Mindfulness and Acceptance and Commitment Therapy ACT in porn and sex addiction recovery therapy

Learning and implementing the principles of mindfulness and Acceptance and Commitment Therapy (ACT), a mindfulness-based Cognitive Based Therapy, is the first step of porn and sex addiction recovery.

Mindfulness

In the first therapy visit, I ask clients to start a minimum five minute per day meditation practice. In this practice, the goal is simply to track the breath. Breathing in, I know I’m breathing in. Breathing out, I know I’m breathing out. When we notice we are distracted, we simply bring our attention back to the breath. Our brain is an organ. It is constantly thinking thoughts. While we are being mindful, we’re not going to get caught up in whether the thought is true or not. We’re not going get caught up in whether or not we “should” be thinking that thought. We don’t judge ourselves for thinking the thought. “ugh, I’m supposed to be meditating, I shouldn’t be thinking thoughts.” No. We simply, note that we are thinking and go back to the breath. Each time we do that is like a bench press for our brain, and our brain is going to get strong! To help you with your daily mindfulness practice, I recorded a series of guided meditations.

Some proven benefits of mindfulness:

– Reduces stress and anxiety
– Enhances self-awareness and self-esteem
– Increases emotional intelligence and resilience
– Promotes better sleep
– Enhances relationship satisfaction and interpersonal relationships
– Promotes overall well-being and happiness
– Helps in managing depression
– Increases patience and tolerance
– Enhances compassion and empathy towards others.

Wow, a lot of benefits. All of this is true! I have noticed this both in myself and in my clients. So please start your mindfulness practice today.

Thich Nhat Hanh on addiction recovery and mindfulness:

When you drink whiskey, learn to drink it with mindfulness. “Drinking whiskey, I know that it is whiskey I am drinking.” This is the approach I would recommend. I am not telling you to absolutely stop drinking. I propose that you drink your whiskey mindfully, and I am sure that if you drink this way for a few weeks, you will stop drinking alcohol. Drinking your whiskey mindfully, you will recognize what is taking place in you, in your liver, in your relationships, in the world, and so on. When your mindfulness becomes strong, you will just stop.

Meditation is not the same as mindfulness

Meditation is not the same as mindfulness. Both are great, but they are a little different. Meditation is when we set aside to intentionally spend the time doing breath attention, which cultivates mindfulness. Mindfulness is a general practice of being non-judgmentally aware of our thoughts, emotions, and body sensations that we can practice all day long. Whenever we find ourselves emotionally dysregulated, triggered by a negative emotion such as anger or fear or anxiety, or even feel a sexual trigger, we can be mindful. We stop, take a few deep breaths, and notice what’s going on inside. Where do I feel it in the body? Do I notice it as a tightness in the chest? Am I noticing a fight-or-flight-response where my heart beat is elevated, muscles tensed, and breathing heightened? I can use mindfulness to take a minute to slow down this response and let my pre-frontal cortex come back online to help me decide what to do, rather than being reactive.

Am I noticing any thoughts that go with the negative emotion? ie I feel a sexual trigger, then do I notice any catastrophizing thoughts or cognitive errors like “it’s always going to be like this, I might as well just act out.” If so, I don’t get caught in the thought, I just note the thought and go back to noticing what else is going on in my mind and boy.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT), founded by Steven Hayes, is a second wave CBT that is based in mindfulness. The first part of ACT is to identify our values. A useful exercise I like is to look at a long list of values and choose the top 12 that best describe what we think is most important. Then from that list of 12, we choose the top four. We want our behaviors to align with our values. When they are not aligned, this causes us mental distress, anxiety, and depression. In ACT, the C is that we commit to live according to our values.

The A in ACT is that we accept or allow negative emotions to exist in our mind, without letting them drive us to action that’s against our values. Seinfeld was a show about nothing. ACT is to feel a negative emotion and do nothing. We typically think we have to do something to drive a negative emotion away. Often we will attempt to escape from it through addiction, distraction, anger, or getting busy. Sometimes we will ruminate on it. We want to neither suppress nor ruminate. When we push our feelings to the basement, they go down and lift weights and come back stronger.

A couple ACT principles to help us “do nothing” when we experience negative emotions like sexual temptation are defusion and urge surfing.

Defusion

Cognitive defusion, a key concept in ACT, is a therapeutic technique that helps individuals to detach from their thoughts, reducing their impact and influence. This technique is particularly effective in managing addiction recovery, including sex or porn addiction. In the throes of addiction, individuals often find themselves trapped in a cycle of negative thought patterns. For example, they may constantly think, “I am a sex addict“ or “I can‘t control my urges.” These thoughts are often perceived as facts, intensifying feelings of guilt, shame, and helplessness, thereby fueling the addiction cycle.

Cognitive defusion in ACT challenges this pattern by teaching individuals to perceive these thoughts as merely thoughts, not facts. The thought “I am a sex addict“ is defused to “I‘m having the thought that I am a sex addict.” This subtle shift in perspective creates a mental distance between the individual and the thought, reducing its power and emotional impact. Moreover, cognitive defusion discourages the labeling of thoughts and emotions as “bad“ or “dangerous,” which often trigger avoidance behaviors. Instead, individuals learn to accept these thoughts and emotions without judgment, reducing the need to resist or escape from them.

Urge Surfing

Urge surfing is a powerful tool in ACT used to combat addictive behaviors, particularly effective in managing sex and porn addiction. The technique revolves around the concept that urges, like ocean waves, rise, crest, and eventually subside. It emphasizes that these urges, when not fed through rumination or attention, rarely last longer than 30 minutes.

The aim of urge surfing is to experience these urges without succumbing to them. It encourages acceptance of the urge, understanding its transient nature, and then riding it out without acting upon it. This approach is based on the mindfulness understanding that urges cannot be eradicated, but can be managed by accepting and riding them out.

In the context of sex or porn addiction, the urge to engage in the addictive behavior can be overwhelming. However, by applying urge surfing, individuals can learn to observe these urges without judgment, focusing on how they affect the body, and noting their quality, position, boundaries, and intensity.

The technique employs metaphors of water, such as ocean waves, riptides, and waterfalls, to illustrate the process of managing urges. For instance, fighting urges is likened to blocking a waterfall, which can lead to being overwhelmed. Instead, with mindfulness, one can step behind the waterfall, observing the water (urges) pass by.

Practicing mindfulness, noticing thoughts without judgment, and bringing attention back to the breath form the foundation of urge surfing. As one becomes more skilled in this practice, the ability to successfully manage urges improves. It is essential to remember that success in urge surfing comes with time and practice, and self-praise for effort, even in the absence of immediate success, aids in maintaining motivation towards recovery.

CBT vs ACT

In many ways, ACT and CBT are very similar and complementary, but they are different in some important ways. In CBT, if a sexual urge comes, we might analyze the sexual urge and the cognitive distortions that we might fuse together with the sexual urge. Patrick Carnes taught us the four core beliefs of someone suffering with sex addiction.

• I am basically a bad, unworthy person.
• No one would love me as I am.
• My needs are never going to be met if I have to depend on others.
• Sex is my most important need.

In CBT, we might kick back or fight against these core beliefs to help unravel them and lessen the effect on us. In ACT, we don’t bother with that. We simply note that we are thinking this core belief and do nothing. We don’t need to convince our brain it is wrong, we just note that our brain is thinking this, maybe even thank our brain, and make space for that though to coexist with all the other thoughts in our brain that may or may not be true.

I like CBT, but I utilize CBT concepts using IFS (Internal Family Systems), which I think is a very effective method to get into those core beliefs embedded deep in our sub-cortical brain and implicit memory. It’s very difficult to use CBT, a pre-frontal cortex exercise, to fix core beliefs that are stored as trauma in our limbic (sub-cortical) brain.

ACT goes against some traditional addiction recovery methods like to use a control strategy when we feel a sexual urge. A control strategy might be to take a cold shower, exercise, walk around the block, call a friend. ACT views these control strategies as reinforcing the “monkey mind”. We teach our sub-cortical trauma brain that it was good to go into fight-or-flight mode when the sexual trigger came, because we acted on it. That reinforces the feedback loop and trains the amygdala to fire fight-or-flight the next time a sexual trigger comes. In ACT we note the thought, defuse, urge surf, and “do nothing”. This trains the amygdala to calm down and over the long term, the sexual urges decrease. That said, it’s better to use a control strategy than to act out, so if the mindfulness methods don’t calm you down, feel free to move to a control strategy like calling a friend or sponsor.

 

Research studies showing effectiveness of ACT in sex and porn addiction

There have only been two randomized studies proving a successful approach to sex addiction recovery in the last 10 years. Both used ACT. I still think IFS is the most effective therapy method in sex addiction recovery, but it’s new and we don’t have any studies yet. Right now, ACT is considered the most effective evidence-based therapy for sex and porn addiction recovery. One of them was a study by Crosby and Twohig in a 2016 study titled  that showed the effectiveness of the therapy modality Acceptance and Commitment Therapy. Their participants experienced a 93% reduction in porn viewing and significant improvement in mental distress. The second study is Hallberg et al. (2019) published a study that showed positive results for group-administered cognitive behavioral therapy (CBT). Much of their material overlapped with the Crosby and Twohig ACT group (mindfulness, urge-surfing, values work, etc) , but also included CBT related to understanding behavioral patterns and cognitive distortions. Their participants showed a 20% reduction in symptoms and 23% decrease in sexual compulsivity measures compared to a waitlist group.

Additionally there are numerous studies done showing ACT’s success in general addictions such as: smoking, alcohol, eating, and drugs. Stephen Hayes goes into this detail in his book A Liberated Mind: How to Pivot Toward What Matters.

Conclusion

The principles of mindfulness and ACT  are crucial components of addiction recovery, particularly in the context of sex and porn addiction. By focusing on the breath, becoming non-judgmentally aware of thoughts and emotions, and allowing negative feelings to exist without driving action, individuals can strengthen their mental resilience and break the cycle of addiction. Techniques such as cognitive defusion and urge surfing are particularly effective in managing addictive behaviors. While Cognitive Behavioral Therapy (CBT) also offers valuable insights, ACT‘s approach of acknowledging thoughts without the need to challenge or change them can be more effective for deeply ingrained beliefs. Research supports the efficacy of ACT, with studies showing significant reductions in porn viewing and mental distress among participants.

 

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Mindfulness, Acceptance and Commitment Therapy ACT in porn and sex addiction recovery therapy