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

• Published in: Internet interventions : the application of information technology in mental and behavioural health 2022-12, Vol.30, p.100590-100590, Article 100590
• Main Authors: Lätth, Johanna, Landgren, Valdemar, McMahan, Allison, Sparre, Charlotte, Eriksson, Julia, Malki, Kinda, Söderquist, Elin, Öberg, Katarina Görts, Rozental, Alexander, Andersson, Gerhard, Kaldo, Viktor, Långström, Niklas, Rahm, Christoffer
• Format: Article
• Language: English
• Subjects: Child sexual abuse; Full length; Internet -based intervention; Pedophilic disorder; Placebo; Preventive psychiatry; Psychology; Psykologi
• ISSN: 2214-7829; 2214-7829
• DOI: 10.1016/j.invent.2022.100590

The use of child sexual abuse material (CSAM) is an international public health and child protection challenge. To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users. 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+. 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. 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. •Child sexual abuse material (CSAM) users were recruited globally from Darknet.•Anonymous, online CBT reduced the use of CSAM more than psychological placebo.•Fewer negative side-effects were reported from treatment than placebo.•Initial evidence for the feasibility, efficacy and safety of treatment is suggested.