by Tamara Penix Sbraga and William T. O'Donohue
New Harbinger, 2003
Review by Christian Perring, Ph.D. on Mar 27th 2007
On the cover of The Sex Addiction Workbook, it proclaims "The only scientifically supported treatment method for sex addicts." This book uses a form of self-administered cognitive behavioral therapy (CBT) to treat sexual addiction. The workbook consists of eighteen chapters over about 200 pages, divided into five parts. First, the book starts to help readers identify their problems, and then understand what sorts of solutions are available. Part II focuses on identifying the faulty thinking that accompanies sexual addiction, understanding and changing the planning that goes around sexual activity, and coping with sexual fantasizing. Part III focuses on feelings, guiding the reader through exercises to help with anger, depression, sexual frustration, and leading to self-acceptance and forgiveness. Part IV helps the reader to change behavior in response to specific situations or environments, and Part V addresses the need to achieve a healthy lifestyle balance.
The book uses simple language and divides each chapter into approachable sections. The exercises are easy to understand, and presumably if the reader follows them, he or she will gain a better understanding of his or her problems and how to control them. The authors include both sexual Internet activity, pornography use, visiting sexual places such as strip clubs and sex shows, and sexual behavior with other people. They emphasize the risks of the different forms of behavior and the many ways there are to modify one's self-defeating or dangerous behavior. So the book may well be helpful for those who are committed to changing.
However, the authors' claims that their methods are scientifically proven seem overblown. They provide no direct evidence. In their introduction, they refer to a 1999 article by Grossman, Martis and Fichtner. They summarize this article saying "the majority of the evidence suggests that the cognitive behavioral treatment approaches you are about to learn are effective in significantly reducing the out-of-control sexual actions of some people" (4). However, when one looks up this article, one finds some problems with this claim. First, the article, "Are Sex Offenders Treatable? A Research Overview," is focused on sex offenders, with some emphasis on child molesters, rather than the much wider category of sex addicts. Second, the research was a literature review for work published between 1970 and 1998, so it is unlikely to address issues to do with cybersex and the Internet. Third, the author's endorsement of CBT was far less emphatic than Penix Sbraga and O'Donohue suggest. The article's main conclusion is:
Although some forms of treatment for sex offenders appear promising, little is known definitively about which treatments are most effective, or for which offenders, over what time span, or in what combinations. What emerges from the literature is a strong suggestion that a comprehensive cognitive-behavioral program should involve components that reduce deviant arousal while increasing appropriate arousal and should include cognitive restructuring, social skills training, victim empathy awareness, and relapse prevention. In addition, patients should be considered for antiandrogen medication if they are at high risk of reoffending.
Furthermore, the CBT that was measured in the studies surveyed was most likely to have been administered by a professional therapist, not provided through a self-help book.
Thus, the claim that The Sex Addiction Workbook will actually help readers is completely unsupported by any evidence provided by the authors. It might be more successful when used in conjunction with working with a CBT professional, but even then, there's no evidence that it will be helpful. The authors of the book are experienced clinicians: William T. O’Donohue is the Nicholas Cummings Professor of Organized Behavioral Healthcare Delivery at the University of Nevada, Reno, has published many books, and is an active researcher. Tamara Penix Sbraga is a clinical faculty member at Central Michigan University. So these are reputable clinicians and the approaches used in this workbook certainly fall within the range of standard methods used by CBT. It is possible that since the publication of the book, further studies have been done on the effectiveness of CBT for people with difficulties with controlling their sexual behavior. Nevertheless, readers should not place too much confidence in the methods recommended by this workbook. Rather, they would do better if they took responsibility for their own change, and simply used the book as a possible method to accomplish that change. It's important to realize that ending behavioral addictions is extremely difficult, and that the danger of giving up on the effort to change or relapsing into old habits is very high. It would be foolish to regard a self-help book as a promise of a cure. People who have identified themselves as having a problem with sexual addiction may find The Sex Addiction Workbook helpful, and it is one of the few such books available. However, their struggle is likely to be prolonged and they will need to engage in continual self-education and self-monitoring to prevent themselves from going back to their old ways.
© 2007 Christian Perring. All rights reserved.
Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Reviews. His main research is on philosophical issues in medicine, psychiatry and psychology.