From the NARTH Collected Papers, 2002

A. Dean Byrd, Ph.D., MBA, MPH

"Though a thousand times a thousand men are conquered by the one in battle, the one who conquers himself is truly a master of the battle." Gotama Buddha, Dhammapada, 103

Introduction

Sexual addictions seem to be center stage for many of the men that I treat. Indeed some of the at-risk characteristics cited by Jeffrey Robinson are perhaps predisposing to addictions: emotional sensitivity, an unusual degree of introspection (preoccupation with being different) and perfectionism. The strength of some of the sexual addictions as determined by the sheer number of partners and the preoccupation with sexual fantasies seem to approximate drug addictions. One of the better treatment models is the psycho-physiological model developed by Jeffrey Schwartz in 1996. The focus of the model is on changing the way your brain works.

First, it is important to talk about sexual addiction as an obsessive-compulsive disorder. What is the difference between an Axis I and an Axis II Obsessive-Compulsive disorder? Of course, it is whether or not the person is distressed by the disorder. In the Axis I Disorder, the individual feels the distress and in the Axis II Disorder, others feel the distress! That is, in the Axis II Disorder, there is minimal distress if any. Please note that this model does not work well with Axis II Disorders. I am not sure what model does. Therefore, it is important to ascertain whether or not the individual is distressed by the sexual addiction. You may have to complete significant therapeutic work prior to introducing this model.

Definitions

Let's consider some definitions first. Obsessions are defined as unwanted distressful thoughts and mental images. From the Latin word meaning to besiege, the unwanted thought does just that: it besieges you. These thoughts create anxiety, distress and havoc. Compulsions are acts or behaviors that an individual performs over and over again to somehow allay the anxieties caused by the obsessions. Interesting enough, performing the behavior actually increases the obsessions. The behavior does eliminate the obsessions. Frequently, the individual who acts out the compulsive behavior ends with heightened obsessions accompanied by rituals.

Key Points

There is a relationship between what we think and do and our brains. Psychology and biology have long suspected this, but only recently have they found support in the scientific literature: functionalism causes structuralism. Translated this means that sexual addiction like other obsessive-compulsive behaviors causes a biochemical response in the brain. Recent research has suggested that you can actually change how your brain responds to thoughts and urges. You can physically change the way your brain works.

The following points are important to remember in our discussion today:

• Sexual addiction is related to a biochemical imbalance in the brain
• Obsessions are intrusive, unwanted thoughts
• Compulsions are repetitive, unwanted behaviors
• Doing the compulsions makes the obsessive thoughts worse
• Changing your behavior creates experiences that change your brain chemistry

Common Preconditions

The following preconditions to sexual addictions find substantial support in the scientific literature:

• A high probability of a chaotic family of origin where damage to self-worth has negatively impacted both intimacy (how to be close) and dependency (whom to trust)
• A history of abuse - emotional, physical and/or sexual with the accompanying consequences of feelings of unworthiness and abandonment
• Addictions, sexual and other types, among family members

The Addiction Cycle

The addiction cycle begins with a preoccupation where the individual's mood seems laced with thoughts of sex. Bordering a trance-like state, the individual begins an obsessive search for sexual stimulation. The second phase of the cycle is a ritualization process. There is a ritualized routine leading up to the sexual behavior approximating a kind of self-grooming. This ritual intensifies the preoccupation, adding arousal and excitement. The third phase is the acting out behavior itself. This compulsive sexual behavior is the actual end goal of the preoccupation and ritualization. Sexual addicts feel compelled to perform the sexual behavior. The last phase of the cycle is despair. This is the feeling of utter hopelessness over the behavior. The signs of addiction are many but typically include the following:

• Pattern of out-of-control behavior
• Severe consequences due to sexual behavior
• Inability to stop the acting out despite adverse consequences
• Persistent pursuit of self-destructive or high-risk behavior
• Ongoing desire or effort to limit sexual behavior
• Sexual obsessions and fantasy as a primary coping strategy
• Increasing numbers of sexual experiences because the current level is no longer adequate
• Severe mood shifts around sexual activity
• Inordinate amount of time spend obtaining sexual experiences
• Neglect of important social, occupational and/or recreational activities because of sexual behavior

Treatment Described

The treatment approach was developed by Dr. Jeffrey Schwartz at UCLA. His book, Brain Lock, is based on the idea that addictions result in the brain being stuck and unable to shift. His approach is designed to assist the brain to shift. It should be noted that Dr. Schwartz has been able to use brain scans to document changes in the brain before and after the treatment process.

The stages in this process model are described as follows:

• Relabel. In this stage you label the intrusive thought or urge to do troublesome behavior as exactly what it is-an obsessive thought. You clearly recognize the reality of the situation. Don't be tricked by the feelings. Begin by verbalizing, "I have an obsession, a compulsive urge. It's bothering me again." Recognition involves admission and can actually help curb the acting out process.
• Reattribution. Oftentimes, here you can reflect what you have learned from therapy. The urge may have emerged from unmet needs or unresolved issues, many of which were noted in the preconditions. A phrase often used by patients is that such urges are often distorted attempts to meet legitimate needs.
• Refocus. Don't try to disguise the problem but turn your attention to more constructive thoughts and behaviors. Just describe the urges for what they really are: false messages provided by your brain. Refocus your attention on other behaviors-do something useful and positive. By performing an alternative, wholesome behavior, you are actively repairing the "gear box" in your brain. Once you have learned to refocus in a consistent way, the next stage in this process will naturally follow.
• Revalue. You revalue the thoughts and urges when they arise. You will then learn to devalue the unwanted thoughts as soon as they arise.