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.2017 Sep;42(10):2021-2031.
doi: 10.1038/npp.2017.78. Epub 2017 Apr 14.

Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use

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Can Pornography be Addictive? An fMRI Study of Men Seeking Treatment for Problematic Pornography Use

Mateusz Gola et al. Neuropsychopharmacology.2017 Sep.

Abstract

Pornography consumption is highly prevalent, particularly among young adult males. For some individuals, problematic pornography use (PPU) is a reason for seeking treatment. Despite the pervasiveness of pornography, PPU appears under-investigated, including with respect to the underlying neural mechanisms. Using functional magnetic resonance imaging (fMRI), we examined ventral striatal responses to erotic and monetary stimuli, disentangling cue-related 'wanting' from reward-related 'liking' among 28 heterosexual males seeking treatment for PPU and 24 heterosexual males without PPU. Subjects engaged in an incentive delay task in the scanner, in which they received erotic or monetary rewards preceded by predictive cues. Blood-oxygen-level-dependent responses to erotic and monetary cues were analyzed and examined with respect to self-reported data on sexual activity collected over the 2 preceding months. Men with and without PPU differed in their striatal responses to cues predicting erotic pictures but not in their responses to erotic pictures. PPU subjects when compared with control subjects showed increased activation of ventral striatum specifically for cues predicting erotic pictures but not for cues predicting monetary gains. Relative sensitivity to cues predicting erotic pictures vs monetary gains was significantly related to the increased behavioral motivation to view erotic images (suggestive of higher 'wanting'), severity of PPU, amount of pornography use per week, and number of weekly masturbations. Our findings suggest that, similar to what is observed in substance and gambling addictions, the neural and behavioral mechanisms associated with the anticipatory processing of cues specifically predicting erotic rewards relate importantly to clinically relevant features of PPU. These findings suggest that PPU may represent a behavioral addiction and that interventions helpful in targeting behavioral and substance addictions warrant consideration for adaptation and use in helping men with PPU.

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Figure 1
Figure 1
Data collection and experimental procedure. (a) After psychiatric assessment, subjects who met study criteria (see Patients and Methods section) completed questionnaires assessing self-reported sexual behavior and substance use in the weeks preceding fMRI. (b) Incentive delay task used in the fMRI session. Subjects first saw a cue informing them about the type (pictogram with a $ or a woman), magnitude (size of pictogram), and probability (pie chart) of an upcoming reward. Examples of all possible cases of cues are presented in Figure 1c. An empty circle was used to signal control trials with a 100% likelihood of getting no reward (Figure 1b, top). Next, the cue was replaced by a question mark, symbolizing a delay period during which a pseudorandom draw was performed according to the previously displayed probability. Following this anticipation phase, participants had to perform a target discrimination task within 1 s. The target was either a triangle (left button press required) or a square (right button press required). If subjects answered correctly within<1 s, they were then allowed to view the outcome of the pseudorandom draw. RTs were later used as an index of motivation. In rewarded monetary trials (following the cue with pictogram of a $ Figure 2b, middle), subjects saw a monetary amount displayed on a safe. In rewarded erotic trials (following cue with the pictogram of woman; Figure 2b, bottom), subjects saw an erotic picture. After each reward outcome, subjects had to provide a hedonic rating on a continuous scale (1—do not like it to 9—like it very much). In non-rewarded and control trials, subjects saw a scrambled picture (top). (c) Types of cues. Both monetary and erotic cues provided information about the magnitude and probability of reward. For erotic rewards, a small magnitude was always predictive of pictures of women in lingerie or swimming suits, and a large magnitude was always predictive of explicit pictures of woman in postures inviting sexual activity. For monetary cues, a small magnitude was predictive of gains ranging from 1 to 3 PLN (approximately 0.25–0.75 EUR), while a large magnitude was predictive of gains ranging from 6 to 8 PLN (1.5–2 EUR). The probability of obtaining a reward after a correct and fast (<1 s) response was indicated by a background pie chart representing probabilities of 25, 50, or 75%. All monetary gains were paid to the participants at the end of the experiment. Credits for the sample photo: Lies Thru a Lens, CC BY 2.0. For license terms, see: CC BY 2.0.
Figure 2
Figure 2
Behavioral and neuroimaging results. (a) Comparison of RTs in the discrimination task (see Figure 1b). (b) Comparison of accuracy. (c) Comparison of hedonic value ratings (see Figure 1b). (d) Comparison of BOLD signal change in the ventral striatum for cue presentation (BOLD signal averaged across 2a priori defined regions of interests in the left and right brain hemisphere: 8-mm spheres centered around: Left:x=−12,y=10z=−6; Right:x=12,y=10,z=−4). (e) Comparison of BOLD signal response in the ventral striatum for reward presentation. Allpost hoc tests were carried out with Bonferroni correction for multiple comparisons. Error bars indicates SEM. *p<0.05; ***p<0.001. CSub, control subjects; PPU, problematic pornography users.
Figure 3
Figure 3
Between-group differences in ventral striatal reactivity for cues predicting small and large magnitudes of monetary (green) and erotic (red) rewards. (a) Comparison of RTs for cues predictive of small and large rewards. (b) Comparison of BOLD signal response in the ventral striatum (the same ROIs as in Figure 2) for presentations of cues with different magnitudes. Error bars indicates SEM. **p<0.01; ***p<0.001. CSub, control subjects; PPU, problematic pornography users.
Figure 4
Figure 4
Correlations of ventral striatal cue-reactivity with amount of pornography use, frequency of masturbation, and clinical features of PPU. The correlations between differential striatal reactivity to monetaryvs erotic cues and (a) relative motivation index measured as difference between RTs for monetary–erotic trials; (b) severity of CSB measured by the Sexual Addictions Screening Test—Revised (20 points scale, which was not used at recruitment phase); (c) average amount of pornography consumption per week, and (d) frequency of masturbation per week. Error lines depicts 95% confidence intervals. Bonferroni–Holms correction was used for multiple comparisons. CSub, control subjects; PPU, problematic pornography users.
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