Iatrogenic effects of Reboot/NoFap on public health: A preregistered survey study

Abstract

“Reboot,” especially NoFap, promotes abstinence from masturbation and/or pornography to treat “pornography addiction,” an unrecognized diagnosis. While the intention of Reboot/NoFap is to decrease distress, qualitative studies have consistently suggested that “Reboots” paradoxically cause more distress. The distress appears to occur in response to (1) the abstinence goal, which recasts common sexual behaviors as personal “failures,” and (2) problematic and inaccurate Reboot/NoFap forum messaging regarding sexuality and addiction. This preregistered survey asked men about their experience with perceived “relapse” and NoFap forums. Participants reported that their most recent relapse was followed by feeling shameful, worthless, sad, a desire to commit suicide, and other negative emotions. A novel predictor of identifying as a pornography addict in this lower religiosity sample was higher narcissism. Participants reported that NoFap forums contained posts that were misogynist (73.7% of participants), bullying (49.1%), anti-LGBT (42.9%), antisemitic (32.0%), instructing followers to harm or kill themselves (23.5%), or threats to hurt someone else (21.1%). More engagement in NoFap online forums was associated with worse symptoms of erectile dysfunction, depression, anxiety, and more sex negativity. Results support and expand previously documented harms and problems with Reboot/NoFap claims of treating pornography addiction from qualitative research.

Keywords

addiction abstinence iatrogenic nofap pornography reboot

Introduction

The United States appears to be experiencing a resurgence in anti-porn sentiment. Part of this anti-porn campaign appears to be using science and health terminology to advocate for legislation (Burke and MillerMacPhee, 2020). One aspect of this campaign is the idea that pornography is an “addiction” that is treated by abstinence. The largest abstinence community appears to be an online group of young, adult males who follow a concept they call “Rebooting.” The term “Reboot” refers to a period of abstinence from pornography that they believe will reset their body to a healthy state, based upon the assumption that their previous use of pornography had been harmful. For example, porn abstinence is described by Reboot followers as a cure for erectile dysfunction (Imhoff and Zimmer, 2020), and will “lead to a greater penis size when it’s flaccid” (The Reboot Nation, 2021a), based on claims that pornography causes the penis to “shrivel up” (Church, 2016a). The largest group making these sorts of claims, and selling treatments for medical disorders based on these claims,^1,² is NoFap (Gałuszka, 2020).

Rebooters who follow NoFap are known as the “NoFap Army” (Rhodes, 2013) and occupy many social media platforms. Their largest presence appears to be on Reddit—special interest forums are called “subreddits” and denoted with an “r/” before their name (i.e., r/NoFap). The founder and moderator of r/NoFap, also moderates r/NoFapChristians, r/pornaddiction, r/NoFapArmy, and r/monkmode, among others. The r/NoFap forum’s concept of abstinence from pornography often extends to any orgasm at all. The NoFap founder described Rebooting “hard mode” abstinence as “not allowed to masturbate under any circumstances (no edging). Absolutely no deliberately viewing pornography or anything close to it [...] unless if it is sex with someone I actually care about (no ‘booty calls’ or casual sex)” (Rhodes, 2014). The NoFap founder posted a description of “monk mode” abstinence as 90 days of Rebooting, which required “not engage with any sexuality, not checking out women [...], not fantasizing, not approaching any women” (Rhodes, 2018). Most descriptions of Reboot treatments extend beyond abstinence from pornography into abstinence from masturbation, non-monogamous sex, sexual thoughts, and similar.

Rebooters refer to one another in these forums as “king,” “bro,” “soldier,” and similar. While women and gay men are not prohibited from registering in NoFap forums, they rarely post. Rebooters’ posts usually focus on “days abstinent.” Posts can be self-tagged with eight different “flair” describing a post’s content (e.g., “Victory,” “Success story,” “Motivation,” etc.). As suggested by the braggadocious flair, forum users are described as challenging each others’ masculinity by proving who can abstain longer (Taylor and Jackson, 2018). The founder conceptualized NoFap forums as possibly a “wall of shame’ post listing those who haven’t updated and give them one last chance before marking them down as failures” (Rhodes, 2011). NoFap appears to reflect that goal. Posts contain either authors’ brags about abstinence improving their mood, erectile function, muscularity, energy, mental clarity, focus, confidence, motivation, productivity, emotional intensity, and attractiveness to women (Fernandez et al., 2021) or despair and shame at having “relapsed” from abstinence, frequently describing a desire to kill themselves or die as a result. In summary, NoFap forum contents could be described as bipolar, filled with posts by young men and youth about personal sexual experiences that are extremely positive or extremely negative.

Since “pornography addiction” does not appear as a diagnosis in either the Diagnostic and Statistical Manual or the International Classification of Disorders, markers of “success” in treating it are unclear. Minimally, someone who is upset by their sexual behaviors should probably feel less upset if a treatment is efficacious. Reboot/NoFap would not be considered an efficacious or effective treatment by the standards of the American Psychological Association (Lilienfeld, 2019). Despite no evidence to support it and a likelihood of creating harm, Reboot/NoFap has been widely recommended in national media and endorsed by licensed professionals in the Society for the Advancement of Sexual Health. This study seeks to test associations of Reboot/NoFap abstinence treatment components with some of its claimed effects using a preregistered cross-sectional online survey.

Reboot/NoFap harms

Research suggests Reboots can be harmful or iatrogenic. “Iatrogenic” is from the Greek “iatro-,” meaning healer, and “-genic,” meaning produced by. Iatrogenic, or “healer caused,” refers to unplanned, usually negative, effects of treatment (Bootzin and Bailey, 2005). Users from Reboot subreddits (r/NoFap and r/PornFree) in one study were theorized to possess weak identities, leading to them uniting against pornography to regain their masculinity; however, the Reboot/NoFap intervention fueled increased anxiety and a need for self-improvement, ultimately causing greater distress at relapse events and maintenance (rather than resolution) of the problem (Chasioti and Binnie, 2021). A central claim of Reboot is that pornography causes erectile dysfunction, but this has been refuted by dozens of studies (Hoagland and Grubbs, 2021). One study specifically surveyed men who participated in a Reboot abstinence program. While anxiety strongly predicted erectile difficulties in this group, pornography viewing neither mediated nor moderated that relationship (Prause and Binnie, 2022). The authors interpreted this as possibly indicating that those in Reboot were misled by health disinformation on Reboot websites or may exaggerate their erectile difficulties.

Another study analyzed top posts on six male health topics from TikTok and Instagram (Dubin et al., 2022). The NoFap/SemenRetention topic was the most active topic and the only topic to have no physicians posting about it. The authors concluded that the accuracy of NoFap/SemenRetention information was significantly lower than all other male sexual health topics on these social media platforms. Others have echoed that NoFap grounds their false medical claims on misinterpretations of science to support sexually conservative values (Monea, 2022; Watson, 2020).

The main strategy for abstinence in Reboot seems to be distraction, which is unlikely to work. “Thought stopping” techniques for sexual content are known to paradoxically increase sexual thoughts (Efrati, 2019). Further, mere distraction is known to fail over the long term (Thiruchselvam et al., 2011). As these distraction efforts fail, Reboot followers may experience distressing emotions, such as shame or disgust, in response to their relapse. Since shame associated with sexual behaviors paradoxically increases sexual desires (Van Tuijl et al., 2021), this might explain why qualitative studies found followers’ distress does not improve with Reboot.

NoFap “Support” forums

Reddit offers the ability for any subreddit to restrict users to those over 18, but r/NoFap does not use that restriction. Thus, anyone age 13 or older (the age restrictions on the Reddit platform) can engage in this aspect of Reboot treatment. Parental consent is not described on r/NoFap. In a different study scraping the data of 1194 r/NoFap followers (Prause, in preparation), 5.4% of followers who posted text (i.e., not just a cartoon) spontaneously reported that their age was under 18, with several claiming to be 10 years old. The current study only recruited adults to comply with federal ethics requirements. Including youth in a treatment for sexual issues alongside adults without clear parental consent should be studied by ethicists.

Not everyone engages equally in Reboot forums. Some followers may only read a few forum posts, while others posted consistently for months. Previous research showed the more engaged a client was with mobile health interventions, the more their symptoms improved (Molloy and Anderson, 2021). Specifically with substance addiction treatments, more engagement (not mere attendance) with support groups caused improvements in symptoms (Dodes and Dodes, 2015). If Reboot forums are therapeutic, greater engagement with Reboot forums should be associated with improvement in symptoms.

Sexism and homophobia

Reboot forums have been criticized for misogynist and anti-gay rhetoric. NoFap forum followers have been estimated to be 99% male (Imhoff and Zimmer, 2020) and described as the most conservative group of the “manosphere” promoting misogyny (Burnett, 2021; Han and Yin, 2022; Hartmann, 2020). This impression may have developed from the framing of Reboot/NoFap as a masculinity challenge, where failure means you are not a [heterosexual] man deserving of a sexual relationship (Taylor and Jackson, 2018). Reboot/NoFap forums and videos frequently use openly sexist language like “bitches” and “girls” (Hartmann, 2020). r/NoFap also shared members with “r/MRA” (Men’s Rights Activists), “r/MGTow” (Men Going Their Own Way), and “r/Incel” (involuntary celibates) subreddits (Khan and Golab, 2020; Massachs et al., 2020), widely known for hateful posts about women. Possibly related to some hatred of feminism, Reboot/NoFap also claim that viewing homosexual erotic images is evidence of “escalation” of the disease of pornography addiction (Hartmann, 2020). Rather than viewing homosexual pornography as exploring one’s own sexuality, viewing homosexual pornography is conceptualized as a symptom to abstain. Given this, it is unsurprising that r/NoFap members are rarely members of LGBT communities (Massachs et al., 2020).

Anti-semitism

NoFap forums were described as productive targets for white supremacist recruitment (Von Sydow, 2020). This is linked to a false conspiracy theory that Jewish persons control the pornography industry for the purpose of promoting race mixing (Kerl, 2020). Some have theorized this may be why NoFap is most active on Reddit forums, where misogyny and anti-semitism occur in largely unregulated forums (Johanssen, 2021). A scrape of Twitter data discussing NoFap also identified anti-semitic language infused with this false conspiracy theory (Burnett, 2021).

Trolling and violence

To our knowledge, neither trolling nor violence has been explored systematically in NoFap forums. Trolling has been defined as “Internet users who aim to disrupt online interactions” (Brubaker et al., 2021). Trolling comments are thought to constitute about 1% of Reddit posts (Fichman and Sharp, 2020) but are more common on subreddits that solicit high affect posts, use sexual vulgarities, and include long posts (Tsantarliotis et al., 2017). The NoFap moderator described trolls on his forum as in the “millions,”³ which may prevent the environment from providing support.

Suicidal ideation was not associated with problem pornography viewing in a survey of 283 men (Shirk et al., 2021). Yet, in a qualitative analysis of 104 journals from a Reboot website (Fernandez et al., 2021), three followers spontaneously expressed suicidal ideation as a response to their Reboot. In addition, 23.1% of followers in that study described negative affect attributed to Rebooting. Reboot coaches describe suicidality and negative emotions as an expected part of Reboot suffering required to “heal”^4,^5,^6,^7,^8,⁹. Homicidal threats were surprisingly common in NoFap forums, exceeding by several hundred posts in other subreddits of comparable post frequency and content (Prause, 2023). Posts describe graphic plans to murder “pornographers”^10,¹¹ and women who tempt them to “relapse.”^12,¹³ Other scientists also noted a remarkably “angry tone adopted by many NoFap members in response to pornography. The tone is almost combative in its abhorrence” (Taylor and Jackson, 2018).

Predictors of “Pornography Addict” identity in Rebooters

“Moral incongruency” theory suggests that those who believe they are addicted to pornography experience distress due to personal values that conflict with their own pornography viewing (Grubbs and Perry, 2019). These conservative values often arise from a religious upbringing. Yet, Reboot treatments were marketed to secular audiences. If Reboot followers actually are less religious than other self-identified pornography addicts, then what drives Rebooters’ identification as pornography addicts?

Several lines of evidence suggest narcissism might underlie self-identification as a pornography addict in those who are not religious. Self-identity as “sexually compulsive” is associated (r = 0.52) with narcissism (Oswald et al., 2021). Reboot clients encourage each other by claiming one another and themselves to be triumphant, strong, and attractive (Taylor and Jackson, 2018). Narcissists may attribute erectile difficulties to something outside of their control to maintain a positive self-image (Douglas et al., 2017), leading coaches to appeal to clients as “unwitting victim [s]” of imagined pornography cabal(s) (Burnett, 2021).

Narcissism and belief in conspiracies appear linked by a desire to maintain self-infallibility by demonizing others (Cichocka et al., 2016). Narcissists are convinced their unique brilliance leads them to know more than scientists in the relevant field (Bertin et al., 2021; Bowes et al., 2021; Lantian et al., 2017). Conspiracy beliefs are, at their core, a mistrust of authority, making scientific authorities a frequent target (Pierre, 2020). For example, Reboot coaches claimed to media, without evidence or expertise, that pornography “hijacks” neurocircuitry (Burke and MillerMacPhee, 2020), and described actual scientists in conspiratorial terms.^14,^15,¹⁶ Other common conspiracies in Reboot include that pornography companies have secret deals with pharmaceutical companies to cause erectile dysfunction,¹⁷ and that Jews/feminists/liberals secretly run the pornography industry in order to stop them from reproducing with “real girls” (Burnett, 2021). While individuals are susceptible to conspiracies for different reasons (Andrade, 2020), those who believe conspiracies scored lower on critical thinking tests (Lantian et al., 2021). Relatedly, those who use social media to garner health information tend to be misled to inaccurate health information due to a belief in false conspiracies (Allington et al., 2021).

Yet, individuals also may deny their conspiracy beliefs to avoid being viewed as gullible and/or socially excluded (Lantian et al., 2018). A narcissist might be attracted to the “addict” label to avoid social moral judgements that might otherwise be viewed as failures of the individual (Bailey, 2005). This is a problem, because adherence to the “addict,” rather than recovery, identity has been associated with lower self-efficacy, more negative behaviors, and maintained distress (Buckingham et al., 2013). Narcissists’ efforts to self-regulate problem behaviors ultimately result in seeking positive feedback rather than actual change (Morf and Rhodewalt, 2001). Narcissists also perceive personal slights everywhere (McCullough et al., 2003), which may make them resistant to expertise. Narcissism and belief in conspiracies may predict identifying as a “porn addict” in Reboot/NoFap treatments.

Hypotheses

Hypotheses were preregistered prior to data collection (https://osf.io/ux47b/?view_only=6739f6f8d4e74a809e95cd64b836dade).

Hypothesis 1

The reported intensity of suicidal thoughts attributed to relapse events will be significantly higher than population mean (i.e., mu) = 1 (having no suicidal thoughts). The shaming approach of Reboot that call viewing porn a personal “failure” may lead to thoughts of suicide. As suicidality is a highly negative outcome, any elevation of suicidal ideation by perceived “relapse” events is considered clinically significant.

Hypothesis 2

The more engaged with the Reboot forum NoFap (a) the more negative emotions associated with relapse (b) the more likely they are to have witnessed negative behaviors on the NoFap website and (c) the more sexually restrictive. Qualitative research suggested on NoFap suggested that these “support” forums actually shame participants for common sexual behaviors, and this shaming is often in the form of attacks on individuals’ core identity (e.g., sexual orientation, gender).

Hypothesis 3

Those with higher depression, anxiety, narcissism, belief in conspiracy, erectile dysfunction, and religiosity also will report greater certainty that they are addicted to pornography. Most research has pointed to conservative values as an important predictor of identify as a pornography addict, but Reboot/NoFap claims to be secular. This hypothesis tests which traits or symptoms are more likely to predict an identity as a pornography addict in men familiar with Reboots.

Hypothesis 4

Those who report being more sure that they are a porn addict also will report more erectile dysfunction, but this will be mediated by participation in Reboot interventions.¹⁸

Hypothesis 5

Those who believe NoFap is run by scientists or licensed therapists also are less likely to have sought help from licensed mental health professionals.¹⁹

Hypothesis 6

Those who believe NoFap harmed them also will report higher depression, anxiety, and erectile dysfunction. If Rebooters are young or sexually inexperienced, they may struggle to accurately attribute their mental health symptoms. If Rebooters who believe they were harmed by NoFap also reported poorer health outcomes, this argues against the possibility that they are poor at attributing changes in their mental health. If a belief they were harmed is related to more positive outcomes (or vice versa), then they are more likely inaccurate in their attributions.

Every registered analysis was conducted and reported. The study was approved by a federally assured Institutional Review Board at the Community-Academic Consortium for Research on Alternative Sexualities.

Methods

Most research on Reboot has been qualitative. We sought to quantify relevant constructs. However, like early Alcoholics Anonymous (Dodes and Dodes, 2015), Reboot groups actively fight and threaten litigation to avoid being researched (Gałuszka, 2020). Thus, a survey with platform advertisements was used to reach men who had heard of Reboot.

Questionnaires

Participants provided demographic and sexual history information, relationship happiness (Spanier, 1976), responses to standardized questionnaires (see below).

Religiosity

Religiosity was assessed using three items. One item concerned the frequency of attendance at religious services (Lugo and Cooperman, 2010), another concerned prayer frequency outside of religious services (Mockabee et al., 2001), and the third concerned how important religion was in their life (Michalak et al., 2007). These three items have been added previously to characterize religiosity (Arbuckle and Konisky, 2015) and specifically religiosity as related to pornography use and attitudes (Grubbs et al., 2020a). The score range was 3–17.

Mental health

Symptoms of major depressive disorder (Kroenke et al., 2003) and generalized anxiety disorder were measured using two items each (Kroenke et al., 2009). Participants were asked “Over the last 2 weeks, how often have you been bothered by any of the following problems?” and could respond 0 (“Not at all”) to 3 (“Nearly everyday”). Responses were added (total range 0–6). These brief screeners had comparable discriminative validity to both 9 and 7-item screeners, respectively (Staples et al., 2019). A meta-analysis examined the relationship between this depression screener and clinical interviews for depression. For scores >2 sensitivity (detecting diagnosis when present) = 0.91 and specificity (not detecting diagnosis when not present) = 0.67; for scores >3 sensitivity = 0.72 and specificity = 0.85 (Levis et al., 2020). This means, depending on which decision you want to optimize, this scale is able to accurately identify up to 91% of depression when it is present and accurately identify up to 85% of people as not having depression when they truly do not.

Personality

Participants reported their narcissism and belief in conspiracy. Narcissism was measured using the Single Item Narcissism Scale (SINS). SINS is “To what extent do you agree with this statement; ‘I am a narcissist’” with responses from 1 (“not very true of me”) to 7 (“very true of me”). The word ‘narcissist’ means egotistical, self-focused, and vain (Konrath et al., 2014). Narcissists were fairly aware of their own narcissism and readily reported the same (Carlson, 2013). SINS correlated with longer measures of narcissism (Ames et al., 2006) and was discriminable from measures of self-esteem (Van der Linden and Rosenthal, 2016). A score of 4 or above has been interpreted as “higher” narcissism (Macenczak et al., 2016).

A single-item scale was used to assess propensity to believe in conspiracies.²⁰ This item demonstrated concurrent, convergent, discriminant, and predictive validity (Lantian et al., 2016). Although the item lacks some construct and factorial validity (Goreis and Voracek, 2019), it converged with related concepts like the psychological need to feel unique (Lantian et al., 2017) and refusing to follow COVID-19 precautions (Coroiu et al., 2020). This measure was distinct from paranoia (Imhoff and Lamberty, 2018).

Sexuality

Three dimensions of sexuality were measured, including erectile functioning, pornography use, and openness to casual sex.

International Index of Erectile Function-5

The International Index of Erectile Function uses five items to measure erectile function (Rosen et al., 2000). The range is 5–25 where higher scores indicate fewer erectile problems (suggested interpretation is severe = 5 to 7, moderate = 8 to 11, mild to moderate = 12 to 16, mild = 17 to 21, and none = 22–25). The IIEF-5 has been used to screen large clinic populations (Rhoden et al., 2002). In that study, dysfunction prevalence was estimated as 53.9%, highlighting what may be a tendency to over identify ED. The IIEF is conservatively interpreted to reflect erectile “difficulties” rather than dysfunction. The IIEF-5 was elevated in men with coronary artery disease (Gazzaruso et al., 2004) and positively associated with age, body mass index, cholesterol, and triglycerides in patients with heart disease (Fung et al., 2004).

Pornography use

Pornography use is notoriously challenging to measure (Kohut et al., 2020). It was assessed using three questions (cp., Grubbs et al., 2020a). Pornography was defined for participants as “any sexually explicit films, video clips or pictures displaying the genital area, which intends to sexually arouse the viewer; this may be seen on the internet, in a magazine, in a book, or on television.” Participants indicated their average solo viewing in the last year (1 “Not at all” to 8 “once a day or more”), frequency of masturbation during viewing (1 “Never” to 5 “Always/Almost always”), and frequency of viewing pornography when masturbating (0 “I never touch myself for sexual pleasure” to 6 “Always/Almost always”). Identity as a pornography addict was assessed by “Would you say that you are a “porn addict”? (0 “Definitely not a porn addict” to 6 “Definitely a porn addict”). Since some individuals may continue to identify as an addict despite viewing themselves as recovered, we included “How upset are you about your current pornography viewing?” (0 “Not at all upset” to 6 “Extremely upset”).

Sociosexual orientation inventory (SOI)

SOI is a 9-item measure characterizing sexual openness (Simpson and Gangestad, 1991), especially interest in uncommitted sex (Penke and Asendorpf, 2008). In addition, this questionnaire also served as reinforcement for participation. Individuals who chose to complete all 9 items were provided their score, graphically compared to norms for their gender and age. This novel incentive eliminated the risks associated with collecting identifying information for financial rewards (Buchanan and Hvizdak, 2009).

Relapse affective response

Participants who indicated that they had tried a “Reboot” answered how many times they had relapsed. If they had relapsed at least once, they were prompted to describe their response to their “most recent” relapse. Specifically, they rated a list of emotions that they may have experienced in response to a “relapse” from the Positive and Negative Affect Scales (Watson et al., 1988) from 1 (“not at all”) to 5 (“extremely”). We added the item “suicidal.” We included one positive experience, “joy,” so participants could indicate (unexpected) positive experiences from relapse.

NoFap online forums

If the participant responded that they had visited NoFap forums, then they were asked to rate how they felt about NoFap on a scale from 1 (“Strongly disagree”) to 5 (“Strongly agree”). Items included “NoFap helped me” and “NoFap is a source for accurate scientific information.” Further, they were asked to rate how often they noticed ten problems in the forums. They could respond from 1 (“Never saw such posts”), 2 (“One post ever”) up to 7 (“Posts overwhelming”). Items included “Sexism (bad comments about women),” “Bodyshaming (bad comments about fat, muscularity, or similar),” and “Told to harm or kill myself.”

Procedures

Study data were collected using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at University of Southern California. REDCap is a secure, web-based platform designed to support data capture for research (Harris et al., 2019). Invitations with a link to the Informed Consent were presented through accounts posted by, or tagged, on Twitter (e.g., @TheIASR, @Reboot_Nation, @JustinLehmiller, and @NoFap, etc.), Reddit (e.g., r/NoFap, r/pornfree, r/pmohackbook, etc.), and Discord servers (e.g., “Reboot Warriors,” “PMO recovery,” “No Nut Central,” etc.). Forums were selected for recruitment where followers were likely to have heard of Reboot approaches. Advertisements also were placed on Twitter and Reddit targeting these communities.

Members of these groups did attempt to sabotage the research. These escalated into threats against the investigators reported to Reddit and law enforcement. Groups also attempted to block their members from learning about the study. Paid advertising (e.g., on Reddit) was used to circumvent blocks.

Data analysis

All hypothesis tests were pre-registered on Open Science Framework https://osf.io/ux47b/?view_only=6739f6f8d4e74a809e95cd64b836dade. Tests were powered using a criterion of 1 - 𝛃 = 0.80, p = 0.05, and ES = 0.1. Power refers to the ability of a test to detect an effect of a particular size if the effect is actually present. Where unplanned tests occurred, they were noted. Sexuality variables are often right skewed, meaning most people choose low levels of a variable with fewer and fewer people choosing higher and higher values (e.g., lifetime partner count). The reader may notice tests varying depending on the distribution of particular variables being tested. These are described more fully in the preregistration (above) complete with R analytic code.

Results

Non-completion rates were high like most online surveys. Of the 693 participants who started the questionnaires, 587 completed at least the first background questionnaire. Six were excluded for being female. Median completion time was 10.1 min. Ultimately, 417 (71.0%) completed every single questionnaire. This was comparable with other online surveys (cp., 68.5% in Lauer et al., 2013; 75% and 63.7% in Miller et al., 2020).

Participants

Participants were primarily white, moderately educated and heterosexual men (see Table 1). Most participants had personally tried a Reboot. Those who tried Reboot reported many relapses.

Table 1.

Demographic information.

Variable	Mean	SD.
Age	31.8	12.2
Lifetime sexual intercourse partners^a	13.5	22.8
International index of erectile function^b	19.8	4.8
Sociosexual orientation inventory^e	2.8	0.7
Depression symptoms	2.3	1.9
Anxiety symptoms	2.3	1.9
Pornography viewing frequency^f	6.6	1.6
Belief porn addict identity^d	3.6	2.1
Concern about porn use^c	3.2	1.6
Narcissism	3.0	1.6
Belief in conspiracies	4.9	2.5
Relapse count^g	20.7	19.1
	Count	Percentage
Education
None	2	0.3%
8th grade/less	1	0.2%
9–11 grades	10	1.7%
High school	88	15.0%
Technical or trade school	21	3.6%
Some college	120	20.4%
Associate degree	29	4.9%
Bachelor’s degree	175	29.8%
Master’s degree	81	13.8%
Professional degree	26	4.4%
Doctoral degree	24	4.1%
Race^h
American Indian or Alaska Native	10	1.7%
Asian	73	12.4%
Black or African American	32	5.5%
Native Hawaiian or Pacific Islander	5	0.9%
White	385	65.6%
Other	61	10.4%
Don’t know	5	0.9%
Refuse to answer	23	3.9%
Sexual orientation
Homosexual	36	6.7%
Bisexual	71	13.2%
“Straight” or heterosexual	402	74.7%
Something else	22	4.1%
Decline to answer	7	1.3%
Current romantic relationship
Single, choose to be single	125	23.3%
Single, but prefer not to be single	189	35.3%
Have a steady romantic partner (like a girlfriend or boyfriend)	74	13.8%
Living with a romantic partner (like a girlfriend or boyfriend)	24	4.5%
Married or similar commitment (common law marriage, religious bond, etc.)	124	23.1%
Current sexual relationship
Not sexually active with others by choice	130	24.1%
Not sexually active with others, but wish I was	168	31.2%
Casual partners	47	8.7%
Monogamous partner (we are only sexual with each other)	157	29.2%
Open partner (my main partner and I are sexual with others by agreement)	21	3.9%
“Cheating” partner (sexual with others than my main partner without their knowledge or consent)	15	2.8%
Personally tried to “Reboot”	257	62.5%

^aSex partners could be reported up to 100.

^bLower score indicates better erectile function.

^cRange from 1 “Not at all concerned” to 5 “Very concerned.”

^dRange from 0 “Definitely not a porn addict” to 6 “Definitely a porn addict.”

^eRange from 1 to 5 with higher scores indicating less constrained sexuality.

^fRange from 1 “Not at all” to 8 “Once a day or more.”

^gThe maximum number of relapses that could be reported was 50, which was selected by 60 participants.

^hParticipants could select more than 1 category.

Descriptives

Defining reboot and relapse

The definition of what constitutes a “Reboot” or “relapse” varied between participants. The most agreement (lowest variance) of relapse (see Figure 1) was for “Masturbating while viewing pornography” (SD = 0.88). The least agreement (highest variance) was for “Hidden sex with a partner who is not my primary (main) partner” (SD = 1.73). The number of days a participant believed they should be abstinent to complete a “Reboot” averaged 42.0 days with high variance (SD = 36.6).²¹

Figure 1.

Belief that a behavior constitutes a Reboot relapse.

NoFap forum problems

Some individuals would rate that they had “Never” seen any of the post types, or that every single post type was “Overwhelming,” a response set known as “straightlining” (Schonlau and Toepoel, 2015). This creates outliers (Leiner, 2019). These are not regarded as valid and interfere with the distribution requirements for statistical tests. Respondent-level standard deviation identified straightlining (Barge and Gehlbach, 2012). Respondents whose SD = 0 were removed from this analysis. This meant that only reporting “Overwhelming” or only reporting “Never” would be equally removed.

NoFap forum visitors reported witnessing content that was trolling (88%), misogynist (73.7%), bullying (49.1%), anti-LGBT (42.9%), or anti-semitic (32.0%). Many participants were told to harm or kill themself (23.5%) and witnessed threats to hurt others (21.1%), and dox others (17.1%) on NoFap forums.

Responses to most recent relapse

Only participants who indicated that they had experienced a relapse were invited to answer these questions.

Suicidality (H1)

Sixty-six (28.9%) participants reported they felt suicidal due to their most recent relapse, with 12 reporting feeling “extremely” suicidal (see Figure 2). The distribution of scores were right skewed (skew = 1.4, Jarque = 223.3, p < 0.001). Following our analytic plan, transformations did not sufficiently reduce skew. A Wilcoxon signed-rank test (V) was used, because it only requires that variables be ordinal rather than continuous and normally distributed.²² Suicidal feelings were significantly elevated from “Not at all” in response to relapse (V (234) = 2346, p < 0.001).

Figure 2.

Intensity of feeling suicidal following the most recent “relapse.”

We explored whether suicidal feelings were linked to engagement in NoFap forums. Spearman’s rank test (rho), which only requires that variables be ordinal rather than continuous and normally distributed, demonstrated a significant positive relationship (rho (206) = 0.20, p = 0.004). The more involved a participant was with NoFap forums, the more suicidal they reported feeling in response to their last relapse (see Figure 3).²³

Figure 3.

The more involved with NoFap online forums, the more likely participants experienced suicidal ideation at their last “relapse” event.

NoFap involvement associations (H2)

Negative emotions during relapse (H2a)

The factor solution fit well with a single factor (R² = 0.94, see Table 2). In other words, the variance among the negative emotions reported tended to vary together, such that one score could be computed to characterize when negative emotions, in general, changed. The bootstrapped correlation between the negative emotion factor and participation in NoFap forums was significant (r_boot (200) = 0.42, p < 0.001, see Figure 4).²⁴ The more involved a participant was with the NoFap forums, the more negative emotions that they reported experiencing following their most recent relapse. One exploratory follow-up test supported that the more involved a person was with NoFap, the more “ashamed” they felt in response to their most recent relapse (rho (208) = 0.27, p < 0.0001).

Table 2.

Emotion weights contributing to factor score.

Emotion	Weight in factor score
Sad	0.79
Anxious	0.66
Worthless	0.86
Upset	0.86
Angry	0.81
Despair	0.80
Disgusted	0.85
Ashamed	0.83

Figure 4.

Involvement with NoFap and feeling negative emotions with last “relapse.”

Negative forum behaviors (H2b)

The MANOVA was significant (F (1,230) = 2.4, p = 0.01). Follow-up, one-way ANOVA’s demonstrated involvement with NoFap was related to the participant more frequently witnessing the instructions “told to harm or kill myself” (F (1,118) = 5.7, p = 0.02, see Figure 5).²⁵

Figure 5.

Involvement with NoFap and being told to “harm or kill myself.”

More sex negative (H2c)

Involvement with NoFap and sex negativity was significant (r_boot (368) = −0.23, p < 0.0001, see Figure 6). The more involved a participant was with NoFap, the more sex negative their Sociosexual Orientation Inventory scores.

Figure 6.

Involvement with NoFap and sociosexual orientation score.

Predictors of addict identity (H3)

The linear model was significant (F (6, 351) = 20.5, p < 0.001, $R_{a d j}^{2}$ = 0.25, see Figure 7). Narcissism ( $ϐ_{s t d}$ = 0.21, CI = 0.12 to 0.30, $η_{p}^{2}$ = 0.06), anxiety ( $ϐ_{s t d}$ = 0.24, CI = 0.12 to 0.36, $η_{p}^{2}$ = 0.06), and erectile difficulties ( $ϐ_{s t d}$ = −0.22, CI = −0.31 to −0.13, $η_{p}^{2}$ = 0.06) predicted identification as a pornography addict (see Figure 7). Specifically, those who more strongly identified as a pornography addict in this sample also reported more narcissism, anxiety, and erectile dysfunction.

Figure 7.

Predictors of identity as a pornography addict.

NoFap harms (H6)

A belief that “NoFap helped me” was associated with anxiety and erectile difficulties. Specifically, the more a participant believed that NoFap helped them, the more anxiety (rho (338) = 0.11, p = 0.04) and erectile (rho (278) = −0.17, p = 0.004) difficulties they reported (see Figure 8). Depression symptoms were not significantly associated with the belief that NoFap was helpful.

Figure 8.

Belief NoFap helped and symptoms of erectile dysfunction and anxiety.

Perhaps individuals did not receive a sufficient “dose” of the Reboot treatment? An exploratory analysis identified that the more involvement a participant reported in NoFap forums, the more anxiety (rho (375) = 0.20, p < 0.001), depression (rho (377) = 0.18, p < 0.001), and erectile (rho (318) = −0.15, p = 0.007) difficulties they reported (see Figure 9). To explore why participants might feel helped despite worse symptoms, we explored belief in conspiracies. A shared belief in false conspiracies, such as “The porn industry is targeting NoFap,” might have supported a feeling of belongingness to this group despite poorer actual measures of health. Those who reported that NoFap had been more helpful also were more likely to believe in conspiracies (r (328) = 0.26, p < 0.001, see Figure 10).

Figure 9.

The more involved with NoFap online forums, the more symptoms of anxiety, depression, and erectile dysfunction.

Figure 10.

The more involved in NoFap online forums, the greater the belief in conspiracies.

Discussion

This cross-sectional, preregistered survey examined associations with “Reboot” treatments for pornography addiction, including abstinence goals and online forums. Many (28.9%) Reboot participants reported that their most recent failure to maintain/reach the Reboot abstinence goal caused them to feel suicidal. The more engaged a participant was with NoFap, the more (1) negative emotions they experienced at their most recent relapse, (2) likely they had been told to “harm or kill themself,” and (3) restrictive (disapproving of casual sex) their sexuality. Predictors of identifying as a “pornography addict” in this sample included being more narcissistic, higher anxiety, and more erectile dysfunction. Very few participants sought care from licensed professionals for their pornography concerns. Finally, the more a participant believed that NoFap had helped them, the more anxiety and erectile problems they reported. Relatedly, participants who reported more engagement in NoFap forums also reported more current depression, anxiety, and erectile problems in contrast to previous research on treatment engagement associated with fewer symptoms.

Evaluating any treatment requires considering the spontaneous recovery rate of the problem behavior. In a study that followed a large sample of randomly selected persons for 5 years, 95% of men who reported pornography concerns at baseline spontaneously recovered within 5 years (Konkolÿ Thege et al., 2015). Recent data show sex/pornography problems over 5 years were not chronic (Gooding et al., 2022). While some have advocated research into abstinence (Fernandez et al., 2020), continuing to spend limited research resources for clinical trials (Heiman, 2002) developing abstinence Reboot programs now appears wasteful, especially given the spontaneous recovery rate.

While still lacking a random-assignment, controlled clinical trial (Floyd et al., 2021), a number of potentially effective interventions for distress regarding pornography have been tested. Two smaller trials of Acceptance and Commitment Therapy (ACT) reduced distress regarding pornography viewing (Crosby and Twohig, 2016; Twohig and Crosby, 2010). When a romantic partner is available, empirically supported treatments for couples’ distress are appropriate (Sniewski et al., 2018). A case series of meditation for pornography viewing distress specifically sought (mostly unsuccessfully) to reduce guilt and shame following pornography viewing (Sniewski et al., 2020). None of these treatments used abstinence or community support touted by Reboot coaches. Thus, Reboot treatments create additional harms by leading the public away from these evidence-based treatments.

Exploratory analyses suggested those who are more engaged with NoFap also report more belief in conspiracies. Belief in conspiracies is thought to be a response to experiencing uncertainty, presumably as a mechanism to feel in control (Adam-Troian et al., 2021). If a man is anxious about his erections, the conspiracy beliefs in Reboot forums likely provide a way for the man to feel he is unique/special (not simply anxious) and/or paranoia that the pornography industry conspired against him (Pierre, 2020). These individuals tend to have low science literacy, possibly consistent with younger age of those participating in Reboot (Landrum and Olshansky, 2019). Further, these conspiracies may drive some of the threats to harm others that were witnessed by participants. Specifically, “activists within the anti-pornography movement have not, for the most part, faced violence, discrimination, or mistreatment, where sex workers and their allies, especially queer people of color, have” (Burke, 2022). The role of conspiratorial thinking was not a focus of this study, but appears possibly useful to explore in future research.

Reboot/NoFap treatment is usually administered by unlicensed “coaches” who refer to followers as “clients” (e.g., Church, 2015). Lifestyle coaches lack clear or standardized credentials, and their claimed expertise usually is solely experiential (George, 2013). They often do not have any occupational history that informs client relationships (Murphy and Kreiner, 2020). Despite this lack of training, strong claims of expertise²⁶ and guarantees of a cure²⁷ are common among Reboot coaches. Coaches reassure clients that they can cure a variety of concerns by remaining porn-abstinent.^28,^29,³⁰ Coaches have no relevant education, training, licensing, or supervision requirements, offering no real legal protections for clients who are harmed (Aboujaoude, 2020). Unlike licensed mental health care professionals, a coach is under no legal obligation to protect the confidentiality of their clients’ disclosures (Anderson et al., 2012) and cannot discern when a mental health care referral is needed (Anderson et al., 2012). Such pseudo-practitioners are known for pushing their clients into acts that are inappropriate (Giraldez Hayes, 2021). However, even “certified sex addiction therapists” have no published efficacy for their claimed treatments (Grubbs et al., 2020b). These licensed therapists vested in addiction models may be unable or unwilling to direct clients away from iatrogenic addiction therapies (Speers et al., 2022). The results in the current study cannot definitively apportion blame to the pseudo-practitioners or the Reboot treatment modality: both appear faulty.

The data regarding suicidality are concerning given that Reboot treatments are mostly administered by untrained coaches. Although even licensed professionals debate the best course of action to reduce the risk of suicide (e.g., Rudd et al., 2006), Reboot coaches and communities have neither the training nor authority to respond adequately to self-harm reports. Narcissists are more likely to become suicidal when shamed (Gabbard, 2022). Given that Reboot is a shame-based treatment, narcissists may be the participants reporting feeling most suicidal in response to the Reboot treatment. They may be unable to reconcile their self-concept as “king” and “soldier” with experiences described by Reboot coaches as personal failures. As with any study, this study had limitations. The sample suffers from the same problem of low ethnic and sexual orientation diversity as studies of sexual compulsivity (Jennings et al., 2021). However, this might reflect the nature of these particular men, many following a program with forums commonly assailing LGBT persons. It may be that the low diversity actually is representative of men who have heard of Reboot, who appear to seek reassurance that they are not gay from viewing gay pornography or wish to avoid LGBT persons due to prejudice (Hartmann, 2020). Treatment programs for sex and pornography “addiction” also are well-known to primarily include white clients (Ley et al., 2014).

Several of the measures, while peer-reviewed and well-characterized psychometrically, were very brief. For example, a single-item measure of narcissism was used. Some scientists have suggested that narcissism has multiple, differentiable components, such as grandiose or vulnerable narcissism (e.g., Foster et al., 2015). The single item used in this study does have predictive validity thought to reflect both grandiose and vulnerable narcissism (Konrath et al., 2014). Future research may explore whether current findings with brief scales can be replicated with longer measures, or may be specific to facets of the constructs studied.

Harmful therapies are well-documented in clinical science (Lilienfeld, 2007; Williams et al., 2021). They can slip through unnoticed for years because therapists often struggle to catch when their clients are deteriorating (Hatfield et al., 2010) and do not use instruments designed to monitor for client harms (Gilbody et al., 2001). Reboot treatments are most similar to iatrogenic, anti-LGBT conversion therapies. These also shame sexual behaviors and promote suicidal ideation (Glassgold, 2022). Additional research into Reboot/NoFap treatment efficacy appears unwarranted, as it is unethical to expose participants to iatrogenic treatments. Therapists who refer clients to Reboots/NoFap will most likely harm their clients. Given decades of research on pornography concerns without evidence-based treatment literature (Grubbs et al., 2020b), scientists also should not waste further time and resources testing harmful Reboot abstinence treatments.

Footnotes

Declaration of conflicting interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: NP receives fees to provide continuing education workshops for mental health professionals concerning sex therapy. NP received death threats on Reboot platforms. JB has no conflicts of interests to declare.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Nicole Prause

Notes

Nicole Prause, PhD completed this work as a Biostatistician II at Children’s Hospital, Los Angeles, and is curently a Senior Statistician in the University of California, Los Angeles, Department of Medicine. Dr. Prause also is a licensed psychologist in California (#27778). Her research includes the neuroscientific study of sexuality, orgasm physiology, the health effects of sexual arousal, and violent extremism and disinformation in online spaces.

James Binnie, MSc, is a senior lecturer in counselling psychology at London South Bank University and a senior therapist in private practice. His teaching and research both focus upon psychotherapy and mental health.

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