ReDirection Therapy for Reducing CSAM Risk

Recruiting at 1 trial location

Overseen By Michael Seto, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: The Royal Ottawa Mental Health Centre

Disqualifiers: Under 18, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 5-6 weeks

300 Participants Needed

Trial Summary

What is the purpose of this trial?

The creation and distribution of child sexual abuse material (CSAM) is a large-scale global problem. CSAM is sometimes referred to as child pornography. It includes images, videos, live-streaming, and any other material that depicts sexual acts with a child or adolescent (i.e., a person under the age of 18). It also includes material that shows a child or adolescent in a sexually suggestive or explicit manner partially clothed, or nude, and can include material that does or does not illustrate sexual activity. CSAM use is a problem that continues to drastically increase in size despite the numerous political, police, and technological initiatives that have been put forth as solutions. Previous research also suggests that many active CSAM users desire help to stop their use, but have experienced difficulties finding support that is anonymous. Thus, there is a great need for anonymous intervention programs that assist active and at-risk CSAM users in developing skills to manage their thoughts, feelings, and behaviours related to CSAM. ReDirection is a free, anonymous, online, self-guided, cognitive behavioural therapy (CBT)-based program for individuals concerned about their use or risk to use CSAM. The treatment program is based on many years of clinical experience working with patients who have committed sexual offences, and the results of several previous research projects. This study will implement a scientifically rigorous design (a three-armed randomized waitlist-controlled trial) to evaluate two versions of this intervention (ReDirection 1.0 and ReDirection 2.0). The primary difference between the two versions of ReDirection is the length of the program and whether it includes the option for asynchronous messaging with a ReDirection specialist. The study design compares ReDirection 1.0 and ReDirection 2.0 with a waitlist control group. Participants in the waitlist control will wait six weeks before starting active treatment. While on the waitlist, participants will respond to questions about ongoing about sexual urges and behaviours. Participants will be recruited directly from the ReDirection website, where they will be directed to a secure platform designed specifically for clinical trials of internet-mediated CBT. This platform is called Iterapi. Potential participants learn about the ReDirection program through advertisements on both the "Clearnet" and "Darknet." All trial activities, including participant registration, random assignment, intervention, and evaluation will be conducted via Iterapi. Treatment includes five-to-six modules over five-to-six weeks and the content includes CBT-based psychoeducation and exercises that aim to help participants gain greater understanding of, and skills to manage risky sexual thoughts, feelings, and behaviours.

Do I need to stop taking my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications. It is best to consult with the trial organizers or your healthcare provider for guidance.

How is the ReDirection treatment different from other treatments for reducing CSAM risk?

ReDirection Therapy is unique because it specifically targets individuals with a sexual interest in minors who voluntarily seek help, focusing on reducing the risk of engaging with Child Sexual Abuse Material (CSAM). This approach is novel as it provides a confidential treatment service for non-forensic individuals, which is not commonly available in standard treatments for this condition. ^{1 2 3 4 5}

Research Team

Carissa Augustyn, PhD

Principal Investigator

The Royal Ottawa Mental Health Centre

Eligibility Criteria

This trial is for individuals concerned about their use or risk of using child sexual abuse material (CSAM). Participants must be seeking anonymous support and willing to engage in a self-guided online cognitive behavioural therapy program. Specific eligibility criteria are not provided, but it's implied that participants should have internet access and be comfortable with the digital format.

Inclusion Criteria

I am 18 years old or older.

Have used or experienced urges to use CSAM within the last six months

I can read and understand either English or Spanish.

Exclusion Criteria

I am under 18 years old.

Have not used or experienced urges to use CSAM within the last six months

I cannot read or understand English or Spanish.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Waitlist Control

Participants in the waitlist control will wait six weeks before starting active treatment, responding to questions about ongoing sexual urges and behaviours

6 weeks

Treatment

Participants receive the ReDirection program, which includes five-to-six modules over five-to-six weeks, with CBT-based psychoeducation and exercises

5-6 weeks

Follow-up

Participants are monitored for changes in urges to use CSAM and proclivity to offend, using modified SSAS and study-specific measures

Up to 8 weeks

Treatment Details

Interventions

• ReDirection 1.0
• ReDirection 2.0
• Waitlist

Trial Overview The study tests two versions of ReDirection, an online CBT-based intervention aimed at reducing CSAM use. One version includes asynchronous messaging with a specialist; the other does not. The effectiveness of both will be compared to a waitlist control group over five-to-six weeks through randomized assignment.

Participant Groups

Group I: ReDirection 2.0 Experimental Treatment 1 Intervention

Group II: ReDirection 1.0 Experimental Treatment 1 Intervention

Group III: Waitlist Active Control 1 Intervention

Who Is Running the Clinical Trial?

The Royal Ottawa Mental Health Centre

Lead Sponsor

Trials

24

Recruited

2,300+

Johns Hopkins Bloomberg School of Public Health

Collaborator

Trials

441

Recruited

2,157,000+

Protect Children Organisation, Finland

Collaborator

Trials

3

Recruited

420+

Findings from Research

In a study of 680 participants from the COMBINE study, those who set abstinent drinking goals achieved significantly better outcomes, including more weeks without drinking and fewer heavy drinking days, compared to those with nonabstinent goals.

Both groups showed reductions in drinking behaviors and alcohol-related problems over the 16-week intervention, but the findings suggest that setting an abstinent goal may lead to more favorable treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pretreatment alcohol drinking goals are associated with treatment outcomes. Dunn, KE., Strain, EC.[2021]

A history of childhood sexual abuse (CSA) was reported by 16.7% of women and 5.4% of men in a study of 1991 same-sex twin pairs, and was linked to significantly higher risks of major depression, suicide attempts, and other adverse psychosocial outcomes, particularly in women.

The study found that even when controlling for family background, individuals with a history of CSA had a greater risk for negative outcomes compared to their CSA-negative twins, highlighting the direct impact of CSA on mental health and well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study. Nelson, EC., Heath, AC., Madden, PA., et al.[2019]

Cognitive remediation therapy (CRT) significantly improved working memory and executive function in outpatient veterans with substance use disorders, compared to standard work therapy alone, based on a pilot study with 48 participants over 6 months.

Both treatment groups showed excellent substance use outcomes, with high rates of abstinence, indicating that while CRT enhanced cognitive functions, it did not significantly change overall substance use recovery rates compared to work therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of cognitive remediation and work therapy in the early phase of substance use disorder recovery for older veterans: Neurocognitive and substance use outcomes. Bell, MD., Laws, HB., Petrakis, IB.[2018]

The study found that individuals with a sexual interest in minors who voluntarily seek therapy have a significantly higher history of child sexual abuse (CSA) and child sexual abuse material (CSAM) offenses compared to the general male population, indicating a substantial risk for recidivism.

The recidivism rate for viewing CSAM was 39%, which is 11 times higher than expected, while the 14% rate for CSA was comparable to those with prior convictions, suggesting that treatment resources for this group are justified despite criticisms of their risk level.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose? von Franqué, F., Bergner-Koether, R., Schmidt, S., et al.[2023]

Cognitive Remediation Therapy (CRT) was found to be feasible and acceptable for young females (ages 12-18) with anorexia nervosa, showing significant improvements in set-shifting abilities and moderate improvements in central coherence after just four sessions.

The study indicated that young people with Autism Spectrum Disorder (ASD) features also benefited from CRT, particularly in central coherence, suggesting that CRT could be a valuable treatment adjunct for this population as well.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: a feasibility study. Rhind, C., Mahdi, M., Simic, M., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Pretreatment alcohol drinking goals are associated with treatment outcomes. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of cognitive remediation and work therapy in the early phase of substance use disorder recovery for older veterans: Neurocognitive and substance use outcomes. [2018]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Individuals under voluntary treatment with sexual interest in minors: what risk do they pose? [2023]

5. Germany pubmed.ncbi.nlm.nih.gov

Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: a feasibility study. [2022]