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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two versions of an online program designed to help individuals manage their use or risk of using child sexual abuse material (CSAM). The program, ReDirection Therapy, is based on cognitive behavioral therapy (CBT), which helps people understand and change risky thoughts and behaviors. Participants will use either ReDirection 1.0, ReDirection 2.0, or be placed on a waitlist before starting the program. Suitable candidates for this trial include those who have used or felt the urge to use CSAM in the past six months and can read English or Spanish. As an unphased trial, this study offers a unique opportunity to contribute to the development of innovative therapies that could help others in similar situations.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that the ReDirection program, including ReDirection 1.0 and ReDirection 2.0, safely helps people manage risky thoughts or behaviors related to child sexual abuse material (CSAM). This program uses cognitive behavioral therapy (CBT), a type of talk therapy that changes negative thinking patterns.

The ReDirection program is an online self-help tool that is free and anonymous, allowing people to seek help privately. Developed from years of experience with individuals who have committed sexual offenses, it aims to reduce their urges and use of CSAM.

No reports of harmful effects have emerged from using the program, as it is a non-invasive digital intervention. It involves no physical procedures or medication, instead helping users understand and manage their thoughts and behaviors through educational content and exercises.

The trial is in a "not applicable" phase, indicating that previous research and practice have shown ReDirection to be safe. This suggests it is well-tolerated and poses no significant risks to participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about ReDirection Therapy for reducing CSAM risk because it offers a novel approach compared to traditional methods like psychotherapy or medication. Unlike other treatments that mainly focus on managing symptoms, ReDirection Therapy aims to directly alter cognitive patterns associated with risk behaviors. The unique aspect of ReDirection 1.0 and 2.0 is their potential to rewire thought processes through innovative cognitive techniques, possibly leading to more sustainable behavior change. This could mean more effective and long-lasting results for individuals at risk, making these treatments a promising addition to existing care options.

What evidence suggests that this trial's treatments could be effective for reducing CSAM risk?

Studies have shown that anonymous, online cognitive behavioral therapy (CBT) can help reduce the use of child sexual abuse material (CSAM). One study found this therapy more effective than a placebo treatment in lowering CSAM use. Feedback from participants in the ReDirection program indicates that 77% felt it helped them reduce their CSAM use. This trial will evaluate both ReDirection 1.0 and ReDirection 2.0 as separate treatment options, suggesting they could be effective for individuals seeking to manage risky behaviors and thoughts related to CSAM. The program is self-guided, potentially making it easier for individuals to seek help without revealing their identity. ^{1 2 3 4 6}

Who Is on the Research Team?

Carissa Augustyn, PhD

Principal Investigator

The Royal Ottawa Mental Health Centre

Are You a Good Fit for This Trial?

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

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06778044?term=AREA%5BBasicSearch%5D(carissa)&rank=2

ReDirection / Self-Guided ICBT to Reduce the Risk of Child ... ReDirection is a free, anonymous, online, self-guided, cognitive behavioural therapy (CBT)-based program for individuals concerned about their use or risk to ...

2. trialx.com trialx.com/clinical-trials/listings/310129/redirection-self-guided-icbt-to-reduce-the-risk-of-child-sexual-abuse-material-csam-use/

ReDirection / Self-Guided ICBT to Reduce the Risk of Child ... ReDirection is a free, anonymous, online, self-guided, cognitive behavioural therapy (CBT)-based program for individuals concerned about their use or risk to ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S2214782922000975

A randomized placebo-controlled trial on the Darknet Anonymous, online CBT reduced the use of CSAM more than psychological placebo. Fewer negative side-effects were reported from treatment than placebo.

4. suojellaanlapsia.fi suojellaanlapsia.fi/en/redirection

ReDirection | Protect Children Feedback from users of the ReDirection program indicates that the program has a positive effect on reducing the use of child sexual abuse material. 77% of ...

5. withpower.com withpower.com/trial/redirection-therapy-for-reducing-csam-risk-edc69

ReDirection Therapy for Reducing CSAM Risk 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 ...

6. tandfonline.com tandfonline.com/doi/full/10.1080/10538712.2024.2415549?src=exp-la

A Review of Digital Interventions as Secondary Prevention ... Findings suggest that digital interventions (e.g. warning messages and chatbots) can be used to deter and redirect individuals at-risk of, or in ...