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expert reaction to results of RCT into new therapy that could reduce level of child sex offending

Results of a randomised placebo-controlled trial into internet delivered cognitive behavioural therapy (CBT) on use of child sexual abuse material has been published in Internet Interventions.

This Roundup was accompanied by an SMC Briefing.


Prof Peer Briken, Professor for Sex Research, Sexual Medicine, and Forensic Psychiatry, and Director of the Institute for Sex Research and Forensic Psychiatry at University Medical Center Hamburg-Eppendorf, said:

To what extent do you consider the therapeutic approach to be suitable for treating people with paedophile tendencies?

“Certainly, the therapeutic approach has all the limitations that an online-based intervention always has – but also the advantages. It is low-threshold, relatively cheap, can reach many people worldwide, even in rural areas, is therapist-supported, and it addresses relevant risk factors.”

To what extent can it be ensured that, despite anonymity and recruitment in the Darknet, “honest” test persons can be encountered and tangible study data can be generated?

“I think it is unlikely that people make the effort and fake here. First of all, you have to fake that you are participating in the therapy programme and secondly, you have to fake to do questionnaires. I think that anonymity might support the sincerity of the answers. But there are always answers in the sense of social desirability in this topic.”

How do you assess the success of the method? Is the clinical efficacy convincing?

“The methodological approach in the study, an RCT, meets the highest scientific quality standards. This is very important. The therapeutic effects with regard to the primary outcome, time of CSAM reputation, are small but significant in terms of potency.”

“As part of the European Union-funded collaborative project PRIORITY, led by our Institute, we will offer a translated and culturally adapted form of the same but revised online treatment (PreventIt2) in Portugal, Sweden, and Germany. The evaluation will be done by Prof. Elisabeth Letourneau (Johns Hopkins, USA) and Michael Seto (Royal Ottawa, Canada).”


Dr Alexandra Bailey, Forensic Psychologist at The Lucy Faithfull Foundation, said:

“This well-designed work gives a promising start to recognising the benefits of providing online, anonymous help to people viewing sexual images of children, to support them to stop.

“The RCT has a blind aspect, something which we rarely see in this field. This is useful for counteracting potential bias, thereby improving the quality of the research.

“The iCBT model and placebo did both appear to result in positive behaviour change, particularly in terms of weekly viewing of sexual images of children. Although a small difference between the intervention groups was found, for me it still gives an overall early indication of the benefits of providing intervention with this group of individuals.

“This is something we have felt for a while, which is why we’ve provided our own CBT-based approach – Stop It Now! Get Help – for anonymous online use since 2015. What we have also noticed with Get Help, which comes across in this article, is the benefit of the participant communicating with a professional. Research shows that accountability can be a useful tool in managing online behaviour and the presence of a professional can help with this.

“While this research is important and there are positives, this is at an early stage and more work would be needed to solidify these results. There are also some caveats.

  • Behaviour is self-reported. This means that participants are able to lie, but the anonymous nature of the research means that they are less incentivised to.
  • The participants were a subgroup of individuals who view sexual images of children i.e. Darknet users with paedophilic disorder. People who sexually offend against children, including online, are a diverse group and come from all backgrounds and walks of life and many offend on the open web. So not all people who offend will be using the Darknet or meet the criteria for paedophilic disorder. Further work should be done to consider the effectiveness of online interventions with other groups.
  • For scientific research this is a small sample size, but for the area of research this is a good number of participants. However there were high attrition rates.
  • The follow-up time is short. Viewing sexual images of children can be a long-term behaviour – people can stop for periods of time, and then go back. Having longer follow-ups would give a better idea of the long-term effectiveness of these types of online interventions.

“Estimates from law enforcement suggest there are tens of thousands of people viewing sexual images of children online in the UK. The scale is such that police have said that we can’t arrest our way out of the problem. Approaches like in this study can help address the problem in a different and complementary way and research such as this is important so that we can learn what works best to prevent online child sexual abuse.

“We know from working with men who have offended online that they come from all backgrounds and walks of life, and don’t conform to the stereotypes. Often they don’t have a long-standing sexual interest in children, but tell us they started viewing sexual images of children through an escalating legal pornography habit that becomes more extreme. The group in this research is different – offending on the Darknet and having paedophilic disorder.

“Some men can be supported to stop offending and our anonymous helpline, online self-help and evidence-based programmes give them ways to do this.

“Just as important as helping people to stop offending is stopping people from offending in the first place. We work with police forces, health and other organisations across the UK to raise awareness that viewing sexual images of under-18s is illegal, causes huge harm to victims, and can have life-changing consequences to the offender – including possible arrest, imprisonment and loss of family.”



Effects of internet delivered cognitive behavioural therapy on use of child sexual abuse material: a randomised placebo-controlled trial on the Darknet’ by Christoffer Rahm et al. was published in Internet Interventions at 00:01 UK time on Thursday 1st December.


The Lucy Faithfull Foundation is the only UK-wide charity dedicated solely to preventing child sexual abuse. We work with adults and young people concerned about their own or someone else’s sexual thoughts or behaviour towards children.



Declared interests

Dr Alexandra Bailey: “The Lucy Faithfull Foundation is the only UK-wide charity dedicated solely to preventing child sexual abuse. We work with adults and young people concerned about their own or someone else’s sexual thoughts or behaviour towards children.”

For all other experts, no reply to our request for DOIs was received.

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