This review explored existing evidence regarding problematic pornography use (PPU) and its impact on people’s thought processes. PPU is characterized by:

• excessive time and effort spent on watching and searching for pornography
• impaired self-control over pornography use
• failure to fulfill family, social, or work responsibilities
• persistence in these sexual behaviors regardless of consequences

Twenty-one experimental studies from six countries were included in this review. Collectively the studies assessed 1,706 participants. The studies were analyzed for the cognitive domain evaluated and the experimental tasks used in their assessments (e.g., type of task, stimuli employed, instructions). The study reported:

• Findings from all five studies which tested for “attentional bias” showed that individuals with PPU or greater pornography consumption are more likely to show attentional bias toward sexual stimuli. This is significant because attentional bias is a known indicator of addiction. According to classical conditioning processes, cues related to addiction (e.g., a wine bottle to an alcoholic) are more attention grabbing to people with addictions than those without. The results from this review show that in the case of people with PPU, they are more likely to prefer and have their attention captured by sexual imagery.
• PPU is related to impaired “inhibitory control.” Inhibitory control is an executive function which plays a “central role” in regulating human behavior. It is especially critical in managing what we call “self-control”—that is resisting temptations and resisting acting impulsively.¹ It allows people to suppress or override certain thoughts, actions, and emotions so that they choose behaviors that allow them to meet goals and avoid negative consequences. This review showed that individuals with PPU have more problems with motor response inhibition and shifting attention away from irrelevant stimuli.
• Individuals with PPU and/or greater pornography use are more likely to perform worse in tasks assessing “working memory.” As the authors explained, “Working memory is necessary to keep things in mind while performing complex tasks, such as reasoning, comprehension, or learning.” Impairments to working memory increase the risk of engaging in problematic behaviors such as substance abuse and behavioral addictions. Results were “highly consistent,” showing that individuals with PPU or greater pornography use were found to perform worse in working memory tests compared to health controls, especially so when sexual stimuli was present at the same time.
• PPU is related to impaired decision making. Decision making, as defined by the authors, is the “ability to select optimal choices considering all available information.” People with impaired decision making tend to:
  • prefer short-term small gains over long-term large gains (“delay discounting”)
  • choose riskier options
  • be more attracted to reward-related cues (e.g., drugs) despite negative consequences
  • misjudge the likelihood and magnitude of potential outcomes
  • persist in their decisions despite negative results

Multiple studies associate these problems with addiction. This review showed that people with PPU prefer short-term small gains rather than long-term large gains, have more impulsive choice patterns, have approach tendencies toward sexual stimuli (results in this area were mixed), as well as inaccuracies when judging the likelihood and magnitude of potential outcomes under ambiguity.