Introduction

Although the clinical phenomenon of compulsive sexual behavior (CSB; also conceptualized as ‘sex addiction’, ‘hypersexuality’, ‘sexual impulsivity’ or ‘out-of-control-sexual-behavior’) has been described and theorized about in the literature for decades (e.g., Barth & Kinder, Citation1987; Carnes, Citation1983; Coleman, Citation1991; Goodman, Citation1992; Grubbs et al., Citation2020; Kafka, Citation2010), it has only recently received formal recognition as a clinical disorder. In 2019, the World Health Organization (WHO) included the diagnosis of compulsive sexual behavior disorder (CSBD) as an impulse control disorder in the eleventh revision of the International Classification of Diseases (ICD-11; World Health Organization [WHO], 2019). A conservative approach was taken for the ICD-11 in categorizing it as an impulse control disorder instead of an addictive disorder because there is (to date) insufficient clinical evidence to determine whether the processes involved in the development and maintenance of the disorder are equivalent to other recognized forms of addiction (Kraus et al., Citation2018).

The prevalence of CSB in the adult population has been estimated to be between 3% and 8.6% (Bőthe et al., Citation2020; Dickenson, Gleason, Coleman, & Miner, Citation2018; Klein, Rettenberger, & Briken, Citation2014; Sussman, Lisha, & Griffiths, Citation2011). According to the ICD-11, CSBD is characterized by “a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior… over an extended period (e.g., six months or more) and causes marked distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning” (World Health Organization, Citation2019, p. 1). CSB encompasses various types of compulsive solo or relational sexual behaviors such as masturbation, pornography use, cybersex, casual sex with multiple partners, use of escort services and sex workers, or frequenting of strip clubs (Karila et al., Citation2014; Reid, Carpenter, & Lloyd, Citation2009). Moreover, individuals with CSB may engage in more than one sexual behavior that is compulsive (Derbyshire & Grant, Citation2015). These compulsive behaviors lead to significant negative consequences for the individual, including (but not limited to) emotional distress, relationship difficulties (e.g., betrayal of trust in romantic relationships), diminished self-esteem and self-respect, unintended pregnancies, and risk of HIV and sexually transmitted infections (McBride, Reece, & Sanders, Citation2008; Muench et al., Citation2007; Reid, Garos, & Fong, Citation2012). While rigorous outcome studies on CSB treatments using gold-standard approaches such as randomized controlled trials are scarce, likely due to CSB only recently receiving formal recognition as a clinical disorder (Grubbs et al., Citation2020), various treatments have nonetheless been delivered to treatment-seekers over the years. Treatment approaches (for reviews, see Briken, Citation2020; Dhuffar & Griffiths, Citation2015a; Efrati & Gola, Citation2018b; Garcia et al., Citation2016; Malandain, Blanc, Ferreri, & Thibaut, Citation2020; Miles, Cooper, Nugent, & Ellis, Citation2016) include individual and/or group psychotherapies, pharmacotherapies, and mutual-help support groups such as 12-step groups, which is the focus of the present study.