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, 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

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.

Conflict of interest statement

We declare no competing interests.

© 2022 Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
CONSORT diagram. Included individuals participated in 0–8 modules (among individuals providing post-treatment data, 33 completed all modules [Prevent It, N = 12; Placebo, N = 21]).
Fig. 2
Fig. 2
Treatment effects on child sexual abuse-related behaviors. All graphs represent mixed-effects regression models with time as a second-order polynomial. Blue = Prevent It, iCBT; red = Psychological placebo. Panels: A) Self-reported time (h) using CSAM per week, primary outcome. B) Time (h) spent weekly on behaviors related to sexual interest in children other than viewing CSAM, secondary outcome. C) Highest severity (COPINE scale 1–10) of consumed CSAM per week, secondary outcome. D) Age of youngest child (years) viewed in CSAM past week, post-hoc analysis.

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