How effective is hypnosis for paraphilias



Treatment approaches for paraphilias include traditional psychoanalysis, hypnosis, and behavior therapy techniques. More recently, a class of drugs called antiandrogens that drastically lower testosterone levels have been used temporarily in conjunction with these treatments. The drug lowers sex driving in men and can reduce the frequency of mental images of sexually arousing scenes. This enables concentration on counseling without strong distraction from the paraphilic urge. Increasingly, the evidence suggests that combining drug therapy with cognitive behavioral therapy can be effective.

The level of a person's sex drive is not consistently related to paraphilic behavior. In addition, high testosterone levels do not predispose a man to paraphilias. That said, hormones like medroxyprogesterone acetate (Depo-Provera) and cyproterone acetate lower levels of circulating testosterone, thereby reducing sex drive and aggression. These hormones can reduce the frequency of erections. sexual fantasies and initiation of sexual behaviors, including masturbation and intercourse. Hormones are typically used in conjunction with behavioral and cognitive treatments. Antidepressants like fluoxetine (Prozac) have also been successful in reducing sex drive, but have not effectively targeted sexual fantasies.

Research suggests that cognitive behavior models are effective in treating paraphilias. In aversive conditioning, for example, negative stimuli are used to reduce or eliminate behavior. In the case of covert sensitization, the patient relaxes and visualizes scenes with deviant behavior, followed by a negative event, e.g. B. when his penis is in the zipper of his pants. Assisted aversive conditioning is similar to covert awareness, except that the negative event is realized, most likely in the form of a foul odor pumped into the air by the therapist. The aim is for the patient to associate the deviant behavior with the foul odor and take measures to avoid the odor by avoiding this behavior. In proxy sensitization, video tapes with deviant behaviors and their consequences are shown, e.g. B. Victims who describe what is wanted, watch revenge or perhaps even surgical castration.

There are also positive conditioning approaches that can focus on training social skills and alternative behaviors for the patient that are more appropriate. Reconditioning techniques are about providing instant feedback to the patient so that behavior changes immediately. For example, a person may be connected to a plethysmography biofeedback machine that is connected to a light. The person is taught to keep the light in a specific range of colors while the person is exposed to sexually stimulating material. Masturbation training might focus on separating the pleasure associated with masturbation and climax from the deviant behavior.

The cognitive therapies described include cognitive distortion restructuring and empathy training. The restructuring of cognitive biases involves correcting erroneous beliefs of the patient, which can lead to behavioral errors such as seeing a victim and constructing faulty logic that the victim deserves to be involved in the deviant act. Empathy training involves helping the perpetrator take the victim's perspective and better identify with them in order to understand the damage done.