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Roberto, a 23-year-old college student, was nervous. This was his first therapy session and he had no idea what to expect. After I introduced myself and discussed the basics of the therapeutic relationship, I asked why he’d come to see me. He reluctantly told me, “I’m having problems with my girlfriend. Sexually, I mean. She’s really hot, and I really care about her, but I’m having trouble getting aroused. It’s so bad that I’m actually making up excuses to not have . And I really don’t know what’s wrong. I’m fine when I look at porn, but then, when she’s right there in front of me, I can’t get an erection to save my life. And if I do, it doesn’t last. It’s humiliating, and I’m really depressed about it. I’m actually thinking about breaking up with her just so I don’t have to feel this way.”

After further gentle questioning, Roberto admitted that he was watching porn two to three hours per day. “I go online after classes to unwind, mostly because I’m out and about school and some other things, like my relationship.” He also stated that his porn use started when he was 14. “My dad got out of prison right around them, and he was really angry. He was drunk all the time and yelling at my mom, so I would go in my room and lock the door and lose myself in porn for a few hours as a way to not hear or feel what was happening.”

At this point, it was clear to me, based on evolving research and years of clinical experience, that Roberto’s porn use, which he engaged in more for than sexual pleasure, was a likely driver of his sexual dysfunction, his relationship struggles, and his . Certainly there were other issues to deal with, particularly the unresolved surrounding his father. But his escapist compulsivity with online needed to be addressed first, as it was clearly and directly linked to his most pressing issues.

New Research

Physically healthy young men like Roberto appear in therapy offices more and more frequently, and clinical experience suggests that their extensive use of pornography—especially the unending, constantly changing array on the Internet—may be a primary cause of their presenting issues. We now see research that confirms this. The most recent study, looking at French men age 18 and older, examines usage patterns, motivations for use, and possible effects of online sexual activity, and reaches three important conclusions:

Porn use is by far the most common online sexual activity for adult males, engaged in by 99% of the study’s 434 participants. Men who engage in online sexual activities for temporary emotional escape are significantly more likely to experience related negative consequences. Sexual dysfunction with real-world partners, in particular , can be linked to heavy engagement in online sexual activities.

The first finding, that the men use porn, should not surprise anyone—research tells us that 13 percent of all internet searches seek some form of erotic content. The third finding, that heavy porn use can lead to sexual dysfunction with real-world partners, is also no surprise—at least not to clinicians who work with compulsive porn users on a regular basis. Such clients, many of them young men in their sexual prime, repeatedly tell their therapists and primary care physicians that they’re able to perform perfectly well with online stimulation but struggle with their real-world partners. (Click here for more on that issue.)

But it is the second conclusion, on the surface is the least "sexy" of the three findings, that is by far the most meaningful from a diagnostic and treatment perspective.

The “Why” Really Does Matter

In addition to the three findings listed above, the study found that the most common reasons for engaging in online sexual behaviors involve sexual pleasure—with 94.4 percent of users seeking sexual satisfaction, 87.2 percent seeking arousal, and 86.5 percent seeking . However, a desire to regulate uncomfortable emotions was not far behind, with 73.8 percent of users hoping to alleviate stress, 70.8 percent trying to assuage boredom, and 53 percent wanting to forget their daily problems. (Obviously, most porn users have multiple motivations, such as feeling stressed out or bored while also wanting sexual satisfaction and orgasm.)

This information gets really useful, from a clinician's perspective, when the research team links the reasons for going online to other factors, such as time spent online, activities engaged in online, and, most important, negative life consequences. What they found was a powerful link between escapist motivations and negative consequences. They concluded that men like Roberto who use online porn to escape emotional discomfort are far more likely to experience related problems than men who go online primarily for sexual pleasure. This indicates that porn use (and other online sexual activities) are, for some users, a maladaptive coping strategy rather than a pleasure-seeking strategy.

This result is very much in line with what we know about other compulsive and addictive behaviors, including substance use disorders and . In fact, almost any addict of any type can tell you that the biggest trigger for use, regardless of the substance or behavior, is emotional discomfort—stress, anxiety, depression, , boredom, , , etc. In short, these individuals use not to feel pleasure but to escape emotional discomfort. It is a desire for emotional escape rather than a desire to “get high” that is the crux of all addictions and compulsive behavior.

Self-Soothing and

Usually when people think about the use of external experience as a way to numb their feelings and dissociate, they think about the use of substances like , , prescription , and illicit drugs. And without question, these are used by millions of people as a temporary escape. But self-soothing and self-regulating behaviors can be used in exactly the same fashion. In fact, this occurs rather often. Who among us hasn’t had a bad day at work, gone home, and turned on the TV for some mindless distraction? And if it’s not TV, it’s some other external source of escape, including but by no means limited to online sexual activity.

Unfortunately, the consistent attempt to find emotional regulation through hyper-stimulating and hyper-satiating substances and/or behaviors can for some people develop into a full-blown compulsivity or with clearly identifiable consequences. When this occurs, all sorts of problems may ensue—damaged relationships, trouble at work or in school, financial woes, declining physical health, anxiety, depression, shame, legal issues, and more.

As this recent study shows, with porn there is a clear link between repeated attempts at mood regulation and problematic usage. As such, the most effective way to treat problematic porn use—usage that results in negative life problems—initially involves not prescription medications and extensive , but a behavioral approach focused, in part, on the development of healthier coping mechanisms. Even though this is the approach that compulsivity and addiction-focused therapists have been taking with such clients for many years, it’s nice to have new research that backs this up.

I am senior vice president of national clinical development for Elements Behavioral Health; visit my website or follow me on Twitter @RobWeissMSW.