(272) Cognitive-Behavioral Therapy for Paraphilic Disorders: A Single-Case Experimental Design Protocol

Introduction Sexual violence represents a major societal and public health concern. Paraphilic disorders and sexual preoccupation are established risk factors for both the onset and recidivism of sexual offending. Despite being recognized psychiatric conditions, paraphilic disorders are rarely assessed or treated within general psychiatry, and knowledge regarding evidence-based approaches in healthcare settings remain scarce. Cognitive-behavioral therapy (CBT) has shown promise in related conditions such as Compulsive Sexual Behavior Disorder (CSBD) and in the treatment of paraphilic disorders within forensic contexts. However, whether these findings can be generalized to help-seeking individuals with paraphilic disorders in outpatient care remains to be evaluated. Objective This study aims to evaluate the efficacy of a 10-module CBT program for help-seeking men with paraphilic disorders, delivered within an outpatient healthcare setting. Methods Fourteen participants will be recruited, divided into two diagnostic groups: (1) voyeuristic, exhibitionistic, or frotteuristic disorder (n = 7), and (2) coercive sexual sadism disorder (n = 7). The intervention consists of 10 structured CBT modules delivered by licensed psychologists over a maximum of 12 weeks, either face-to-face or via secure video sessions. A multiple-baseline single-case experimental design will be employed, with seven randomized baseline lengths across participants. Repeated measures will assess paraphilic urges and behaviors, sexual preoccupation, and comorbid symptoms (e.g., depression, anxiety). Primary outcomes include time spent on problematic behaviors, intensity of sexual urges, use of sexual activity as a coping mechanism, and overall well-being. To address the clinical and criminological needs of individuals with paraphilic disorders, we have adapted an established CBT manual, originally developed at our clinic for CSBD, to specifically target paraphilic symptomatology and common comorbidities, including depression and anxiety. The manual integrates CBT components including functional behavioral analysis, cognitive restructuring of distorted beliefs, behavioral activation, mindfulness, emotion regulation strategies, and social skills training. Relapse prevention techniques are included to support long-term maintenance of behavioral change. Results Not available- data collection is ongoing. Conclusions This will be the first study to evaluate a CBT program specifically designed for paraphilic disorders using a multiple baseline single-case experimental design. The findings are expected to advance the understanding of treatment of these conditions, reduce individual suffering, and ultimately contribute to prevention of sexual offending. Disclosure No