able to evaluate them once you have achieved them.

Keep in mind that thoughts and feelings are hard to control, your goals should therefore be stated in terms of behaviors.

It may be helpful to think about the steps you can take on your way towards your end goal - in other words your intermediate goals. For example, if you value having close relationships with your friends or family, a goal could be to try calling/texting/hanging out with them once a week or so. The point is to set manageable goals that seem reasonable to achieve.

Their questions and my answers:

Work/education: Education is more important than people realize. Ignorance breeds all manner of atrocities. Shine the light of education over the darkness of ignorance! I will apply for college within the next 365 days. I will put myself out there, apply to a few different colleges. And once I’m in, I’ll begin my higher education in earnest.

Leisure/hobbies: Leisure is distracting. I take too much of it. For me, it has become laziness. I must forego these basic pleasures so I can focus on what’s really important, like my education and my future. I need to get my affairs in order. I must ensure that I will have no distractions going forward. Eliminate these useless things from my life.

Personal growth/health: I am an unhealthy sod. Overweight. It’s literally killing me. And it puts a strain on the people around me. I will lose 30lbs within the next 365 days. I will start eating better/less and exercise more. My exercises will start small, getting more intense with time as I lose weight.

Relationships (family, friends, partners): This is a tricky one. On the one hand, I want to be loved. I love my family and would like to have more friends, perhaps even have a family of my own someday. Ah, but I fear letting them down or hurting them. I want to find happiness with others, but I do not know if I can, or even if it’s right for me! My family is my greatest motivator, but also my greatest hurdle. I cannot be more open with my family for fear of violence. If they knew what was in my head, I’m a dead man. And not by my own hand on my own terms. I will keep this all to myself. I dare not tell anybody about my disposition…

Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

:heavy_check_mark:Yes
No

You selected “yes” to the above question, please share which aspects you found particularly useful:

Reflection is a useful tool for setting goals. This will help me on my path to a healthier and more educated life.

Were there any aspects of this module that you did not find useful?

Yes

:heavy_check_mark:No

Were there any lessons or strategies from Module 2: Values and Goal Setting that you found particularly confusing?

Yes

:heavy_check_mark:No


In the next module you will be charting your behaviors and the situations you tend to engage in problematic behaviors.

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That last part concerns me. Why shouldn’t my reward be sexual? Are they saying I cannot reward myself by masturbating to legal, moral porn or having sex with an appropriate, consenting partner? Do they intend on shutting down my sexuality entirely? This is only one sentence out of many, I’ll give them the benefit of the doubt. But this has put me on edge and makes me wonder what else this experiment could entail…

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I’m a non-expert spitballing, so I could be totally wrong, but my guess would be that since they’re likely dealing with people who have compulsive sexual behavior or related addictions, viewing sex acts as a reward could serve as a way to internally justify harmful sexual behaviors.

“I’ve gone a week without illegal content, I’ll look at it once to reward myself”

It would be nice if they explained their reasoning so people can make educated decisions about what’s best for them personally

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I was sent a message in response to my answers in Module 2. Here is a excerpt from that message:

You write about your concerns, that you are worried about being unable to make and maintain changes. I think this is a normal fear to have, especially when you haven’t made these changes before. Hopefully we can give you the tools you need to make these steps confidently, and if you have ”relapses”, or times where you make mistakes, it is important you keep your motivation and keep going forwards.

I am conflicted about this. In this case, “relapsing” isn’t making a mistake: it’s committing a serious crime.

There’s a difference between an alcoholic or drug addict relapsing and indulging in substances, and a person with violent/sexual compulsions giving in to their urges. You can’t just pick yourself up say “I made a mistake, and it’s ok to make mistakes”. You’re committing a crime!

Prostasia and others have said that shame and fear prevent people from seeking help. This is true, but what about cases where a crime has been committed? Shouldn’t the person feel shameful of what they’ve done? Shouldn’t they be severely punished for what they’ve done? Even if it’s “just” looking at CSAM, it’s still a crime with hefty consequences. Sometimes, it’s NOT ok to make mistakes. No matter how much you want help or how remorseful you are, you don’t get a second chance because what you did was too much.

I think they’re trying to make a distinction between understanding that something is wrong and feeling ashamed about it. Sure, shame is a reasonable reaction when you’ve done something like viewing CSAM, but for the purposes of helping people change their behavior, it isn’t useful. Their goal is to help participants avoid doing it again. Whether or not the participants feel ashamed of it likely has little value to them.

As for them saying it’s okay as long as you’re making forward progress, remember that for most people in the study, the alternative is continuing to view illegal content at the same rate they were before. Even a small reduction for a couple of people could mean significant declines in the rates at which this content is viewed and shared online. That’s the goal, not convincing the participants that what they did was bad. People who don’t think it’s bad wouldn’t be participating in the study.

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Module 3: Your Life in Balance

Most of us try to do things to ensure that we will feel as good as possible. You eat to avoid the unpleasant feeling of being hungry, and to have energy throughout the day. You sleep because you’re tired and need to rest to cope with everyday life. Behaviors such as eating or sleeping are vital to us, but these behaviors can also have adverse effects if we engage in them too much. Eating too much may lead to poor health, even though it feels good while doing it, and if you sleep more than you need, it can make you feel drowsy and even more tired.

It’s important to keep a balance in our behaviors to feel good, both in the short term and in the long term. In other words, problems can arise, not because of what you do, but because of how much you do it.

For example, if you spend a lot of time watching online pornography and engaging in sexual fantasies, less time will be spent on other areas in your life that may be important to you, such as loved ones, hobbies and work. The importance is placed on what you want to reinforce in your life, to lead you where you want to be. In the last module we looked at your goals and values to identify what you want to be focusing on, here is a good opportunity to think further on how your current habits are either helping or hurting these goals.

Here is what to think about when analyzing your behavior:

We want you to identify the behaviors, thoughts, and feelings that you engage in more than you would want and those that you engage in less than you want.

Behaviors are external and can be observed by others, while thoughts and feelings can only be registered by yourself.


Part A: Exercise

In order to feel good about yourself and in life you need to increase the behaviors you aren’t doing enough of. This will give you less time to spend on problematic behaviors, which in turn will reduce your need or wish to engage in them.

Here is a chart with examples to help you get started:

Behaviors that you engage in too much:
-Checking CSAM or pornography websites
-Categorizing material
-Other sex-related behaviors if done in excess
-Being online for large amounts of time (even for nonsexual reasons)
-Avoidance
-Time-consuming activities such as watching TV and surfing websites
-Searching for the perfect material
-Etc.

Thoughts or feelings that you engage in too much:
-Fantasizing about child sexual abuse
-Sexual fantasizing
-Feelings of hopelessness, worthlessness, self doubt, etc.
-Loneliness
-Pondering over the past
-Destructive thoughts
-Aggressiveness towards the environment and myself
-Irritation
-High demands on myself
-Etc.

Behaviors that you engage in too little:
-Social activities with family or friends (be specific)
-Exercise
-Goal related behavior
-Expressing my views
-Keeping in touch with my friends
-Setting goals for the future
-Planning and organizing my time
-Etc.

Thoughts or feelings that you engage in too little:
-Confidence
-Feelings of control
-Positive thoughts about myself
-Belief in my own ability to cope with things
-Positive emotions and joy
-Feeling of presence in the moment
-Motivation to change me
-Etc.

Track your own behaviors, thoughts and feelings in the worksheet below:

Behaviors that you engage in too much:
-Masturbating to pornography
-Web-surfing
-Spending time alone
-Eating junk food
-Compulsive spending
-Self-harm
-Etc.

Thoughts or feelings that you engage in too much:
-Self-loathing
-Suicidal ideation
-Homicidal ideation
-Rape/molestation ideation
-Torture ideation
-Existential crises
-Misanthropy
-Sex negativity
-Moralism
-God complex
-Messiah complex
-Narcissism
-Fear of missing out
-Apeirophobia
-Death anxiety
-Fear of negative evaluation
-Autophobia
-Having a chip on my shoulder
-Self-pity
-Grandiose delusions
-Projection
-Etc.

Behaviors that you engage in too little:
-Being with family
-Working
-Eating healthy
-Exercise
-Being outside
-Making IRL friends
-Etc.

Thoughts or feelings that you engage in too little:
-Positivity
-Sex positivity
-Happiness
-Forgiveness
-Etc.

  1. What effect or consequences have you noticed from your listed behaviors that you engage in too little?

My answer:

Poor mental and physical health, poor relationship with family, lack of interaction with other people/the outside world, etc.

  1. Reflect on your behaviors, thoughts, or feelings that you engage in too often. How do they affect how your time is spent?

My answer:

I spend most of my time locked in my room, stewing on my failures and feeling sorry for myself. I project my insecurities onto the rest of the world and blame the universe for why I am the way that I am, refusing to take responsibility for my beliefs or actions because I do not believe in free will.

  1. Do you have any other reflections about this chart?

My answer:

Laying it all out like that feels good. To look at that long list of issues and to be able to identify just how deeply mentally ill/unstable I truly am.

Part B: Charting your behavior

Our thoughts, feelings, and behaviors are all interconnected; you’ve surely noticed this already. For example, if someone has depression, they tend to be more self-critical, with negative thoughts such as “I’m not fun to be around”. These thoughts can lead them to avoid spending time with others, and instead staying home, isolating themselves. The consequence, which they may not realize themselves, is they feel even more depressed and in turn isolate themselves even further. This example shows you how our behaviors affect how we think and feel.

Thoughts, feelings, and behaviors are interconnected. In fact, the way we perceive an everyday situation in our head, can be more closely connected to our emotional reactions to the situation, rather than to the situation itself.

You will be aware that in CBT, the primary focus is on changing your behavior. Not only to help you act differently, but also to achieve a change of your thoughts and emotions over time.

Behaviors can be controlled, while thoughts and feelings are harder to influence.

Start analyzing your behavior

Now let’s begin with the first task! The goal is to gain a better understanding of your problematic behavior. For some this will mean looking at why you have used or are tempted to use online child sexual abuse material (CSAM), and why it is so hard for you to control these behaviors. For those who only have urges to look at CSAM or engage in other problematic behaviors, your goal will be looking at risk situations that increase your urges to engage in your identified behavior. You will do this by using a behavioral analysis chart, called the ABC model.

ABC stands for antecedent, behavior and consequence.

A - the antecedent, is the context for problematic behaviors. A is the situation you’re in just before you engage with unwanted behavior. In short, A is all the factors that are present in the actual situation, including time, location, thoughts and feelings.
A can for example be;

“Coming home after having a bad day, my home is a mess and I feel tired, anxious, lonely and hungry. I think ‘I have so much to do! I’m overwhelmed!’ or ‘I need to do something to make up for this crappy day."

It is good to think of a specific context and how you felt in the moment. Were you happy, sad, aroused, stressed, etc.?

B - the behavior, is what you do next - this would be your problematic sexual behavior, for example:

“Logging on to the computer, watching pornography that triggers a sexual desire for something new and more sexually arousing, which leads into watching material with people that are underage, masturbating and getting stuck in front of the computer for hours.”

C - refers to the consequences of your behavior. C in terms of short-term consequences can for example be:

“Immediate relief of unpleasant feelings and sexual satisfaction.”

Example of C in terms of long-term consequences:

“Maintaining the behavior and feelings of shame. Exposing myself to risk and getting further away from living in accordance with my own values.”

The consequences determine the effect of the behavior and whether or not it will be established and repeated. Research has shown that the short-term consequences of an act have a bigger impact on our future behaviors than the long term consequences that we don’t notice right away.

For this reason, C is divided into short-term and long-term consequences, where short-term consequences are those that occur immediately following a behavior and long-term consequences are those that occur after an extended period of time. Sometimes, as in the example above, the short-term consequences are positive; however, in the long-term the behaviors have negative effects. You have been working on defining your values, so you can also think about the behaviors in terms of what takes you in the direction you want to move towards. Are the long-term consequences working for or against your values and goals? For example, if a goal of yours is to strengthen your relationship with family and friends, behaviors that keep you home or isolated might be working against your set goals in the long-term.

Part B Exercise: ABC Chart

Your exercise for the week is to focus on processes that end up with you engaging in problematic behaviors. If you don’t use CSAM, or engage in other problematic behaviors, you can choose situations where you have intense urges to do so.

After this, please create a new ABC analysis based on the same risk situations, the same “problematic A”. But try out new behaviors, B, e.g. taking a walk instead of a sexual or unwanted one. Then evaluate the consequences, C, in the short- and the long-term.

Something important to keep in mind: you want to pick alternative behaviors that fulfills the same function as using the behavior would. For example, if you used CSAM because you were aroused then you need to think of a legal way to satisfy this need. This is mentioned again in the ABC instructions.

If you want this treatment to work, it is important that you try to make concrete changes in your life. The treatment is not only here on the internet, but just as much when you’re offline. Every week throughout the whole treatment you should be challenging your urges and testing a new behavior.

Here are some common examples that can help you when filling out your ABC chart:

Antecedent Situation
-I came home late from a hard day at work where I had a lot of work assignments.

Antecedent Thoughts and Feelings
-I am thinking about the stressful day. I am feeling stressed and want to relax and reward myself after an intense day. I think “I will just look at some normal/adult pornography”.

Behavior
-Browse online on porn sites using material with younger and younger persons until I go to CSAM forums and use material found there. I am looking at more extreme material than I thought I would, and for a much longer time.

Short-term Consequences
-Sexual gratification, relaxation and less stress.

Long-term Consequences
-Increased anxiety and shame. Reinforcing using CSAM as a way to destress. I need more and more extreme material to reach the same level of arousal. I am becoming more risk-taking.

Antecedent Situation
-I have been at home for several hours with nothing to do.

Antecedent Thoughts and Feelings
-I am feeling bored, restless, lonely and unsettled. I think “I wonder what they are talking about in the forum” and “I will just look for a second before I do something more useful”.

Behavior
-I go online to CSAM communities to browse material and talk to others.

Short-term Consequences
-Sexual gratification and feeling less lonely, talking to others who share my interest.

Long-term Consequences
-Not building any long term relationships. Ends up further away from meaningful social relationships. Reinforcing using CSAM as a way to cope with boredom. Spending less and less time on hobbies, friends, and family.

Antecedent Situation
-I am sitting at home, bored.

Antecedent Thoughts and Feelings
-I am starting to have sexual thoughts, I am feeling frustrated and want to be able to feel sexually satisfied.

Behavior
-I go out in order to observe children at the beach and I masturbate to these observations either there or later that evening.

Short-term Consequences
-Sexual gratification, excitement, some frustration but still satisfied.

Long-term Consequences
-Reinforcing this risky and illegal behavior and making it more difficult to feel satisfied with legal behaviors that are inline with my values.

Antecedent Situation
-It is late at night. I watch TV and see a person I find attractive.

Antecedent Thoughts and Feelings
-I think “I need to masturbate to be able to sleep” and “everyone’s asleep, it doesn’t matter what I do”. I am feeling restless but tired and at the same time sexually aroused.

Behavior
-I log on to a forum, use CSAM until I’m exhausted and fall asleep early in the morning.

Short-term Consequences
-Sexual gratification, excitement.

Long-term Consequences
-My sleep is disturbed. I’m feeling like this will never change. Increasing urges for CSAM use over time; spending less time using legal sexual material or working toward building a healthy sexual relationship.

Antecedent Situation
-I have a difficult and demanding task ahead of me and I don’t know how I will manage it.

Antecedent Thoughts and Feelings
-I feel insufficient, stressed, and frustrated. I think “I will never manage this!” and “I must clear my mind before I start”.

Behavior
-I delay my tasks and begin reading the news, viewing different apps, until I eventually end up in a chat forum where CSAM is shared. I masturbate to this for a few hours.

Short-term Consequences
-I temporarily reduce my stress and feelings of insufficiency, I feel relaxed and escape all expectations for a while.

Long-term Consequences
-I end up behind at work and the task remains incomplete, I feel increasingly inadequate and useless. I risk losing my job and maintain the tendency to watch CSAM as soon as I feel pressured.

Here you can fill in yours below:

Antecedent Situation
-While in public (work, school, store, restaurant, etc.), I see children that I find attractive.

Antecedent Thoughts and Feelings
-My attraction towards children causes myself such agonizing and crippling shame, guilt and depression that is impossible to escape from.

Behavior
-I hurry home and have an emotional breakdown. Will involve extreme suicidal/euthanasia ideation and copious amounts of crying and self-loathing. Can include self harm (mostly punching myself in the head and face) or even choking/suffocating myself!

Short-term Consequences
-Relief from my emotional pain, a feeling of repentance through physical torture.

Long-term Consequences
-Normalization of self harm/injury and increasing risk of suicide. An inability to exercise my emotions in a more healthy and less self-destructive manner. Reinforcing the pain and terror of hopelessness and fearfulness. Continuing the cycle of horror with my attractions and beliefs clashing with my wanting for purpose and to do good.

Antecedent Situation
-I am watching legal pornography out of habit and boredom.

Antecedent Thoughts and Feelings
-I begin to feel sick with myself. Despite being legal and hurting noone, the stuff I watch is incredibly fetishistic and still causes me great and terrible emotional distress. My brain, seeking to protect itself, projects blame onto the pornstars for how I feel instead of myself.

Behavior
-I suffer an emotional breakdown. I become angry and begin arguing with imaginary people, fantasizing about killing prostitutes and pornstars for “making me feel this way”.

Short-term Consequences
-A feeling of moral superiority and righteous fury. I calm myself by telling myself that I’m right and they’re wrong.

Long-term Consequences
-Reinforcing my sex negative beliefs. Promoting violence and hate towards innocent sex workers just trying to make an honest living. Increasing my risk of murdering people due to my self-perceived inability to change and my fear of whatever I cannot control/my need to destroy what I cannot control (including myself).

By altering the antecedent situations, you can affect some of your urges. For example, depending on your trigger situations, you could try not to be inactive for long periods of time, try drinking less alcohol or not surfing other kinds of pornography that may lead to you entering illegal sites. There are also ways to modify the consequences to make them more immediately desirable such as setting up reward schedules if you choose your healthier alternatives. Some also find that adding an undesirable consequence when they engage in a problematic behavior is also helpful to strengthen their commitment and make it more difficult to give in to urges, for example, having to donate a specific amount of money to a charity they don’t like.

Some other stimuli – certain situations, thoughts, feelings or bodily sensations are a part of life and cannot be affected or controlled. However, you can learn new ways to relate to and respond to these stimuli. These charts are used to help identify the function of a behavior so we can find an alternative that can fulfill this function. For example, if the reason you started engaging in the problematic behavior was due to boredom, you should find an alternative behavior that can alleviate boredom. If the reason you started engaging in the problematic behavior was due to arousal, you should find an alternative behavior that is legal and still fulfills this role (trying legal adult porn, erotica, audio erotica, etc).

Antecedent Situation
-I came home late from a hard day at work where I had a lot of work assignments.

Antecedent Thoughts and Feelings
-I am thinking about the stressful day. I am feeling stressed and want to relax and reward myself after an intense day. I think “I will just look at some normal/adult pornography”.

Alternate Behavior
-I do a short work out and reward myself with a long bath and something good to eat.

Short-term Consequences
-I feel less stressed and more relaxed. I feel proud I was able to not use CSAM.

Long-term Consequences
-I am helping build positive coping strategies to reduce my stress.

Antecedent Situation
-I have been at home for several hours with nothing to do.

Antecedent Thoughts and Feelings
-I am feeling bored, restless, lonely and unsettled. I think “I wonder what they are talking about in the forum” and “I will just look for a second before I do something more useful”.

Alternate Behavior
-I call/text a friend or family member asking them if they want to hang out. If they can’t, I make a shopping list based on a recipe that I have been meaning to try (in line with my external deficit of not cooking enough homemade meals), I go buy the items and cook myself dinner while listening to music.

Short-term Consequences
-I feel less bored and I am happy to have used my time to work on some hobbies or socialize with people I care about.

Long-term Consequences
-I am learning how to better cope with boredom and loneliness, by choosing activities that are more in line with my goals. I develop my relationships. I feel less lonely and in control of my time.

Antecedent Situation
-I am sitting at home, bored.

Antecedent Thoughts and Feelings
-I am starting to have sexual thoughts, I am feeling frustrated and want to be able to feel sexually satisfied.

Alternate Behavior
-Instead of trying to see or make contact with a child, I decide to focus on a different stimuli to be satisfied with. This could be adult pornography or masturbating to fantasies. If I don’t think this will be enough without engaging in the urges I decide to take a cold shower in order to “ride out the urge”.

Short-term Consequences
-Sexual gratification that might take longer, still some frustration.

Long-term Consequences
-Reinforcing legal behaviors that are inline with my values and that can become more satisfying.

Antecedent Situation
-It is late at night. I watch TV and see a person I find attractive.

Antecedent Thoughts and Feelings
-I think “I need to masturbate to be able to sleep” and “everyone’s asleep, it doesn’t matter what I do”. I am feeling restless but tired and at the same time sexually aroused.

Alternate Behavior
-I set the alarm for 20 minutes to be more in control of the time I spend on masturbating. I masturbate to an erotic novel, I allow myself to reach climax before the alarm goes off.

Short-term Consequences
-Sexual gratification that might take longer at first since I didn’t use CSAM.

Long-term Consequences
-I am decreasing the time spent on CSAM related behaviors and increasing those in line with a healthy sexuality that I can stand for. I feel proud of myself for sticking to my plan.

Antecedent Situation
-I have a difficult and demanding task ahead of me and I don’t know how I will manage it.

Antecedent Thoughts and Feelings
-I feel insufficient, stressed, and frustrated. I think “I will never manage this!” and “I must clear my mind before I start”.

Alternate Behavior
-I allow myself to relax and focus on my breathing for 5 minutes before I begin on the task (I set an alarm for this). I call or email my boss after this to get any clarification I need. I make a list to break down the task into manageable steps.

Short-term Consequences
-It feels difficult at first to give myself the 5 minutes because I keep thinking about how much work I have to do. But I do feel a bit better after. It is also difficult to talk with my boss, but they are able to clarify things to make them more manageable.

Long-term Consequences
-I am coping better with stress and getting my tasks at work done. I feel more competent. I increase my chance to advance in my job and be a person others can count on.

Here you can fill in yours below:

Antecedent Situation
-While in public (work, school, store, restaurant, etc.), I see children that I find attractive.

Antecedent Thoughts and Feelings
-My attraction towards children causes myself such agonizing and crippling shame, guilt and depression that is impossible to escape from.

Alternate Behavior
-I take some extra antidepressant medication and go for long walk in the city or woods to clear my head. My episode passes and I return home to a well deserved nap.

Short-term Consequences
-I have calmed myself without resorting to torturing myself. My body is not bruised and/or bleeding for the time being.

Long-term Consequences
-My body and mind become healthier. Medicine will keep my mind on track, therapeutic activities like walking will keep me from hurting myself or others during a potential breakdown

Antecedent Situation
-I am watching legal pornography out of habit and boredom.

Antecedent Thoughts and Feelings
-I begin to feel sick with myself. Despite being legal and hurting noone, the stuff I watch is incredibly fetishistic and still causes me great and terrible emotional distress. My brain, seeking to protect itself, projects blame onto the pornstars for how I feel instead of myself.

Alternate Behavior
-I put down the porn and go do something nonsexual. Eg., I watch TV, perhaps something funny to cheer me up.

Short-term Consequences
-I get my mind off of porn and step away from the violent clashing of my sex negative beliefs with my warped paraphilias.

Long-term Consequences
-My sex negative thoughts fail to cloud my judgement and my misplaced anger towards others subsides. In doing so, my risk for hurting others decreases tremendously.

Reflections:

How difficult do you think it would be to experiment with these alternative behaviors?

My answer:

I think it would be very difficult. I’ve been feeling this way about things since I was 13yo. My disturbing sexual thoughts go back further to age 5. At age 24, I’m very set in my ways by this point. I fear that it would take an extreme intervention or perhaps even indefinite/permanent institutionalization to prevent me from ever hurting myself or others. When you come to the conclusion that death renders everything you do meaningless, you tend to stop caring about how your actions will affect others.

Each time you end up in a situation where one of your risk situations is present, you might for example think "right now, I’m in a situation that has previously triggered my problematic behavior, I will most likely have the same sexual impulse this time too. What can I do instead of engaging in the behavior? Could I engage in any of my identified alternative behaviors or behaviors I do too little instead?”

Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

:heavy_check_mark:Yes

No

You selected “yes” to the above question, please share which aspects you found particularly useful:

My answer:

I took a break from the program so I could unpack my beliefs and emotions and identify my core issues. If I could determine the primary sources of my mental agony, I could set out to eliminate them without also eliminating myself or causing collateral damage in the process.

Were there any aspects of this module that you did not find useful?

:heavy_check_mark:Yes

No

You selected “yes” to the above question, please share which aspects you did not find useful:

My answer:

I realize that Prevent It might not be sufficient enough to help me sort out all my issues. I fear you may not be equipped to deal with the multitude of extreme issues I suffer from. Frankly, I fear nobody on Earth is equipped enough to help me. It’s why suicide/euthanasia is such an attractive option to me. Especially with increasingly normalization of euthanasia for mental disorders such as in Belgium, where a pedophile under the alias “Sebastian” registered for euthanasia. If it is acceptable for a pedophile to euthanize themself, what reason do I have to not follow in his footsteps?

Were there any lessons or strategies from Module 3: Charting your behaviors that you found particularly confusing?

Yes

:heavy_check_mark:No


In the next module you will be given several mindfulness exercises to try out. These will also be exercises that you can test out when you start to feel urges and want to try to bring yourself back to the present moment.


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Module 4: Mindfulness and Other Exercises

Being aware of and accepting having feelings that cause you severe distress in the moment, might increase your ability to try new behaviors.

Mindfulness is the state of being conscious or aware of something without acting on it. Through mindfulness, your ability to see, live in, and accept your situation in real life can increase. And at the same time your desire to escape, avoid, misinterpret, and judge could become more manageable. When you exercise mindfulness you develop your ability to pay attention to, and observe, your feelings and thoughts without judgment. In this way you can consciously determine how you want to react to them.

Developing your ability to keep your focus and not drift away in nonconscious habitual automatic thoughts might help you to gain a better control of your sexual impulses and help you to choose your reactions. You can choose if you act on the urge or impulse or just let the feeling or thought come and go.

Under the exercise tab you will find several different exercises. Some are related to mindfulness of breathing or of your body, some focus on stress, and some focus on getting through urges. These exercises can be used to increase your awareness of your body and thoughts, they can also be used in situations where you feel stressed or urges arise. The more consistently you practise mindfulness, the better you will become at it. Please read through the different options, try a few throughout the week, and write out your reflections. Continue testing them throughout this treatment to find what works best for you. Everyone is unique, so it is important to have an open mind when investigating each exercise, but at the same time you might find that only certain ones work for you, and that is okay! Our hope is that you can identify a couple that are helpful, or get an idea of what you would like to use, and continue with some type of mindfulness exercise after your treatment with us has ended.

Weekly Exercises

1. Focus On Your Breathing

Sit comfortably with both feet on the floor. Close your eyes and concentrate on breathing, without trying to influence your breath. Notice how the air feels when you inhale and when you exhale.

Take time to just focus on your breathing.

When you notice that you’re thinking of something other than breathing, gently redirect your focus to your breath again.

You may feel a bit uncomfortable sitting completely still; maybe you’ll experience some tingling or feel restless. If so, notice your desire to touch or readjust the body part that is tingling or the desire to hold on to the thought of feeling restless.

Observe this desire, stay calm and continue to focus on breathing.

Your task is to sit completely still and to focus on breathing, no matter what thoughts or feelings appear in your consciousness and without acting on those thoughts or feelings.

Notice how the air feels when you inhale and then exhale.

Notice the thoughts that come and go.

Remember, thoughts are just thoughts, let them come and let them go.

Notice your breath, how the air flows past your nose, into your lungs, down the diaphragm and then all the way back out again.

Notice how your experience of sitting still changes. Perhaps you’re experiencing discomfort, sometimes decreasing and sometimes intensifying.

After a little while, slowly start coming back and open your eyes. You have now handled a type of impulse without giving up and you might even realize that impulses can subside by themselves.

2. The Breathing Anchor

One way to land in the present is to focus on breathing. Now direct your senses towards the breath and observe it without affecting it.

Note how the breath feels when you breathe into your nose and how the breath feels when you breathe out of your nose.

Describe how the air feels; is it cold when you inhale and maybe warmer when you exhale through your nose?

If you become aware that you are no longer paying attention to your breathing, praise yourself for discovering this and then return your focus to breathing.

Continue like this for a while.

Then start changing your breathing. Inhale on one and exhale on four, or think “breathe in” and “breathe out,” just make sure the exhalation is longer than the inhalation.

Work to stay focused breathing for a few minutes. You can do this while waiting for the bus, before giving a presentation or when you feel stressed.

Making sure that the exhalation is longer than the inhalation can lead to you reaching relaxation. You also help the body get rid of old air and replenish with new air that can provide energy and focus.

3. Direct Your Focus to the Present

When you’re experiencing a sexual impulse or some other difficult emotion, your thoughts often revolve around the experience of the impulse or the difficult feeling. Do the exercise from start to finish. If your attention starts to drift away from what you’re doing, redirect it back to the exercise.

You will now do an exercise called 3-3-3, which aims to broaden your attention, something that can be helpful to be able to stay grounded in the present. This might make it easier for you to cope with your sexual problems. You can use this exercise when you’re experiencing a sexual impulse or in other situations where you want to stay grounded in the present and in your senses, here and now.

Try for yourself: Start by naming three things that you see around you. For example, a table, a red flower and a trash can.

Now, name three things that you hear. Perhaps the ventilation in the room you’re in, your own breathing and a clock that’s ticking.

Name three things that you can feel using your body. For example, the chair you’re sitting in, your glasses resting on the bridge of your nose and your feet against the floor.

Name two things you can see around you.

Name two things you can hear.

Name two things you can feel using your body.

Name one thing you can see around you

Name one thing you can hear

Name one thing you can feel using your body

4. Body Scan Exercise to Relax and De-stress

Find a quiet place and sit down in a comfortable chair. Begin by bringing your attention into your body.

You can close your eyes if that’s comfortable for you. Notice your body seated wherever you’re seated. Feeling the weight of your body in the chair on the floor.

Take a few deep breaths. As you take a deep breath, bring in more oxygen enlivening the body and as you exhale, you can notice your feet on the floor. Notice the sensations of your feet touching the floor, your weight and pressure, vibration, heat.

Notice your legs against the chair, pressure, pulsing, heaviness, lightness.

Notice your back against the chair. Bring your attention to your stomach area. If your stomach is tense or tight, let it soften. Take a breath.

Notice your hands; are your hands tense or tight? See if you can allow them to soften. Notice your arms. Feel any sensation in your arms. Let your shoulders be soft. Notice your neck and throat. Let them be soft.

Relax. Soften your jaw. Let your face and facial muscles be soft.

Notice your whole body present. Take another breath. Be aware of your whole body as best you can. Take a breath. And then when you’re ready you can open your eyes.

5. Surf the Urge

This next exercise is to help you ride out the urges you experience.

Take a few moments to notice where you experience urges in your body. You can do this by taking some time to sit in a quiet place, and if you are comfortable doing so, closing your eyes, and just allowing your attention to go to the place(s) in your body where you tend to feel urges. For some people they notice that urges are most connected to sensations in their abdomens; for others, they notice urges in their mouth (e.g., their mouths water when experiencing an urge to drink).

There is no right or wrong place for an urge to be located. What is most important is that you notice where in your body you most notice urges when they show up. If you are having trouble noticing urges, think back to a time when you experienced an urge to engage in an old habit. If you are concerned that thinking about a particular instance when you had an urge will lead to doing the habit, pick a situation where the urge was less strong or you successfully prevented yourself from acting on the urge. Picture the situation as clearly as you can in your imagination. Once the situation is clear in your mind, notice where in your body you are experiencing the urge.

Once you have noticed what part of your body is most connected to the urge, focus your attention on it (if you notice that more than 1 area of your body is connected to an urge, start with the place that you most intensely notice the urge). Take note of the sensations you are having in this body part. What do the sensations feel like? Does it feel like pressure, tingling, warmth, or coolness? How much space do these sensations take up in this place in your body?

Try to draw an outline around the place where the sensations are felt. See if the sensations have any movement. Some people tend to associate sensations with colors or temperatures. Check to see if you notice any colors or temperature associated with these sensations. For some people it can be helpful to silently describe the sensations in an objective and non-judgmental manner (e.g., I notice warmth and tingling in my belly). If more than one part of your body is associated with an urge, go through this exercise with each body part.

Bring your attention to your breath. You do not need to change your breathing at all. Notice your breath for the next 1-2 minutes. Some people find it helpful to bring their attention to a particular place in their body where they notice their breath (e.g., the abdomen); some find it helpful to say phrases like “breathe in,” “breathe out” as they inhale and exhale.

Gently shift your attention back to the part(s) of your body where you notice the urge. Allow yourself to notice whatever sensations come up in these places. If it becomes overwhelming to notice the sensations, gently return your attention back to breath for a few moments and then go back to noticing the sensations connected to the urge. You may find it helpful to imagine sending your breath to the parts of your body that are associated with the urge (e.g., you can breathe into your shoulders and let your breath fill up that part of your body). Notice if and how the sensations change as you watch them. Be sure to practice this step for at least 1 minute, but longer is probably better.

This next step is optional, but many have found it to be helpful. Imagine that the sensations connected with your urge are a wave. Watch the wave rise and fall over and over again as the intensity of your sensations peak and subside. Your job is to use your breath as a surfboard to ride these waves. No matter how big the wave gets, no matter how much you feel as if the wave will consume you, you are a skilled surfer and you will use your breath to ride each wave as it comes. Practice this for at least 1 minute, but again, longer is probably better, particularly the first few times you practice this.

As you’re riding the wave (or just noticing the sensations), you may find it helpful to silently describe the sensations in an objective and non-judgmental way (e.g., I notice warmth in my belly that is increasing…the warmth in my belly is decreasing and my belly feels cooler).

When you are done surfing the urge, take a moment to thank yourself for taking the time and being willing to do something different with your urges. You can also use this time to set your intention for the next few minutes, hour, or day.

6. Describe the Urge

You can do this exercise when you experience urges. By describing the urge for yourself, you create a healthy mental distance between you and your experiences of urges, which can reduce the risk of you being drawn into it. In other words, you develop the ability to observe yourself, your experiences and behaviors, which can help you endure.

Take a moment and think about the urge. Do you sometimes feel the urge for a behavior that you want to stop? How do you experience this?
How long does it last?
What thoughts move in your head when you experience the urge?
Do you feel the urge in one or more places in the body?
Does the urge feel like a tingle or do you experience it as a pressure?
Does the urge travel from one body part to another? How do you know that what you are feeling is craving? If you were to color the craving, what color would you choose?

7. Practice the STOP Skill

Say STOP quietly to yourself. Imagine a STOP sign.
Take a deep breath and relax your shoulders.
Direct your attention away from the thought and quietly describe to yourself the details of the surroundings.
Say STOP quietly to yourself. Imagine a STOP sign.
Take a deep breath and relax your shoulders.

8. Mindfulness Walk

A mindfulness walk can be a good way to consciously move away from all the thoughts in your head and instead focus your attention on your senses. Mindful walking can be done in as little as 5 to 10 minutes. This can also be something to incorporate into your day when you are feeling frustrated or stuck, as it can help bring you back to the present moment, bringing awareness to your current surroundings and how your body is feeling. We are going to go through all the senses to take notice of everything around us. If you notice that you have started focusing too much on your thoughts and stopped being conscious of your surroundings and body, use your next step as an opportunity to start over and bring your focus back to what you are doing.

As you start walking, notice how your body is feeling.
Pay attention to your posture
How are your arms moving, are they swinging or are they still?
How are your legs feeling as they move? Notice how your muscles contract and release as you take your next steps
Feel your foot as it makes contact with the ground and pushes off it with the next step
Feel the movement of your body as you continue into your next step
Look at your environment, try to notice the details
Next, focus on your breathing. Take several slow deep breaths. Notice any aromas or scents around you.
Are you able to notice any tastes as you walk? Can you taste the air?
Try to be open to any sensations, thoughts or feelings that arise. The key is to allow these to pass as you continue walking with openness and curiosity without lingering on anything in particular.
Did you notice anything unexpected?

9. Box Breathing

Step 1: Breathe in counting to four slowly. Feel the air enter your lungs.
Step 2: Hold your breath for 4 seconds. Try to avoid inhaling or exhaling for 4 seconds.
Step 3: Slowly exhale through your mouth for 4 seconds.
Step 4: Repeat steps 1 to 3 until you feel re-centered.


Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

Yes

:heavy_check_mark:No

Were there any aspects of this module that you did not find useful?

:heavy_check_mark:Yes

No

You selected “yes” to the above question, please share which aspects you did not find useful:

My answer:

I’ve never found nonsense like breathing and meditation helpful whatsoever. Walking is the only thing suggested in this module that remotely helps, but that’s only because the alternative is getting into a boxing match with myself. I’m sorry, but I just don’t find creepy girls whispering into my ears all that calming. The opposite rather.

Were there any lessons or strategies from Module 4: Mindfulness that you found particularly confusing?

:heavy_check_mark:Yes

No

You selected “yes” to the above question, please identify what these lessons and/or strategies were?

My answer:

Why medical professionals insist that deep breathing is some sort of remedy for deep-rooted psychological issues I’ll never understand. This module has left me extremely angry. Legitimately hostile! The previous modules were helpful, this one simply wasn’t at all.


In the next module you will be creating a risk card for yourself to use in risk situations, using the alternative behaviors you have been testing.

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Risk Card

Chart your risk situations

You will now consider what your most common stimuli for acting out sexually or having urges to do so are. These can be regarded as “red flags”, which is a signal that you are about to initiate a problematic sexual behavior.

Red flags

The goal is to avoid your identified risk situations, but sometimes they cannot be avoided and you have to handle them differently. You can do this with for example a mindfulness exercise where you, in an objective way, notice your impulse but shift your attention to something else.

For this week’s worksheet, you will be listing out your updated “red flag” or risk situations and what your plan of action will be. You can consider this as your “risk card” for when you encounter an unavoidable situation where you start to experience feelings that usually lead you to a problematic behavior, and also as a tool to help you stay conscious of these situations and handle them in a more flexible way.

You have been testing your alternative behaviors, and finding which ones are most effective. You have also immersed yourself in what is important in your life, what behaviors you need to increase to find a balance, and have been testing different ways to deal with emotional changes and urges. Great job working with these modules and challenging yourself! Based on these new insights, we want you to build a risk card where you list situations where you risk acting on your sexual urges and how to handle them in a long-term sustainable way. A way that is in line with your values, increasing the behaviors you want to include in your life, and meeting your goals.

Choose the behaviors and activities you have found most effective so far to write on your risk card. This can serve as a reminder for you in the moment, that if you have a strong urge you can choose instead to use your plan of action.

Get your ABC analysis from module 3 and check what constitutes your normal stimuli. Think also about other situations you have started to notice increase your risk of engaging in a problematic behavior. Write these situations in the risk card and then describe how you want to handle them beneath each red flag.

This will be your personal risk card, which can help you to pay attention to the situations that usually lead to your problematic behaviors. Being attentive to red flags may help you handle situations in new ways.

As we discussed in module 3, you can try to change or alter some of your antecedents/risk situations. This could include making plans so that you aren’t inactive or bored for long periods of time, or making sure to avoid certain types of pornography that tend to lead you to going to illegal sites. However, other stimuli such as certain situations, thoughts, feelings or bodily sensations are a part of life and cannot be affected or controlled. Instead, you can learn new ways to relate to and respond to these stimuli.

Each time you end up in a situation where one of your red flags are present, you might for example think, "right now, I’m in a situation that has previously triggered my problematic behavior, I will most likely have the same sexual impulse this time too. What can I do instead of acting on it? A mindfulness exercise? Engage in any of my deficit behaviors instead?”

Fill out your risk card and carry it with you in your wallet, smartphone or somewhere you can access it easily. You can do this in a way that isn’t self incriminating, for example, by focusing on only listing out your alternative behaviors.

At the end of the treatment, you will be able to update this risk card.
We encourage you to continue to update this throughout your life as your life circumstances change.

Another visual cue you can use to help you self regulate your impulses is to have a rubber band on your wrist as a daily visual reminder to use your coping strategies. Some patients also use this as a mindfulness exercise where they snap the rubber band and focus on the sensation as a way to focus on the present moment and allow the urges to decrease.

Weekly Reflections and Exercises

Here is a chart with examples of common red flag situations:

High risk or Red Flag situation Plan of action
I have a difficult and demanding day ahead I make a structured plan in my notebook where I can mark off what I have done. I work for 45 minutes and take a break for 15. I reward myself when I have achieved my goals
Lying awake at night I do the breathing anchor exercise. I write a list of things I am thinking about. If I have not managed to fall asleep in 20 minutes, I get up and read a book for a while before I try to sleep again.
Stressed over the lack of intimacy in the relationship I express my feelings and thoughts for my partner in a way that is not accusatory

Please fill in the chart below with your red flag situations and your plans of action:

( = A high risk situation for you)

: I am looking at legal pornography but sometimes get the urge to look for something illegal.

Plan of action: I take a break from pornography, stepping away to do something else and letting the illegal urge subside before resuming my legal consumption.

: I’m browsing the Internet when I see people posting links to sketchy sites choc full of CSAM. A desire to click on these links and view the images seeps into my mind.

Plan of action: I report the offending link and, in the meantime, go do something else until the link has been taken care of.

: I’m feeling suicidal and have stopped caring about consequences.

Plan of action: I calm myself down, seeking the aid of family/friends if needed. Getting fresh air, putting on cozy and comforting clothing, etc., until the episode subsides. If things ever got too bad, I could always schedule a therapy session or even voluntarily commit myself for a week or so if necessary. But hopefully it won’t come to the latter.

Reflections:

Which mindfulness exercises did you try? How did it work for you? How did you feel before and after?

My answer:

N/A Mindfulness and me never mixed, as I explained in my response to the previous module.

Did you test any of your alternative behaviors this week? If so, which ones? Specify if they were effective or not.

My answer:

N/A Thankfully, no situations came up where I needed to exercise any alternate behaviors. But I’ll still be sure to keep my alt behaviors in mind for if/when I do.


Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

:heavy_check_mark:Yes

No

You selected “yes” to the above question, please share which aspects you found particularly useful:

My feedback:

The risk card is a novel idea! I can honestly see many of these modules (alt behaviors, risk cards, etc.) having immense practical use outside of CSA/CSAM urges. Perhaps I should make some risk cards to control my eating habits…

Were there any aspects of this module that you did not find useful?

Yes

:heavy_check_mark:No

Were there any lessons or strategies from Module 5: Risk Card that you found particularly confusing?

Yes

:heavy_check_mark:No


In the next module you will be reflecting on the potential consequences of sexual behaviors.

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Thoughts and Feelings

Sexual and romantic behaviors

Sexual preference of any kind seems to be mostly predetermined and, as research indicates, not chosen. Nobody gets to decide his or her sexual or romantic preferences or attractions.

While we may not be responsible for deciding our sexual or romantic preferences, we are still responsible for our behaviors.

You’ve applied to this treatment program because at some level you worry that your sexual thoughts cause you, or others, problems and you want to strive towards ending a problematic behavior.

As we discussed in module 2 and 3, some people find it hard to find time for other things in life because their time is spent on surfing for pornography or fantasizing or pursuing a romantic relationship or crush. This is one reason why we encourage you to increase your time spent on work/leisure/goals so that you have less time for risky or illegal behavior. Others feel ashamed about their sexuality, which affects their self-image and their ability to maintain relationships with other people.

In this module, we’ll start your journey to change this.

Sex and fantasy as a way to deal with negative emotions

It’s not uncommon to avoid or flee from negative feelings such as anxiety, sadness or stress by surfing for pornography. Sexual acts or thoughts temporarily might help the person to escape the discomfort associated with the negative feelings. The more negative feelings you have, the more likely you are to engage in behaviors that give you instant gratification.

As we discussed previously, sexual behaviors can be healthy if there is a balance. If you engage in them compulsively or way too often they can become problems for you in your daily life. Sexual behaviors could include watching pornography, masturbating, engaging in online chats about sex, having sex with new partners, etc.

Sexual activities can make us feel good. Because one tends to feel more relaxed, calm, and happy after sexual activities, some end up using sex as a way to deal with unpleasant emotions. This can include feeling sad, anxious, or even bored. Sexual acts can reduce this discomfort for a short time, and after a while, negative emotions or discomfort become a cue associated with sexual acts or thoughts. This can become a vicious cycle of avoidance, and makes it harder to develop positive coping mechanisms to process emotions and to listen to the message these emotions are trying to convey. For example, if someone is feeling anxious, watching porn and masturbating will not allow them to process this emotion, and will instead push it away for a short time. It is important to think about the long term consequences and if these behaviors are working for or against your values. Consider how using sexual behaviors to deal with negative emotions can lead to these emotions getting worse over time. This could cause behaviors to get more extreme, and cause increasing difficulty in handling these situations.

Your challenge will be to develop a more flexible and varied range of behavioral choices, and to create distance between your sexual impulses and acting out a sexual behavior.

When sex or fantasies have negative consequences

Compulsive sexuality can have negative consequences as a result of spending too much time on sexual thoughts and behaviors. There are the negative consequences to others, where you may be continuing a cycle of exploitation. The consequences could also be the risks involved, such as increased risk of STDs or pregnancy. There could also be legal risks if the behaviors are illegal.

As stated earlier, another large risk is that by spending too much time focused on sexual thoughts, behaviors, planning or fantasizing, that the time spent doing non-sexual activities is decreasing. This can become a vicious circle. For example, the more time you spend isolating yourself from your friends and family, the less people might try to include you, which can make you feel more isolated. Engaging in sexual behaviors to avoid negative emotions could lead to feeling passive in life, which means that life may feel empty or meaningless.
In module 2 you charted some of your important life areas. This was to help you identify which areas you needed to spend more time on, and what you would like those areas to look like in the future. If you feel like you spend way too much time sitting with sexual thoughts and feelings, it may be good to focus on your different life areas such as hobbies or relationships where you can increase your non-sexual activities.

To experience that you lose control

Feeling a loss of control is common if you have compulsive sexual behaviors or fantasies. Many people who seek treatment state that they have tried a few times to reduce or stop certain sexual behaviors, and that they might have been successful for a while, but that they eventually return to their old coping strategies and problematic sexual behaviors. Giving in to an urge in the moment instead of using alternative strategies can cause this experience of losing control.

Having set goals and a plan to handle these urges, even if you make mistakes, can help bring a larger sense of control.

Weekly Reflections and Exercises

Think about your own behavior, do you try to escape from or avoid certain emotions through sexual behaviors? If so, what feelings are you trying to avoid? Please answer the questions in this week’s worksheet.

  1. Please make a list of your most common problematic sexual behaviors and/or urges:

My list:

Compulsive masturbation, looking at pornography for copious amounts of time every single day, consuming material that skirts too close to reality, etc.

  1. Do you use sexual behaviors to avoid certain feelings or difficulties in your everyday life, if so, which ones? Think about whether you are fleeing from or avoiding certain situations or stress through sexual behaviors.

My response:

It’s less that I use pornography to escape stress. It’s more that it’s become a habit. Like ritual.

  1. What do you think a healthier way to deal with this emotion is?

My response:

To preoccupy myself with more important things. My family, my work, my education, etc.

  1. What consequences do you think govern your problematic behaviors? In other words, what do you think is reinforcing this behavior and causing you to continue engaging in it?

My response:

A lack of purpose in life. A crippling fear of rejection/failure. Poverty. Anxiety/depression. A total deprivation of social skills. Asperger’s. Low self-esteem. Nihilism. Poor health. Etc., Etc., Etc…

  1. What negative consequences have you experienced as a result of your sexual thoughts and behaviors?

My response:

I’m currently 24 and never learned how to drive despite living in a rural area. I never went to college or learned a trade. In America, that costs so much money it doesn’t seem worth it. I feel completely and utterly trapped. Pornography is one of my few comforts. The only solution I see out of this mess is suicide.

  1. As you stop engaging in your sexual problematic behaviors, what will you miss about it?

My response:

I wouldn’t miss a thing if it meant I could actually pull myself together and make something of my miserable and pointless existence. A significant reduction of my pornographic consumption is a worthy sacrifice for security and happiness.

Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

:heavy_check_mark:Yes
No

You selected “yes” to the above question, please share which aspects you found particularly useful:

I dunno if I’d call it “useful”, but it certainly doesn’t hurt to be able to identify why I behave in the ways that I do. I just wish I had the privileges, the resources, the opportunities to actually turn my life around without resorting to crime or suicide…

Were there any aspects of this module that you did not find useful?

Yes
:heavy_check_mark:No

Were there any lessons or strategies from Module 6: Thoughts and Feelings that you found particularly confusing?

Yes
:heavy_check_mark:No

In the next module you will read about different communication styles, experiment with different behaviors, and map out your social network.

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Ah I remember I missed the window to participate in this. Maybe I can get in this time.

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Social skills

People have different social needs in life. Some prefer a large social network with many relatives and friends to keep in touch with; others thrive in a small social circle with a few confidants. For some, social interaction feels awkward, incomprehensible or perhaps completely uninteresting. Common to most is a need to be part of some kind of community. People who isolate themselves from their surroundings seem to lose important social skills. This leads to us feeling lost, an increased risk of mental illness, and the risk that we feel that our actions do not matter and therefore the risk that we do things that go against laws and norms increases. It is enough to affect your health positively if you have a couple of contacts that you can turn to if something happens. If you have no relatives or friends, a professional can be an option.

Something we have heard from many participants is that they have built strong social networks online. Sometimes these online forums can be used to discuss, watch, or share CSAM. Other forums have different rules. Some participants feel a strong sense of community with people who have a similar attraction as they do. In the wrong environment, ones that encourage illegal behavior, this can be problematic. Certain relationships can be factors that lead to the continued use of CSAM. Allowing your network to be made up of people who share illegal behavior can cause false perceptions that you may have around this behavior to continue to be normalized and strengthened. When you are online you cannot be sure of the other person’s authenticity. You have little control over whom you talk to, and generally, people do not take as much responsibility for what they say and do. Focusing on building connections with people who share something you think is important, such as a value or hobby, can give you both validation and belonging.

Some people feel a sense of loss if they decide to leave these networks behind, which is understandable, especially if it took up a lot of one’s time and made up an important social component. For a while, this can feel lonely and empty, but by gradually taking new social steps in other areas of life, new, more meaningful bonds can be formed.

If you feel strong discomfort or insecurity in social situations and have difficulty knowing how to behave, it is not surprising if you start to avoid social interaction. One problem to avoid is that we miss things that we know are important for our well-being in life. Going against your anxiety and staying in the discomfort with the risk of being rejected, saying something wrong, or being perceived as strange is the key to deepening your social skills and relationships.

It is possible to train social skills and in this module you will receive general advice and support in communication and social interaction. We address this because many people with a sexual interest in children experience difficulties with social interaction and how they “should be” in relationships with friends and intimate partners.

Communication

Communicating is important for functioning relationships. How you are with others and how you communicate can be different, depending on what situation you are in and who you are talking to. Maybe you find it easier to express your opinions in some situations but that it is much more difficult in others.

We start by going through four different communication styles: passive, aggressive, passive-aggressive and assertive. The assertive style is the most effective of the four, but for various reasons it is not always used and therefore there can be problems and frustrations in the social interaction.

Passive Communication

The passive communication style is characterized by excessive restraint, a desire to please others, often to avoid conflicts. People who communicate in a passive way respond to others’ opinions and wishes with expressions such as “if you think so…”, “I agree with you”, “I do not know” or “no problem, I will take care of it”. In the short-term, a person with a passive communication style can be seen as accommodating and helpful, but in the long run, the communication style creates problems as the person avoids expressing their own opinions, wishes and needs.

The person who communicates passively may experience that they do not control their life, that they are not respected and that life becomes stressful. Other people may experience that the passive person only participates half-heartedly in relationships and that they avoid taking responsibility.

Aggressive Communication

Aggressive communication is characterized by the person wanting to have their own needs met and their own opinions confirmed, often at the expense of others. Aggressive communication is often characterized by words such as “should”, “must” or other language that conveys that the recipient is expected to fulfill the wishes expressed or to agree with the opinions that are conveyed. An example of an aggressive way of expressing oneself is “I can not understand how people can be so unintelligent that they vote for that person, if you do you have not understood much about how the world works”, or "You have to shape up and take hold of your life ”.

Aggressive communication leads to others being given very little space to express their own opinions. In the short-term, the person with an aggressive style can experience control, get his way and make his opinion heard. However, the person does not receive information about others and their perspectives, which can lead to a lack of understanding of others and an experience of loneliness. In the long run, there is a great risk that the person will not be liked and will not be able to create close relationships.

Passive-Aggressive Communication

Passive-aggressive communication means a contradictory way of communicating. It can be about the person agreeing or saying yes, and then acting in the opposite way. For example, a person who undertakes a task when they don’t really want to or can’t, and then performs it poorly or not at all. The passive-aggressive communication style means that the person behaves passively when it comes to expressing themselves, but on the other hand aggressively in action. That is, the person does not do what they have agreed to do, or does it carelessly or otherwise tries to take revenge on others. People with a passive-aggressive style do not have to assert themselves in the short-term and handle any conflicts. By then acting aggressively, the person can get an outlet for the frustration that has been built up by the passive way of expressing themself. In the long-run, the communication pattern leads to others not trusting the person and the risk of conflict is high as a result of the aggressive action.

Assertive Communication

The assertive style is the most effective of the four. Assertive communication means that personal opinions, needs and boundaries are expressed in a respectful way with an interest in the opinions and needs of others. The goal is not to get their way through but to achieve understanding for each other and to find the best solution together. This means both a willingness to compromise with certain needs but also to stick to others. To be able to communicate assertively, the person needs to work on becoming aware of their thoughts and feelings in order to be able to express them and not be controlled by them in the short-term. For example, a person who is afraid of conflicts may still choose to address issues in the relationship or at work as clearly as possible. Assertive style means making wishes, asking for help, saying yes to other people’s wishes if you find them reasonable or to say no if wishes are deemed unreasonable. It is also about being clear with opinions and feelings or receiving and giving positive or negative feedback. Assertive behaviors are thus behaviors that can make you feel and be seen as honest, clear and interested in others. Individuals may experience less stress and discomfort in relation to others through assertive communication and therefore it is good to practice expressing themselves more assertively.

Tips for expressing yourself assertively

As one of the tasks this week, you will start practicing expressing yourself assertively. Below are some tips that can help you along the way: Feel free to try to express yourself with “I-message”, which means that you make clear what your opinions, thoughts, feelings and needs are. This means that you convey what you yourself feel and think and do not claim to come up with a general truth about how things are.

It is also good to think about having an inviting body language. Eye contact can make the recipient feel that you are talking to them and the message becomes more personal. Crossed arms can be perceived as threatening and distancing.

Think about the timing. If you want to try to address and, if possible, solve a problem with a partner, friend or work colleague, then choose a suitable time when you and the person you are talking to have time for each other and can be undisturbed. Be prepared for difficult feelings to arise, but try to leave them there and focus instead on expressing yourself clearly and understanding the other person. It’s not about winning, but about finding a solution together that can work for both of you.

Reflection:

Do you recognize yourself in any of the communication skills? Do you use any or some of them more than others?

My response:

I have always held very poor communication skills. I never was any good at making connections or pursuing goals or anything of the sort.

I’ve dabbled in all three non-ideal variations of communication. Never asking for what I need, being stubborn when I really shouldn’t, and making promises I had no intention of keeping.

I’m certainly no social butterfly.

Exercise: Try out new behaviors

When you try to change your behaviors in order to achieve your goals, there is a great risk that negative thoughts and beliefs might hold you back. To challenge them, you will work with something called behavioral experiments in this module. Beliefs seldom change as a result of only thinking through the situation. By engaging in the emotions, and actually testing new ways to act, one can find evidence that confirms new ideas and beliefs.

The purpose of behavioral experiments is to investigate the accuracy of your negative thoughts and beliefs by testing them against reality. We can also use this module to test using assertive communication.

  1. Behavioral experiment

You choose a thought or emotion that holds you back, for example:

“If I say no to an assignment, my boss will be disappointed with me.”

Then, you design a behavioral experiment, where you “say no to a task” and record what happens. You will see that some of your assumptions may be accurate, and others will not be.

Some of your experiments can also be testing your identified alternative behaviors.

Begin with a behavioral experiment that doesn’t feel too difficult and continue with behaviors that are more challenging. For example, if you want to initiate activities with others, it’s easier to send a text message to a friend that you have texted with before and ask if they want to catch up, rather than inviting a group of colleagues for dinner. Remember to use assertive communication and start from I-messages, for example, “Hey it has been a long time since we saw each other. I thought it would be very nice to catch up, do you have time to see each other this week?”

Date of experiment (yyyy-mm-dd)
•2023-05-22

Experiment
•I will ask my parents some difficult questions. Stuff about my education, my abilities, etc.

Assumptions about what will happen
•I will be told that I am indeed the unfavored compared to my sister. I will be told that it’s too late for me to turn my life around. That I should continue being where I am in life and learn to live with it.

What happened
•My parents were much more encouraging than I expected. They told me that I should focus on what makes me happy and what doing I need to do to get there if I’m not. They even told me it doesn’t matter if I’m still living with them until I’m fifty as long as I pull my weight and am happy with myself.

What I learned
•While I still feel like a disappointment, I know that my parents want me to be alive more than anything else. If that means living with them forever, so be it.

Which situations did you test assertive communication? What happened? Was it expected? How did you feel before and after?

My response:

As I stated above, I did what I had to do and talked to my parents about how I felt. I was assertive and concise with what I wanted to say. They assured me that they only wanted me to be content with who I am. As long as I am happy, they’re happy.

Not what I was expecting. And I’m still not sure how to process all this. But hopefully, I can find the courage and strength to keep going. I’ll always have SOMEBODY who can support me in my endeavors.

  1. Map your social network

Here are some questions to get you started…

•Which people have been most important to you in your life?

•What does contact with them look like today?

•Have you lost contact with someone who was important to you and with whom you would like to reconnect?

•How about the contact with your family?

•What does it look like with colleagues at work?

•Who do you hang out with in your spare time?

•Are you dating or do you want to start dating?

My responses:

•My most important people are my immediate family (mother, father, sister).

•They are all always working, never around much. I am practically a stay-at-home son/brother and always all alone.

•There are 3 girls (now women) from back in high school who are/were all very close and important to me that I never kept much contact with. I regret that.

•I never interact with my extended family the way I should. My grandparents, my aunts and uncles, my cousins, etc. I very rarely see them.

•My colleagues at work are just that: colleagues. They’re either much older than me or not people I would want to be friends with. I get along with them just fine, but we never hang out or anything.

•I spend all my time alone. I have nobody because I am nobody.

•The only date I ever went on was prom, one of the girls I hardly speak to nowadays. I’ve got no one in mind who I’d wanna date. I’m prolly no good for anybody anyways…

3. Check in about exercises

Which mindfulness exercises did you try? How did it work for you? How did you feel before and after?

My response:

I’ve been having myself some good cries lately. I take Lexapro but was unable to secure a refill on my prescription. I’ve been suffering some of the worst depression I’ve had in a long time the past two months. I still need to hold out one more month before I can try again for a refill. Pardon my language, but this f****** sucks so, so much…

Did you test any of your alternative behaviors this week? If so, which ones? Specify if they were effective or not.

My response:

If having very, very frequent and intense crying sessions while rocking in the fetal position counts as an “alternate behavior”, then sure.

Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

:heavy_check_mark:Yes

No

You selected “yes” to the above question, please share which aspects you found particularly useful:

My response:

Well, sorta. I was already doing a lot of thinking and was already planning on talking to my parents about how I felt. But it’s just an odd coincidence that a module all about how to talk to others was on the docket. So it was less useful in actually pushing me to talk to them (not saying it didn’t help push me at all), but it’s more helpful after-the-fact to parse what I’ve learned from our chat.

Were there any aspects of this module that you did not find useful?

Yes

:heavy_check_mark:No

Were there any lessons or strategies from Module 7: Social skills that you found particularly confusing?

Yes

:heavy_check_mark:No


In the next module you will reflect on consent in an adult relationship, and which behaviors can be risky.

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Consent and sexual activity

The purpose of this treatment program is not that you should give up on sex. Rather, it’s your potential problematic sexual behavior that needs to stop in order for you to feel satisfied with your life and sexuality in the long term.

You did not choose your sexual attractions. They have probably been with you a long time, they may have become an important part of who you are. Nobody needs to give up their sexual attraction in order to have healthy sexual behaviours.

Let’s separate thoughts from actions.

Why is all sexual activity with children considered non-consensual?

It is not uncommon that false beliefs arise as a way of shielding ourselves from our behaviors, in attempts to explain or justify what we’re doing. This can apply to anybody regardless of sexual attraction. An example of this for people with sexual attraction to children, is thinking that a child who is posing, laughing or wearing provocative clothes is consenting. However, children have the right to be kept safe from sexual approaches from adults. Children who are sexually assaulted or exploited by an adult run a huge risk of developing mental health issues and dysfunctional strategies to deal with them during their lives. We know from research and clinical work that this includes difficulties in establishing relationships and severe problems with their self-image later in life. If someone views something through rose-tinted glasses, they only see the good side of things. In summary, to expose a child to sexual abuse and exploitation, violates their rights to be kept safe.

As you have read, according to Convention on the Rights of the Child, you are a child until you turn 18. This is the framework we use in this program.

Children have different developmental stages, but are not capable of being an equal sexual partner because they cannot fully comprehend the content, behavior or consequences of sexual behaviors. Children, just like adults, react in different ways in critical situations, and this includes reactions to experiencing sexual assault. The calm and controlled victim can be just as traumatized as victims behaving differently can, but may be unable to express it. Absence of resistance or protest doesn’t mean that the child is consenting to what they are exposed to. A child may even be active if they think it is necessary for not getting hurt or that the adult will get angry or like the child less.

Children are unable to give consent to sexual activity because of their inability to regulate emotions and understand the consequences of their actions. The child in any CSAM imagery has neither consented to the involvement in the material nor that someone would take part of it or spread it. In fact, every time the material is being watched, it can be considered as a secondary abuse. The sharing and use of the material strengthens the trauma and leads to feeling that the abuse never ends. The individual choosing to look at the image is responsible for his or her own actions, but also for the effects or consequences the child being portrayed experiences.

Consent with adults

There is a wide variety of sexual activities that you can engage in with consenting adults or alone. It is important to understand and remember that sexual activities are most enjoyable when partners have an agreement of what they are doing and no one is harmed. Consent between adults is important to reflect upon, especially for someone who has felt a loss of control when it comes to one’s sexuality. Communicating and openness when talking about sex is key to mutual consensual sex. Consent is also something that can apply to different types of sexual activities; just because you agree to some activities, it doesn’t necessarily mean you agree to others. It is important to not only listen to your partners about what they want and enjoy, but to also let them know about what you want and enjoy. Again, communication is key! During sex, if something is uncomfortable, it is also okay for you or your partner to decide they want to stop or to change something. If you are ever unsure if something is okay, ask!

Some people find it difficult to accept a “no” from their partners. This leads to them getting upset and trying to coerce their partner into sex. If you feel like this might apply to you, it would be a good idea to work on accepting a “no” without trying to persuade them otherwise.

  1. Do you have any problems determining whether someone is consenting to a sexual activity?

My response:

I am a 24yo virgin. I wouldn’t know what consent looked like unless the person looked me directly in the face and said “I want you to have sex with me”.

  1. When and how did you discover that you could feel sexual attraction to children? What has your sexuality looked like over time?

My response:

Let me get this outta the way: I was never groomed or molested by any adults or teens or other children. Like I said, I’m still a virgin.

I was 12yo when I realized I was attracted to children much younger than myself, but I had been extremely precocious when it came to sexuality long before this.

My earliest sexual fantasies occured at around age 5, revolving around both adults and other children (mostly performing fellatio on men or having fellatio performed on me by girls my own age). And these fantasies were sometimes incredibly bizarre and violent. At the time, I hadn’t realized how truly sick my thoughts were.

I hadn’t yet been exposed to pornography or sex by this point (I wouldn’t discover Internet porn until around 10ish), yet I developed unmistakably sexualized fantasies at a very young age. I don’t know/understand the psychology behind how this is possible. It was almost like instinct, like how animals seem to just know how to do things.

I was sexually attracted to several of my female classmates in elementary school and, as I said, would fantasize frequently of receiving oral sex from them. I would also fantasize of (and there’s no lighter way of putting it) raping adult women. After I discovered Internet porn (again, around 10ish), I was quickly exposed to many strange sexual ideals and practices. I began to fantasize more about performing oral sex boys my own age, my male classmates or even the other neighborhood boys.

I recognize that my sexuality was already incredibly warped from long before I found porn. But I cannot help but feel that my youthful exposure to the Internet has exacerbated and furthered the warping. That isn’t to say the Internet is to blame or that porn should be censored, I’m just making an observation.

  1. Do you have a parallel sexual attraction to adults?

My response:

I am attracted to adults. I couldn’t tell you if I’m overall attracted to adults and children equally or if my attraction leans in a certain direction. It seems to depend on my mood.

  1. Do you have any other reflections, questions or comments?

My response:

I am incredibly suicidal as a result of my attractions. I didn’t realize how just how harmful my behaviors were when I was young. I’ve been feeding into them for almost 20 years now and I feel broken, like I’ve ruined myself. My porn usage has become totally habitual. I don’t do it because I actual like it. I do it because it’s become deeply ingrained inside my mind. I wonder if my Asperger’s has played a role in this…

I fear that my life is inherently worth less than the lives of others. I managed to graduate with an advanced diploma but I feel like I didn’t earn it. Getting my diploma required extensive psychological support. I feel like a fraud, like my dependency makes my diploma invalid. I feel like a failure and a burden on those around me.

I’m 24 and I don’t know how to drive. Even though I live in a semi-rural area where driving is necessary to getting around. I graduated with my advanced diploma six f****** years ago and I still work only 16 hours a week as a Goddamn dishwasher. Everytime I think about maybe learning how to drive or going to college, it just doesn’t seem worth it. It feels like it’s too late now.

And the loans! I don’t want such debt looming over me my entire life. I understand why America cannot have free healthcare and education (nobody wants to or is able to pay the necessary taxes to fund these endeavors), but it’s still unfortunate that an American’s value as a human being is seemingly tied to a dollar sign next to a number. We’re not people, we are numbers. Statistics. And instead of enjoying life in the moment we insist on putting off our own happiness until retirement, when our bodies are now too crippled from a lifetime of work to even enjoy retirement. The system is broken, and working exactly as intended.

All I want is for my sister and her boyfriend to succeed, to Hell with myself. I’d give my blood, my bones, my very life itself if it meant they’d be better off.

I know much of what I just said has little to nothing to do with my sexuality. I just wanted to vent. I WISH my attractions were my only problem. I would happily trade all my other issues in exchange for being exclusively attracted to children. I’m already still a virgin, I could easily forego any pornographic sexual needs with the help of medication and therapy (medicine and therapy I could afford IF I HAD MONEY). As long as I was otherwise financially and emotionally stable, I could live long and die smiling.

The only other solution I can fathom is to up and f****** die.

Think about your sexual behaviors in relation to the colors of a traffic light, divided into red, yellow and green light. Think of the colors as “stop, slow and go”.

The red light contains behaviors that indicate or cause you or someone else harm. Illegal behaviors are always red.

Examples of red behaviors are:

•Watching sexual material depicting children

•Producing and sharing such material

•Approaching or planning to approach a child with the intention to achieve sexual gratification online or offline

•Chatting with others about children in a way that encourages abuse or exploitation

•Any sexual behaviors with people who are non-consenting

The yellow light contains behaviors that are risky for you to engage in. That means when engaging in such behaviors you need to be careful so you don’t end up in a red light behavior.

Examples of yellow behaviors could be those in your risk card, for example:

•Watching extreme pornography

•Watching pornography in categories such as “teens”

•Watching material on some website where you’re uncertain of the age of the person in it

•Following algorithm-based links leading to illegal material on for example social media sites

Green behaviors mean “green light”, these sexual behaviors you can continue to or start engaging in with no restrictions. Just like many other things, what constitutes a healthy and positive sexuality is individual.

There is a wide variety of sexual activities that you can engage in with consenting adults. Perhaps it could mean:

•Having sex with your adult partner or another adult

•Masturbating to a sexual fantasy

•Sex chatting with consenting adults without encouraging sexual abuse or exploitation of children

•Watching pornography depicting adults

•Reading erotic novels

•Listening to erotic novels

•Exploring some new sexual fantasy

•Masturbating in the shower

When it comes to fantasies, as we said before, thoughts and feelings are not chosen. We are hoping to help you find a healthy balance and level of these activities that are helpful in achieving your goals.

Now, take a moment and list your red, yellow and green sexual behaviors. Include both online and offline activities.

Think about your sexual behaviors in relation to the colors of a traffic light, divided into red, yellow and green lights. The red light contains behaviors that indicate or cause you or someone else harm. The yellow light contains behaviors that are risky for you to engage in. That means when engaging in such behaviors you need to be careful so you don’t end up in a red light behavior. Green behaviors mean “green light”, these sexual behaviors you can continue to or start engaging in with no restrictions. To gain sexual pleasure/gratification through visual stimuli means activating only one out of the five senses, therefore, you can try to find various ways to stimulate yourself sexually, e.g. by touch or sound.

Take a moment and list your red, yellow and green sexual behaviors. Include both online and offline activities.

My chart:

:vertical_traffic_light:

STOP :stop_sign:

•Masturbating to drawn or CG images based on IRL people, especially children. Deepfake pornography in particular.

•Looking at pornography in public spaces like doctor’s offices.

SLOW :yellow_circle:

•Habitually and compulsively masturbating to pornography (even legal porn) every day, multiple times a day, to the detriment of my mental health.

•Confining myself to my bedroom and never leaving, letting myself alone with my thoughts and feelings. That’s how dangerous stuff starts to happen, wether it means I’m looking at something I shouldn’t or preparing to commit suicide.

GO :green_circle:

•Chatting with people my own age about sexual topics, if they’re comfortable with it that is.

•Masturbating only so often as to relieve stress without it consuming too much of my time. Sadly, I fear I may be far too stressed to just quit masturbating so much…

One exercise you can try, now that you have defined your traffic lights, is the “STOP” technique. Some choose to visualize the traffic light colors when doing this. For instance, if you are currently engaging in a yellow light activity you can visualize a yellow traffic light, think the word “stop,” and start this check-in exercise.

STOP is an acronym, which stands for:

S: Stop. Pause whatever you are doing at the current moment.

T: Take a breath. By reconnecting with your breath, you can be better anchored to the present moment.

O: Observe. Observe the present moment. What is happening internally and externally? Where are your thoughts now? What do you feel? What are you doing?

P: Proceed. Use the information gained during this check-in to change course. Whatever you do, do it mindfully.

Sensate focus task:

Fantasies and thoughts are, as we mentioned earlier, more difficult to control than actual behaviors. Thoughts often pass without us having the opportunity to control them. However, there is a difference between noting the thought and letting it pass, and engaging in the thought more actively, for example, by lying down and consciously directing the fantasies in a certain direction. Thinking and fantasizing sexually about children is not in itself illegal or dangerous. On the other hand, if you feel that these fantasies increase your risk of acting out then this is something you will want to give attention to. Some individuals have the experience that if they engage in an interest through active fantasies it can increase the risk of starting to engage in illegal activities.

Many people who enter into this program are used to primarily using visual stimulation when they masturbate, not being so aware of bodily sensations. The sensate focus task is a way for individuals to try using other senses through mindfulness of their bodies to become more in contact with the sensations that are happening. In this way, one can become more conscious of their body and how one acts on their urges.

Whether you live in a relationship or are single, you may want to evolve your sexuality. You may want or need to reduce the amount of time you spend on some sexual fantasies or decrease your surfing for pornography. One way to develop your sexuality is to try out new sexual behaviors, such as doing exercises where you focus on your body’s sensations! Below are sensuality exercises that you can explore:

Make time for yourself when you won’t be disturbed. Make it as comfortable as possible for yourself: think of the temperature in the room, nice lighting, and perhaps quiet music. Focus on being with all your senses.

Remember to notice your thoughts, feelings and other distractions and calmly redirect your focus to the exercise and what you experience in your body with your senses.

Begin by touching your whole body, except for erogenous zones such as breast and genitals, without trying to reach excitement and orgasm. Look and treat yourself in different ways, for example hard, soft, slow or fast. If thoughts of others or some sexual fantasies appear, note this, but then focus on your body and on how your touch feels in the body. Do this exercise on a few separate occasions. Note if you experience new body sensations, you may discover new spots on the body that you like to touch.

Then proceed to touch the entire body, even erogenous zones. Touch yourself like before in different ways. You can try to use oil or lotion while exploring your body. The purpose is not to reach orgasm; it’s rather about having the opportunity to be with yourself.

In the next step, you continue to touch your entire body and explore your sexual excitement. Try new ways of touching your genitals and erogenous zones. Try to play with your excitement, let the excitement come and go by varying the touch. The purpose is not to get the fastest possible orgasm, rather about learning to enjoy the experiences of the body. If some thoughts or sexual fantasies that you dislike occur, just notice these and redirect your attention to your body and your mind.

Reflection:

How was this exercise for you? How did you feel before and after? Did you notice anything new? Was anything unexpected?

My response:

With all due respect, as I’ve explained before I’ve been suffering my sexual fantasies since I was 5. About 20 years later now and I’ve experimented quite a bit with masturbation already. Using different substances, sex toys, positions, variety in fantasy/pornography, etc. I don’t think I could possibly learn anything new about my body that I don’t already know.

Check in about exercises:

Which mindfulness exercises did you try? How did it work for you? How did you feel before and after?

My response:

Well, I sat outside for a bit to get some fresh air. Noticed a wasp beginning to build a nest inside our mailbox so I swiftly dealt with that.

Finally, we would be very grateful if you could give us feedback on this week’s module content.

Were there any aspects of this module that you found particularly useful?

Yes
:heavy_check_mark:No

Were there any aspects of this module that you did not find useful?

:heavy_check_mark:Yes
No

You selected “yes” to the above question, please share which aspects you did not find useful:

My response:

For the most part, I already understand what is and is not appropriate sexual behavior. I brought up stuff like drawn, heavily stylized hentai depicting real people like politicians and celebrities (including famous child actors) because I consider it a gray area. Is it sexually abusive or does it fall under artistic expression? Like a political cartoon, wherein the politicians in question certainly did NOT consent to being depicted in a negative light? What’s considered OK for freedom of speech and freedom of expression, and what’s considered going too far and actually causing people real and abusive damage?

Were there any lessons or strategies from Module 8: Sexuality that you found particularly confusing?

Yes
:heavy_check_mark:No

The next module is the final module in this program! You will be working to create a maintenance program for yourself to continue your progress.

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