Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet

Johanna Lätth; Valdemar Landgren; Allison McMahan; Charlotte Sparre; Julia Eriksson; Kinda Malki; Elin Söderquist; Katarina Görts Öberg; Alexander Rozental; Gerhard Andersson; Viktor Kaldo; Niklas Långström; Christoffer Rahm

doi:10.1016/j.invent.2022.100590

Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material: A randomized placebo-controlled trial on the Darknet

Internet Interv. 2022 Nov 15:30:100590. doi: 10.1016/j.invent.2022.100590. eCollection 2022 Dec.

Authors

Johanna Lätth^{1

2}, Valdemar Landgren^{1

2}, Allison McMahan^{1

2}, Charlotte Sparre^{1

2}, Julia Eriksson³, Kinda Malki⁴, Elin Söderquist^{1

2}, Katarina Görts Öberg⁵, Alexander Rozental^{1

2}, Gerhard Andersson^{6

7}, Viktor Kaldo^{1

8

2}, Niklas Långström^{1

2}, Christoffer Rahm^{1

2}

Affiliations

¹ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, 7th floor, 113 64 Stockholm, Sweden.
² Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
³ Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 171 77 Stockholm, Sweden.
⁴ Department of Medicine, K2 Medicin, Solna, K2 KEP Askling Pasternak, Karolinska Institutet, 171 77 Stockholm, Sweden.
⁵ Department of Medicine, H7 Medicin, Huddinge, H7 Endokrinologi och diabetes Rydén, Karolinska Institutet, 171 77 Stockholm, Sweden.
⁶ Department of Behavioural Sciences and Learning, Linköping University, 58 183 Linköping, Sweden.
⁷ Department of Biomedical and Clinical Sciences, Linköping University, 58 183 Linköping, Sweden.
⁸ Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, 35 252 Växjö, Sweden.

Abstract

Introduction: The use of child sexual abuse material (CSAM) is an international public health and child protection challenge.

Objective: To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users.

Methods: We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019-2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre- to post-treatment, according to the Sexual Child Molestation Risk Assessment+.

Results: A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18-29 [49]; 30-39 [30]; 40-49 [15]; 50-59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre- to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate -0.25, 95 % CI, -0.46 to -0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events.

Conclusion: We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.

Keywords: Child sexual abuse; Internet-based intervention; Pedophilic disorder; Placebo; Preventive psychiatry.