Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use
Mateusz Gola et al.
Neuropsychopharmacology 42, no. 10 (2017): 2021‒2031, doi:10.1038/npp.2017.78.
Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use
Mateusz Gola et al.
Neuropsychopharmacology 42, no. 10 (2017): 2021‒2031, doi:10.1038/npp.2017.78.
This double-blind, experimental study applied a popular theory of addiction to pornography use by comparing the brain responses of men with and without problematic pornography use (PPU). Brain responses to sexual pictures in PPU men revealed dissociation between measures of “wanting” and “liking” but not in men without PPU, providing strong evidence that PPU may represent a behavioral addiction. This dissociation was significantly correlated to the severity of the PPU subjects’ compulsive sexual behaviors, the amount of pornography consumed, and frequency of masturbation reported.
Researchers exploring incentive sensitization theory (IST) in the context of possible pornography addiction conducted a double-blind, experimental study that utilized functional magnetic resonance imaging (fMRI). This allowed them to compare ventral striatal1 responses of men with problematic pornography use (PPU) with those of men who used pornography at least once in the preceding year but had never experienced it as a problematic behavior.
Incentive Sensitization Theory Explained
Before proceeding to this study’s findings, it’s important to understand the theory underlying it. This requires a bit of extra reading, but the extra few minutes of your time is a good investment since this background information will help you fully appreciate the significance of Gola et al.’s findings. Here is a link to our article explaining incentive sensitization theory.
Methodology
The subjects for this study were heterosexual males ranging in age from 18–48 years. The final analysis included data from 28 PPU subjects and 24 non-PPU subjects, all of whom were of comparable ages and incomes and without other psychiatric diagnoses. Participants completed a psychiatric interview, as well as self-assessments measuring sexual activity and substance abuse in the eight weeks preceding the fMRI. Finally, participants completed an incentive delay task2 during an fMRI session which measured their response times to sexual (“erotic” cues) and monetary cues predictive of rewards. Response times were used as an indicator of motivation. Participants were also asked to rate their liking of monetary and sexual rewards on a scale of 1 to 9 (1 do not like – 9 liking very much). These procedures also allowed researchers to observe blood-oxygen-level-dependent (BOLD) responses in the brain related to “wanting” (cues) and “liking” (rewards).
Findings
| PPU Men | Non PPU Men | |
| Average minutes of pornography use per week | 287.87 minutes | 50.77 minutes |
| Longest time of pornography consumption in 1 day | 284.74 minutes | 70.55 minutes |
| Average frequency of masturbation per week | 5.66 | 2.37 |
| Average maximum number of masturbations in one day | 5.21 | 3.1 |
Gola et al. found classic behavioral and neurobiological indicators of incentive sensitization among men with PPU but not controls including:
Dissociation between “wanting” and “liking” is a hallmark feature of IST. Further, the level of ventral striatal reactivity to sexual cues was significantly related to amount of pornography use per week, frequency of masturbation, and severity of PPU. The results also suggest that the conditioned response to cues associated with sexual reward “may overshadow motivational values of alternate sources of reward in men with PPU.”4 Finally, the increased BOLD responses in the ventral striatum of PPU men is significant because conditioned or salient cues are associated with increased blood-oxygen-level-dependent (BOLD) responses in the ventral striatum of the brain, as well as shorter reaction times.5 In summary, this study adds to the growing body of evidence demonstrating that problematic pornography users’ display striking similarities to people with substance and other behavioral addictions.
1 The striatum is the central interface of the cortico-basal ganglia-thalamic circuit which receives input from a variety of brain regions (e.g., prefrontal cortex, ventral tegmental area) to guide behavioral output, including motor planning, decision-making, motivation, and reward. As described by Yager et al. it is “a key site for the neuroplastic events that underlie addiction.” See Yager et al., “The Ins and Outs of the Striatum: Role in Drug Addiction,” Neuroscience 301 (2015): 529–541, doi:10.1016/j.neuroscience.2015.06.033.
2 An incentive delay task disentangles cue- (i.e., anticipation) and reward-related (i.e., outcome) phases, allowing for measurement of neural indicators of ‘wanting’ and ‘liking’ and for comparison of addiction-related stimuli with another reward. As described by Sescousse et al. it involves a cue presented during reward anticipation, followed by a delay period and a discrimination task, which involves correctly and quickly responding to a target. “Discrimination tasks” measure one’s ability to respond to different stimuli differently. Success on the discrimination task allows subjects to view the reward, while incorrect or slow responses lead to no reward. See Guillaume Sescousse, Jérôme Redouté, and Jean-Claude Dreher, “The Architecture of Reward Value Coding in the Human Orbitofrontal Cortex,” The Journal of Neuroscience 30, no. 39 (2010): 13096, doi:10.1523/JNEUROSCI.3501-10.2010.
3 Yori Gidron, “Trait Anxiety,” in Encyclopedia of Behavioral Medicine, eds. Marc D. Gellman and J. Rick Turner (New York: Springer, 2013), doi:10.1007/978-1-4419-1005-9_1539.
4 Gola et al., ibid, 2028.
5 Gola et al., ibid.