A systematic review and meta-analysis of three clinical trials with Acceptance and Commitment Therapy for problematic pornography use

Introduction
Pornography use is at once a widespread and understudied practice. In this study, we explore the role of the Acceptance and Commitment Therapy (ACT) on treating problematic pornography viewing.

Material and methods
We searched controlled trials (CTs) articles on the effect of ACT on treating problematic pornography use (PPU). We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in PubMed, PubPsych, Scopus, Google Scholar, SID and Iranmedex, and other databases (for gray literatures, e.g. conference papers, key journals) for relevant CTs articles. We used the Cochrane Collaboration’s checklist to assess the risk of bias, using random-effects model meta-analysis to combine data. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) method was used to evaluate overall study quality. The primary and secondary outcomes were time spent on viewing pornography. This paper is registered in PROSPERO (registration no. CRD42018107247).

Results
This study consists of three CTs articles with a total of 70 participants (39 in the non-treatment and 31 in the treatment group). Random-effects model in meta-analysis were conducted with the results indicating a standard mean difference of 1.11 (95% CI: –0.003 to 2.44; p = 0.000) between the two groups. This indicates an improvement in pornography-related problems. However, significant heterogeneity was observed in the meta-analysis. To identify the source of heterogeneity, we applied random-effects model in the meta-analysis separately to two studies that had adult men as their target population. According to the results, the standard mean difference between two groups was 1.71 (0.97-2.44) and I2 = 0 (p = 0.7). The results of meta-analysis on participants’ quality of life exhibited a standard mean difference of –0.002 (95% CI: –0.526 to 0.523) between the two groups, indicating the effect of ACT on boosting the participants’ quality of life. Publication bias was assessed using Begg and Egger tests with a p-value of 0.1 and confidence interval of –14.3 to 24.8. The results registered the absence of publication bias.

Conclusions
The findings exhibit that ACT has a positive effect on problematic pornography use and quality of life in patients.