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  • 1 Department of Psychology, Bowling Green State University, USA
  • 2 VISN 1 New England MIRECC, Edith Nourse Rogers Memorial Veterans Hospital, USA
  • 3 Department of Psychiatry, Yale University School of Medicine, USA
  • 4 VISN 1 New England MIRECC, VA Connecticut Healthcare System, USA
Open access

Background and aims

This study employed a newly developed questionnaire to evaluate whether men’s self-efficacy to avoid using pornography in each of 18 emotional, social, or sexually arousing situations was associated with either their typical frequency of pornography use or their hypersexuality.

Methods

Using an Internet-based data collection procedure, 229 male pornography users (Mage = 33.3 years, SD = 12.2) who had sought or considered seeking professional help for their use of pornography completed questionnaires assessing their situationally specific self-efficacy, history of pornography use, self-efficacy to employ specific pornography-reduction strategies, hypersexuality, and demographic characteristics.

Results

Frequency of pornography use was significantly negatively associated with level of confidence in 12 of the 18 situations. In addition, lower hypersexuality and higher confidence to employ pornography-use-reduction strategies were associated with higher confidence to avoid using pornography in each of the 18 situations. A principal axis factor analysis yielded three clusters of situations: (a) sexual arousal/boredom/opportunity, (b) intoxication/locations/easy access, and (c) negative emotions.

Discussion and conclusions

This questionnaire could be employed to identify specific high-risk situations for lapse or relapse and as a measure of treatment outcome among therapy clients, but we recommend further examination of the psychometric properties and clinical utility of the questionnaire in treatment samples. Because only one of the three clusters reflected a consistent theme, we do not recommend averaging self-efficacy within factors to create subscales.

Abstract

Background and aims

This study employed a newly developed questionnaire to evaluate whether men’s self-efficacy to avoid using pornography in each of 18 emotional, social, or sexually arousing situations was associated with either their typical frequency of pornography use or their hypersexuality.

Methods

Using an Internet-based data collection procedure, 229 male pornography users (Mage = 33.3 years, SD = 12.2) who had sought or considered seeking professional help for their use of pornography completed questionnaires assessing their situationally specific self-efficacy, history of pornography use, self-efficacy to employ specific pornography-reduction strategies, hypersexuality, and demographic characteristics.

Results

Frequency of pornography use was significantly negatively associated with level of confidence in 12 of the 18 situations. In addition, lower hypersexuality and higher confidence to employ pornography-use-reduction strategies were associated with higher confidence to avoid using pornography in each of the 18 situations. A principal axis factor analysis yielded three clusters of situations: (a) sexual arousal/boredom/opportunity, (b) intoxication/locations/easy access, and (c) negative emotions.

Discussion and conclusions

This questionnaire could be employed to identify specific high-risk situations for lapse or relapse and as a measure of treatment outcome among therapy clients, but we recommend further examination of the psychometric properties and clinical utility of the questionnaire in treatment samples. Because only one of the three clusters reflected a consistent theme, we do not recommend averaging self-efficacy within factors to create subscales.

Introduction

Compulsive sexual behaviors, including problematic viewing of pornography, may be conceptualized as behavioral addictions (Kraus, Voon, & Potenza, 2016). Pornography refers to written or pictorial material describing or showing sexually explicit images designed to elicit sexual arousal in the reader or viewer. Recreational use of pornography, most of which is currently viewed online, is common among both heterosexual and gay men but less common among women (Morgan, 2011; Ross, Mansson, & Daneback, 2012; Rosser et al., 2013; Traeen et al., 2014; Wright, 2013). For many individuals, viewing pornography may be a healthy sexual activity to facilitate solitary masturbation or enhance dyadic sexual activity (Kohut, Fisher, & Campbell, 2017; Weinberg, Williams, Kleiner, & Irizarry, 2010).

However, some individuals view pornography excessively, have difficulty controlling their use, report intense urges or cravings, experience social–occupational impairment, or use pornography to cope with anxiety or dysphoric moods (Gola & Potenza, 2016; Gola et al., 2017; Kor et al., 2014; Kraus & Rosenberg, 2014; Kraus, Meshberg-Cohen, Martino, Quinones, & Potenza, 2015; Kraus, Potenza, Martino, & Grant, 2015). In addition, frequent use of pornography has been associated with relationship dissatisfaction among coupled men and women (Bridges & Morokoff, 2011; Poulsen, Busby, & Galovan, 2013). Research by Reid et al. (2012) suggested that men report more problems with excessive use of pornography and other compulsive sexual behaviors (e.g., frequent anonymous/casual sex, paid sex, and compulsive masturbation) than women. Additional research is needed to better understand the psychological characteristics associatedwith problematic use of pornography, which, in turn, could aid in the identification of individuals experiencing problems and the development of therapies to help them reduce their use of pornography (Kraus, Martino, & Potenza, 2016).

Those who use pornography problematically may face obstacles as they attempt to quit using or reduce the frequency with which they view pornography. These obstacles include situations in which one is tempted to watch pornography (e.g., when sexually aroused, after drinking or drug use, or when feeling bored or sad). Coping with tempting situations could be influenced, in part, by one’s self-efficacy or self-confidence to avoid using pornography in such situations. Self-efficacy (Bandura, 1977) refers to confidence in one’s ability to engage in behaviors to reach desired goals. Self-efficacy beliefs are not simply predictions about what one will do, but are beliefs about what one is capable of doing (Maddux, 2009). Self-efficacy theory proposes that efficacy beliefs contribute to psychological adjustment, physical health, and efforts to change one’s behavior.

Over the past several decades, researchers have developed multiple self-report questionnaires designed to assess individuals’ self-efficacy to abstain from other addictive behaviors, such as drinking alcohol (Miller, Ross, Emmerson, & Todt, 1989; Oei, Hasking, & Young, 2005; Young, Oei, & Crook, 1991), using illicit drugs (Martin, Wilkinson, & Poulos, 1995; Sklar, Annis, & Turner, 1997), and gambling (Casey, Oei, Melville, Bourke, & Newcombe, 2008; Hodgins, Peden, & Makarchuk, 2004) in different situations (e.g., with friends, at favorite bars/pubs, feeling bored, and experiencing strong cravings/urges). Designed for use with both clinical and non-clinical samples, these self-efficacy questionnaires typically ask respondents to rate their confidence they could abstain from their preferred substance or avoid gambling using a scale from 0% to 100% in 10% increments. Research suggests that lower drinking refusal self-efficacy is related to increased alcohol consumption (Lee & Oei, 1993; Stevens, Littlefield, Blanchard, Talley, & Brown, 2016) and that problem gamblers report significantly lower gambling refusal self-efficacy than non-problem gamblers (Casey et al., 2008).

Although a questionnaire to assess situation-specific self-efficacy to avoid using pornography could be of value to researchers, clinicians, and clients, we could not find any research that examined whether individuals’ confidence to avoid using pornography varies across different circumstances. Therefore, we developed a questionnaire to measure pornography users’ confidence that they could avoid using pornography in 18 situations, such as when intoxicated, sexually aroused, exposed to pornographic material, and experiencing a variety of emotional states. To develop a pool of potential situations for the questionnaire, we modified nine contexts from the Drinking Refusal Self-Efficacy Questionnaire – Revised (Oei et al., 2005) that could also be applied to the use of pornography and added nine additional situations in which people who use pornography might have difficulty avoiding use.

Using a sample of men who had sought or had considered seeking therapy for their use of pornography, we tested whether self-efficacy to avoid using pornography in each of the 18 situations varied as a function of respondents’ typical weekly frequency of pornography use. Based on our assumption that those who use pornography more frequently would report less confidence in their ability to avoid using it in various circumstances, we expected that confidence would be lower among individuals using pornography more frequently, but we did not hypothesize whether the association would occur in all or only some of the 18 situations.

In addition, we expected that self-efficacy to avoid using pornography in these tempting situations would be negatively associated with a measure of hypersexuality (Reid, Garos, & Carpenter, 2011) and positively associated with self-efficacy to employ self-initiated pornography-use-reduction strategies (Kraus, Rosenberg, & Tompsett, 2015). Finally, we conducted a principal axis factor analysis to evaluate whether there were clusters of situations for which ratings of self-efficacy were highly correlated. Given the exploratory nature of this study, we did not propose a specific factor structure for the newly developed questionnaire.

Method

Participants

Using data from a larger investigation that assessed 1,298 participants’ self-efficacy to employ cognitive-behavioral strategies to reduce pornography use regardless of context (Kraus, Rosenberg, & Tompsett, 2015), we identified 83 men who had sought professional help previously and 186 men who were currently interested in seeking professional help for pornography use. In this study, we analyzed data only from this subset of 229 men, because we sought to evaluate self-efficacy to avoid using pornography in different contexts among individuals who might be experiencing problematic use as indicated by having contemplated or sought treatment. As Table 1 shows, the sample comprised relatively young, typically married/partnered men, about two thirds of whom self-identified as heterosexual. As Table 2 reveals, the sample comprised active users of pornography (80% viewed pornography at least weekly or more), and almost three fourths had attempted to quit using pornography at least once.

Table 1.

Demographic and sexual history characteristics of men who had sought or were interested in seeking treatment for pornography use (n = 229)

CharacteristicsM (SD) or %
Age33.3 (12.2)
Country where currently residing
 United States80%
 Other English-speaking countries  (Canada, UK, and Australia)20%
Highest education level completed
 Some high school/high-school diploma22%
 Some college or associated degree41%
 Bachelor’s degree25%
 Advanced degree (PhD, MD, and JD)12%
Relationship status
 Single and not dating35%
 Dating and not exclusive22%
 Engaged, married, and partnered43%
Living situation
 Alone21%
 With roommates16%
 With partner and/or family member63%
Sexual orientation
 Heterosexual66%
 Gay11%
 Bisexual17%
 Uncertain6%
Sexual activities engaged in during the last 30 daysa
 Solitary masturbation99%
 Vaginal intercourse48%
 Anal intercourse26%
 Oral sex (given and/or received)57%
 Mutual masturbation (given and/or  received)49%
Had contracted a sexually transmitted disease14%
Number of lifetime partners with whom engaged in vaginal or anal intercourse
 None12%
 1–324%
 4–614%
 7–108%
 11–2013%
 21+29%

Note. Proportions based on number answering that question. Some totals may not equal 100% due to rounding. SD: standard deviation.

Participants could mark more than one answer on this question.

Table 2.

Pornography history characteristics of men who had sought or were interested in seeking treatment for pornography use (n = 229)

CharacteristicsM (SD) or %
Frequency with which pornography watched during previous 6 months
 Several times a month or less20%
 1 day a week5%
 2–3 days a week21%
 4–6 days a week27%
 Daily or several times a day28%
Total amount of time watching pornography each week
 Pornography viewed less than once per week7%
 30 min or less28%
 Up to 1 hr23%
 Between 1 and 2 hr20%
 3 or more hours22%
Proportion of pornography viewing occasions on which participant masturbated to orgasm
 Did not masturbate to pornography3%
 Between one-fourth and three-fourths of the  occasions33%
 Every or almost every occasion64%
Typical methods used to access pornographya
 Internet: computer, laptop, tablet, and  smartphone99%
 Rented/purchased DVDs26%
 Magazines22%
 Erotic books18%
 Adult movie theatres14%
 Sex clubs20%
Who are you typically with when viewing pornography?a
 Alone (solitary activity)98%
 Romantic partner (e.g., boyfriend, girlfriend,  spouse, etc.)26%
 Friend(s)14%
 Online date (e.g., Craigslist, dating site, etc.)27%
 Other person(s) via online webcam21%
In the past, how many times have you attempted to quit completely using pornography?
 None26%
 1–3 times36%
 4+ times39%

Note. Proportions based on number answering that question. Some totals may not equal 100% due to rounding. SD: standard deviation.

Participants could mark more than one answer on this question.

Consistent with their having considered or sought professional assistance for their use of pornography, these 229 men had a significantly higher mean score on a measure of hypersexuality (M = 61.0, SD = 17.5) compared with the 1,069 men who had not considered or sought assistance [(M = 39.4, SD = 15.6), t(1, 295) = 18.61, p < .001, Cohen’s d = 1.30]. Similarly, the subset of 229 men had made more attempts to quit using pornography (0 attempts = 25.8%, 1–3 attempts = 35.8%, 4+ attempts = 38.4%) compared with the 1,069 men who had not sought assistance [(0 attempts = 76.9%, 1–3 attempts = 18.2%, 4+ attempts = 4.9%), χ2(1) = 296.89, p < .001, Cramer’s V = 0.48]. Third, the subset of 229 men watched pornography significantly more frequently (4+ days per week = 55.5%) than the 1,069 men who had not sought assistance [(4+ days per week = 42.4%), χ2(1) = 13.72, p < .001, Cramer’s V = 0.10]. These comparisons supported our decision to include in the analyses only that subset of men who reported having sought or considering seeking professional help for their use of pornography.

Procedure

Following approval of the project by the Institutional Review Board of Bowling Green State University (BGSU), we posted a short description of the study during June and July 2013 on several websites (88% of replies came from postings to Craigslist and 12% came from postings to Psych Research, Psych Hanover, and American Sexual Health Association). To be eligible, men had to be at least 18 years old and had to report having watched pornography at least once in the previous 6 months. As an incentive, we informed eligible participants that we would donate $2.00 for every completed survey to the American Cancer Society (up to a maximum of $150).

After they read the informed consent sheet, participants were provided the following definition of pornography: “Pornography is defined as any materials designed to cause or enhance sexual arousal or sexual excitement in the viewer. Such materials show clear and explicit sexual acts, such as vaginal intercourse, anal intercourse, oral sex, group sex, etc. Pornography does not include materials, such as underwear catalogs or materials containing men and women posing naked unless these images portray clear and explicit sexual acts.” We provided this definition so that respondents would know we considered pornography to be materials that displayed overt sexual acts. This definition of pornography was adapted from another investigation (Hald & Malamuth, 2008), and we have used it in two previous studies (Kraus & Rosenberg, 2014, 2016). Next, participants completed the self-efficacy questionnaire and additional measures assessing history of pornography use, self-efficacy to employ specific pornography-reduction strategies without reference to context, and hypersexuality.

Measures

Pornography-Use Avoidance Self-Efficacy Scale (PASS)

To develop the pool of situations for the PASS, we (a) modified nine contexts from the Drinking Refusal Self-Efficacy Questionnaire – Revised (Oei et al., 2005) that could also be applied to use of pornography and (b) generated nine additional situations in which one might have difficulty in avoiding the use of pornography (e.g., when sexually aroused, logging onto the Internet, driving by an adult bookstore or strip club) based on the first author’s clinical work with individuals seeking treatment for problematic pornography use at a specialty outpatient clinic that treats individuals for behavioral addictions. We used the Drinking Refusal Self-Efficacy Questionnaire – Revised as a model, because it has been evaluated in both community and clinical samples (Oei, Hasking, & Phillips, 2007; Oei et al., 2005; Young, Hasking, Oei, & Loveday, 2007). Participants rated on an 11-point scale [from 0% (“not at all confident”) to 100% (“completely confident”) in increments of 10%] as how confident they were that they could avoid using pornography in each of 18 situations. Specifically, the instructions stated, “We are not asking whether you WOULD avoid using pornography in these situations. Rather, we are asking how confident you are that you COULD avoid using pornography in these situations.” The instructions and situations are easily readable [Flesch–Kincaid Grade Level = 4.1; Flesch Reading Ease = 73.3 on a scale of 0 (most difficult) to 100 (easiest)]. See Appendix for a copy of the PASS.

Self-initiated Pornography Use-Reduction Self-Efficacy Questionnaire

This questionnaire measures individuals’ self-efficacy to use eight specific cognitive-behavioral strategies intended to reduce the frequency and duration of their pornography use without any reference to context (Kraus et al., 2015). Participants were instructed to rate their current confidence [on an 11-point scale from 0% (“not at all confident”) to 100% (“completely confident”) in increments of 10%] that they could use each of the listed strategies [e.g., “Set a limit of using porn no more than once per day;” “Before using porn, set a limit on the number of minutes that each porn session will last;” “Use porn only on pre-selected days of the week (e.g., only on weekends);” “Increase the number of days that you do not watch porn in between porn-watching days;” “Do something else for a while when you might use more porn than usual;” “Stay away from places where you might use more porn than usual;” “Do not keep a large stash of porn available (e.g., collection of DVDs, magazines, movies, pictures, or bookmarked websites on your computer and/or smartphone);” and “Record the date and the length of time you spent watching porn after each session”]. A total mean score was calculated by averaging confidence ratings across the eight items. Higher scores denote greater self-efficacy to employ these strategies. In the current sample, this scale had good scale score reliability (Cronbach’s α = .87).

Hypersexual Behavior Inventory

This 19-item questionnaire assesses characteristics of hypersexuality, such as engaging in sex in response to stress or dysphoric mood, repeated unsuccessful attempts to control sexual thoughts, urges, and behaviors, and sexually related impairment (Reid et al., 2011). Respondents rated how often they have experienced each sexual behavior (1 = “never,” 2 = “rarely,” 3 = “sometimes,” 4 = “often,” and 5 = “very often”). Scores on the inventory can range from 19 to 95, and a total score of 53 or higher is suggestive of hypersexuality (Reid et al., 2011, p. 44). In the current sample, the internal consistency reliability coefficients were excellent for the total score (α = .94), coping subscale (α = .91), consequences subscale (α = .87), and control subscale (α = .92).

Past professional help for pornography use

We measured men’s lifetime history of seeking assistance for pornography use by asking them to indicate “yes” or “no” to the following question: “Have you ever sought out professional help because of your use of pornography (by professional help we mean seen a counselor, therapist, psychologist, and psychiatrist)?”

Current interest in seeking professional help for pornography use

We assessed men’s current interest in seeking assistance for their pornography use by asking them to indicate “yes” or “no” to the following question: “Would you like to seek professional help for your pornography use but have not yet done so due to various reasons (e.g., shame, embarrassment, not sure where to go, etc.)?”

Demographic and Sexual History Questionnaire

We devised a questionnaire for this study to assess participants’ demographic background (e.g., age, country of residence, education level, relationship status, sexual orientation, and living situation) and sexual history (e.g., frequency of sexual activity within the previous 30 days, number of sexually transmitted infections, and number of lifetime sexual partners).

Pornography History Questionnaire

We devised a questionnaire for this study to assess participants’ pornography history characteristics (e.g., frequent use and typical method used to access pornography).

Statistical analyses

We used SPSS-21 (IBM Corp., Released 2012., IBM SPSS Statistics for Windows, version 23.0, Armonk, NY) to conduct one-way analyses of variance (ANOVAs) to examine context-specific self-efficacy to avoid using pornography. To evaluate whether there were clusters of situations for which ratings of self-efficacy were correlated, we conducted a principal axis factor analysis of the contexts using a direct oblimin rotation. We employed an oblique rotation because it produces simpler solutions, assumes that any factors will correlate, and provides estimates of correlations among factors (Fabrigar, Wegener, MacCallum, & Strahan, 1999).

Ethics

All procedures in this study were carried out in accordance with the Declaration of Helsinki. The Institutional Review Board of BGSU approved the study. All study participants were informed about the scope of the study and all provided informed consent.

Results

Ratings of self-efficacy by situation and frequency of pornography use

Although we conducted 18 separate one-way ANOVAs to evaluate the association of frequency of use and self-efficacy for each situation, we did not reduce the alpha for statistical significance because we were not testing a specific hypothesis and because a Bonferroni correction is considered overly conservative in this type of exploratory study (Bender & Lange, 2001). As Table 3 reveals, lower frequency of pornography use was significantly associated with higher self-efficacy for 12 of the 18 situations. Specifically, those who typically viewed pornography once per week or less had significantly higher self-efficacy they could avoid using pornography when alone at home, experiencing different types of emotional states (e.g., stress, boredom, and happiness), feeling sexually excited, wanting to masturbate, having opportunities to use, and having easy access to pornography. As shown in Table 3, effect sizes for all significant ANOVAs were low (partial η2 ranged from 0.05 to 0.14).

Table 3.

Means (SDs), F ratios, and effect sizes on the 18 items of the Pornography-Use Avoidance Self-Efficacy Scale by typical weekly pornography use

Typical weekly pornography use
VariableOnce a week or less M (SD)2–3 times a week M (SD)4+ times per week M (SD)F scorePartial η2
Alone in your house/apartment52.0 (33.4)a,b36.0 (33.7)a27.5 (32.5)b10.63**0.09
Feeling sad64.0 (32.4)c,d44.0 (30.7)c47.4 (37.5)d5.39**0.05
Alone in your workplace78.4 (32.9)78.5 (31.6)70.2 (37.1)1.580.01
You want to masturbate48.9 (33.1)e,f34.7 (32.6)e26.8 (28.5)f10.11**0.08
Feeling stressed63.3 (32.0)45.3 (27.6)39.3 (34.6)10.00**0.08
Upset with a romantic partner58.3 (37.4)55.1 (30.8)51.3 (38.2)0.740.01
Feeling sexually excited (i.e., horny)44.4 (34.7)g,h28.1 (31.5)g23.3 (30.7)h8.53**0.07
Feeling bored53.1 (34.4)i43.0 (32.4)j29.9 (30.7)i,j10.67**0.09
You are at a friend’s house81.5 (28.8)82.6 (28.7)79.5 (31.0)0.200.0
After driving by adult bookstores or strip clubs73.6 (34.1)71.9 (35.2)69.3 (36.2)0.310.0
You have been drinking alcohol65.3 (35.6)62.1 (32.6)55.6 (37.8)1.550.01
Someone offers you the opportunity to use it68.9 (33.9)k62.3 (36.2)49.9 (38.3)k5.62**0.05
You see other people using it66.9 (32.4)l57.5 (35.8)46.3 (38.6)l6.41**0.05
You are using other drugs besides alcohol67.3 (34.2)66.0 (33.9)61.1 (41.6)0.590.01
You use the Internet67.1 (28.3)m,n45.3 (30.1)m36.6 (32.1)n18.75**0.14
Something triggers you to want to use it49.8 (30.7)o,p32.3 (29.9)o30.4 (31.4)p7.88**0.07
Feeling happy81.8 (26.5)q73.7 (29.5)58.7 (33.9)q11.64**0.09
You are thinking about how good it would feel if you used it58.6 (35.4)45.5 (33.9)42.4 (35.1)4.15*0.04

Note. Partial η2 statistics were calculated for continuous variables where 0.2 = small, 0.13 = medium, and 0.26 = large effect. Superscript letters are used to denote means that are significantly different (p < .05) within each situation using least significant difference. For each situation, means that do not contain superscript letters are not significantly different (p < .05) from each other. SD: standard deviation.

*p < .05. **p < .01.

Associations of situational self-efficacy with hypersexuality and self-efficacy to employ self-initiated pornography-use-reduction

Next, we calculated Pearson’s product movement correlations to examine the relationships between mean self-efficacy to avoid using pornography in each of the 18 situations with hypersexuality (Reid et al., 2011) and with self-efficacy to employ self-initiated pornography-use-reduction strategies (Kraus, Rosenberg, et al., 2015). As the negative correlations in Table 4 (column 5) indicate, lower hypersexuality was associated with higher confidence to avoid using pornography in each of the 18 situations (r = −.25 to −.43, all p values <.001). As the positive correlations in Table 4 (column 6) reveal, higher confidence to employ pornography-use-reduction strategies was associated with higher confidence to avoid using pornography in each of these 18 situations (r = .35–.64, all p values <.001).

Table 4.

Factor loadings on the Pornography-Use Avoidance Self-Efficacy Scale and correlations of self-efficacy with hypersexuality and self-initiated pornography-use-reduction self-efficacy

How confident are you that you COULD AVOID using pornography when…Factor loadingsCorrelations with HBI, rCorrelations with SIP-URSQ, r
123
Alone in your house/apartment0.70−.32**.64**
You use the Internet0.66−.35**.61**
Something triggers you to want to use it0.78−.34**.57**
Feeling sexually excited (i.e., horny)0.89−.28**.53**
Feeling bored0.57−.35**.56**
You want to masturbate0.65−.27**.52**
Alone in your workplace0.49−.26**.39**
You are at a friend’s house0.64−.27**.35**
After driving by adult bookstores or strip clubs0.69−.30**.45**
Someone offers you the opportunity to use it0.80−.32**.52**
You see other people using it0.71−.32**.50**
You are using other drugs besides alcohol0.56−.25**.41**
You have been drinking alcohol0.58−.30**.44**
Upset with a romantic partner0.55−.39**.50**
Feeling stressed0.71−.41**.54**
Feeling sad0.58−.43**.57**
You are feeling happy−.29**.52**
You are thinking about how good it would feel if you used it0.490.43−.33**.56**
Eigenvalue8.071.961.21
Percent variance44.8510.866.71
Mean inter-item correlation0.610.450.58

Note. Item loadings in boldface indicate loading on the factor. Rating scale ranged from 0% (“not at all confident”) to 100% (“completely confident”) in 10% increments. Factor loadings below 0.40 were removed from the table for clarity of presentation. The current principal axis factor analysis used a direct oblimin (oblique) rotation. HBI: Hypersexual Behavior Inventory; SIP-URSQ: Self-initiated Pornography-Use-Reduction Strategies Self-Efficacy Questionnaire.

p < .001.

Exploratory factor analysis

A principal axis factor analysis of self-efficacy in the 18 situations identified three factors with eigenvalues greater than 1.0. The first factor had an eigenvalue of 8.07 and accounted for 44.9% of the variance; the second factor had an eigenvalue of 1.96 and accounted for 10.9% of the variance; and the third factor had an eigenvalue of 1.21 and accounted for 6.7% of the variance.

Examination of the pattern matrix in Table 4 (column 2) reveals six situations that loaded 0.50 or higher on the first factor. These situations do not reflect any unified theme, but include situations in which the person experiences sexual arousal (feeling horny; wanting to masturbate; and something triggers desire), feels bored, and has various opportunities to use pornography (alone in own home and using the Internet). The second cluster was composed of seven situations, all of which loaded 0.49 or higher on this factor (Table 4, column 3). These situations include three types of contexts, one reflecting intoxication (using drugs or alcohol), a second reflecting locations in which one could be tempted to view pornography (alone at workplace; at friend’s house), and a third reflecting easy access to pornography (driving by an adult bookstore; offered an opportunity to use pornography; and seeing others viewing pornography). The third cluster was composed of three situations, all of which loaded 0.55 or higher on this factor (Table 4, column 4). These situations reflect negative emotions (feeling stressed; feeling sad; and feeling upset with romantic partner). One of the remaining two situations (feeling happy) did not load above 0.40 on any of the three factors and the other remaining situation (thinking about how good it would feel to use pornography) cross-loaded on two factors.

Discussion

Based on previous research showing that self-efficacy to avoid drinking, using drugs, and gambling varies by context and frequency of engaging in the addictive behavior (Casey et al., 2008; Oei et al., 2005), we tested whether pornography users’ confidence that they could avoid using pornography varied in each of 18 situations as a function of the typical frequency with which they used pornography. To examine this question, we developed the PASS and administered the questionnaire to men who had sought or considered seeking professional help for their use of pornography.

Those who used pornography once per week or less reported significantly higher self-efficacy in situations such as feeling sexually aroused, being alone at home, using the Internet, and experiencing sadness, boredom, or stress. However, even those men who used pornography once per week or less reported relatively low self-confidence (approximately 50% or lower on average) that they could avoid using pornography when they felt sexually excited, wanted to masturbate, or something triggered them to want to use it. The present findings also suggest that these men had notably high confidence (average self-efficacy scores 70% or higher) that they could avoid using pornography at their workplace, at a friend’s house, and after driving by an adult bookstore or strip club, regardless of how often they typically used pornography each week.

As a follow-up analysis, we also conducted a principal axis factor analysis to determine whether there were clusters of situations for which ratings of self-efficacy were correlated. Because only one of the three clusters reflected a consistent theme (relating to negative emotions), we do not recommend averaging self-efficacy within or across clusters composed of different types of situations. Instead, we recommend the PASS to be used to identify each of the specific situations in which clients or research participants perceive they would have difficulty avoiding use of pornography.

In addition to examining whether self-efficacy varied by context, we found that confidence to employ specific strategies to reduce one’s use of pornography (Kraus, Rosenberg, & Tompsett, 2015) was significantly positively correlated with self-efficacy to avoid using pornography in each of the 18 situations. However, the size and range of coefficients, which varied from 0.35 to 0.64 across the 18 situations, indicates that assessing how confident these men felt about avoiding use of pornography in each of these contexts was associated only moderately with their confidence to employ specific strategies to reduce how often and for how long they use pornography. This suggests that knowing how confident men are that they can employ specific strategies is different from knowing their confidence that they can refrain from use in specific situations. In addition, because one of the underlying characteristics of hypersexuality is difficulty controlling one’s sexual behavior (Kafka, 2010), it lends credibility to the ratings of self-efficacy that scoring higher on hypersexuality was associated with having lower self-efficacy to avoid using pornography when tempted by external or internal cues.

Theoretically, self-efficacy (Bandura, 1977) may be construed as both a relatively stable trait-like sense of confidence in one’s ability to avoid pornography and a waxing and waning state that may vary considerably as a function of one’s mood, the intensity of craving to use pornography, the amount of time that has passed since one last used pornography, and whether one is trying to stop using pornography. Additional research could evaluate the stability over time of self-efficacy in high-risk situations, whether craving or deprivation is associated with one’s confidence to avoid using pornography in these various contexts, and the relationship of avoidance self-efficacy with compulsive use.

Limitations

This study has several limitations. First, the use of self-report measures depends on respondents’ recollection of and their willingness to disclose their sexual and pornography-related behavior. However, use of an online data collection procedure and the promise of anonymity may have encouraged disclosure rather than underreporting of sexual behaviors by participants. Second, our findings may not generalize to individuals who do not use the Internet to access pornography (e.g., those concerned with privacy issues or those without Internet access). Third, the 18 situations on the PASS are not an exhaustive list of contexts in which one might use pornography. Therefore, clinicians and researchers might include an open-ended question to measure self-efficacy in additional situations (e.g., after seeing an online advertisement for pornography, when one’s sexual partner is currently unavailable, and when one is having difficulty becoming sexually aroused) to enhance the content validity of the scale. In addition, because this is the first study to evaluate context-specific avoidance self-efficacy, we are unable to compare our findings with those obtained from other samples of treated or untreated pornography users, or among those wishing to abstain completely from pornography. Another potential limitation was the exclusive recruitment of men, primarily because more men use pornography than women (Morgan, 2011; Ross et al., 2012; Rosser et al., 2013; Traeen et al., 2014; Wright, 2013) and because men are more likely to seek treatment for problematic use of pornography (Kraus, Potenza, et al., 2015; Reid et al., 2012). We recommend additional research with women who are contemplating or seeking treatment for problematic use of pornography.

Conclusions

These limitations notwithstanding, we believe there are several possible applications of the scale. First, assessing clients’ confidence that they could avoid using pornography in different contexts could enhance treatment planning and relapse prevention training. Depending on the specific situations they identify as difficult, clients could be taught and encouraged to employ self-control coping skills (Kraus, Rosenberg, et al., 2015) to help them avoid using pornography in situations where they have little confidence. Second, the questionnaire could be used as a therapy outcome measure to evaluate the degree to which therapeutic interventions increase a client’s self-confidence to avoid using pornography. Third, researchers could use the questionnaire to test hypotheses about the associations of avoidance self-efficacy in specific situations with personality (e.g., non-sexual sensation-seeking or impulsivity) and environmental factors (e.g., accessibility of Internet pornography; time spent alone vs. with others), which may predict problematic use of pornography.

Authors’ contribution

SWK (Principal Investigator) and HR contributed to the initial study design, data collection, interpretation of results, and drafted the original manuscript. SM, MNP, and CN contributed to the interpretation of the results, manuscript development, and final draft approval. SWK had final responsibility for the decision to submit for publication. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of interest

The authors declare no conflict of interest regarding this article.

References

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    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Crossref
    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Crossref
    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
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    • Crossref
    • Search Google Scholar
    • Export Citation
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    • Search Google Scholar
    • Export Citation
  • Martin, G. W., Wilkinson, D. A., & Poulos, C. X. (1995). The Drug Avoidance Self-Efficacy Scale. Journal of Substance Abuse, 7(2), 151163. doi:10.1016/0899-3289(95)90001-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miller, P. J., Ross, S. M., Emmerson, R. Y., & Todt, E. H. (1989). Self-efficacy in alcoholics: Clinical validation of the SituationalConfidence Questionnaire. Addictive Behaviors, 14(2), 217224. doi:10.1016/0306-4603(89)90052-X

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    • Crossref
    • Search Google Scholar
    • Export Citation
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Appendix: Pornography-Use Avoidance Self-Efficacy Scale (PASS)

Directions: Please indicate your current confidence on a scale from 0% (“not at all confident”) to 100% (“completely confident”) that you COULD avoid using pornography in each of the following listed situation:

We are not asking whether you WOULD avoid using pornography in these situations. Rather, we are asking how confident you are that you COULD avoid using porn in these situations.

0% (not at all confident) to 100% (completely confident)
How confident you are that you COULD…
1. Avoid using porn when alone in your house/apartment________%
2. Avoid using porn when alone in your workplace________%
3. Avoid using porn when you are at a friend’s house________%
4. Avoid using porn when feeling stressed________%
5. Avoid using porn when feeling sexually excited (e.g., horny)________%
6. Avoid using porn when feeling bored________%
7. Avoid using porn when upset with a romantic partner________%
8. Avoid using porn when feeling sad________%
9. Avoid using porn when you plan to masturbate________%
10. Avoid using porn when feeling happy________%
11. Avoid using porn after driving by adult bookstores and strip clubs________%
12. Avoid using porn when you are thinking about how good it would feel if you used it________%
13. Avoid using porn when you have been drinking alcohol________%
14. Avoid using porn when you have been using other drugs besides alcohol________%
15. Avoid using porn when someone offers you the opportunity to use it________%
16. Avoid using porn when you see other people using it________%
17. Avoid using porn when you log into the Internet________%
18. Avoid using porn when something “triggers” you to want to use it________%

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191215. doi:10.1037/0033-295X.84.2.191

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bender, R., & Lange, S. (2001). Adjusting for multiple testing—When and how? Journal of Clinical Epidemiology, 54(4), 343349. doi:10.1016/S0895-4356(00)00314-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bridges, A. J., & Morokoff, P. J. (2011). Sexual media use and relational satisfaction in heterosexual couples. Personal Relationships, 18(4), 562585. doi:10.1111/j.1475-6811.2010.01328.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Casey, L. M., Oei, T. P., Melville, K. M., Bourke, E., & Newcombe, P. A. (2008). Measuring self-efficacy in gambling: The Gambling Refusal Self-Efficacy Questionnaire. Journal of Gambling Studies, 24(2), 229246. doi:10.1007/s10899-007-9076-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4(3), 272299. doi:10.1037/1082-989X.4.3.272

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gola, M., & Potenza, M. (2016). Paroxetine treatment of problematic pornography use: A case series. Journal of Behavioral Addictions, 5(3), 529532. doi:10.1556/2006.5.2016.046

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, B., Wypych, M., Makeig, S., Potenza, M. N., & Marchewka, A. (2017). Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology, 42(10), 20212031. doi:10.1038/npp.2017.78

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hald, G. M., & Malamuth, N. M. (2008). Self-perceived effects of pornography consumption. Archives of Sexual Behavior, 37(4), 614625. doi:10.1007/s10508-007-9212-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hodgins, D., Peden, N., & Makarchuk, K. (2004). Self-efficacy in pathological gambling treatment outcome: Development of a Gambling Abstinence Self-Efficacy Scale (GASS). International Gambling Studies, 4(2), 99108. doi:10.1080/14459790412331296947

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377400. doi:10.1007/s10508-009-9574-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kohut, T., Fisher, W. A., & Campbell, L. (2017). Perceived effects of pornography on the couple relationship: Initial findings of open-ended, participant-informed, “bottom-up” research. Archives of Sexual Behavior, 46(2), 585602. doi:10.1007/s10508-016-0783-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kor, A., Zilcha-Mano, S., Fogel, Y. A., Mikulincer, M., Reid, R. C., & Potenza, M. N. (2014). Psychometric development of the Problematic Pornography Use Scale. Addictive Behaviors, 39(5), 861868. doi:10.1016/j.addbeh.2014.01.027

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S., & Rosenberg, H. (2014). The Pornography Craving Questionnaire: Psychometric properties. Archives of Sexual Behavior, 43(3), 451462. doi:10.1007/s10508-013-0229-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Martino, S., & Potenza, M. N. (2016). Clinical characteristics of men interested in seeking treatment for use of pornography. Journal of Behavioral Addictions, 5(2), 169178. doi:10.1556/2006.5.2016.036

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Meshberg-Cohen, S., Martino, S., Quinones, L. J., & Potenza, M. N. (2015). Treatment of compulsive pornography use with naltrexone: A case report. The American Journal of Psychiatry, 172(12), 12601261. doi:10.1176/appi.ajp.2015.15060843

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Potenza, M. N., Martino, S., & Grant, J. E. (2015). Examining the psychometric properties of the Yale-Brown Obsessive-Compulsive Scale in a sample of compulsive pornography users. Comprehensive Psychiatry, 59, 117122. doi:10.1016/j.comppsych.2015.02.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., & Rosenberg, H. (2016). Lights, camera, condoms! Assessing college men’s attitudes toward condom use in pornography. Journal of American College Health, 64(2), 139146. doi:10.1080/07448481.2015.1085054

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Rosenberg, H., & Tompsett, C. J. (2015). Assessment of self-efficacy to employ self-initiated pornography use-reduction strategies. Addictive Behaviors, 40, 115118. doi:10.1016/j.addbeh.2014.09.012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kraus, S. W., Voon, V., & Potenza, M. N. (2016). Should compulsive sexual behavior be considered an addiction? Addiction, 111(12), 20972106. doi:10.1111/add.13297

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lee, N. K., & Oei, T. P. (1993). The importance of alcohol expectancies and drinking refusal self-efficacy in the quantity and frequency of alcohol consumption. Journal of Substance Abuse, 5(4), 379390. doi:10.1016/0899-3289(93)90006-W

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Maddux, J. E. (2009). Self-efficacy: The power of believing you can. In S. J. Lopez & C. R. Snyder (Eds.), Oxford handbook of positive psychology (pp. 335343). New York, NY: Oxford University Press.

    • Search Google Scholar
    • Export Citation
  • Martin, G. W., Wilkinson, D. A., & Poulos, C. X. (1995). The Drug Avoidance Self-Efficacy Scale. Journal of Substance Abuse, 7(2), 151163. doi:10.1016/0899-3289(95)90001-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Miller, P. J., Ross, S. M., Emmerson, R. Y., & Todt, E. H. (1989). Self-efficacy in alcoholics: Clinical validation of the SituationalConfidence Questionnaire. Addictive Behaviors, 14(2), 217224. doi:10.1016/0306-4603(89)90052-X

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Morgan, E. M. (2011). Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction. Journal of Sex Research, 48(6), 520530. doi:10.1080/00224499.2010.543960

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Oei, T. P., Hasking, P., & Phillips, L. (2007). A comparison of general self-efficacy and drinking refusal self-efficacy in predicting drinking behavior. The American Journal of Drug and Alcohol Abuse, 33(6), 833841. doi:10.1080/00952990701653818

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Oei, T. P., Hasking, P. A., & Young, R. M. (2005). Drinking Refusal Self-Efficacy Questionnaire – Revised (DRSEQ-R): A new factor structure with confirmatory factor analysis. Drug and Alcohol Dependence, 78(3), 297307. doi:10.1016/j.drugalcdep.2004.11.010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Poulsen, F. O., Busby, D. M., & Galovan, A. M. (2013). Pornography use: Who uses it and how it is associated with couple outcomes. Journal of Sex Research, 50(1), 7283. doi:10.1080/00224499.2011.648027

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., Cooper, E. B., McKittrick, H., Davtian, M., & Fong, T. (2012). Report of findings in a DSM-5 Field Trial for hypersexual disorder. The Journal of Sexual Medicine, 9(11), 28682877. doi:10.1111/j.1743-6109.2012.02936.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient sample of men. Sexual Addiction & Compulsivity, 18(1), 3051. doi:10.1080/10720162.2011.555709

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ross, M. W., Mansson, S. A., & Daneback, K. (2012). Prevalence, severity, and correlates of problematic sexual Internet use in Swedish men and women. Archives of Sexual Behavior, 41(2), 459466. doi:10.1007/s10508-011-9762-0

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  • Rosser, B. R. S., Smolenski, D. J., Erickson, D., Iantaffi, A., Brady, S. S., Grey, J. A., Hald, G. M., Horvath, K. J., Kilian, G., Træen, B., & Wilkerson, J. M. (2013). The effects of gay sexually explicit media on the HIV risk behavior of men who have sex with men. AIDS and Behavior, 17(4), 14881498. doi:10.1007/s10461-013-0454-8

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  • Impact Factor (2018): 4.873
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Language: English

Founded in 2011
Publication: One volume of four issues annually

Publishing Model: Gold Open Access
Article processing charge: EUR 850.00 (as for discounts, please, check Author's instructions

Publication Programme: 2020. Vol. 9.

Senior editors

Editor(s)-in-Chief: Zsolt Demetrovics

Assistant Editor(s): Csilla Ágoston

Associate Editors

  • Judit Balázs (ELTE Eötvös Loránd University, Hungary)
  • Joel Billieux (University of Lausanne, Switzerland)
  • Matthias Brand (University of Duisburg-Essen, Germany)
  • Anneke Goudriaan (University of Amsterdam, The Netherlands)
  • Daniel King (Flinders University, Australia)
  • Ludwig Kraus (IFT Institute for Therapy Research, Germany)
  • Anikó Maráz (Humboldt University of Berlin, Germany)
  • Astrid Müller (Hannover Medical School, Germany)
  • Marc N. Potenza (Yale University, USA)
  • Hans-Jurgen Rumpf (University of Lübeck, Germany)
  • Attila Szabó (ELTE Eötvös Loránd University, Hungary)
  • Róbert Urbán (ELTE Eötvös Loránd University, Hungary)
  • Aviv M. Weinstein (Ariel University, Israel)

Editorial Board

  • Max W. Abbott (Auckland University of Technology, New Zealand)
  • Elias N. Aboujaoude (Stanford University School of Medicine, USA)
  • Hojjat Adeli (Ohio State University, USA)
  • Alex Baldacchino (University of Dundee, United Kingdom)
  • Alex Blaszczynski (University of Sidney, Australia)
  • Kenneth Blum (University of Florida, USA)
  • Henrietta Bowden-Jones (Imperial College, United Kingdom)
  • Beáta Bőthe (University of Montreal, Canada)
  • Wim van den Brink (University of Amsterdam, The Netherlands)
  • Gerhard Bühringer (Technische Universität Dresden, Germany)
  • Sam-Wook Choi (Eulji University, Republic of Korea)
  • Damiaan Denys (University of Amsterdam, The Netherlands)
  • Jeffrey L. Derevensky (McGill University, Canada)
  • Naomi Fineberg (University of Hertfordshire, United Kingdom)
  • Marie Grall-Bronnec (University Hospital of Nantes, France)
  • Jon E. Grant (University of Minnesota, USA)
  • Mark Griffiths (Nottingham Trent University, United Kingdom)
  • Heather Hausenblas (Jacksonville University, USA)
  • Tobias Hayer (University of Bremen, Germany)
  • Susumu Higuchi (National Hospital Organization Kurihama Medical and Addiction Center, Japan)
  • David Hodgins (University of Calgary, Canada)
  • Eric Hollander (Albert Einstein College of Medicine, USA)
  • Jaeseung Jeong (Korea Advanced Institute of Science and Technology, Republic of Korea)
  • Yasser Khazaal (Geneva University Hospital, Switzerland)
  • Orsolya Király (Eötvös Loránd University, Hungary)
  • Emmanuel Kuntsche (La Trobe University, Australia)
  • Hae Kook Lee (The Catholic University of Korea, Republic of Korea)
  • Michel Lejoyeux (Paris University, France)
  • Anikó Maráz (Eötvös Loránd University, Hungary)
  • Giovanni Martinotti (‘Gabriele d’Annunzio’ University of Chieti-Pescara, Italy)
  • Frederick Gerard Moeller (University of Texas, USA)
  • Daniel Thor Olason (University of Iceland, Iceland)
  • Nancy Petry (University of Connecticut, USA)
  • Bettina Pikó (University of Szeged, Hungary)
  • Afarin Rahimi-Movaghar (Teheran University of Medical Sciences, Iran)
  • József Rácz (Hungarian Academy of Sciences, Hungary)
  • Rory C. Reid (University of California Los Angeles, USA)
  • Marcantanio M. Spada (London South Bank University, United Kingdom)
  • Daniel Spritzer (Study Group on Technological Addictions, Brazil)
  • Dan J. Stein (University of Cape Town, South Africa)
  • Sherry H. Stewart (Dalhousie University, Canada)
  • Attila Szabó (Eötvös Loránd University, Hungary)
  • Ferenc Túry (Semmelweis University, Hungary)
  • Alfred Uhl (Austrian Federal Health Institute, Austria)
  • Johan Vanderlinden (University Psychiatric Center K.U.Leuven, Belgium)
  • Alexander E. Voiskounsky (Moscow State University, Russia)
  • Kimberly Young (Center for Internet Addiction, USA)

Dr. Zsolt Demetrovics
Institute of Psychology, ELTE Eötvös Loránd University
Address: Izabella u. 46. H-1064 Budapest, Hungary
Phone: +36-1-461-2681
E-mail: jba@ppk.elte.hu

Including gaming disorder in the ICD-11: The need to do so from a clinical and public health perspective

Commentary on: A weak scientific basis for gaming disorder: Let us err on the side of caution (van Rooij et al., 2018)