Heal the body, the mind follows

It’s not often that psychology articles begin with an article from a famous actor, but this one seemed perfectly appropriate for this instance. So, without further ado, here is Jim Carrey’s take on depression:

“I believe depression is legitimate. But I also believe that if you don’t exercise, eat nutritious food, get sunlight, get enough sleep, consume positive material, surround yourself with support, then you aren’t giving yourself a fighting chance.” – Jim Carrey, Actor and Comedian

From ACT to CBT and ABC to XYZ, there is no shortage of psychological approaches to help people better understand what is going on within their respective minds. It also makes sense that in an effort to solve our mental health woes, we would gravitate towards techniques that focus efforts predominantly on the fundamental base of mental health: the mind. But what if focusing solely on cognitive interventions means that we are forgetting – or worse, ignoring – that the mind and our mental health are inexorably linked to our health of our body? In a world where beautifully formulated and articulated cognitive theories garner media attention, it would seem too simple, and far too obvious, to acknowledge and examine an individual’s physical lifestyles in order to understand how they may be influencing and contributing to mental wellbeing.

The big three: Physical lifestyles that impact mental health When it comes to the connection between the body and the mind, there is a preponderance of evidence supporting the argument to start with the body, specifically with an assessment of an individual’s daily lifestyle. Food, exercise, and sleep likely constitute the three most significant healthy lifestyle choices most often cited within literature. One of principal ways we interact with our external environment is through the food we eat, and the influence that our food has on our bodies cannot be overstated. Hippocrates famously stated – and has been quoted thousands of times since – to ‘let food be thy medicine and medicine be thy food’. Science has explored this notion from myriad different angles to truly understand how, and the extent to which, our mental and emotional wellbeing are linked to the food we eat. From gestation into adulthood, dietary habits have been linked not only to the disruption of energy balance, but also to attention, mood, behaviour, and even mental health disorders (Murphy & Mercer, 2013).

Few are aware of the key connection between nutritional deficiencies and mental disorders, such as the role that food choice may have in the onset – as well as severity and duration – of depression (Rao et al., 2008). Research has shown that many of the clinically identified dietary patterns linked with depression (i.e., poor appetite, skipping meals, and a dominant craving for sugary and sweet foods) are likely present prior to the onset of depressive symptoms (Rao et al., 2008). The relationship seems to exist in both directions, with diet- and nutrient-based interventions demonstrating the potential to ameliorate symptoms associated with mental disorders, such as anxiety-related symptoms (Murphy & Mercer, 2013; Kiecolt-Glaser et al., 2011), reduction of depression symptoms (Francis et al, 2019; Lai et al., 2014), and generally supports overall mood and mental wellbeing (Firth et al., 2019). Lastly, increasing amounts of scientific attention has been placed on gut and digestive health because, firstly, the majority of the cells that make up the human body are bacterial cells (Sender, Fuchs, & Milo, 2016) and, secondly, the biological significance of the microbiota in relation to its interactions with the brain regions associated with mood and behaviour (Tillisch et al., 2017). Dysbiosis – a microbial imbalance of maladaptation such as an impaired microbiota – has been linked to anxiety and depression (Clapp et al., 2017).

Indeed, probiotic-rich fermented foods have demonstrated a protective effect and serve as a low-risk intervention for improving mental health because fermented foods support a healthy microbiome (Hilimire, Devylder, & Forestell, 2015).

Food, exercise, and sleep likely constitute the three most significant healthy lifestyle choices most often cited within literature.

Two other lifestyle choices with scientifically validated significant impacts on mental wellbeing are regular exercise and adequate sleep. Exercise could be considered one of the magic bullets for mental health disorders because of its positive impacts on anxiety (Stonerock et al., 2015), depression (Craft & Perna, 2004), schizophrenia (Gorczynski & Faulkner, 2010), and bipolar disorder (Thomson et al., 2015). And the kind of exercise matters little as all exercise types have been associated with a lower mental health burden (Chekroud et al., 2018). In addition to healthy dietary choices and consistent exercise, sleep – and the lack thereof – has been significantly associated with mental health and wellbeing as poor sleeping patterns have been associated with higher levels of depression and anxiety (Al-Khani et al., 2019). Indeed, sleep difficulties might be a contributory causal factor in the occurrence of mental health problems, which supports the notion that treatment of disrupted sleep may require a higher clinical priority with mental disorders (Freeman et al., 2017). The fact that eating healthy food, exercising, and getting quality sleep seem like common sense is likely one of the contributing factors for overlooking these lifestyles within clinical settings. It’s only when we take the analysis one step deeper that we begin to see why our physical lifestyles have such a significant impact on our mental health. Two important questions arise out of such an exploration. Firstly, what are the common biological ramifications of unhealthy lifestyle choices (i.e., poor diet, sedentary lifestyle, poor sleep quality) and how are these commonalities related to mental health disorders? Secondly, what are the common physiological implications shared among healthy lifestyle choices (i.e., healthy eating habits, consistent exercise, adequate sleep) and how do they support mental health and wellbeing? The likely answer to both these questions is likely related to the concept of inflammation.

Inflammation: The conceptual bridge between physical lifestyles and mental health Inflammation is a natural defence mechanism in the human body. Acute inflammation is beneficial and part of the body’s natural immune response. Chronic inflammation – characterised by slow, long-term exposure to inflammation lasting for prolonged periods of several months to years – however, has been shown by increasing bodies of evidence to be the cause of many diseases (Hunter, 2012). Though inflammation is a physiological phenomenon that occurs at the physical level, it is also incredibly relevant in the world of mental health as pro-inflammatory bodily states are associated with a proclivity towards mental health disorders such as depression and anxiety (Slavich & Irwin, 2014; Strawbridge et al., 2015; Furtado & Katzman, 2015). Additionally, evidence suggests a significant relationship between inflammatory processes and pathways in the body and the relapse of depression (Liu et al., 2019), and also helps explain why some individuals exhibit poor responses to conventional antidepressant therapies as increased inflammation may interfere with the efficacy of antidepressants (Felger, 2019). Lastly, supporting the notion of chronic inflammation and its role in mental health disorders are the higher rates of depression across a broad range of conditions associated with activation of the immune system (i.e., allergies, autoimmune diseases such as Type-1 diabetes, multiple sclerosis, systemic lupus erythematosus, and rheumatoid arthritis, and infections) (Lee & Giuliani, 2019).

Literature suggests that inflammatory pathways are considered important biological meditators of mental health and wellbeing, specifically that decreases in inflammatory pathway activation during periods without active bodily infection are associated with both better physical and mental health (Elenkov et al., 2005). And here is where healthy lifestyle choices come in as lifestyle choices have been shown to have significant impacts on inflammation (Jarvandi et al., 2012). The food we eat can be pro- inflammatory and cause chronic, low-grade inflammation (Minihane et al., 2015). Conversely, eating healthy foods such as olive oil, garlic, apples, and cocoa powder can have anti-inflammatory effects and, thus, help reduce the overall inflammatory burden of the body (Schwingshacki, Cristoph, & Hoffmann, 2015; Lapuente et al., 2019). Dietary interventions have been utilized to treat mental health disorders such as depression, schizophrenia, and bipolar precisely because of this link between inflammation and mental health disorders (Firth et al, 2019a). It is thus not surprising that in addition to a healthy anti- inflammatory diet, both consistent

exercise and adequate sleep have also been significantly associated with decreases in – and healthy metabolization of – stress and inflammation (Woods et al., 2012; Mullington et al., 2010). How we choose to live our life will have a direct impact and influence on the inflammatory pathways in our body. And this is why Jim Carrey’s quote really brings it home. The actor – who himself publicly battled with depression – did not stop with healthy eating, exercise, and sleep when discussing his take on the optimal lifestyle and environment for the treatment of depression. He listed many other lifestyle choices. Quite reasonably, and probably without realizing it, he knew that there’s more to a healthy lifestyle than just eating healthily, exercising, and sleeping well. Each and every one our lifestyle choices are either pro-inflammatory or anti-inflammatory, either adding or reducing stress, either helpful or detrimental to our mental wellbeing. Every lifestyle choice – day-to-day, moment-to- moment – matters.

Destressing: The whole lifestyle matters Sometimes eating healthily or exercising are not enough on their own, especially when the other aspects of an individual’s life do not promote health and wellbeing. This is because when it comes to healthy lifestyles and their impacts on mental health and wellbeing, it is not about one single factor, but rather the sum of all the parts. The whole lifestyle matters. How someone eats, moves, sleeps, laughs, loves, thinks, connects, talks, and rests all come into play in the cumulative equation of stress and inflammation. For the perspective of mental health, research certainly supports this notion, as the concepts of belonging to a community (Mushtaq et al., 2014), exposure to nature, outdoors, and sunshine (Pearson & Craig, 2014; Penckofer et al., 2010), and meditation (Hoge et al., 2013; Black & Slavich, 2016) have all been associated with a wide range of mental health benefits, particularly related to stress. Indeed, nearly every activity that reduces stress plays an integral role in reducing chronic inflammatory activity (Maydych, 2019), as the two are inexorably linked. The more we stress ourselves (i.e., poor diets, work stress, sedentary lifestyle, poor sleep) the more chronically inflamed our body becomes. With this mind, it may help the reader to conceptualise healthy lifestyles as those that promote rest, recovery, and destressing.

The real magic that results from healthy lifestyles, however, is when someone truly embraces the notion that the whole is greater than the sum of the individual parts. Healthy lifestyle choices support each other, thus compounding the mental health benefits to be derived from each individual lifestyle choice. Two prime examples include the positive compounding effects of both exercise and meditation, which individually are associated with a wide range of mental health benefits, but also improve sleep quality (Banno et al., 2018; Black et al., 2015). Mental health is thus the direct consequence of the environment that your body lives in 24 hours a day. The whole lifestyle counts. When we put our bodies in an environment that promotes health and stress management, then improvements to vast arrays of mental benefits naturally manifest. When we begin to consider the interconnectedness of the various aspects of physical lifestyles and mental wellbeing, it becomes increasingly relevant in clinical settings.

How much is our physical lifestyle contributing to our debilitating psychological states? What would happen if we started first with the health of the body in order to see how much of the issues/symptoms are resolved naturally as a consequence of improved biological function, and only then dive in with cognitive approaches to see what’s left over. These are important questions for practitioners to consider when working with clients because of their respective significant impacts on mental and emotional wellbeing. If the root cause of an individual’s mental disorder is a manifestation of physiological and biological variables, then it doesn’t matter how good you are at ACT or CBT, it’ll be a long road to recovery as the physiological root cause will remain unaddressed.

This piece sheds light on what is often overlooked, undervalued or considered secondary in modern approaches to improving mental health: the human body and the environment created by someone’s daily physical lifestyle. Bodily health has tremendous impacts on psychological wellbeing and the manifestation of mental disorders.

Literature suggests that inflammatory pathways are considered important biological meditators of mental health and wellbeing, specifically that decreases in inflammatory pathway activation during periods without active bodily infection are associated with both better physical and mental health

Interventions focused on the health of the body via proactive physical lifestyles may even play a primary role in treating and preventing mental disorders. My hope is that this article has highlighted the importance of assessing and intervening with physical health – maybe even first and foremost – before exploring the thought processes that could be the direct consequence of physiological variables that psychological interventions simply cannot address. student forum

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Breaking isolation: Men, too, need connection

When Chief Coroner, Judge Deborah Marshall released the most recent suicide statistics in New Zealand, the sobering reality of the current mental health crisis sent shockwaves throughout the world. Annual statistics reported 685 suicide deaths in New Zealand in the most recent reporting year; the highest since official records began in 2007 (Henry, 2019). Suicide deaths have increased each of the last four years; the suicide rate now stands at 13.93 per 100,000 people, and the rates of suicide among Māori and Pasifika have risen dramatically (Henry, 2019). Given that suicide rates are a sign of the mental health and social wellbeing of the population, these alarming statistics emphasise that suicide may represent the most serious health and social issue New Zealand currently faces. For me, the findings and statistics confirmed a call to action that I sought to answer when I began my doctoral research at AUT in 2017.

While the staggering nature of these suicide statistics is alarming, what has captured the attention of health authorities is the extent to which suicide has disproportionally impacted men, specifically young men. In New Zealand, suicide rates for men are more than twice as high as for women (Henry, 2019). Indeed, men of all age groups made up 68% of suicides (Bateman, 2019). The bigger concern, however, is how suicide is impacting the young men of New Zealand. Of the 685 suicide deaths last year, 112 were men between the ages of 15 and 24 (Bateman, 2019). Among the long list of 41 OECD and EU countries, New Zealand has the highest youth suicide rate in the developed world (Illmer, 2017). The rate of 15.6 suicides per 100,000 people is twice as high as the rate in the United States and almost five times that of Britain (Illmer, 2017). While the reasons and explanations are likely complex, contextual and multi-faceted, research suggests there is one variable in particular that could be largely responsible for these staggering male suicide statistics: loneliness, and isolation that proceeds it (Calati et al., 2019).

The long-standing mainstream culture and narrative around masculinity in New Zealand calls for emotional stoicism (Illmer, 2017). What it means to ‘be a man’ has not left the necessary space for boys and young men to express and be open about their emotionality or psychological distress. Growing up, boys are given clear messages to be ‘strong’, ‘tough’, and never cry or show emotion. Hence, accessing mental health support resources goes against the ingrained cultural expectations of masculinity. As a result, men generally put off getting help for problems, especially when the issue is related to mental health. Instead, they exacerbate the debilitating effects of depression and anxiety by isolating themselves from the world and from meaningful connections that could help them work through their emotional distress.

Luckily, there has been recent upsurge of academic interest and activism around the subject of male mental health, due in large part to the media spotlight and high-profile figures who have been vocal and vulnerable about their own struggles and experiences with depression and anxiety. Here in New Zealand, many of the male icons who have been put on the highest pedestal of traditional ‘tough bloke’ masculinity have displayed incredible strength and come forward with their stories of personal struggles and suffering through mental health challenges. John Kerwin and Mike King are two prime examples. These brave men – and many others – are helping to fight the stigma of male vulnerability, and communicating that the core principle of being emotionally vulnerable firmly belongs in the framework of modern masculinity.

My own interest in men’s mental health has stemmed directly from the doctoral research I have been working on over the last three years at the Auckland University of Technology. My PhD research focused on examining meditation as an intervention for men with self-perceived problematic pornography use. I could have probably picked any addictive substance or behaviour and been able to complete the degree requirements simply because of the utility and efficacy that meditation has shown within other addiction-related and mental health contexts (Sniewski, 2018; Reid et al., 2014; Zgierska et al., 2009).

While the staggering nature of these suicide statistics is alarming, what has captured the attention of health authorities is the extent to which suicide has disproportionally impacted men, specifically young men.

My interests, though, were less about adding to the already massive mountain of evidence in support of meditation and more about examining the many layers and contexts of pornography use, especially given the widespread consumption of pornography in New Zealand. PornHub – the most popular free pornography website – has over 58 million visits per day, with New Zealanders – on a per capita basis – representing the fifth most regular visitors worldwide (“Kiwi Porn Habits Revealed,” 2016). So while one of the primary research aims of the study was to assess whether meditation could be used as a tool for men attempting to quit or reduce their pornography viewing, the study was designed in such a way that it brought to light other – and arguably more significant – findings related to the contexts that contribute to the participant’s self-perceived problematic pornography use, its origins, the reasons these men came forward to take part in the intervention, and an exploration of past attempts at quitting.

Anyone could have guessed – and this certainly did not constitute groundbreaking research – that participants did not talk about their pornography viewing and masturbation habits with others. Men watch pornography in isolation and tend to not want to talk about it (Sniewski & Farvid, 2019). Not only does opening up about personal struggles position a man as vulnerable, the added layer of stigma associated with pornography only serves to reinforces hidden and anonymous pornography use (Sniewski & Farvid, 2019). The combination of inadequate sex education, cultural stigma surrounding pornography, and the inability of parents to talk about sex and pornography in productive ways has made pornography a very difficult topic to discuss with others (Sniewski & Farvid, 2019). The most significant takeaways from our research, however, emerged when we started investigating why these men were watching pornography and the reasons they provided for perceiving their viewing to be problematic (Sniewski & Farvid, 2019).

When the men in the study consumed pornography, it served as a form of experiential avoidance. It was in an effort to cope with and manage unwanted thoughts or memories, negative feelings, or uncomfortable physical sensations, even if the coping strategy created additional harm and negative consequences (Wetterneck et al, 2012). For these research participants, pornography evolved from a conscious choice motivated by pleasure-seeking and sexual stimulation into a habitual act, triggered by the need to avoid stress and other uncomfortable emotional states (Sniewski, Farvid, & Carter, 2018). When life and circumstances became too distressing or challenging, instead of seeking professional help or talking to someone, they reached for pornography. In the absence of other coping mechanisms, pornography provided the most reliable – although short-lived and fleeting – solution to coping with the emotional states that they had been raised to believe they should not talk about, let alone feel.

All of the participants reported feelings of shame and guilt after viewing pornography. The temporary relief from affective discomfort that pornography provided only served to reinforce continued use and continued isolation (Sniewski & Farvid, 2019). The downward spiral can be quick and fast when you cannot talk about the pain and discomfort underlying pornography use, and you cannot talk about the developing pornography problem since pornography itself is shame-ridden and stigmatised. And this is precisely how and why addiction begins to erode a person’s life. When someone becomes isolated and alone, they need connection to heal. Pornography – and the stimulus that it provides – attempts to provide this sense of connection and relief but falls well short of anything meaningful and substantive. If isolation and disconnect is at the root of the addictive cycle, then surely the answer is breaking isolation and finding meaningful, authentic connection.

It became evident why many of the participants’ pornography viewing began decreasing during the baseline phase of the research, before they had even started the meditation intervention designed for the study. Pornography, as it turns out, was an incredibly effective topic, which helped men to not only talk about a deeply shameful topic (i.e., pornography), but also to open up about deeper mental and emotional issues beneath the surface of their pornography use. Indeed, many of the participants were able to reflect upon and begin to break the subconscious behavioural patterns associated with their pornography

use long before they sat down, closed their eyes, and observed their breathing. The walls of their self- and culturally-imposed isolation began breaking down from the moment they emailed me to participate in the study. Participants started to see first-hand that they only used pornography to avoid uncomfortable emotional states and felt empowered to act on these new insights into their behaviour.

Men – especially young men, as many of the participants were university students – need support for their mental health, but instead turn to pornography because they feel isolated, alone, and feel too ashamed to turn to anyone for help. This study provided the framework for that kind of support to be provided, even though that was not the original intention of the study. Indeed, the study represented the first instance that many of these men had spoken openly and honestly about their pornography use without being judged or shamed for it (Sniewski, 2018a). Just being able to talk about their pornography use, as well as the emotional contexts that triggered use, effectively started to break the automatic behavioural cycle. Instead of suffering in isolation and habitually avoiding the uncomfortable emotional states that were perceived as too heavy of a burden, these men were given a safe space to be vulnerable and communicate without being judged, told to stop complaining and grow up, told to ‘toughen up’, or take a ‘concrete pill’. In fact, many of the men made it a point to mention the immense relief they felt after being able to talk about their pornography use during their pre-study interviews (Sniewski & Farvid, 2019). It became abundantly clear that these men started to break their ritualistic pornography viewing habits because they were breaking the isolation that had, in essence, served as the incubator for the habit to become largely subconscious and habitual.

What it means to ‘be a man’ has not left the necessary space for boys and young men to express and be open about their emotionality or psychological distress.

Since being involved with the Auckland-based men’s group, Men Being Real – first as a participant and now as a member of the Board of Trustees – I have come to witness first-hand how important it is for men to be vulnerable and share their struggles in a non-judgmental space. Within men’s groups and over the course of weekend workshops run by Men Being Real, men are supported in taking care of themselves mentally and emotionally by being provided a platform to talk openly about their inner worlds. Since my involvement, it is clear that most men are starving for this type of brotherhood, as they feel isolated, alone, and lost in their struggles. For some – and arguably many – pornography is just one of the ways to perpetuate this continued isolated struggle.

We need this kind of men’s work because it is helping to rewrite the guidebook of what it means to be a man in New Zealand. More importantly, men’s work supports men in becoming better fathers, and we certainly need to teach our boys and young men that they do not have to isolate themselves and get stuck in the same self-destructive patterns as too many men before them. As men learn to tap into their own emotional well of wisdom, they can – in turn – provide a safe place for their children’s emotional expression and communication. Talking about feelings is coachable and teachable. Instead of telling our boys to stifle their feelings, bottle up emotions and embrace the stereotypical ‘stoic male’, our boys need to be allowed to express and understand their emotions, otherwise they put their mental, physical, and emotional health at risk. Boys need empathy and engagement, just like everyone else. If they do not get this type of nurturing, then the result is isolated boys who become isolated men – suffering from anxiety, depression, and loneliness. The current mental health and suicide crisis in New Zealand is one of the consequences of ignoring the issue for too long.

Through my own commitment to inner work that has included years of therapy, mindfulness practice, and men’s group work, I realised shortly after my arrival in New Zealand four years ago that my calling was to help other men within the contexts of emotional intelligence and vulnerability. That journey started with my postgraduate diploma in drug and alcohol studies, progressed to my PhD research, and now is moving gradually towards registration with the New Zealand Psychologists Board. Men need help and support, too. I am just answering that calling. The skills and knowledge that have been gained during these last four years of academic and professional ventures have provided me with a deeper understanding of the broad contexts within which problematic and addictive behaviours manifest. The men in my research did not need instructions on how to quit pornography or to learn about the consequences of viewing too much pornography. What they needed was empathy, acceptance, and non- judgmental listening. The pornography viewing naturally began falling away when they received what they needed most: connection. Pornography was merely a Band-Aid solution for the core problem, which was the experiences of depression, anxiety, and stress being compounded by isolation and loneliness.

References Bateman, S. (2019). New Zealand’s suicide statistics increase on last year. Newshub. Extracted on September 13, 2019 from https://www.newshub.co.nz/ home/new-zealand/2019/08/new-zealand-s-suicide-statistics-increase-on-last-year. html Calati, R., Ferrari, C., Brittner, M., Oasi, O., Olié, E., Carvalho, A. F., & Courtet, P. (2019). Suicidal thoughts and behaviors and social isolation: A narrative review of the literature. Journal of Affective Disorders, 245, 653–667. Henry, D. (2019). New Zealand suicides highest since records began. New Zealand Herald. Extracted on September 13, 2019 from https://www.nzherald. co.nz/nz/news/article.cfm?c_id=1&objectid=12262081 Illmer, A. (2017). What’s behind New Zealand’s shocking youth suicide rate? BBC News. Extracted on September 13, 2019 from https://www.bbc.com/news/ world-asia-40284130 Jones, N. (2019). Mental health workers for GP clinics – but where will they come from? New Zealand Herald. Extracted on September 13, 2019 from https:// www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=12235971 Kiwi porn habits revealed. (2016, August 20). New Zealand Herald. Retrieved from http://www.nzherald.co.nz/lifestyle/news/article .cfm?c_id6 Reid, R., Bramen, J., Anderson, A., & Cohen, M. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70(4), 313-321. Sniewski, L., Farvid, P., & Carter, P. (2018). The assessment and treatment of adult heterosexual men with self-perceived problematic pornography use: A review. Addictive Behaviors. 77, 217-224. Sniewski, L. (2018). Mindfulness meditation as a catalyst for behavioural change. Psychology Aotearoa. 10(1), 43-45. Sniewski, L. (2018a). The problem with problematic pornography use. Psychology Aotearoa. 10(2), 116-118. Sniewski, L. & Farvid, P. (2019). Hidden in shame: Heterosexual men’s experiences of self-perceived problematic pornography use. Psychology of Men and Masculinity. Advance online publication http://dx.doi.org/10.1037/men0000232 Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R., & Marlatt, A. (2009). Mindfulness Meditation for Substance Use Disorders: A Systematic Review. Substance Abuse : Official Publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 266–294.

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The Problem With Problematic Pornography: A Researcher's Reflection

I began my PhD journey exploring how meditation might work as an intervention for men with problematic pornography use at the Auckland University of Technology nearly two years ago. Quite quickly, it became the humbling experience I probably should have expected. What I thought was going to be a simple, straightforward project, turned into an important lesson in what it means to be a competent and capable researcher. My Postgraduate Diploma, Master’s Degree, and cumulative life experiences did not stand a chance against the nuances, complexities, and the humanistic realities of the subject matter I was diving into. After all, when you consider the currently stigmatised and shame-ridden nature of problematic pornography use, the last thing I should have expected was simplicity. What I have learned during my study, and what will be discussed in this article, is the importance of contextualisation, and integrating quantitative and qualitative data in order to improve the validity and rigour of academic research.

Naïve confidence is often the seed of inspiration that fuels the brave souls that decide to venture down the path towards a doctorate degree. I surely had plenty of it. And probably like every person reading this article, I wanted to help people that needed help. But it was pure naivety that made me think I already knew enough about pornography, about how men talk about and experience their use, about why men identify their use as problematic, and which interventions would work best. This PhD was going to be a breeze.

Over the last two years of my PhD, however, I have found myself continuously amazed by new, fresh, and thought- provoking perspectives; most of which have come directly from the first-hand experiences and insights offered by research participants. The research process has transformed my emotionally-charged, dogmatic beliefs about problematic pornography into a grounded, practical, and realistic worldview that takes into account the myriad of variables that make each case unique and different. Nothing is ever as simple as sensational media headlines can make it seem, especially problematic pornography use.

Self-perceived problematic pornography use (SPPPU) has become a heated topic within academic and clinical settings (Duffy, Dawson, & das Nair, 2016). SPPPU refers to the extent to which an individual feels they are unable to regulate their pornography use and relies overwhelmingly on the user’s subjective self-perception and experiences (Grubbs et al., 2015). Individuals who perceive their relationship with pornography as problematic, however, classify their use as such for a myriad of reasons, including religious, moral or ethical, social and relationship, quantity of time spent viewing, or viewing in inappropriate contexts (Twohig & Crosby, 2009). Because of the variety of quantitative and qualitative factors that play a part in determining if and how pornography use is problematic, it would be unrealistic to assume that a single scale or questionnaire could accurately capture or assess each type of pornography user. This is why the main problem with SPPPU is likely the same problem that exists within most psychological contexts, fields, and phenomena: contextualisation.

Naïve confidence is often the seed of inspiration that fuels the brave souls that decide to venture down the path towards a doctorate degree. I surely had plenty of it.

In the clinical world, contextualisation and looking at the bigger picture is likely standard practice. Clinicians dig into the life of their client in order to understand their behaviours and circumstances. In the critical world of sexuality studies, the context of the individual is taken into account as well as the broader social, cultural and economic context of a given society. Utilising both these approaches and applying them to problematic pornography research would greatly improve mainstream pornography research. It would allow researchers to understand pornography in a more nuanced manner; along with a greater degree of contextualising, both in terms of the person and in terms of society. In conducting my interviews, for example, it was surprising that this was the first time many of these men had ever spoken about pornography to anyone. Uncovering and exploring the reasons for the lack of communication and opening up would provide meaningful insights for the field of problematic pornography use.

One of the immediate takeaways (and definitely an unanticipated insight) from my research is that whether or not a man perceives his pornography use as problematic does not correlate well with the existent scores of scales and questionnaires related to porn use. One participant might watch porn very infrequently but consider their viewing to be extremely problematic, while another watches it every day and only feels he needs to tone it down a bit. Additionally, and not surprisingly, every participant identified very different and very specific reasons (i.e. specific content went against moral values, porn was the only coping mechanism for loneliness, violation of religious beliefs, felt unable to control the urge to watch, incapable of proper intimacy with real women, neglects childcare responsibilities in order to view) as to why they perceived their pornography use to be problematic. These first-hand experiences broke through some of the stereotypical myths and expectations around what is perceived as problematic pornography use. The continued challenge is the current lack of criteria for problematic pornography consumption, which means that determining whether or not consumption is problematic in a standardised way is difficult, and arguably impossible because of the many contextual layers involved. The raw numbers and questionnaire scores do not tell the full story.

On the surface, my own research seems fairly straightforward; examining meditation as an intervention for men with SPPPU. The research has been investigating the implications and experiences of an intervention which allows participants to practise sitting and observing their internal experience with non-reaction and acceptance, with the principal hypothesis that the consistent practice of ‘being with self ’ will develop the participant’s capacity to respond to cravings and urges to use pornography, and unwanted ruminating thoughts, in more productive ways. The research methods and methodology used, however, had to be carefully selected and designed in order to adequately address contextualisation. Quantitative measures such as scales, questionnaires, and logging sheets were used to assess and analyse the effectiveness of meditation, but in-depth qualitative data in the form of pre- and post-study interviews provided the much-needed contextualisation.

In the critical world of sexuality studies, the context of the individual is taken into account as well as the broader social, cultural and economic context of a given society. Utilising both these approaches and applying them to problematic pornography research would greatly improve mainstream pornography research.

One of the primary reasons for using such a mixed methods approach was in large part due to previous research acknowledging that qualitative factors were often better indicators of problematic pornography use than quantitative factors (Sniewski, Farvid, & Carter 2018). Indeed, the frequency of pornography use is not always the underlying issue with pornography use as negative symptoms experienced by the individual more strongly predict the individual seeking treatment (Gola, Lewczuk, & Skorko, 2016). This made a mixed methods approach the most useful way forward for generating a thorough understanding of the issue.

The initial data from the participants’ actual pornography use confirmed suspicions. Self-reported use was well below thresholds that would be classified as problematic within research settings. For example, the Pornography Craving Questionnaire (PCQ) attempts to predict the likelihood of relapse following therapy by measuring subjective craving for pornography (Kraus & Rosenberg, 2014), while the Problematic Pornography Use Scale (PPCS) helps distinguish between non-problematic and problematic pornography use (Bőthe et al., 2018). Although both of these scales are scientifically validated, scores from neither would have categorised the majority of the participants’ pornography use as problematic even though they identified themselves as having a problem for this research. Additionally, Cooper, Delmonico, and Burg (2000) quantified problematic pornography use as spending at least 11 hours viewing pornography per week; a threshold that no participant in my research came within 50% of reaching. While the quantitative data provided by the scales and questionnaires can provide some information, it was the in-depth qualitative exploration of each participant that provided a rich, detailed and contextualised account of what these numbers actually meant.

The initial data from the participants’ actual pornography use confirmed suspicions. Self-reported use was well below thresholds that would be classified as problematic within research settings.

When you combine these methods to match the intention and aim of the study, you get richer data and a much clearer picture of what is actually going on in the lives of the respective participants, and certainly data that is less encumbered by research assumptions. This kind of data would help push the field forward. The results more closely resemble the participant and the many contexts that make him unique. There is more meaning behind the numbers. And this is why contextualisation matters.

In terms of pornography use, and likely many other psychological contexts, contextualisation further reinforces the notion of finding the uniqueness of the client’s experience and focusing on the bigger picture context of their life, and not just aspects, markers, scales, and quantitative assessments. The quantitative data is important, especially when the scales have been validated, but information needs to be contextualised with in-depth qualitative discussions. While the literature and data on pornography continues to mount, it will greatly benefit the field to integrate mixed methods that support and build a richer story beneath the scores. It is also this researcher’s belief that much of the sensationalism, stigma, and shame would disintegrate if the participant’s pornography use were viewed from the contextual reference point of their life.

References Bőthe, B., Tóth-Király, I., Zsila, Á., Griffiths, M. D., Demetrovics, Z., & Orosz, G. (2018). The Development of the Problematic Pornography Consumption Scale (PPCS). Journal of Sex Research, 55(3), 395-406. Cooper, A., Delmonico, D. L., & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention, 7(1–2), 5–29. Duffy, A., Dawson, D., & das Nair, R. (2016). Pornography addiction in adults: A systematic review of definitions and reported impact. The Journal of Sexual Medicine, 13(5), 760-777. Gola, M., Lewczuk, K. & Skorko, M. (2016) What matters: quantity or quality of pornography use? Psychological and behavioral factors of treatment seeking for problematic pornography consumption. Journal of Sexual Medicine. 13(5): 815-24. Grubbs, J., Exline, J., Pargament, K., Hook, J., & Carlisle, R. (2015). Transgression as addiction: religiosity and moral disapproval as predictors of perceived addiction to pornography. Archives of Sexual Behavior, 44(1), 125-136. Kraus, S. & Rosenberg, H. (2014). The pornography craving questionnaire: psychometric properties. Archives of Sexual Behaviour, 43(3), 451- 462. Sniewski, L., Farvid, P., & Carter, P. (2018). The assessment and treatment of adult heterosexual men with self-perceived problematic pornography use: A review. Addictive Behaviors, 77217-224. Twohig, M., Crosby, J., & Cox, J. (2009). Viewing internet pornography: For whom is it problematic, how, and why?. Sexual Addiction & Compulsivity, 16(4), 253-266.

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