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An international randomized waitlist-controlled trial of internet-delivered cognitive behavioral therapy for sexual
Allison McMahan1, Malin Joleby1, Gerhard Andersson1
1Karolinska Institutet, Department of Clinical Neuroscience, Centre for Psychiatry Research.
Insights
The Prevent It 2.0 internet-delivered cognitive behavioral therapy (iCBT) program significantly reduced sexual urges and behaviors toward children in a 9-week trial. This online intervention shows promise for preventing child sexual exploitation and abuse.
Area of Science:
- Psychology
- Clinical Psychology
- Forensic Psychology
Background:
- Child sexual exploitation and abuse remain significant societal problems.
- Effective interventions are needed to reduce sexual urges and behaviors toward children.
- Internet-delivered cognitive behavioral therapy (iCBT) offers a scalable approach to treatment.
Purpose of the Study:
- To evaluate the efficacy of Prevent It 2.0, a 9-week anonymous iCBT program.
- To determine if the program reduces sexual urges and behaviors directed toward children.
- To assess the potential of iCBT in preventing child sexual exploitation and abuse.
Main Methods:
- A randomized waitlist-controlled trial with crossover design was conducted.
- 203 adults with sexual urges toward children were allocated to iCBT or a waitlist.
- The primary outcome was the severity of sexual urges toward children, with secondary outcomes including time spent observing children for sexual purposes.
Main Results:
- Participants in the iCBT group showed a significantly greater reduction in sexual urges toward children compared to the waitlist group.
- The iCBT program also led to a significant decrease in time spent observing children for sexual purposes, including the use of child sexual abuse material.
- These reductions were clinically significant over the 9-week intervention period.
Conclusions:
- The Prevent It 2.0 iCBT program is effective in reducing sexual urges and offending-related behaviors toward children.
- The anonymous, online format makes this intervention accessible to a wider population.
- This study provides evidence for the utility of iCBT in preventing child sexual exploitation and abuse.
Objective:
Test whether Prevent It 2.0, a 9-week, anonymous internet-delivered cognitive behavioral therapy (iCBT) program, reduces the severity of sexual urges and behaviors toward children to prevent acts of child sexual exploitation and abuse.
Method:
In a randomized 1:1 waitlist-controlled trial with crossover at Karolinska Institutet, Sweden, N = 203 adults (≥18 years; 92.1% men, 0.5% women, 7.4% other; age 18-70, 66.6% aged 21-40; 49.8% Europe, 38.9% North America) were allocated to iCBT (n = 100) or waitlist (n = 103). The preregistered primary outcome was severity of sexual urges toward children (adapted Sexual Symptoms Assessment Scale). Secondary outcomes included weekly time spent observing children for sexual purposes, including use of child sexual abuse material, and severity of accessed material. The study was preregistered on https://ClinicalTrials.gov (ID: NCT05663047; Karolinska Institutet, 2022) and the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/Y2DC4; Rahm et al., 2022).
Results:
iCBT participants reported a significantly greater reduction in sexual urges toward children (-6.41 scale points, 95% confidence interval, CI [-8.26, -4.56]; d = -1.01, 95% CI [-1.30, -0.72]), as well as a significant decrease in time spent observing children for sexual purposes (including use of child sexual abuse material; -1.87 hr weekly, 95% CI [-2.91, -0.82], d = -0.517, 95% CI [-0.806, -0.228]) after 9 weeks compared to the attention-controlled waitlist.
Conclusions:
Prevent It 2.0 demonstrated efficacy in reducing sexual urges and offending related behaviors toward children, producing clinically significant reductions over 9 weeks, in an anonymous online sample. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
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