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What is a Sexual Addiction powerpoint 06052012

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What is a Sexual Addiction powerpoint 06052012

  1. 1. Yvette Gates, Mdiv, LPC & Nadia G. Barnett, LPC PhD students in Counselor Education & Supervision Mercer University College of Continuing and Professional Studies Department of Counseling and Human Sciences Created by Nadia Barnett & Yvette Gates 4/2012
  2. 2. Overview  Introduction  How sexual addictions can progress  Types of sexual addictions: non threatening vs threatening  Types of current effective treatment options  Recommendations for future research & counselor education  Conclusion Created by Nadia Barnett & Yvette Gates 4/2012
  3. 3.  Sexuality is dependent on many factors, including individual and relationship variables, societal values, cultural [morals], ethnic and religious beliefs (Kaplan & Kruegar, 2010). Created by Nadia Barnett & Yvette Gates 4/2012
  4. 4. What comes to mind when you think of the following?  “sexual addiction”  “hypersexuality”  “problematic sexual behaviors”  “sexual behavior disorder”  “sexually compulsive behaviors”  “sexual compulsivity”  “out-of-control sexual behaviors” Created by Nadia Barnett & Yvette Gates 4/2012
  5. 5. Lacks of categorization of sexual behaviors Created by Nadia Barnett & Yvette Gates 4/2012
  6. 6. DSM-IV-TR contains …  Current available diagnoses under the section of “Sexual Disorders”  Sexual dysfunctions  Sexual desire disorders  Sexual arousal disorders  Orgasmic disorders  Sexual pain disorders  Sexual dysfunctions due to a general medical condition  Paraphilias * Created by Nadia Barnett & Yvette Gates 4/2012
  7. 7.  In any discussion of whether a sexual behavior is problematic or not, it is critical to attempt to define what constitutes [a sexual addiction] problem for self or others (Kaplan & Kruegar, 2010).  For the purpose of this presentation, the term ‘sexual addiction’ will be used and has been defined as:  A progressive compulsive or obsessive behavior that occurs in response to an increase in anxiety, characterized by an indirect or direct sexual act. Created by Nadia Barnett & Yvette Gates 4/2012
  8. 8. Academic literature connects sexual addiction with …  Childhood attachment trauma on sex addicts (Katehakis, 2009)  Direct or witnessed sexual, physical, or emotional abuse (Katehakis, 2009)  Poorer ability in self regulation (Billingham, Finn, Monahan, Perera, & Reece, 2009)  Sexual behaviors that may place one at high risk for contracting HIV/AIDS or a sexually transmitted disease (STD) (Cole, Dogde, Reece, & Sandfort, 2004)  Food addiction (Power, 2005)  Substance and/or alcohol addiction (Katehakis, 2009) Created by Nadia Barnett & Yvette Gates 4/2012
  9. 9.  The literature regarding sexual addiction indicates that a person’s particular sexual addiction type can manifest, change, and progress through three phases.  Obsessions  Compulsions  Impulsions Created by Nadia Barnett & Yvette Gates 4/2012
  10. 10. Obsessions  One has “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress” (Giugliano, 2009)  The individual with obsessions usually attempts to  ignore or suppress such thoughts or impulses  to neutralize them with some other thought or action [such as masturbation, voyeurism, or the use of pornography] Created by Nadia Barnett & Yvette Gates 4/2012
  11. 11. Compulsions  One is demonstrating “repetitive behaviors or mental acts of which the goal is to prevent or reduce anxiety or distress” (Giugliano, 2009).  The person is driven to perform the compulsion to reduce the distress that accompanies an obsession [which may manifest in either nonthreatening, such as masturbation, fetishism, voyeurism, or the use of pornography; or threatening sexual addiction types such as frotteurism] Created by Nadia Barnett & Yvette Gates 4/2012
  12. 12. Impulsions  “the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or others” through physical contact (Giugliano, 2009).  These characteristics may fit individuals who are child molesters or serial murderers; examples of the threatening types of sexual addiction are exhibitionism, frotteurism, pedophilia, and rape Created by Nadia Barnett & Yvette Gates 4/2012
  13. 13. Nonthreatening Types  Defined here as a sexual addiction that either has no physical contact with any person(s) regardless of age or physical contact with persons of sexual consenting age.  Types: Created by Nadia Barnett & Yvette Gates 4/2012 •masturbation •pornography •frequent visits to strip clubs •cyber sex •phone sex •simultaneous or repeated sexual affairs •fetishism * •Voyeurism *
  14. 14. Nonthreatening Types (cont.)  Masturbation, Pornography, Frequent visits to strip clubs, and Phone sex – (in this context) cause clinically significant distress or impairment in social, occupational, economical, or other important areas of functioning (Kaplan & Krueger, 2010).  Cybersex - users report getting further and further into the bizarre, losing interest in their previous sexual activities and partners, and seeking more and more unusual experiences (Schneider, 2000). Created by Nadia Barnett & Yvette Gates 4/2012
  15. 15. Nonthreatening Types (cont.)  Simultaneous sexual affairs  a sexual interaction with more than one person at the same time  Repeated sexual affairs  sexual interaction that occurs at different times but on a frequent basis Both of the above can occur with known partners and unknown partners (through the use of escort services, massage parlors, prostitutes, or some other anonymous person) Created by Nadia Barnett & Yvette Gates 4/2012
  16. 16. Nonthreatening Types (cont.)  Defined by the DSM-IV-TR:  Fetishism – over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments) (American Psychiatric Association (APA), 2000)  Voyeurism - over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity (APA, 2000). Created by Nadia Barnett & Yvette Gates 4/2012
  17. 17. Threatening Types  Defined here as a type of sexual addiction that involves physical contact with a child, adolescent, or non- consenting adult.  Types Created by Nadia Barnett & Yvette Gates 4/2012 •Rape •Exhibitionism * •Frotteurism * •Pedophilia * •Sexual sadism * •Sexual masochism *
  18. 18. Threatening Types cont.  Rape - defined as “the crime of having sexual intercourse with a person forcibly and without consent” (Agnes, 1996).  The DSM-IV-TR defines exhibitionism, frotteurism, pedophilia, sexual sadism, and sexual masochism as the following:  Exhibitionism - over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one’s genitals to an unsuspecting stranger (APA, 2000) Created by Nadia Barnett & Yvette Gates 4/2012
  19. 19. Threatening Types cont.  Frotteurism - over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person (APA, 2000).  Pedophilia - over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (APA, 2000). Created by Nadia Barnett & Yvette Gates 4/2012
  20. 20. Threatening Types cont.  Sexual sadism - over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) in which the psychological or physical suffering (including humiliation) of the victim is sexually exciting to the person (APA, 2000).  Sexual masochism - over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer (APA, 2000). Created by Nadia Barnett & Yvette Gates 4/2012
  21. 21. Treatment Options  CBT  Affective Neuroscience  EMDR  Medication  Brief Multimodal Experiential Group Therapy  Motivational Interviewing Created by Nadia Barnett & Yvette Gates 4/2012
  22. 22. CBT  Cognitive Behavioral Therapy has the following characteristics  Collaborative relationship between client and therapist.  Premise of psychological distress as a function of cognitive processes.  Focus on changing cognitions to produce desired changes in affect and behavior  Generally time limited and educational treatment that focuses on specific and targeted problems. Created by Nadia Barnett & Yvette Gates 4/2012
  23. 23. CBT cont.  When looking at CBT, Carnes (2005) believes long term success is linked to behavior. He designed experiences and assigned them as tasks to recovering patients. When patients finished each assignment, it signaled they had completed the task, grasped its concepts, and made progress toward recovery. Created by Nadia Barnett & Yvette Gates 4/2012
  24. 24. CBT cont.  The tasks were specific competencies (skills) that individuals in recovery from sexual addiction could use to manage their illnesses. The skills were divided into thirty recovery tasks.  Each task consists of performables and life competencies. Performables are smaller tasks individuals in recovery complete that make up the larger recovery task. Life competencies are what the recovering addict learns as a result of completing the tasks. Created by Nadia Barnett & Yvette Gates 4/2012
  25. 25. Affective Neuroscience  Affective Neuroscience is the study of the neural mechanisms of emotion. This interdisciplinary field combines neuroscience with the psychological study of personality, emotion, and mood. By understanding the impact of early childhood attachment patterns on the neuropsychobiology of sexual addicts and their partners, we can create a more effective model for recovery(Katehakis, 2009). Created by Nadia Barnett & Yvette Gates 4/2012
  26. 26. Affective Neuroscience cont.  Neuropsychobiology elucidates how affective disturbances in the central nervous system (CNS) autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal system (HPA axis) causes neurobiological deficits in infancy, and how these deficits undermine both emotional and intellectual growth, and how such damage may manifest as sexual addiction (Katehakis, 2009). Created by Nadia Barnett & Yvette Gates 4/2012
  27. 27. Walking in Your Shoes  Empathically relates to the client.  Integration of the body and the mind.  Observing, tracking and pointing out signs of anxiety as defenses against deeper affect.  Asking about bodily functions.  Tracking affect  Client attending to therapist prosody and body language.  Enabling insight and tuition. Created by Nadia Barnett & Yvette Gates 4/2012
  28. 28. Walking in Your Shoes cont.  Client awareness of physical signs of anxiety is encouraged by the therapist.  Indicates client ability to move to deeper feeling states without decompensating.  Therapist monitor signs of anxiety that may not be noticed by the client. Created by Nadia Barnett & Yvette Gates 4/2012
  29. 29. EMDR  EMDR (Eye Movement Desensitization and Reprocessing)  Phases of EMDR:  client history and treatment planning,  preparation,  assessment,  desensitization,  installation,  body scan,  closure  reevaluation Created by Nadia Barnett & Yvette Gates 4/2012
  30. 30. Client History and Treatment Planning  Obtaining client history and preparing a treatment plan. Created by Nadia Barnett & Yvette Gates 4/2012
  31. 31. Preparation  Establishing rapport.  Explaining the process of EMDR and outcomes/effects that could be expected. Created by Nadia Barnett & Yvette Gates 4/2012
  32. 32. Assessment  Client assesses where they are regarding emotional distress. Created by Nadia Barnett & Yvette Gates 4/2012
  33. 33. Desensitization  The client processes distressing image(s) using EMDR and emotions that came with the image(s). It also involves processing the images while confronting and challenging the irrational beliefs and faulty cognitions that accompanied them Created by Nadia Barnett & Yvette Gates 4/2012
  34. 34. Installation  This phase describes the therapeutic objective of replacing negative cognitions with positive cognitions. Created by Nadia Barnett & Yvette Gates 4/2012
  35. 35. Body Scan  The client is asked to visualize the traumatic memory and also perform a mental scan of his/her entire body, identifying areas where he/she experiences any kind of unusual sensation Created by Nadia Barnett & Yvette Gates 4/2012
  36. 36. Closure  The client returns to a calming, relaxed state through the use of relaxation techniques such as guided imagery. Created by Nadia Barnett & Yvette Gates 4/2012
  37. 37. Reevaluation  This phase is conducted to determine the effectiveness of EMDR after each session. Created by Nadia Barnett & Yvette Gates 4/2012
  38. 38. Medication as an Intervention  Non-paraphilic sexual addiction (NPSA) was treated successfully with psychotropic medication.  According to Elmore (2005) NPSA is defined as distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used (APA, 2000). Created by Nadia Barnett & Yvette Gates 4/2012
  39. 39. Brief Multimodal Experiential Group Therapy  Both genders had  significant reductions in psychological distress from pretreatment to posttreatment.  Significant reductions in depression symptoms. Created by Nadia Barnett & Yvette Gates 4/2012
  40. 40. Brief Multimodal Experiential Group Therapy, Cont’d  Men had significant reductions in obsessive compulsive-symptoms.  Stable at six-month follow up.  Women had reductions but they were not significant.  Both genders reported significant reductions in their preoccupation with sexual stimuli and difficulty with controlling impulses. Created by Nadia Barnett & Yvette Gates 4/2012
  41. 41. Brief Multimodal Experiential Group Therapy, Cont’d  Discordant Scale  significant reductions in discordance scores were obtained from post treatment to follow-up Created by Nadia Barnett & Yvette Gates 4/2012
  42. 42. Motivational Interviewing  Motivational interviewing is defined as appreciation of client strengths and simultaneous de-emphasis on pathology, which creates the establishment of a relational blueprint characterized by clarity, support and respect instead of criticism, ambiguity or dependence. Created by Nadia Barnett & Yvette Gates 4/2012
  43. 43. Motivational Interviewing cont.  Primary focus on the individual instead of the disease (Del Giudice & Kutinsky, 2007).  The shame and relational deficits common to sexual compulsivity and addiction seem most logically addressed by an approach that makes unconditional acceptance of clients a centerpiece of the therapy itself.  Advantageous to the client’s internal locus of control and discourages dependence on the therapist. Created by Nadia Barnett & Yvette Gates 4/2012
  44. 44. Recommendations for Future Research  Comparative Studies measuring the effectiveness of CBT, EMDR, medication treatment, and motivational interviewing.  Outcome measures could focus on the quality of the therapeutic alliance, session attendance rates, long term group cohesiveness, mood state and relapse frequency. Created by Nadia Barnett & Yvette Gates 4/2012
  45. 45. Recommendations for Future Research  The study by Hagedorn (2009) found that future research could also focus on identified competencies of family, pre-treatment, sexual addiction assessment interventions, sexual addiction specialty counseling, treatment planning, and professional practice being given to a wider clinical sample (other than addiction counselors) to determine their perceptions of importance.  Although treatment interventions mentioned previously are promising, research participation is limited. Created by Nadia Barnett & Yvette Gates 4/2012
  46. 46. Recommendations for Counselor Education  Crucial that counselors are adequately trained.  Paucity of therapist trained in this area which could be due to differing societal views about sex and the nature of the addiction.  More dialogue is needed to assist counselors in exploring their feelings about sexual addiction and its influence on their clients.  Modeling acceptability in talking about sexual addiction is imperative. Created by Nadia Barnett & Yvette Gates 4/2012
  47. 47. Conclusion  Sexual addiction is a challenging topic because of differing societal views about sex. Because of this, individuals suffering from this addiction feel shame and embarrassment which makes it difficult for them to seek treatment. It is hoped that this literature will add to the growing awareness and affirm the need for more treatment in this area. Created by Nadia Barnett & Yvette Gates 4/2012

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