Terapia de aceptación y compromiso (ACT) para el tratamiento de hipersexualidad y chemsexprotocolo de intervención y resultados de un estudio de caso

  1. Francisco Montesinos 1
  2. Marta Ortega 1
  1. 1 Universidad Europea de Madrid
    info

    Universidad Europea de Madrid

    Madrid, España

    ROR https://ror.org/04dp46240

Revista:
Análisis y modificación de conducta

ISSN: 0211-7339 2173-6855

Año de publicación: 2022

Volumen: 48

Número: 177

Páginas: 89-111

Tipo: Artículo

Otras publicaciones en: Análisis y modificación de conducta

Resumen

The case of a 44 years old HIV positive homosexual male, with highly frequent unprotected sexual behaviour associated to drug use, affecting his social, family and work spheres is presented. The aim was to assess the usefulness of an eight session ACT-based protocol to treat hypersexual behaviour. The study also aimed at assessing the feasibility of the protocol to be rolled out to a larger sample. Changes were tracked during the treatment and three months after through selfmonitoring and standardized questionnaires. Jacobson-Truax clinically significant change index showed improvements in hypersexuality and psychological flexibility. The treatment has proven to be successful in reducing participant’s hypersexuality 90% (t=-0.9, p=0.0). Time spent looking for sexual intercourses, as well as the number of encounters, different partners, and frequency of drug usage during sex was drastically reduced after intervention. Results provided evidence that ACT contributed to improve compulsive sexual behaviour and therefore justified its use in subsequent clinical trials.

Referencias bibliográficas

  • Amamou, B., Missaoui, C., Haouala, A. Ben, Mhalla, A., Zaafrane, F., & Gaha, L. (2020). Sexual addiction, self-esteem and personality dimensions. Journal of Addiction Therapy and Research, 4(1), 6–12. https://doi.org/10.29328/journal.jatr.1001011
  • Ballester-Arnal, R., Castro-Calvo, J., Gil-Julia, B., Giménez-García, C., & Gil-Llario, M. D. (2019). A Validation Study of the Spanish Version of the Hypersexual Behavior Inventory (HBI): Paper-and-Pencil Versus Online Administration. Journal of Sex and Marital Therapy, 45(4), 283–302. https://doi.org/10.1080/0092623X.2018.1518886
  • Ballester-Arnal, R., Castro-Calvo, J., Gil-Llario, M.D., & Giménez-García, C. (2020). Adicción al cibersexo: teoría, evaluación y tratamiento. Alianza Editorial, Madrid.
  • Ballester-Arnal, R., Gómez-Martínez, S., Gil- Llario, M. D., & Salmerón-Sánchez, P. (2013). Sexual compulsivity scale: Adaptation and validation in the spanish population. Journal of Sex and Marital Therapy, 39(6), 526–540. https://doi.org/10.1080/0092623X.2012.665816
  • Barraca, J. (2004). Spanish adaptation of the acceptance and action questionnaire (AAQ). International Journal of Psychology and Psychological Therapy, 4(3), 505–515.
  • Blonna, R. (2012). Sex ACT. Unleash the power of your sexual mind with Acceptance and Commitment Therapy. Createspace.
  • Blümel M, J. E., Binfa E, L., Cataldo A, P., Carrasco V, A., Izaguirre L, H., & Sarrá C, S. (2004). Índice De Función Sexual Femenina: Un Test Para Evaluar La Sexualidad De La Mujer. Revista Chilena de Obstetricia y Ginecología, 69(2), 118-125. https://doi.org/10.4067/s0717-75262004000200006
  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary Psychometric Properties of the Acceptance and Action Questionnaire-II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007
  • Bőthe, B., Kovács, M., Tóth-Király, I., Reid, R. C., Griffiths, M. D., Orosz, G., & Demetrovics, Z. (2019). The Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale Nonclinical Sample. Journal of Sex Research, 56(2), 180–190. https://doi.org/10.1080/00224499.2018.1494262
  • Brewer, G., & Tidy, P. (2019). Sex addiction: therapist perspectives. Sexual and Relationship Therapy, 34(1), 40–53. https://doi.org/10.1080/14681994.2017.1347618
  • Brown, K. W., & Ryan, R. M. (2003). The Benefits of Being Present: Mindfulness and Its Role in Psychological Well-Being. Journal of Personality and Social Psychology, 84(4), 822–848. https://doi.org/10.1037/0022-3514.84.4.822
  • Carnes, P. J. (2000). Sexual addiction and compulsion: recognition, treatment & recovery. CNS Spectrums, 5(10), 63–72. https://doi.org/10.1017/S1092852900007689
  • Castro-Calvo, J., Ballester-Arnal, R., & Gil-Llario, M. D. (2017). Validación preliminar del inventario de hipersexualidad en jóvenes. Àgora De Salut, 4(6), 53-64. https://doi.org/10.6035/agorasalut.2017.4.6
  • Crosby, J. M. (2011). Acceptance and Commitment Therapy for the Treatment of Compulsive Pornography Use: A Randomized Clinical Trial [Thesis, Utah State]. https://digitalcommons.usu.edu/etd/999
  • Crosby, J. M., & Twohig, M. P. (2016). Acceptance and Commitment Therapy for Problematic Internet Pornography Use: A Randomized Trial. Behavior Therapy, 47(3), 355–366. https://doi.org/10.1016/j.beth.2016.02.001
  • Daneback, K., Cooper, A., & Månsson, S. A. (2005). An internet study of cybersex participants. Archives of Sexual Behavior, 34(3), 321–328. https://doi.org/10.1007/s10508-005-3120-z
  • Derbyshire, K. L., & Grant, J. E. (2015). Compulsive sexual behavior: A review of the literature. Journal of Behavioral Addictions, 4(2), 37–43. https://doi.org/10.1556/2006.4.2015.003
  • Dodge, B., Reece, M., Cole, S. L., & Sandfort, T. G. M. (2004). Sexual Compulsivity among heterosexual College Students. The Journal of Sex Research, 41(4), 343–350. https://doi.org/10.1080/00224490409552241
  • Echeburúa, E. (2012). ¿Existe realmente la adicción al sexo? Adicciones, 24(4), 281–286. https://doi.org/10.20882/adicciones.77
  • Eifert, G.H. & Forsyth J.P. (2005). Acceptance & Commitment Therapy for Anxiety Disorders, New Harbinger
  • Elrafei, H., & Jamali, Q. (2021). Assessment and treatment of hypersexuality: a review. BJPsych Advances, 1-8.
  • Estudio Homosalud (2021). Consumo recreativo de drogas y su uso sexualizado (Chemsex) en hombres gay, bisexuales y otros hombres que tienen sexo con hombres (GBHSH) de España. https://stopsida.org/wpcontent/uploads/2021/05/HOMOSALUD_ Informe_13052021-1.pdf
  • Fernández-Dávila, P. (2017). Consumo de drogas y su relación con el sexo: Escuchando las voces de un grupo de hombres gais y bisexuales de la ciudad de Barcelona que practican ChemSex. Barcelona: Stop Sida, CEEISCAT y Subdirecció General de Drogodependències-Agència de Salut Pública de Catalunya. Disponible en: http://stopsida.org/wp-content/uploads/2017/11/Informe-estudiocualitativo-ChemSex.pdf
  • García-Barba, M., Ballester-Arnal, R., Gil-Llario, M. D., Castro-Calvo, J., & Nebot-García, J. E. (2020). El papel de los problemas emocionales en la hipersexualidad. Revista INFAD de Psicología. International Journal of Developmental and Educational Psychology, 1(1), 443–452. https://doi.org/10.17060/ijodaep.2020.n1.v1.1806
  • Gerber, J. (2008). Treatment of Sexually Compulsive Adolescents. Psychiatric Clinics of North America, 31(4), 657–669. https://doi.org/10.1016/j.psc.2008.06.006
  • Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C., Masley, S., Roach, L., Lloyd, J., May, L., Clarke, S., & Remington, B. (2014). The Development and Initial Validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45(1), 83–101. https://doi.org/10.1016/j. beth.2013.09.001
  • Gold, S. N., & Heffner, C. L. (1998). Sexual addiction: many conceptions, minimal data. Clinical Psychology Review, 18(3), 367–381.
  • González-Baeza, A., Dolengevich-Segal, H., Pérez-Valero, I., Cabello, A., Téllez, M.J., Sanz, J., Pérez-Latorre, L., Bernardino, J.I., Troya, J., De La Fuente, S., Bisbal, O., Santos, I., Arponen, S., Hontañon, V., Casado, J.L., & Ryan, P. (2018). Sexualized Drug Use (Chemsex) Is Associated with High-Risk Sexual Behaviors and Sexually Transmitted Infections in HIV-Positive Men Who Have Sex with Men: Data from the U-SEX GESIDA 9416 Study. AIDS Patient Care STDS, 32(3), 112-118. doi: 10.1089/apc.2017.0263. https://pubmed.ncbi.nlm.nih.gov/29620925/
  • Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Jokinen, J., & Öberg, K. G. (2019). A randomized controlled study of groupadministered cognitive behavioral therapy for hypersexual disorder in men. The journal of sexual medicine, 16(5), 733-745.
  • Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., & Öberg, K. G. (2017). A cognitive-behavioral therapy group intervention for hypersexual disorder: A feasibility study. The Journal of Sexual Medicine, 14(7), 950-958.
  • Hall, P. (2011). A biopsychosocial view of sex addiction. Sexual and Relationship Therapy, 26(3), 217–228. https://doi.org/10.1080/146 81994.2011.628310
  • Hayes, S. C., Strosahl, K. D., & Wilson, K. (2014). Terapia de Aceptación y Compromiso. Proceso y práctica del cambio consciente (Mindfulness). Desclee de Brower.
  • Hardy, S. A., Ruchty, J., Hull, T. D., & Hyde, R. (2010). A preliminary study of an online psychoeducational program for hypersexuality. Sexual Addiction and Compulsivity, 17, 247–269
  • Hickson F. (2018). Chemsex as edgework: towards a sociological understanding. Sex Health, 15(2), 102-7.
  • Honarparvaran, N., Tabrizy, M., Navabinejad, S., Shafiabady, A., & Moradi, M. (2010). The efficacy of Acceptance and Commitment Therapy (ACT) training with regard to reducing sexual dissatisfaction among couples. European Journal of Social Sciences, 15(1), 166–172.
  • Hook, J. N., Reid, R. C., Penberthy, J. K., Davis, D. E., & Jennings, D. J. (2014). Methodological review of treatments for nonparaphilic hypersexual behavior. Journal of sex & marital therapy, 40(4), 294-308.
  • Howard, M. D. (2007) Escaping the pain: examining the use of sexually compulsive behavior to avoid the traumatic memories of combat. Sexual Addiction & Compulsivity, 14, 77–94.
  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12– 19. https://doi.org/10.1037/10109-042
  • Jaspal, R. (2020). Chemsex among men who have sex with men: a social psychological approach. En M. Croston & S. Rutter (eds.), Psychological perspectives in HIV care. London: Routledge.
  • Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377–400. https://doi.org/10.1007/s10508-009-9574-7
  • Karila, L., Wery, A., Weinstein, A., Cottencin, O., Petit, A., Reynaud, M., & Billieux, J. (2014). Sexual Addiction or Hypersexual Disorder: Different Terms for the Same Problem? A Review of the Literature. Current Pharmaceutical Design, 20(25), 4012–4020. https://doi.org/10.2174/138161281131999 90619
  • Kegg, K., Nada-Raja, S., Dickson, N., & Paul, C. (2010). Perceived “out of control” sexual behavior in a cohort of young adults from the Dunedin Multidisciplinary Health And Development study. Archives of Sexual Behavior, 39(4), 968–978. https://doi.org/10.1007/s10508-009-9504-8
  • Kingston, D. A., & Firestone, P. (2008). Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction and Compulsivity, 15(4), 284–310. https://doi.org/10.1080/10720160802289249
  • Klontz, B. T., Garos, S., & Klontz, P. T. (2005). The effectiveness of brief multimodal experiential therapy in the treatment of sexual addiction. Sexual Addiction and Compulsivity, 12(4), 275–294. https://doi.org/10.1080/10720160500362488
  • Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109–110. https://doi.org/10.1002/wps.20499
  • Lantheaume, S. (2018). Thérapie d’acceptation et d’engagement (ACT) et addiction sexuelle. Encephale, 44(4), 387–391. https://doi.org/10.1016/j.encep.2017.06.001
  • Levine, S. B. (2010). What is sexual addiction? Journal of Sex and Marital Therapy, 36(3), 261–275. https://doi.org/10.1080/00926231003719681
  • Luciano, C. M., Valdivia, S., Gutiérrez, O., & Páez-Blarrina, M. (2006). Avances desde la Terapia de Aceptación y Compromiso (ACT). EduPsykhé: Revista de Psicología y Psicopedagogía, 5(2), 173–202.
  • Maia, M. F. C., Santos, B. F. D., Castro, L. C. D., Vieira, N. S. T., & Silveira, P. S. D. (2021). Terapia de Aceptación y Compromiso y Uso de Drogas: Una Revisión Sistemática. Paidéia (Ribeirão Preto), 31.
  • Ministerio de Sanidad (2020). Abordaje del fenómeno del chemsex. Secretaría del Plan Nacional sobre el Sida. https://www.sanidad.gob.es/fr////ciudadanos/enfLesiones/enfTransmisibles/sida/chemSex/docs/CHEMSEX._ABORDAJE.pdf
  • Ministerio de Sanidad (2020). Encuesta europea on-line para hombres que tienen sexo con hombres (EMIS-2017): resultados en España. https://www.sanidad.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/INFORMES/Encuesta_Europea_Online_para_hombres_que_tienen_sexo_ con_otros_hombres._Acces.pdf
  • Montesinos, F. (2003). ACT, Orientación del Deseo Sexual y Trastornos de la Erección. Un Estudio de Caso. Análisis y Modificación de Conducta, 29, 124, 291-320
  • Montesinos, F., & Castilla, C. (2021). Claves para la aplicación de la Terapia de Aceptación y Compromiso en identidad sexual y expresión de género: un estudio de caso. Análisis y Modificación de Conducta, 175 (47), 3-19
  • Montesinos, F., & Páez, M. (2008). Sexualidad y cáncer de mama: aportaciones desde la terapia de aceptación y compromiso (ACT). Sexología Integral, 5 (1), 39-46.
  • Montesinos, F., & Páez, M. (2012). La aplicación de ACT en la superación de barreras psicológicas en la sexualidad. En M. Páez y O. Gutiérrez, Múltiples aplicaciones de la Terapia de Aceptación y Compromiso. Madrid: Ed. Pirámide (pp. 183-199)
  • Nezhad, M. S., & Shameli, L. (2017). The effect of acceptance and commitment therapy on sexual satisfaction of couples in Shiraz. International Journal of Medical Research & Health Sciences, 6(1), 58–65.
  • Odlaug, B. L., Lust, K., Schreiber, L. R. N., Christenson, G., Derbyshire, K., Harvanko, A., Golden, D., & Grant, J. E. (2013). Compulsive sexual behavior in young adults. Annals of Clinical Psychiatry, 25(3), 193–200.
  • O’Leary, M. P., Fowler, F. J., Lenderking, W. R., Barber, B., Sagnier, P. P., Guess, H. A., & Barry, M. J. (1995). A brief male sexual function inventory for urology. Urology, 46(5), 697–706. https://doi.org/10.1016/S0090-4295(99)80304-5
  • Orford, J. (1978). Hypersexuality: Implications for a Theory of Dependence. British Journal of Addiction, 73(3), 299–310. https://doi.org/10.1111/j.1360-0443.1978.tb00157.x
  • Orzack, M. H., Voluse, A. C., Wolf, D., & Hennen, J. (2006). An ongoing study of group treatment for men involved in problematic Internetenabled sexual behavior. Cyberpsychology and Behavior, 9, 348–360.
  • Páez, M., & Montesinos, F. (2019). Claves y evidencias en la aplicación de la Terapia de Aceptación y Compromiso en el tratamiento de las adicciones. Análisis y Modificación de Conducta, 171-172 (45), 1-24. http://dx.doi.org/10.33776/amc.v45i171-2.3682
  • Pakianathan, M. R., Lee, M. J., Kelly, B., & Hegazi, A. (2016). How to assess gay, bisexual and other men who have sex with men for chemsex. Sexually transmitted infections, 92(8), 568-570.
  • Pakianathan, M., Whittaker, W., Lee, M. J., Avery, J., Green, S., Nathan, B., & Hegazi, A. (2018). Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics. HIV medicine, 19(7), 485-490.
  • Price, C. J., & Thompson, E. A. (2007). Measuring dimensions of body connection: Body awareness and bodily dissociation. Journal of Alternative and Complementary Medicine, 13(9), 945–953. https://doi.org/10.1089/acm.2007.0537
  • Quezada-Berumen, L. D. C., González-Ramírez, M. T., Cebolla, A., Soler, J., & Garcla-Campayo, J. (2014). Body awareness and mindfulness: Validation of the Spanish version of the Scale of Body Connection. Actas Españolas de Psiquiatría, 42(2), 57–67.
  • Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sexual Addiction and Compulsivity, 18(1), 30–51. https://doi.org/10.1080/10720162.2 011.555709
  • Romero-Moreno, R., Márquez-González, M., Losada, A., Gillanders, D., & FernándezFernández, V. (2014). Cognitive fusion in dementia caregiving: Psychometric properties of the spanish version of the Cognitive Fusion Questionnaire. Behavioral Psychology/Psicología Conductual, 22(1), 117–132.
  • Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., & D’Agostino, R. (2000). The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26(2), 191–208. https://doi.org/10.1080/009262300278597
  • Ruiz, F. J., Langer Herrera, Á. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013). Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire - II. Psicothema, 25(1), 123–129. https://doi.org/10.7334/psicothema2011.239
  • Segal, Z. V., Williams, M., & Teasdale, J. (2015). El camino del mindfulness: Un plan de 8 semanas para liberarse de la depresión y el estrés emocional. Paidós.
  • Shepherd, L. (2010). Cognitive behavior therapy for sexually addictive behavior. Clinical Case Studies, 9(1), 18–27. https://doi.org/10.1177/1534650109348582
  • Soler, J., Tejedor, R., Feliu-Sol, A., Pascual, J. C., Cebolla, A., Soriano, J., Alvarez, E., & Perez, V. (2012). Propiedades psicométricas de la versión española de la escala Mindful Attention Awareness Scale (MAAS). Actas Españolas de Psiquiatría, 40(1), 18–25. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=73981849&lang=es&site=ehost-live&scope=site
  • Soriano, R. (2017). El chemsex y sus vínculos con el uso de aplicaciones de geolocalización entre hombres que tienen sexo con hombres en España: un análisis etnográfico virtual. Rev Multidiscip Sida, 5(11), 8-20. Disponible en: http://www.revistamultidisciplinardelsida.com/elchemsex-y-sus-vinculos-con-el-uso-deaplicaciones-de-geolocalizacion-entrehombres-quetienen-sexo-con-hombresen-espana-un-analisis-etnografico-virtual/
  • Strizzi, J., Fernández-Agis, I., Alarcón-Rodríguez, R., & Parrón-Carreño, T. (2016). Adaptation of the New Sexual Satisfaction Scale-Short Form Into Spanish. Journal of Sex and Marital Therapy, 42(7), 579–588. https://doi.org/10.1080/0092623X.2015.1113580
  • Štulhofer, A., Buško, V., & Brouillard, P. (2010). Development and bicultural validation of the new sexual satisfaction scale. Journal of Sex Research, 47(4), 257–268. https://doi.org/10.1080/00224490903100561
  • Vallejo-Medina, P., Guillén-Riquelme, A., & Sierra, J. C. (2009). Análisis psicométrico de la versión española del Brief Sexual Function Inventory (BSFI) en una muestra de hombres con historia de abuso de drogas. Adicciones, 21(3), 221–228. https://doi.org/10.20882/adicciones.232
  • Weatherburn, P., Hickson, F., Reid, D., TorresRueda, S., & Bourne, A. (2017). Motivations and values associated with combining sex and illicit drugs (‘chemsex’) among gay men in South London: findings from a qualitative study. Sexually transmitted infections, 93(3), 203-206.
  • Wilson, K. G., & Luciano, C. (2002). Terapia de Aceptación y Compromiso: Un Tratamiento conductual orientado a los valores. Ediciones Pirámide.
  • Wilson, M. D. (2010). A comparative study of art therapy and cognitive behavioral therapy in the treatment of sexually addictive behaviors and an investigation into the relationship between shame and sexually addicted behaviors in adults (Unpublished doctoral dissertation). Minneapolis, MN: Capella University
  • El País (2021). ‘Chemsex’ al alza: la práctica sexual que eleva el riesgo de infección, adicciones y mala salud mental. 31/10/2021 https://elpais.com/sociedad/2021-10-31/chemsex-al-alza-la-practica-sexual-queeleva-el-riesgo-de-infeccion-adicciones-ymala-salud-mental.html