Arch Sex Behav (2014) 43:451–462 DOI 10.1007/s10508-013-0229-3

ORIGINAL PAPER

The Pornography Craving Questionnaire: Psychometric Properties Shane Kraus • Harold Rosenberg

Received: 7 July 2012 / Revised: 4 March 2013 / Accepted: 15 August 2013 / Published online: 28 January 2014  Springer Science+Business Media New York 2014

Abstract Despite the prevalence of pornography use, and recent conceptualization of problematic use as an addiction, we could find no published scale to measure craving for pornography. Therefore, we conducted three studies employing young male pornography users to develop and evaluate such a questionnaire. In Study 1, we had participants rate their agreement with 20 potential craving items after reading a control script or a script designed to induce craving to watch pornography. We dropped eight items because of low endorsement. In Study 2, we revised both the questionnaire and cue exposure stimuli and then evaluated several psychometric properties of the modified questionnaire. Item loadings from a principal components analysis, a high internal consistency reliability coefficient, anda moderate mean inter-item correlation supported interpreting the 12 revised items as a single scale. Correlations of craving scores with preoccupation with pornography, sexual history, compulsive internet use, and sensation seeking provided support for convergent validity, criterion validity, and discriminant validity, respectively. The enhanced imagery script did not impact reported craving; however, more frequent users of pornography reported higher craving than less frequent users regardless of script condition. In Study 3, craving scores demonstrated good one-week test–retest reliability and predicted the number of times participants used pornography during the following week. This questionnaire could be applied in clinical settings to plan and evaluate therapy for problematic users of pornography and as a research tool to assess the prevalence and contextual triggers of craving among different types of pornography users.

S. Kraus (&)
H. Rosenberg Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, USA e-mail: [email protected]

Keywords Craving
Pornography
University students
Sex
Internet

Introduction Each day, millions of people view pornography. Although definitions vary by culture, pornography (often referred to colloquially as‘‘porn’’) may be defined as written or pictorial material—describing or showing explicit images of sexual acts—that is read or viewed with the intention of increasing sexual arousal (e.g., Hald & Malamuth, 2008). Over the last decade, use of internet pornography has increased, attributable in large part to the accessibility, affordability, and anonymity provided by free and low cost websites displaying sexually explicit videos (Cooper, Delmonico, & Burg, 2000; Ross, Ma˚nsson, & Daneback, 2012; Wallace, 2011). Pornography appeals to many individuals across all age groups and is especially common among college-aged men (Gordon & Kraus, 2010; Shaughnessy, Byers, & Walsh, 2011; Wright, 2013). Surveys find that approximately 50 % of male college students watch pornography weekly, as do 5–10 % of female college students (Carroll et al., 2008; Morgan, 2011). Two recent studies found that undergraduates’ reported reasons for using internet pornography included habit, sexual excitement, sexual satisfaction, convenience, curiosity, anonymity, and mood management (Paul & Shim, 2008; Ross et al., 2012). Although the use of pornography may serve as a healthy sexual outlet for many users (e.g., Daneback, Sevcikova, Ma˚nsson, & Ross, 2013; Hald & Malamuth, 2008; Paul & Shim, 2008; Weinberg, Williams, Kleiner, & Irizarry, 2010), surveys of mental health professionals suggest that the number of individuals seeking treatment for pornography-related problems has increased over the years (Goldberg, Peterson,

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Rosen, & Sara, 2008; Mitchell & Wells, 2007; Philaretou, Mahfouz,& Allen,2005).Researchersandpractitionersdisagreeabout howtobestconceptualizesexualcompulsionssuchasproblematic use of pornography. For example, different scholars view such behavior as a form of obsessive–compulsive disorder (Cooper, Delmonico, Griffin-Shelley, & Mathy, 2004; Young, 2005), as an impulse control disorder (Shapira et al., 2003; Young, 2005), as a paraphilic disorder (Kafka, 2001; Kalman, 2008), or as a symptom of hypersexual disorder (Kafka, 2010; Kaplan & Krueger, 2010; Reid, Li, Gilliland, Stein, & Fong, 2011). In light of its similarities with substance abuse and dependence, there is growing support for conceptualizing problematic sexual compulsions as an addictive disorder (Barak & King, 2000; Griffiths, 2001; Meerkerk, Van Den Eijnden, & Garretsen, 2006; Orford, 2001). One element of addiction— and of many impulse control and paraphilic disorders—is the subjective experience of craving. Furthermore, urges or cravings may also occur among those who use pornography without experiencing psychological distress, harmful consequences or a compulsion to do so. There is so little research on the experience of urges or cravings for pornography that the literature on alcohol and drug craving may provide guidance on the definition and assessment of this experience. Two recent reviews have summarized the debate about how to define and assess drug craving (Rosenberg, 2009; Tiffany & Wray, 2012) and many of these same issues apply to craving for pornography. For example, craving for pornography could be conceptualized as a transient but intense urge or desire that waxes and wanes over time and as a relatively stable preoccupation or inclination to use pornography. In addition, we hypothesize that craving for pornography— like that for psychoactive substances and other addictive activities—comprises a combination of emotional, cognitive, physiological, and overt behavioral elements. Also akin to drug craving, assessment of craving for pornography could employ direct self-report rating scales and questionnaires as well as indirect behavioral and physiological indicators of this experience. One common method of assessing subjective craving is to ask the person to mark the intensity of their urge or craving for a substance or activity using a single-item rating scale. Although single-item rating scales are easy to administer and score, are practical for repeated measurement in clinical and research settings, and are apparently sensitive to changes in emotional state (McCormack, Horne, & Sheather, 1988), they also have several key disadvantages. For example, people who experience an urge or craving as comprising a combination of different cognitive, emotional, andphysiological elements may have difficulty summarizing their multi-dimensional experience with a single numeral or a mark on a line. In addition, single-item ratings may fail to assess the experience of subjective urges or cravings if the person interprets such feelings

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as reflecting another psychological or physiological state, such as withdrawal, anxiety, excitement, frustration or arousal. As an alternative to single-item rating scales, researchers have developed numerous multi-item (and often multi-dimensional) self-report questionnaires to assess craving both for alcohol and drugs (Rosenberg, 2009) and for behavioral addictions such as gambling (Ashrafioun & Rosenberg, 2012). Research evaluating self-report questionnaires of craving for substances and gambling often supports the internal consistency reliability, test–retest reliability, and criterion and convergent validity of these instruments. However, multi-item self-report questionnaires also have several disadvantages, including problems such as reactivity, misinterpretation of items, and social desirability bias. Despite their limitations, multi-item questionnaires comprised of statements reflecting different aspects of subjective craving might assist the study and treatment of problematic pornography use. For example, researchers and clinicians could employ a standardized questionnaire to assess the prevalence of pornography craving in clinical and sub-clinical populations and evaluate the impact of therapeutic interventions designed to ameliorate such craving. Assessing the frequency and intensity of craving may also have implications for diagnosis, if one considered craving indicative of a pornography-related disorder. In addition to these clinical applications, researchers could use a craving questionnaire to measure the prevalence of craving among non-problematic users as well as those seeking treatment. Despite these potential advantages, we found no published self-report questionnairesdesignedto assessthesubjective experience of current craving for pornography. Therefore, we designed a series of three studies to develop and evaluate a multi-item questionnaire reflecting several possible dimensions of craving for pornography, including desire, intention, physiological arousal, and anticipated difficulty restraininguse. InStudy 1,wedevelopeda pool of20potential items by modifying statements appearing on published questionnaires assessing craving for alcohol and drugs. Using a web-based recruitment and data collection procedure, we administered these items to a sample of regular pornography users immediately after having them read a vignette designed to elicit craving forpornographyor acontrol vignette. Using imagery scripts and exposure to drug paraphernalia, researchers have demonstrated that cue exposure often increases self-reported drug craving (e.g., Taylor, Harris, Singleton, Moolchan, & Heishman, 2000; Tiffany & Wray, 2012; Tong, Bovbjerg, & Erblich, 2007). Based on this precedent, we examined whether craving for pornography would also increase as a function of cue exposure. Examining participants’ ratings of agreement with the 20 draft items, we deleted eight items and re-phrased four of the remaining items to develop a revised 12-item scale. To evaluate the psychometric properties of this revised Pornography Craving Questionnaire (PCQ), we recruited two additional

Arch Sex Behav (2014) 43:451–462

samples of frequent pornography users. In Study 2, we evaluated convergent, criterion, and discriminant validity of the revised questionnaire by calculating the association of craving scores with level of typical weekly pornography use, cue exposure, sexual compulsivity, passionate attachment for pornography, compulsive internet use, sensation seeking, and tendency to present oneself in a socially desirable manner. In Study 3, we evaluated the one-week test–retest reliability and predictive validity of the 12-item revised questionnaire. Because of the frequency with which young males use internet pornography, andbecauseitwasconvenienttodoso,werecruitedthreeseparate samples of male university students to participate in this series of studies. Study 1 Method Participants and Procedure Following approval of the project by our Human Subjects Review Board, we sent out an email to 2,000 undergraduate male students. We assigned a random subset of 1,200 students to the Craving-for-Pornography vignette condition and the remaining 800 students to the Control vignette condition. We divided the groups to create this 60/40 split because we wanted a larger sample of participants in the Craving-for-Pornography vignette condition in case we decided to include only cue-exposed participants in the subsequent psychometric analyses. The email described the nature of the study, eligibility requirements (at least 18 years old, male, and viewed pornography within the last 6 months), and compensation (raffle to win either one $200 or one $100 gift card to a local department store). We sent the first follow-up email 2 days after the initial email and the second (and final) reminder email 4 days after the first reminder. Before participating in the study, participants were asked to read the following definition: ‘‘Pornography is defined as any materials designed to cause or enhance sexual arousal or sexual excitement in the viewer. Such materials show clear and explicit sexual acts such as vaginal intercourse, anal intercourse, oral sex, group sex, etc. Pornography does not include materials such as underwear catalogs (e.g., Victoria’s Secret) or materials containing men and women posing naked unless these images portray clear and explicit sexual acts.’’ After giving consent and reading either the Craving-for-Pornography or the Control Vignette, participants completed the measures described below and saw a debriefing statement regarding the study. At the close of data collection, we had usable data from 109 male participants. As shown in Table 1 (column 1), most participants self-identified as Caucasian, were in their early 20s, and indicated that they were either not dating or were involved ina seriousromantic relationship. As showninTable 2(column1), almost two-thirds of participants reported viewing pornography three or more times per week. The majority of participants

453 Table 1 Demographic characteristics for participants in Studies 1–3 Characteristics

Study 1 M (SD) or %

Study 2 M (SD) or %

Age (years)

24.2 (7.8) 21.8 (3.8) 20.2 (2.4)

Study 3 M (SD) or %

Ethnicity White/European

84 %

87 %

Black/African-American

7%

4%

5%

9%

2% 30 %

Other (e.g. Asian, Latino, Bi-racial) 12 % Years at university First year

91 %

5%

2%

Second year

16 %

22 %

25 %

Third year

25 %

29 %

18 %

Fourth year

27 %

30 %

23 %

Fifth year and up

27 %

17 %

5%

Relationship status Not dating (single)

45 %

44 %

52 %

In a serious relationship

40 %

11 %

25 %

Engaged/married

8%

37 %

5%

Frequent dating

8%

8%

18 %

Living alone

11 %

12 %

9%

With roommates

51 %

38 %

84 %

With romantic partner

13 %

14 %

2%

25 %

29 %

5%

Agnostic

22 %

22 %

20 %

Atheist

13 %

14 %

45 %

Non-denominational Christian

25 %

20 %

25 %

Presbyterian

2%

3%

5%

Residence

With parents/family members Religious preference

Roman Catholic

23 %

20 %

27 %

Other religion/faith

14 %

22 %

14 %

Self-rated level of religiousness 1 = Well below average

35 %

34 %

18 %

2 = Somewhat below average

15 %

27 %

46 %

3 = Average

20 %

20 %

30 %

4 = Somewhat above average

24 %

16 %

7%

5 = Well above average

7%

3%

0%

CIUSa

–

1.3 (.8)

–

SDSb

–

8.7 (3.1)

7.5 (3.3)

BSSSc

–

3.6 (.6)

3.5 (.6)

Some totals may not equal 100 % due to rounding. Blank cells indicate those variables were not measured for that particular sample a

Absolute range, 0–4

b

Absolute range, 0–16

c

Absolute range, 1–5

indicated their pornography sessions lasted, on average, less than 30 min and all but 1 % reported using the Internet as their primary means for accessing pornography.

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Table 2 Pornography and sexual history characteristics for participants in Studies 1–3 Characteristics

Study 1 M (SD) or %

Study 2 M (SD) or %

Study 3 M (SD) or %

Age when first saw pornography

12.6 (2.8)

12.4 (2.5)

12.3 (2.9)

Ever masturbated pornography in lifetime

95 %

98 %

93 %

Age when first masturbated to porn

13.8 (2.5)

13.5 (2.0)

13.4 (2.0)

Table 2 continued Characteristics

With friends

8%

7%

7%

With stranger, online date, webcam

10 %

4%

7%

77 % 21 %

81 % 16 %

84 % 11 %

Sexual orientation Straight Gay/bisexual Uncertain

3%

2%

2%

–

72 %

44 %

–

5%

5%

0

–

16 %

15 %

1–3

–

41 %

42 %

21 %

4–6

–

18 %

19 %

–

12 %

12 %

12 years old or less

32 %

28 %

29 %

Currently sexually active

13–14 15–17

34 % 29 %

44 % 25 %

37 % 34 %

History of STIs

18?

4%

3%

0%

Percentage of time spent masturbating to pornography 50 % or less

12 %

5%

Study Study Study 1M (SD) 2M (SD) 3M (SD) or % or % or %

Lifetime sex partners

51–75 %

17 %

12 %

21 %

7–10

76–100 %

73 %

76 %

61 %

11–15

–

4%

8%

16?

–

8%

4%

SCSb

–

1.5 (.4)

1.5 (.5)

PCQc

–

3.6 (1.3) 4.0 (1.2)

Typical weekly pornography use 0 = 0 times

6%

5%

9%

1 = 1–2 times

30 %

33 %

43 %

2 = 3–5 times

39 %

30 %

27 %

Harmonious passion for pornographyc –

3.3 (1.1) 3.3 (1.3)

Obsessive passion for pornographyc

–

2.4 (1.2) 2.3 (1.2)

3 = 6–10 times

19 %

20 %

11 %

4 = 11? times

7%

12 %

10 %

62 %

39 %

46 %

1 = 1 time

–

–

23 %

–

–

25 %

Length of pornography use session 1 = 15 min or less

Since Time 1, how many unique times have you used porn? 0 = None – – 9%

2 = 16–30 min 3 = 31–59 min

22 % 9%

38 % 16 %

43 % 7%

2 = 2 times 3 = 3 times

–

–

16 %

4 = 1–2 h

4%

6%

5%

4 = 4 times

–

–

9%

0%

5 = 5 times

–

–

6%

6 = 6? times

–

–

11 %

5 = 2–3 h

3%

1%

Money spent on pornography 0 dollars per month

91 %

97 %

100 %

Less than $50 per month

9%

3%

0%

a

Method to view pornographya Internet (computer/laptop)

99 %

99 %

100 %

Rented/purchased DVDs

12 %

8%

14 %

Smart phone

14 %

24 %

32 %

Magazines or erotic books

8%

12 %

11 %

Other method

6%

4%

5%

4%

3%

0%

Want to seek professional help for porn 6 %

4%

5% 100 %

Have received professional help for porn Location when viewing porna At home/apartment/bedroom

99 %

100 %

Romantic partner’s place

17 %

12 %

11 %

Friend’s house/apartment

9%

4%

2%

Other (e.g., work, stranger’s house)

8%

9%

7%

Alone

100 %

98 %

100 %

With romantic partner

26 %

24 %

9%

Pornography companya

123

Blank cells indicate those variables were not included for that particular sample. Some totals may not equal 100 % due to rounding Participants could mark more than one answer

b

Absolute range, 1–4

c

Absolute range, 1–7

Measures For the Pornography Craving Questionnaire (PCQDraft), we developed an initial pool of 20 items by adapting statements from measures designed to assess alcohol and drug craving (e.g., Bohn, Krahn, & Staehler, 1995; Heishman, Singleton, & Pickworth, 2008; James, Davies, & Willner, 2004; Ollo et al., 1995; Ooteman, Koeter, Vserheul, Schippers, & van den Brink, 2006). The items reflected five different dimensions of current craving for pornography: (1) perceived control over porn use (four items) (‘‘Right now, I can control my porn use’’), (2) mood changes (four items) (‘‘If I were watching porn this minute, I would feel less irritable’’), (3) psychophysiological reactivity (three items) (‘‘My hands would shake if I watched porn’’), (4) intention to use pornography (three items) (‘‘Right

Arch Sex Behav (2014) 43:451–462

now, I am making plans to watch porn’’), and (5) desire (six items) (‘‘All I want to do now is watch porn’’). Participants indicated how strongly they agreed with each item on a 7-point scale from ‘‘disagree completely’’ to ‘‘agree completely’’ (presented without numerals). The demographic questionnaire assessed participants’ age, ethnicity, education level, living arrangements, and religious background (see Table 1 for additional details). We constructed a Pornography History Questionnaire to assess participants’ frequency of using pornography, preferred method of viewing sexually explicit material, masturbation practices, and history of seeking treatment for pornography-related issues (see Table 2 for the listing of response options for each pornography history variable). Stimulus Materials The Craving-for-Pornography vignette asked each participant to imagine himself sitting in front of his computer, alone in his room, with the strong urge of wanting to watch his favorite type of pornography. The Control vignette asked each participant to imagine sitting in front of his computer, while alone in his room, with the intention of finding research articles for an academic paper that he was going to write for an upcoming class assignment. The Control vignette made no mention of pornography or other sexually explicit images.

Results Item Reduction and Revision of the PCQ-Draft As the initial step in the evaluation of the PCQ-Draft, we engaged in a process of itemreduction. First, we examined theitemtotal correlations and found that each of the items were moderately correlated (.51–.81, p\.001) with the total score on the PCQ-Draft. Therefore, we did not eliminate any items because of a poor item-total correlation. Next, we examined the frequency counts for each level of agreement for each item on the PCQ-Draft to identify any items on which at least 70 % of the sample disagreed either somewhat or completely. Using this decision rule, we eliminated eight items because we interpreted these items as unlikely to be sensitive enough to capture most participants’ current craving for pornography. See Table 3 for a full list of the 20 draft items and frequency counts. We then conducted several further analyses treating the remaining 12 items as if they comprised a scale (PCQ-DraftRevised). Support for this decision was provided by a high internal consistency reliability coefficient (Cronbach’s a = .89) and a moderate mean inter-item correlation (r = .40), which we interpreted as supporting unidimensionality across the 12 items (Clark & Watson, 1995). As we expected after eliminating items with which participants typically disagreed, a paired t test indicated that mean scores on the 12-

455

item PCQ-Draft-Revised (M = 3.36, SD = 1.32) were significantly higher than mean scores on the 20-item PCQ-Draft (M = 2.76, SD = 1.13), t(108) = 5.54, p\.001. In addition, a Pearson product moment correlation indicated that scores on the 20-item and the 12-item versions were highly correlated with one another, r(107) = .97, p\.001. We interpreted the significant t test and the magnitude of the correlation as suggesting that the 12 items could serve as a shorter but more sensitive measure of current craving for pornography. To evaluate whether participants’ current craving differed as a function of cue exposure, we conducted an independent samples t test with mean scores across the 12 items as the dependent variable. Contrary to our hypothesis, participants exposed to the Control Vignette (M = 3.72, SD = 1.22) had significantly higher mean craving scores than did participants exposed to the Craving-for-Pornography vignette (M = 3.19, SD = 1.33), t(107) = 2.08, p\.05. We interpreted this finding as indicating that both the cue exposure stimuli and items on the PCQ-Draft-Revised required further modification. Therefore, we reviewed the phrasing of the remaining 12 items for clarity of expression and relevance to subjective craving. We decided to re-phrase four of the 12 items in preparation for further evaluation of the questionnaire with new samples of participants. Specifically, we changed one emotional outcome (from ‘‘less irritated’’ to ‘‘energetic’’ so that the item would not be reverse scored); we changed the word ‘‘desire’’ to ‘‘want’’ in another item because the latter word seemed closer to everyday language; and we changed the description of the intensity of craving in two items to broaden their applicability across a wider range of craving experiences. Study 2 We designed this second study to evaluate several key psychometric properties of the modified PCQ. Firstly, to assess two aspects of construct validity of the modified questionnaire, we evaluated (1) whether an enhanced cue exposure vignette yielded significant differences in participants’ current craving for pornography and (2) whether more frequent pornography use was associated with higher reports of craving. Secondly, we investigated whether there were clusters of items that could be considered subscales of the PCQ. Thirdly, we reevaluated the internal consistency and unidimensionality of the questionnaire. Fourthly, we assessed convergent and criterion validity of the PCQ by correlating craving scores with measures of passionate attachment for pornography, sexual compulsivity, compulsive internet use, and typical weekly pornography use. Fifthly, to assess discriminant validity of the questionnaire, we assessed the association of PCQ scores with a measure of non-sexual sensation seeking. Lastly, because impression management might lead some participants to misrepresent their true intention and desire to use pornography, we also evaluated the

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Table 3 Frequency count of agreement levels for the 20 items on the PCQ-Draft (Study 1) Items

DC (%) DS (%) DL (%) NAD (%) AL (%) AS (%) AC (%) M (SD)

1. Right now, I cannot control my porn usea

50

22

12

1

8

2

6

2.2 (1.2)

2. If I watched porn right now, I would not be able to stopb

47

21

9

2

13

5

3

2.4 (1.8)

3. My hands would shake if I watched porna

84

9

1

1

3

2

1

1.4 (1.1)

4. The thought of watching porn makes me sexually aroused

6

18

3

6

25

20

22

4.7 (2.0)

5. My heart would beat faster if I were watching porn right now

9

8

6

8

37

22

10

4.6 (1.7)

6. I would feel less bored if I watched porn right now

12

6

7

17

24

20

14

4.5 (1.9)

7. I want to watch porn so badly I can hardly stand ita

64

17

8

2

6

2

0

1.7 (1.3)

8. If I were watching porn this minute, I would feel happier

27

13

8

19

18

11

4

3.4 (1.9)

9. Right now, I am making plans to watch porn

49

11

7

9

14

7

3

2.6 (1.9)

10. If I were alone, I would watch pornb

22

14

13

14

16

12

9

2.7 (2.0)

11. All I want to do now is watch porna 63 12. If I were watching porn this minute, I would feel less irritableb 39

17 13

3 7

6 11

8 19

3 7

0 5

1.9 (1.5) 3.0 (2.0)

13. My need to watch porn seems overpoweringa

57

16

12

6

8

2

0

2.0 (1.4)

14. I have an urge to watch porn right now

41

19

8

4

18

8

4

2.8 (2.0)

15. I will watch porn as soon as I get the chance

39

21

7

12

11

8

2

2.8 (1.8)

16. I cannot think of anything else but watching porna

74

8

8

3

6

0

1

1.6 (1.2)

17. I crave porn right nowa

60

11

6

6

15

4

0

2.2 (1.7)

18. I would feel less stressed if I watched porn right now

32

12

9

8

23

11

4

3.3 (2.0)

19. Nothing would be better than watching porn right nowa

61

17

8

6

6

3

0

1.8 (1.4)

20. I desire to watch porn right nowb

41

16

6

11

20

6

1

2.8 (1.8)

Some totals may not equal 100 % due to rounding DC disagree completely, DS disagree somewhat, DL disagree a little, NAD neither agree nor disagree, AL agree a little, AS agree somewhat, AC agree completely a

Items dropped because of low item endorsement

b

Items that were reworded from PCQ-Draft to enhance clarity and content

relationship between reported craving and a measure of social desirability bias. Method Participants and Procedure Following approval of Study 2 by our Human Subjects Review Board, we sent out an email to 4,000 undergraduate male students who had not been recruited in Study 1. We assigned a random subset of 2,500 students to the Enhanced Craving-for-Pornography vignette condition and the remaining 1,500 students to the Enhanced Control Vignette condition. As we did in Study 1, the list was divided to create this 60/40 split because we wanted a larger sample of participants in the Craving-for-Pornography vignette condition in case we decided to include only cue exposed participants in the subsequent psychometric analyses. The overture email for both conditions described the nature of the study, requirements participants needed to meet to be eligible (same as in Study 1), and the opportunity to be entered into a raffle to win either one $200 or one $100 gift card to a local department store. After giving consent, participants completed the Brief Sensation Seeking Scale (BSSS) and Social Desirability Scale

123

(SDS) (described below) as a prelude to exposure to the Enhanced Craving-for-Pornography or the Enhanced Control Vignette; they then completed the 12-item modified PCQ, followed by the remaining questionnaires, presented in random orders, except that the Demographic Questionnaire was always administered last. All participants then saw a debriefing statement regarding the study. We recruited 221 male undergraduates to participate in Study 2. As shown in Table 1 (column 2), most participants identified as Caucasian, were in their early 20s, and reported that they were either not dating or were involved in a serious romantic relationship. As shown in Table 2 (column 2), the sample comprised regular weekly pornography users almost all of whom reported viewing sexually explicit material online and while alone. Measures As noted above, the modified PCQ comprised 12 items (see Table 4, column one, for the wording of each item) that reflected five dimensions of craving. Specifically, one item reflected perceived control over pornography use (Item 1); two items reflected current desire to use pornography (Items 9 and 12); two items reflected psychophysiological reactivity (Items 2 and 3); three items reflected intentions to

Arch Sex Behav (2014) 43:451–462

457

Table 4 Means, SDs, and component loadings on the 12 items of the modified PCQ (Study 2) Individual PCQ items

Typical weekly porn use

Component matrix

0–2 times M (SD)

3–5 times M (SD)

6? times M (SD)

1

1. If I watched porn right now, I would have difficulty stopping.

2.81 (1.89)ab

3.73 (1.84)a

4.00 (2.01)b

.63

.19

2. The thought of watching porn makes me sexually aroused.

4.13 (1.58)a

4.53 (1.64)

5.11 (1.78)a

.63

.12

3. My heart would beat faster if I were watching porn right now. 4. I would feel less bored if I watched porn right now.

4.44 (1.82)ab 4.18 (1.85)

5.08 (1.21)a 4.32 (1.75)

5.14 (1.43)b 4.93 (1.74)

.44 .58

.54 .45

5. If I were watching porn this minute, I would feel happier.

3.25 (1.69)a

3.77 (1.63)

4.11 (1.53)a

.72

.33

2

6. Right now, I am making plans to watch porn.

1.88 (1.47)ab

2.65 (1.84)ac

3.41 (2.20)abc

.76

-.46

7. If the situation allowed, I would watch porn right now.

2.67 (1.78)a

3.33 (1.89)b

4.59 (1.88)ab

.78

-.24

8. If I were watching porn this minute, I would feel energized.

3.29 (1.74)a

3.89 (1.61)

4.14 (1.64)a

.68

.33

9. I have an urge to watch porn right now.

2.39 (1.68)ab

3.18 (1.80)a

3.81 (2.05)b

.86

-.30

10. I will watch porn as soon as I get the chance.

1.87 (1.39)ab

2.76 (1.66)ac

3.62 (2.06)bc

.84

-.25

11. I would feel less stressed if I watched porn right now.

2.68 (1.85)a

3.31 (1.85)

3.68 (2.04) a

.70

.07

12. I want to watch porn right now.

2.58 (1.75) a

3.05 (1.84)

3.73 (2.17) a

.84

-.25

Component loadings in boldface indicate higher loading on that component All F ratios except Item 4 were statistically significant at p\.001; subscripts sharing the same letter indicate significant differences (p\.01) among means. Rating scale ranged from 1 (disagree completely) to 7 (agree completely) Component 1 eigenvalue = 6.2; percent of variance = 51.4 % Component 2 eigenvalue = 1.3; percent of variance = 10.4 %

use pornography (Items 6, 7, and 10); and four items reflected mood changes (Items 4, 5, 8, and 11). Participants indicated how strongly they agreed with each item using the same 7-point scale as in Study 1. Readability statistics for the PCQ indicated that the questionnaire items were easily readable [Flesch–Kincaid Grade Level = 4.8; Flesch Reading Ease = 81.4 on a scale of 0 (most difficult) to 100 (easiest)]. We adapted the phrasing of the 14 items on the Passion Scale (Vallerand et al., 2003) to refer specifically to pornography use. Vallerand et al. designed the original Passion Scale to assess two types of passionate attachment—Obsessive Passion (e.g.,‘‘I have difficulty imagining my life without this activity’’) and Harmonious Passion (e.g.,‘‘This activity reflects the qualities I like about myself’’)—for activities that people find especially enjoyable and important to their identity (e.g., gambling, playing video games, playing team sports). To adapt the Passion Scale-Pornography, we replaced the phrase ‘‘this activity’’ in the original items with the word ‘‘pornography’’and made some minor wording changes to two awkwardly phrased items on the original scale. Participants indicated how strongly they agreed with each item using a 7-point scale from ‘‘disagree completely’’ to ‘‘agree completely.’’ Cronbach’s a in the present sample was .79 for the Obsessive PassionPornography subscale and .78 for the Harmonious PassionPornography subscale. Hoyle, Stephenson, Palmgreen, Lorch, and Donohew (2002) designed the BSSS to assess participants’ tendencies to seek out varied and novel situations. Participants indicated how strongly

they agreed with each of the eight items using a 5-point scale from‘‘strongly disagree’’to‘‘strongly agree.’’Cronbach’s a in the present sample was .72. Meerkerk, Van DenEijnden, Vermulst,and Garretsen (2009) designed the Compulsive Internet Use Scale (CIUS) to assess the severity of compulsive internet use. Participants indicated how much they agreed with each of the 14 items using a 5point scale (‘‘never’’to‘‘very often’’). Cronbach’s a in the present sample was .91. Kalichman and Rompa (1995) designed the Sexual Compulsivity Scale (SCS) to assess the extent to which participants agreed with a series of statements related to sexually compulsive behavior, sexual preoccupations, and sexually intrusive thoughts. Participants indicated how much they agreed with each of the 10 items using a 4-point scale (‘‘not at all like me’’ to ‘‘very much like me’’). Cronbach’s a in the present sample was .82. Sto¨ber (2001) developed the SDS to assess how likely a person is to respond in a socially acceptable manner or in a manner that would be viewed favorably by the others. As recommended by Sto¨ber, we dropped the item asking about drug use and had participants indicate whether each of the remaining 16 items were‘‘true’’or‘‘false.’’Higher scores on the SDS-16 suggest a more socially desirable response tendency. Cronbach’s a in the present sample was .70. We had participants complete the same demographic questionnaire and same pornography history questionnaire used in Study 1. We designed an additional questionnaire to assess

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participants’ past sexual experiences (e.g., number of lifetime sexual partners, history of sexually transmitted infections, etc.). Stimulus Materials To evaluate the effect of cue exposure on current craving for pornography, we revised the vignettes used in Study 1. Specifically, the Enhanced Craving-for-Pornography vignette asked the participant to imagine himself sitting in front of his computer, alone in his room, while experiencing a strong urge to watch his favorite type of pornography. We added more explicit instructions to imagine one’s reaction to watching internet pornography (e.g., ‘‘Even now, you may notice how different you feel as you think about the type of pornography that you like to watch—girl-on-girl, oral sex, group sex, anal sex, etc.’’). In addition, we asked participants in this condition to look for 20sat an image designed to look like an entrance page to a website where one could watch free sexually explicit videos.The text in the image read:‘‘Adult Sex Site: Free Porn Pictures and Hardcore Movies.’’ The Enhanced Control Vignette asked the participant to imagine himself sitting in front of his computer, alone in his room, with the intention of finding research articles for an academic paper he was planning to write for class. The Enhanced Control Vignette condition made no mention of pornography or other sexually explicit content. In addition, participants in this condition were asked to look for 20s at an image designed to look like an entrance page to a website where one could receive assistancewritinganacademicpaper.Thetextintheimageread:‘‘Term Paper Helper: Free Research Articles and Academic Resources.’’

Results Association of PCQ with Typical Weekly Pornography Use and Enhanced Cue Exposure Condition To evaluate whether PCQ scores varied as a function of cue exposure and typical weekly pornography use, we conducted a 2 (vignette: craving-for-pornography vs. control) 9 3 (typical weekly pornography use: 0-to-2 times, 3-to-5 times, or 6? times) between-subjects ANOVA. There was neither a significant interaction between cue exposure and typical weekly pornography use, F(2, 215) = 1.61, nor was there a significant main effect for cue exposure, F(1, 215)\1.0. There was, however, a significant main effect for typical weekly pornography use, F(2, 215) = 18.53, p\.001, partial g2 = .15. Specifically, participants who used pornography 6? times a week reported higher craving (M = 4.24, SD = 1.34) than did individuals who used pornography 3-to-5 times per week (M = 3.66, SD = 1.20), who in turn reported higher craving than those who used pornography only 0-to-2 times per week (M = 3.00, SD = 1.16), all ps\.05. In light of the main effect of typical weekly pornography use on total PCQ scores, we also conducted 12 separate one-

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way ANOVAS (Bonferroni corrected post hoc analyses, p\.001) to determine which specific items on the PCQ varied as a function of typical weekly pornography use (0-to-2 times, 3-to-5 times, or 6? times). As shown in Table 4 (middle column), typical weekly pornography viewing was associated with level of agreement on 11 of the 12 items on the questionnaire, and those who used pornography more often reported higher craving than those who used less often. Item Analysis of the PCQ Because there were no significant differences between mean PCQ scores as a function of cue exposure, we used all 221 participants in a series of item analyses. First, examination of the frequency counts revealed no items with which at least 70 % of the sample disagreed somewhat or completely. Next, we conducted a principal components analysis. We did not rotate the solution because we had no a priori basis for assuming the analysis would yield multiple or inter-correlated components, even though we included items reflecting different aspects of craving. This analysis yielded two components with eigenvalues greater than 1.0; however, the first component (eigenvalue = 6.2) accounted for 51.4 % of variance and the second component had a small eigenvalue (1.3) and accounted for a notably smaller proportion of variance (10.4 %) than the first component. In addition, examination of Table 4 (final two columns) showed that 11 of the 12 items loaded above .50 on the first component. Although Item 3 loaded more highly on the second component, the loadings on the two components were sufficiently similar (.44 and .54, respectively) that we decided to treat all 12 items as comprising a single scale. Unidimensionality and Reliability Analysis of the PCQ We calculated the mean inter-item correlation to evaluate the ‘‘unidimensionality’’ of the revised PCQ. Based on Clark and Watson’s (1995) recommendation that the mean inter-item correlation for a focused construct range from .15 to .50, we interpreted the coefficient (r = .46) as supporting the unidimensionality of the PCQ. In addition, the PCQ had excellent internal reliability (Cronbach’s a = .91). Convergent, Criterion, and Discriminant Validity of the PCQ To evaluate several elements of convergent and criterion validity, we calculated Pearson product-moment correlations to measure the relationship between craving scores and preoccupation with pornography, between craving and sexual compulsivity, and between craving and compulsive internet use. Firstly, PCQ scores were significantly and positively correlated with both the Harmonious Passion-Pornography

Arch Sex Behav (2014) 43:451–462

subscale, r(219) = .55, p\.01, and the Obsessive PassionPornography subscale, r(219) = .50, p\.01. Secondly, PCQ scores were significantly positively correlated with sexual compulsivity, r(219) = .36, p\.01. Thirdly, PCQ scores were moderately correlated with CIUS scores, r(219) = .38, p\.01. We interpreted these statistically significant findings as supporting the convergent and criterion validity of the PCQ because current craving should be associated, though only moderately, with being preoccupied with pornography, experiencing intrusive thoughts related to sex, and using the internet compulsively. In addition, as an initial evaluation of its discriminant validity, we correlated PCQ craving scores with a measure of non-sexual sensation seeking. PCQ scores were not significantly correlated with BSSS scores, r(219) = .09. Association of PCQ Scores with Social Desirability Bias Because social desirability bias might lead some young males to misrepresent their current intention and desire to use pornography, we evaluated the relationship between PCQ craving scores and the SDS (Sto¨ber, 2001). The Pearson product-moment correlation indicated that craving and scores on the SDS-16 were not significantly related, r(219) = -.13. Associations of PCQ Scores with Sexual Orientation Although we did not interpret this analysis as bearing on criterion or discriminant validity, we also conducted an independent samples t test to evaluate whether mean scores on the PCQ would differ as a function of sexual orientation. Specifically, we compared individuals who self-identified as‘‘heterosexual’’with those of individuals who self-identified as‘‘gay’’or ‘‘bisexual.’’We omitted those five participants who self-identified their sexual orientation as‘‘uncertain.’’The t test was significant, t(214) = -3.2, p\.01, indicating that gay/bisexual participants reported higher craving for pornography (M = 4.2, SD = 1.3) than did heterosexual participants (M = 3.4, SD = 1.3). To put this finding in context, we also found that level of pornography use (0-to-2 times/week; 3-to-5 times/week, 6?/ week) was significantly associated with sexual orientation, v2(2) = 7.82, p\.05; specifically, 47 % of gay/bisexual participants used pornography 6? times per week compared to 28 % of heterosexual participants who used pornography that often. Study 3 As the next step in our evaluation of the PCQ, we assessed two additional psychometric properties of the questionnaire in a new sample of young male pornography users. Specifically, we evaluated the one-week test–retest reliability of PCQ scores immediately following exposure to the Enhanced Craving-forPornography vignette used in Study 2. Secondly, as one evaluation of the predictive validity of the PCQ, we tested whether

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post-cue exposure reports of craving were significantly associated with the number of times participants used pornography over the course of the next one-week period. Method Participants and Procedure Unlike the previous two studies that used email overtures to inform large numbers of students about the study, we recruited potential participants for Study 3 from four different undergraduate psychology classes. We changed the recruitment procedure because we were asking participants to complete materials on two separate occasions. With the assistance of course instructors, the first author made a 5-min presentation to each class about the nature of the study and the instructors subsequently sent an email to their students with the weblink to the study materials. Eligible participants had to be at least 18 years old, male, and could not have participated in Study 1 or Study 2. We included a screening item immediately after the informed consent to assess whether participants had participated previously in either Study 1 or Study 2. At Time 1, participants completed the BSSS and SDS as a prelude to exposure to the Enhanced Craving-for-Pornography vignette. Immediately thereafter, they completed the PCQ. Following this, we administered the remaining questionnaires (in random order). Seven days following the initial email requesting participation, instructors sent another email to the class reminding those who had participated at Time 1 to complete the materials at Time 2. To ensure that their answers to the measures would remain anonymous, participants completed a separateweb survey to receive extra credit for their participation. At Time 2, participants completed the same two pre-cue exposure questionnaires (BSSS, SDS-16), were exposed to the same Enhanced Craving-for-Pornography vignette, completed the PCQ, were administered the Passion Scale-Pornography, and were asked the number of times they had used pornography in the pastweek.Finally,participantssawadebriefingstatementregarding the study. We recruited 67 male undergraduates who completed the materials at both Time 1 and Time 2. We removed from the database those 23 participants who reported that they had not watched pornography in the last 6 months. As shown in Table 1 (column 3), most of the remaining 44 participants were Caucasian, were in their early 20s, and were either not dating or were involved in a serious romantic relationship. As shown in Table 2 (column 3), almost half of the sample reported using pornography three or more times per week. Measures We administered the PCQ twice, with approximately 1 week between administrations at Time 1 (Cronbach’s a = .92) and Time 2 (Cronbach’s a = .94). Although it was not used to evaluate test–retest reliability or predictive validity, the Passion Scale-Pornography described in Study 2 was administered at both Time 1 and Time 2 as part of another

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investigation. At Time 1, we also administered the same SCS and the same demographic, pornography history, and sexual behaviors questionnaires used in Study 2. We also administered the BSSS and the SDS employed in Study 2 at both Time 1 and Time 2. Stimulus Materials We had participants read the same Enhanced Craving-for-Pornography vignette employed in Study 2 at Time 1 and Time 2.

Results Test–Retest Reliability of the PCQ To assess the one-week test–retest reliability of the PCQ immediately following pornography-related cue exposure on two separate occasions, we correlated participants’ PCQ scores at Time 1 with their scores at Time 2. The coefficient indicated that the questionnaire had good test–retest reliability, r(42) = .82, p\.001. Predictive Validity of the PCQ To evaluate the predictive validity of the PCQ, we conducted a multiple regression analysis in which mean scores on the PCQ and typical weekly pornography use assessed at Time 1 were entered as independent variables to predict the number of days on which participants used pornography in the week just prior to assessment at Time 2. The equation was statistically significant, F(2, 43) = 21.38, p\.001, and accounted for 51 % of the variance. Examination of the beta weights revealed that both typical weekly pornography use (b = .52, p\.001) and PCQ scores (b = .30, p\.05) were significant predictors of pornography use in the following week; in addition, these two predictors were themselves significantly inter-correlated at Time 1, r(42) = .48, p\.001.

Discussion Whether one’s use of pornography is problematic or not, one psychological element of regular pornography use could be craving for sexually explicit material. Because clinicians and researchers could make use of a relatively short multi-item questionnaire assessing emotional, cognitive, and somatic aspects of current craving for pornography, we conducted three studies with male undergraduate pornography users to develop and evaluate such a questionnaire. To begin this process, we created and refined an initial pool of 20 draft items to yield a 12item modified version of the PCQ for psychometric evaluation. As one would expect of a narrow construct such as current cravingforpornography,thePCQ hadexcellentinternalconsistency

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reliability and was unidimensional. These findings, and a principal components analysis showing that 11 of the 12 items loaded on the same component, supported our interpretation that all 12 items comprised a single scale, even though they reflected different dimensions or aspects of subjective craving. Association of PCQ scores with measures of passionate attachment for pornography, sexual compulsivity, and compulsive internet use supported the convergent and criterion validity ofthequestionnaire.Asonetestofdiscriminantvalidity,wefound that participants’ inclination to be a sensation seeker (i.e., willingness to take risks and seek varied, novel, and intense sensations) were not associated with their reported craving for pornography. Because the vast majority of our participants watched pornography via the Internet, it is not surprising that craving and compulsive internet behavior (which would include playing online games,emailing,social networking, and shopping)were related to one other, but the moderate size of the correlation suggested that measuring one’s compulsive internet use is not the same as measuring craving for pornography. Typical weekly pornography use was associated with craving; specifically, participants who used pornography more often reported higher craving, which we interpret as support for one element of construct validity. However, unlike previously published studies examining the impact of cue exposure on drug craving (e.g., Taylor et al., 2000; Tong et al., 2007), an imagery script designed to induce craving had no impact on PCQ scores. We speculate that frequent pornography users such as those who participated in Study 2 were accustomed to watching sexually explicit material via streaming videos and may have found the imagery script and mock web page image insufficiently arousing to induce craving. This explanation is supported by a recent study (Brand et al., 2011), in which undergraduate males who were exposed to 40 non-fetishistic pornographic pictures reported significantly greater‘‘arousal’’ than were those exposed to non-pornographic photos. Furthermore, some of our participants may have viewed and masturbated to pornography shortly before participating in Study 2, thus reducing their reactivity to the Enhanced Craving-forPornography vignette. Future research could compare the level ofcravingafterdifferentperiodsofabstinencefrompornography. Our follow-up analysis showing that the heaviest pornography users reported significantly higher craving on 11 of 12 items on the PCQ indicates that items reflecting several different dimensions of craving varied as a function of typical weekly pornography use. Because a single-item scale asks only about the intensity or strength of craving per se, participants do not have the opportunity to rate their experience of different aspects of craving (e.g., desire, intention, perceived control, mood changes, and psychophysical reactivity). Furthermore, the moderate mean inter-item correlation among the items indicated that these 12 statements were not duplicates for one another, and suggests that all 12 contributed to participants’ report of subjective craving to use pornography. Finally, Study 3 indicated

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that the PCQ had good 1-week test–retest reliability and predictive validity. Although there is considerable debate among scholars whether drug craving is always predictive of subsequent consumption (Tiffany & Wray, 2012; Tracy, 1994), the results from the present study suggest that craving for pornography predicted short-term pornography use, even when accounting for baseline use of pornography. Although many of the analyses support aspects of reliability and validity of the PCQ, the study was limited in several respects. First, we employed a sample of primarily Caucasian, male undergraduates from the same large, state-supported university. The generalizability of the results may be limited if responses to the PCQ vary based on composition of the student body and campus culture (e.g., single-gender or religious-affiliated college or university). An additional limitation is that we recruited a relatively young sample of pornography users, most of whom were heterosexual and few of whom intended to seek treatment for their pornography use. In addition, we purposefully excluded college-aged women in this series of studies, primarily because they use porn less frequently than men do (Carroll et al., 2008; Morgan, 2011). Therefore, future research could evaluate the reliability and validity of the PCQ among older men, distressed individuals seeking treatment, females, and a larger sample of gay/bisexual men. An additional limitation was that we used self-report measures to collect data on participants’ sexual history and current craving, and such questionnaires rely on both participants’ recall of and their willingness and ability to be insightful and honest about their pornography-related behavior. In addition, the response rate was relatively low given the large number of email overtures we distributed. However, many of those to whom the email was sent would not have meet the eligibility criteria and some of those who were eligible may have chosen not to participate because they found the project uninteresting, were not willing to admit that they used pornography, or felt guilt or shame about their pornography use. However, among those who participated in Study 2, current craving for pornography was not statistically associated with their tendency to present themselves in a socially desirable manner. Furthermore, the recruitment email encouraged participants to complete the survey in private. The PCQ also asked participants to rate their current (‘‘right now’’) experience of craving for pornography, but craving may also be conceptualized as a stable inclination to watch pornography (Ferguson & Shiffman, 2009; Tiffany & Wray, 2012). Other measures, such as Vallerand et al.’s (2003) Passion Scale (modified for pornography), may be of value when one wants to assess a more stable inclination or preoccupation to watch pornography.WealsorecognizethatthePCQmaymeasureone’s desire to experience sexual arousal as well one’s craving to watch pornography. When people experience an urge for sexual excitement, reading or watching pornography is only one of many avenues to satisfy that craving.

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Balancing the strengths and limitations of this questionnaire and its evaluation, the PCQ has several potential applications in clinical practice and research settings. Specifically, clinicians treating clients who use pornography problematically could have them complete the PCQ during and between counseling sessions to monitor changes in their experience of craving. Completing the PCQ in real-life settings could reveal those specific contexts in which urges or desires to use pornography are more or less intense. To the degree that craving predicts slips or relapse, administering the PCQ in‘‘high-risk situations’’could help predict a client’s readiness for discharge and likelihood of relapse following therapy for problematic pornography use. This questionnaire also could be used as a research tool to assess the prevalence and contextual triggers of craving among different types of pornography users.

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