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Article
Sexualities
2023, Vol. 0(0) 1–33
© The Author(s) 2023
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DOI: 10.1177/13634607231157070
journals.sagepub.com/home/sex
Iatrogenic effects of Reboot/
NoFap on public health:
A preregistered survey study
Nicole Prause
Children’s Hospital, Los Angeles, USA
James Binnie
London South Bank University, UK
Abstract
“Reboot,”especially NoFap, promotes abstinence from masturbation and/or pornog-
raphy to treat “pornography addiction,”an unrecognized diagnosis. While the intention
of Reboot/NoFap is to decrease distress, qualitative studies have consistently suggested
that “Reboots”paradoxically cause more distress. The distress appears to occur in
response to (1) the abstinence goal, which recasts common sexual behaviors as personal
“failures,”and (2) problematic and inaccurate Reboot/NoFap forum messaging regarding
sexuality and addiction. This preregistered survey asked men about their experience with
perceived “relapse”and NoFap forums. Participants reported that their most recent
relapse was followed by feeling shameful, worthless, sad, a desire to commit suicide, and
other negative emotions. A novel predictor of identifying as a pornography addict in this
lower religiosity sample was higher narcissism. Participants reported that NoFap forums
contained posts that were misogynist (73.7% of participants), bullying (49.1%), anti-LGBT
(42.9%), antisemitic (32.0%), instructing followers to harm or kill themselves (23.5%), or
threats to hurt someone else (21.1%). More engagement in NoFap online forums was
associated with worse symptoms of erectile dysfunction, depression, anxiety, and more
sex negativity. Results support and expand previously documented harms and problems
with Reboot/NoFap claims of treating pornography addiction from qualitative research.
Keywords
addiction, abstinence, iatrogenic, nofap, pornography, reboot
Corresponding author:
Nicole Prause, Children’s Hospital Los Angeles, University of California Los Angeles, 405 Hilgard Avenue, Los
Angeles 90095, CA, USA.
Email: nprause@mednet.ucla.edu
Introduction
The United States appears to be experiencing a resurgence in anti-porn sentiment. Part of
this anti-porn campaign appears to be using science and health terminology to advocate
for legislation (Burke and MillerMacPhee, 2020). One aspect of this campaign is the idea
that pornography is an “addiction”that is treated by abstinence. The largest abstinence
community appears to be an online group of young, adult males who follow a concept
they call “Rebooting.”The term “Reboot”refers to a period of abstinence from por-
nography that they believe will reset their body to a healthy state, based upon the as-
sumption that their previous use of pornography had been harmful. For example, porn
abstinence is described by Reboot followers as a cure for erectile dysfunction (Imhoff and
Zimmer, 2020), and will “lead to a greater penis size when it’sflaccid”(The Reboot
Nation, 2021a), based on claims that pornography causes the penis to “shrivel up”
(Church, 2016a). The largest group making these sorts of claims, and selling treatments
for medical disorders based on these claims,
1,2
is NoFap (Gałuszka, 2020).
Rebooters who follow NoFap are known as the “NoFap Army”(Rhodes, 2013) and
occupy many social media platforms. Their largest presence appears to be on Reddit—
special interest forums are called “subreddits”and denoted with an “r/”before their name
(i.e., r/NoFap). The founder and moderator of r/NoFap, also moderates
r/NoFapChristians, r/pornaddiction, r/NoFapArmy, and r/monkmode, among others. The
r/NoFap forum’s concept of abstinence from pornography often extends to any orgasm at
all. The NoFap founder described Rebooting “hard mode”abstinence as “not allowed to
masturbate under any circumstances (no edging). Absolutely no deliberately viewing
pornography or anything close to it [...] unless if it is sex with someone I actually care
about (no ‘booty calls’or casual sex)”(Rhodes, 2014). The NoFap founder posted a
description of “monk mode”abstinence as 90 days of Rebooting, which required “not
engage with any sexuality, not checking out women [...], not fantasizing, not approaching
any women”(Rhodes, 2018). Most descriptions of Reboot treatments extend beyond
abstinence from pornography into abstinence from masturbation, non-monogamous sex,
sexual thoughts, and similar.
Rebooters refer to one another in these forums as “king,”“bro,”“soldier,”and similar.
While women and gay men are not prohibited from registering in NoFap forums, they
rarely post. Rebooters’posts usually focus on “days abstinent.”Posts can be self-tagged
with eight different “flair”describing a post’s content (e.g., “Victory,”“Success story,”
“Motivation,”etc.). As suggested by the braggadocious flair, forum users are described as
challenging each others’masculinity by proving who can abstain longer (Taylor and
Jackson, 2018). The founder conceptualized NoFap forums as possibly a “wall of shame’
post listing those who haven’t updated and give them one last chance before marking
them down as failures”(Rhodes, 2011). NoFap appears to reflect that goal. Posts contain
either authors’brags about abstinence improving their mood, erectile function, mus-
cularity, energy, mental clarity, focus, confidence, motivation, productivity, emotional
intensity, and attractiveness to women (Fernandez et al., 2021) or despair and shame at
having “relapsed”from abstinence, frequently describing a desire to kill themselves or die
as a result. In summary, NoFap forum contents could be described as bipolar, filled with
2Sexualities 0(0)
posts by young men and youth about personal sexual experiences that are extremely
positive or extremely negative.
Since “pornography addiction”does not appear as a diagnosis in either the Diagnostic
and Statistical Manual or the International Classification of Disorders, markers of
“success”in treating it are unclear. Minimally, someone who is upset by their sexual
behaviors should probably feel less upset if a treatment is efficacious. Reboot/NoFap
would not be considered an efficacious or effective treatment by the standards of the
American Psychological Association (Lilienfeld, 2019). Despite no evidence to support it
and a likelihood of creating harm, Reboot/NoFap has been widely recommended in
national media and endorsed by licensed professionals in the Society for the Ad-
vancement of Sexual Health. This study seeks to test associations of Reboot/NoFap
abstinence treatment components with some of its claimed effects using a preregistered
cross-sectional online survey.
Reboot/NoFap harms
Research suggests Reboots can be harmful or iatrogenic. “Iatrogenic”is from the Greek
“iatro-,”meaning healer, and “-genic,”meaning produced by. Iatrogenic, or “healer
caused,”refers to unplanned, usually negative, effects of treatment (Bootzin and Bailey,
2005). Users from Reboot subreddits (r/NoFap and r/PornFree) in one study were
theorized to possess weak identities, leading to them uniting against pornography to
regain their masculinity; however, the Reboot/NoFap intervention fueled increased
anxiety and a need for self-improvement, ultimately causing greater distress at relapse
events and maintenance (rather than resolution) of the problem (Chasioti and Binnie,
2021). A central claim of Reboot is that pornography causes erectile dysfunction, but this
has been refuted by dozens of studies (Hoagland and Grubbs, 2021). One study spe-
cifically surveyed men who participated in a Reboot abstinence program. While anxiety
strongly predicted erectile difficulties in this group, pornography viewing neither me-
diated nor moderated that relationship (Prause and Binnie, 2022). The authors interpreted
this as possibly indicating that those in Reboot were misled by health disinformation on
Reboot websites or may exaggerate their erectile difficulties.
Another study analyzed top posts on six male health topics from TikTok and Instagram
(Dubin et al., 2022). The NoFap/SemenRetention topic was the most active topic and the
only topic to have no physicians posting about it. The authors concluded that the accuracy
of NoFap/SemenRetention information was significantly lower than all other male sexual
health topics on these social media platforms. Others have echoed that NoFap grounds
their false medical claims on misinterpretations of science to support sexually conser-
vative values (Monea, 2022;Watson, 2020).
The main strategy for abstinence in Reboot seems to be distraction, which is unlikely to
work. “Thought stopping”techniques for sexual content are known to paradoxically
increase sexual thoughts (Efrati, 2019). Further, mere distraction is known to fail over the
long term (Thiruchselvam et al., 2011). As these distraction efforts fail, Reboot followers
may experience distressing emotions, such as shame or disgust, in response to their
relapse. Since shame associated with sexual behaviors paradoxically increases sexual
Prause and Binnie 3
desires (Van Tuijl et al., 2021), this might explain why qualitative studies found followers’
distress does not improve with Reboot.
NoFap “Support”forums
Reddit offers the ability for any subreddit to restrict users to those over 18, but r/NoFap
does not use that restriction. Thus, anyone age 13 or older (the age restrictions on the
Reddit platform) can engage in this aspect of Reboot treatment. Parental consent is not
described on r/NoFap. In a different study scraping the data of 1194 r/NoFap followers
(Prause, in preparation), 5.4% of followers who posted text (i.e., not just a cartoon)
spontaneously reported that their age was under 18, with several claiming to be 10 years
old. The current study only recruited adults to comply with federal ethics requirements.
Including youth in a treatment for sexual issues alongside adults without clear parental
consent should be studied by ethicists.
Not everyone engages equally in Reboot forums. Some followers may only read a few
forum posts, while others posted consistently for months. Previous research showed the
more engaged a client was with mobile health interventions, the more their symptoms
improved (Molloy and Anderson, 2021). Specifically with substance addiction treat-
ments, more engagement (not mere attendance) with support groups caused improve-
ments in symptoms (Dodes and Dodes, 2015). If Reboot forums are therapeutic, greater
engagement with Reboot forums should be associated with improvement in symptoms.
Sexism and homophobia. Reboot forums have been criticized for misogynist and anti-gay
rhetoric. NoFap forum followers have been estimated to be 99% male (Imhoff and
Zimmer, 2020) and described as the most conservative group of the “manosphere”
promoting misogyny (Burnett, 2021;Han and Yin, 2022;Hartmann, 2020). This im-
pression may have developed from the framing of Reboot/NoFap as a masculinity
challenge, where failure means you are not a [heterosexual] man deserving of a sexual
relationship (Taylor and Jackson, 2018). Reboot/NoFap forums and videos frequently use
openly sexist language like “bitches”and “girls”(Hartmann, 2020). r/NoFap also shared
members with “r/MRA”(Men’s Rights Activists), “r/MGTow”(Men Going Their Own
Way), and “r/Incel”(involuntary celibates) subreddits (Khan and Golab, 2020;Massachs
et al., 2020), widely known for hateful posts about women. Possibly related to some
hatred of feminism, Reboot/NoFap also claim that viewing homosexual erotic images is
evidence of “escalation”of the disease of pornography addiction (Hartmann, 2020).
Rather than viewing homosexual pornography as exploring one’s own sexuality, viewing
homosexual pornography is conceptualized as a symptom to abstain. Given this, it is
unsurprising that r/NoFap members are rarely members of LGBT communities (Massachs
et al., 2020).
Anti-semitism. NoFap forums were described as productive targets for white supremacist
recruitment (Von Sydow, 2020). This is linked to a false conspiracy theory that Jewish
persons control the pornography industry for the purpose of promoting race mixing (Kerl,
2020). Some have theorized this may be why NoFap is most active on Reddit forums,
4Sexualities 0(0)
where misogyny and anti-semitism occur in largely unregulated forums (Johanssen,
2021). A scrape of Twitter data discussing NoFap also identified anti-semitic language
infused with this false conspiracy theory (Burnett, 2021).
Trolling and violence. To our knowledge, neither trolling nor violence has been explored
systematically in NoFap forums. Trolling has been defined as “Internet users who aim to
disrupt online interactions”(Brubaker et al., 2021). Trolling comments are thought to
constitute about 1% of Reddit posts (Fichman and Sharp, 2020) but are more common on
subreddits that solicit high affect posts, use sexual vulgarities, and include long posts
(Tsantarliotis et al., 2017). The NoFap moderator described trolls on his forum as in the
“millions,”
3
which may prevent the environment from providing support.
Suicidal ideation was not associated with problem pornography viewing in a survey of
283 men (Shirk et al., 2021). Yet, in a qualitative analysis of 104 journals from a Reboot
website (Fernandez et al., 2021), three followers spontaneously expressed suicidal
ideation as a response to their Reboot. In addition, 23.1% of followers in that study
described negative affect attributed to Rebooting. Reboot coaches describe suicidality and
negative emotions as an expected part of Reboot suffering required to “heal”
4,5,6,7,8,9
.
Homicidal threats were surprisingly common in NoFap forums, exceeding by several
hundred posts in other subreddits of comparable post frequency and content (Prause,
2023). Posts describe graphic plans to murder “pornographers”
10,11
and women who
tempt them to “relapse.”
12,13
Other scientists also noted a remarkably “angry tone adopted
by many NoFap members in response to pornography. The tone is almost combative in its
abhorrence”(Taylor and Jackson, 2018).
Predictors of “Pornography Addict”identity in Rebooters
“Moral incongruency”theory suggests that those who believe they are addicted to
pornography experience distress due to personal values that conflict with their own
pornography viewing (Grubbs and Perry, 2019). These conservative values often arise
from a religious upbringing. Yet, Reboot treatments were marketed to secular audiences.
If Reboot followers actually are less religious than other self-identified pornography
addicts, then what drives Rebooters’identification as pornography addicts?
Several lines of evidence suggest narcissism might underlie self-identification as a
pornography addict in those who are not religious. Self-identity as “sexually compulsive”
is associated (r = 0.52) with narcissism (Oswald et al., 2021). Reboot clients encourage
each other by claiming one another and themselves to be triumphant, strong, and attractive
(Taylor and Jackson, 2018). Narcissists may attribute erectile difficulties to something
outside of their control to maintain a positive self-image (Douglas et al., 2017), leading
coaches to appeal to clients as “unwitting victim [s]”of imagined pornography cabal(s)
(Burnett, 2021).
Narcissism and belief in conspiracies appear linked by a desire to maintain self-
infallibility by demonizing others (Cichocka et al., 2016). Narcissists are convinced their
unique brilliance leads them to know more than scientists in the relevant field (Bertin
et al., 2021;Bowes et al., 2021;Lantian et al., 2017). Conspiracy beliefs are, at their core,
Prause and Binnie 5
a mistrust of authority, making scientific authorities a frequent target (Pierre, 2020). For
example, Reboot coaches claimed to media, without evidence or expertise, that por-
nography “hijacks”neurocircuitry (Burke and MillerMacPhee, 2020), and described
actual scientists in conspiratorial terms.
14,15,16
Other common conspiracies in Reboot
include that pornography companies have secret deals with pharmaceutical companies to
cause erectile dysfunction,
17
and that Jews/feminists/liberals secretly run the pornography
industry in order to stop them from reproducing with “real girls”(Burnett, 2021). While
individuals are susceptible to conspiracies for different reasons (Andrade, 2020), those
who believe conspiracies scored lower on critical thinking tests (Lantian et al., 2021).
Relatedly, those who use social media to garner health information tend to be misled to
inaccurate health information due to a belief in false conspiracies (Allington et al., 2021).
Yet, individuals also may deny their conspiracy beliefs to avoid being viewed as
gullible and/or socially excluded (Lantian et al., 2018). A narcissist might be attracted to
the “addict”label to avoid social moral judgements that might otherwise be viewed as
failures of the individual (Bailey, 2005). This is a problem, because adherence to the
“addict,”rather than recovery, identity has been associated with lower self-efficacy, more
negative behaviors, and maintained distress (Buckingham et al., 2013). Narcissists’
efforts to self-regulate problem behaviors ultimately result in seeking positive feedback
rather than actual change (Morf and Rhodewalt, 2001). Narcissists also perceive personal
slights everywhere (McCullough et al., 2003), which may make them resistant to ex-
pertise. Narcissism and belief in conspiracies may predict identifying as a “porn addict”in
Reboot/NoFap treatments.
Hypotheses
Hypotheses were preregistered prior to data collection (https://osf.io/ux47b/?view_only=
6739f6f8d4e74a809e95cd64b836dade).
Hypothesis 1. The reported intensity of suicidal thoughts attributed to relapse events
will be significantly higher than population mean (i.e., mu) = 1 (having no suicidal
thoughts). The shaming approach of Reboot that call viewing porn a personal “failure”
may lead to thoughts of suicide. As suicidality is a highly negative outcome, any
elevation of suicidal ideation by perceived “relapse”events is considered clinically
significant.
Hypothesis 2. The more engaged with the Reboot forum NoFap (a) the more negative
emotions associated with relapse (b) the more likely they are to have witnessed
negative behaviors on the NoFap website and (c) the more sexually restrictive.
Qualitative research suggested on NoFap suggested that these “support”forums
actually shame participants for common sexual behaviors, and this shaming is often in
the form of attacks on individuals’core identity (e.g., sexual orientation, gender).
Hypothesis 3. Those with higher depression, anxiety, narcissism, belief in conspiracy,
erectile dysfunction, and religiosity also will report greater certainty that they are
addicted to pornography. Most research has pointed to conservative values as an
important predictor of identify as a pornography addict, but Reboot/NoFap claims to
6Sexualities 0(0)
be secular. This hypothesis tests which traits or symptoms are more likely to predict an
identity as a pornography addict in men familiar with Reboots.
Hypothesis 4. Those who report being more sure that they are a porn addict also will
report more erectile dysfunction, but this will be mediated by participation in Reboot
interventions.
18
Hypothesis 5. Those who believe NoFap is run by scientists or licensed therapists also
are less likely to have sought help from licensed mental health professionals.
19
Hypothesis 6. Those who believe NoFap harmed them also will report higher de-
pression, anxiety, and erectile dysfunction. If Rebooters are young or sexually in-
experienced, they may struggle to accurately attribute their mental health symptoms. If
Rebooters who believe they were harmed by NoFap also reported poorer health
outcomes, this argues against the possibility that they are poor at attributing changes in
their mental health. If a belief they were harmed is related to more positive outcomes
(or vice versa), then they are more likely inaccurate in their attributions.
Every registered analysis was conducted and reported. The study was approved by a
federally assured Institutional Review Board at the Community-Academic Consortium
for Research on Alternative Sexualities.
Methods
Most research on Reboot has been qualitative. We sought to quantify relevant constructs.
However, like early Alcoholics Anonymous (Dodes and Dodes, 2015), Reboot groups
actively fight and threaten litigation to avoid being researched (Gałuszka, 2020). Thus, a
survey with platform advertisements was used to reach men who had heard of Reboot.
Questionnaires
Participants provided demographic and sexual history information, relationship happiness
(Spanier, 1976), responses to standardized questionnaires (see below).
Religiosity. Religiosity was assessed using three items. One item concerned the frequency
of attendance at religious services (Lugo and Cooperman, 2010), another concerned
prayer frequency outside of religious services (Mockabee et al., 2001), and the third
concerned how important religion was in their life (Michalak et al., 2007). These three
items have been added previously to characterize religiosity (Arbuckle and Konisky,
2015) and specifically religiosity as related to pornography use and attitudes (Grubbs
et al., 2020a). The score range was 3–17.
Mental health. Symptoms of major depressive disorder (Kroenke et al., 2003) and
generalized anxiety disorder were measured using two items each (Kroenke et al., 2009).
Participants were asked “Over the last 2 weeks, how often have you been bothered by any
of the following problems?”and could respond 0 (“Not at all”)to3(“Nearly everyday”).
Responses were added (total range 0–6). These brief screeners had comparable
Prause and Binnie 7
discriminative validity to both 9 and 7-item screeners, respectively (Staples et al., 2019).
A meta-analysis examined the relationship between this depression screener and clinical
interviews for depression. For scores >2 sensitivity (detecting diagnosis when present) =
0.91 and specificity (not detecting diagnosis when not present) = 0.67; for scores >3
sensitivity = 0.72 and specificity = 0.85 (Levis et al., 2020). This means, depending on
which decision you want to optimize, this scale is able to accurately identify up to 91% of
depression when it is present and accurately identify up to 85% of people as not having
depression when they truly do not.
Personality. Participants reported their narcissism and belief in conspiracy. Narcissism was
measured using the Single Item Narcissism Scale (SINS). SINS is “To what extent do you
agree with this statement; ‘I am a narcissist’” with responses from 1 (“not very true of
me”)to7(“very true of me”). The word ‘narcissist’means egotistical, self-focused, and
vain (Konrath et al., 2014). Narcissists were fairly aware of their own narcissism and
readily reported the same (Carlson, 2013). SINS correlated with longer measures of
narcissism (Ames et al., 2006) and was discriminable from measures of self-esteem (Va n
der Linden and Rosenthal, 2016). A score of 4 or above has been interpreted as “higher”
narcissism (Macenczak et al., 2016).
A single-item scale was used to assess propensity to believe in conspiracies.
20
This
item demonstrated concurrent, convergent, discriminant, and predictive validity (Lantian
et al., 2016). Although the item lacks some construct and factorial validity (Goreis and
Voracek, 2019), it converged with related concepts like the psychological need to feel
unique (Lantian et al., 2017) and refusing to follow COVID-19 precautions (Coroiu et al.,
2020). This measure was distinct from paranoia (Imhoff and Lamberty, 2018).
Sexuality. Three dimensions of sexuality were measured, including erectile functioning,
pornography use, and openness to casual sex.
International Index of Erectile Function-5. The International Index of Erectile Function uses
five items to measure erectile function (Rosen et al., 2000). The range is 5–25 where higher
scores indicate fewer erectile problems (suggested interpretation is severe = 5 to 7, moderate = 8
to 11, mild to moderate = 12 to 16, mild = 17 to 21, and none = 22–25). The IIEF-5 has been
used to screen large clinic populations (Rhoden et al., 2002). In that study, dysfunction
prevalence was estimated as 53.9%, highlighting what may be a tendency to over identify ED.
The IIEF is conservatively interpreted to reflect erectile “difficulties”rather than dysfunction.
The IIEF-5 was elevated in men with coronary artery disease (Gazzaruso et al., 2004)and
positively associated with age, body mass index, cholesterol, and triglycerides in patients with
heart disease (Fung et al., 2004).
Pornography use. Pornography use is notoriously challenging to measure (Kohut et al.,
2020). It was assessed using three questions (cp., Grubbs et al., 2020a). Pornography was
defined for participants as “any sexually explicit films, video clips or pictures displaying
the genital area, which intends to sexually arouse the viewer; this may be seen on the
internet, in a magazine, in a book, or on television.”Participants indicated their average
8Sexualities 0(0)
solo viewing in the last year (1 “Not at all”to 8 “once a day or more”), frequency of
masturbation during viewing (1 “Never”to 5 “Always/Almost always”), and frequency of
viewing pornography when masturbating (0 “I never touch myself for sexual pleasure”to
6“Always/Almost always”). Identity as a pornography addict was assessed by “Would
you say that you are a “porn addict”?(0“Definitely not a porn addict”to 6 “Definitely a
porn addict”). Since some individuals may continue to identify as an addict despite
viewing themselves as recovered, we included “How upset are you about your current
pornography viewing?”(0 “Not at all upset”to 6 “Extremely upset”).
Sociosexual orientation inventory (SOI). SOI is a 9-item measure characterizing sexual
openness (Simpson and Gangestad, 1991), especially interest in uncommitted sex (Penke
and Asendorpf, 2008). In addition, this questionnaire also served as reinforcement for
participation. Individuals who chose to complete all 9 items were provided their score,
graphically compared to norms for their gender and age. This novel incentive eliminated
the risks associated with collecting identifying information for financial rewards
(Buchanan and Hvizdak, 2009).
Relapse affective response. Participants who indicated that they had tried a “Reboot”
answered how many times they had relapsed. If they had relapsed at least once, they were
prompted to describe their response to their “most recent”relapse. Specifically, they rated
a list of emotions that they may have experienced in response to a “relapse”from the
Positive and Negative Affect Scales (Watson et al., 1988) from 1 (“not at all”)to5
(“extremely”). We added the item “suicidal.”We included one positive experience, “joy,”
so participants could indicate (unexpected) positive experiences from relapse.
NoFap online forums. If the participant responded that they had visited NoFap forums, then
they were asked to rate how they felt about NoFap on a scale from 1 (“Strongly disagree”)
to 5 (“Strongly agree”). Items included “NoFap helped me”and “NoFap is a source for
accurate scientific information.”Further, they were asked to rate how often they noticed
ten problems in the forums. They could respond from 1 (“Never saw such posts”), 2 (“One
post ever”)upto7(“Posts overwhelming”). Items included “Sexism (bad comments
about women),”“Bodyshaming (bad comments about fat, muscularity, or similar),”and
“Told to harm or kill myself.”
Procedures
Study data were collected using Research Electronic Data Capture (REDCap) electronic
data capture tools hosted at University of Southern California. REDCap is a secure, web-
based platform designed to support data capture for research (Harris et al., 2019). In-
vitations with a link to the Informed Consent were presented through accounts posted by,
or tagged, on Twitter (e.g., @TheIASR, @Reboot_Nation, @JustinLehmiller, and
@NoFap, etc.), Reddit (e.g., r/NoFap, r/pornfree, r/pmohackbook, etc.), and Discord
servers (e.g., “Reboot Warriors,”“PMO recovery,”“No Nut Central,”etc.). Forums were
Prause and Binnie 9
selected for recruitment where followers were likely to have heard of Reboot approaches.
Advertisements also were placed on Twitter and Reddit targeting these communities.
Members of these groups did attempt to sabotage the research. These escalated into
threats against the investigators reported to Reddit and law enforcement. Groups also
attempted to block their members from learning about the study. Paid advertising (e.g., on
Reddit) was used to circumvent blocks.
Data analysis
All hypothesis tests were pre-registered on Open Science Framework https://osf.io/
ux47b/?view_only=6739f6f8d4e74a809e95cd64b836dade. Tests were powered using
a criterion of 1 - b= 0.80, p= 0.05, and ES = 0.1. Power refers to the ability of a test to
detect an effect of a particular size if the effect is actually present. Where unplanned tests
occurred, they were noted. Sexuality variables are often right skewed, meaning most
people choose low levels of a variable with fewer and fewer people choosing higher and
higher values (e.g., lifetime partner count). The reader may notice tests varying depending
on the distribution of particular variables being tested. These are described more fully in
the preregistration (above) complete with R analytic code.
Results
Non-completion rates were high like most online surveys. Of the 693 participants who
started the questionnaires, 587 completed at least the first background questionnaire. Six
were excluded for being female. Median completion time was 10.1 min. Ultimately, 417
(71.0%) completed every single questionnaire. This was comparable with other online
surveys (cp., 68.5% in Lauer et al., 2013; 75% and 63.7% in Miller et al., 2020).
Participants
Participants were primarily white, moderately educated and heterosexual men (see
Table 1). Most participants had personally tried a Reboot. Those who tried Reboot re-
ported many relapses.
Descriptives
Defining reboot and relapse. The definition of what constitutes a “Reboot”or “relapse”
varied between participants. The most agreement (lowest variance) of relapse (see
Figure 1) was for “Masturbating while viewing pornography”(SD = 0.88). The least
agreement (highest variance) was for “Hidden sex with a partner who is not my primary
(main) partner”(SD = 1.73). The number of days a participant believed they should be
abstinent to complete a “Reboot”averaged 42.0 days with high variance (SD = 36.6).
21
NoFap forum problems. Some individuals would rate that they had “Never”seen any of
the post types, or that every single post type was “Overwhelming,”a response set
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Table 1. Demographic information.
Variable Mean SD.
Age 31.8 12.2
Lifetime sexual intercourse partners
a
13.5 22.8
International index of erectile function
b
19.8 4.8
Sociosexual orientation inventory
e
2.8 0.7
Depression symptoms 2.3 1.9
Anxiety symptoms 2.3 1.9
Pornography viewing frequency
f
6.6 1.6
Belief porn addict identity
d
3.6 2.1
Concern about porn use
c
3.2 1.6
Narcissism 3.0 1.6
Belief in conspiracies 4.9 2.5
Relapse count
g
20.7 19.1
Count Percentage
Education
None 2 0.3%
8th grade/less 1 0.2%
9–11 grades 10 1.7%
High school 88 15.0%
Technical or trade school 21 3.6%
Some college 120 20.4%
Associate degree 29 4.9%
Bachelor’s degree 175 29.8%
Master’s degree 81 13.8%
Professional degree 26 4.4%
Doctoral degree 24 4.1%
Race
h
American Indian or Alaska Native 10 1.7%
Asian 73 12.4%
Black or African American 32 5.5%
Native Hawaiian or Pacific Islander 5 0.9%
White 385 65.6%
Other 61 10.4%
Don’t know 5 0.9%
Refuse to answer 23 3.9%
Sexual orientation
Homosexual 36 6.7%
Bisexual 71 13.2%
“Straight”or heterosexual 402 74.7%
Something else 22 4.1%
Decline to answer 7 1.3%
(continued)
Prause and Binnie 11
known as “straightlining”(Schonlau and Toepoel, 2015). This creates outliers (Leiner,
2019). These are not regarded as valid and interfere with the distribution requirements
for statistical tests. Respondent-level standard deviation identified straightlining
(Barge and Gehlbach, 2012). Respondents whose SD = 0 were removed from this
analysis. This meant that only reporting “Overwhelming”or only reporting “Never”
would be equally removed.
NoFap forum visitors reported witnessing content that was trolling (88%), misogynist
(73.7%), bullying (49.1%), anti-LGBT (42.9%), or anti-semitic (32.0%). Many partic-
ipants were told to harm or kill themself (23.5%) and witnessed threats to hurt others
(21.1%), and dox others (17.1%) on NoFap forums.
Responses to most recent relapse. Only participants who indicated that they had experi-
enced a relapse were invited to answer these questions.
Table 1. (continued)
Variable Mean SD.
Current romantic relationship
Single, choose to be single 125 23.3%
Single, but prefer not to be single 189 35.3%
Have a steady romantic partner (like a girlfriend or boyfriend) 74 13.8%
Living with a romantic partner (like a girlfriend or boyfriend) 24 4.5%
Married or similar commitment (common law marriage, religious bond,
etc.)
124 23.1%
Current sexual relationship
Not sexually active with others by choice 130 24.1%
Not sexually active with others, but wish I was 168 31.2%
Casual partners 47 8.7%
Monogamous partner (we are only sexual with each other) 157 29.2%
Open partner (my main partner and I are sexual with others by
agreement)
21 3.9%
“Cheating”partner (sexual with others than my main partner without
their knowledge or consent)
15 2.8%
Personally tried to “Reboot”257 62.5%
a
Sex partners could be reported up to 100.
b
Lower score indicates better erectile function.
c
Range from 1 “Not at all concerned”to 5 “Very concerned.”
d
Range from 0 “Definitely not a porn addict”to 6 “Definitely a porn addict.”
e
Range from 1 to 5 with higher scores indicating less constrained sexuality.
f
Range from 1 “Not at all”to 8 “Once a day or more.”
g
The maximum number of relapses that could be reported was 50, which was selected by 60 participants.
h
Participants could select more than 1 category.
12 Sexualities 0(0)
Suicidality (H1)
Sixty-six (28.9%) participants reported they felt suicidal due to their most recent relapse,
with 12 reporting feeling “extremely”suicidal (see Figure 2). The distribution of scores
were right skewed (skew = 1.4, Jarque = 223.3, p< 0.001). Following our analytic plan,
transformations did not sufficiently reduce skew. A Wilcoxon signed-rank test (V) was
used, because it only requires that variables be ordinal rather than continuous and
normally distributed.
22
Suicidal feelings were significantly elevated from “Not at all”in
response to relapse (V (234) = 2346, p< 0.001).
We explored whether suicidal feelings were linked to engagement in NoFap fo-
rums. Spearman’s rank test (rho), which only requires that variables be ordinal rather
than continuous and normally distributed, demonstrated a significant positive rela-
tionship (rho (206) = 0.20, p= 0.004). The more involved a participant was with
Figure 1. Belief that a behavior constitutes a Reboot relapse.
Prause and Binnie 13
NoFapforums,themoresuicidaltheyreportedfeelinginresponsetotheirlastrelapse
(see Figure 3).
23
NoFap involvement associations (H2)
Negative emotions during relapse (H2a). The factor solution fit well with a single factor
(R
2
= 0.94, see Table 2). In other words, the variance among the negative emotions
reported tended to vary together, such that one score could be computed to characterize
when negative emotions, in general, changed. The bootstrapped correlation between the
negative emotion factor and participation in NoFap forums was significant (r
boot
(200) =
0.42, p< 0.001, see Figure 4).
24
The more involved a participant was with the NoFap
forums, the more negative emotions that they reported experiencing following their most
recent relapse. One exploratory follow-up test supported that the more involved a person
was with NoFap, the more “ashamed”they felt in response to their most recent relapse
(rho (208) = 0.27, p< 0.0001).
Negative forum behaviors (H2b). The MANOVA was significant (F(1,230) = 2.4, p=
0.01). Follow-up, one-way ANOVA’s demonstrated involvement with NoFap was related
to the participant more frequently witnessing the instructions “told to harm or kill myself”
(F(1,118) = 5.7, p= 0.02, see Figure 5).
25
More sex negative (H2c). Involvement with NoFap and sex negativity was significant
(r
boot
(368) = 0.23, p< 0.0001, see Figure 6). The more involved a participant was
with NoFap, the more sex negative their Sociosexual Orientation Inventory scores.
Predictors of addict identity (H3)
The linear model was significant (F(6, 351) = 20.5, p< 0.001, R2
adj = 0.25, see Figure 7).
Narcissism (0std = 0.21, CI = 0.12 to 0.30, η2
p= 0.06), anxiety (0std = 0.24, CI = 0.12 to
0.36, η2
p= 0.06), and erectile difficulties (0std =0.22, CI =0.31 to 0.13, η2
p= 0.06)
predicted identification as a pornography addict (see Figure 7). Specifically, those who
Figure 2. Intensity of feeling suicidal following the most recent “relapse.”
14 Sexualities 0(0)
more strongly identified as a pornography addict in this sample also reported more
narcissism, anxiety, and erectile dysfunction.
NoFap harms (H6)
A belief that “NoFap helped me”was associated with anxiety and erectile difficulties.
Specifically, the more a participant believed that NoFap helped them, the more anxiety
(rho (338) = 0.11, p= 0.04) and erectile (rho (278) = 0.17, p= 0.004) difficulties they
reported (see Figure 8). Depression symptoms were not significantly associated with the
belief that NoFap was helpful.
Perhaps individuals did not receive a sufficient “dose”of the Reboot treatment? An
exploratory analysis identified that the more involvement a participant reported in NoFap
Figure 3. The more involved with NoFap online forums, the more likely participants experienced
suicidal ideation at their last “relapse”event.
Prause and Binnie 15
Table 2. Emotion weights contributing to factor score.
Emotion Weight in factor score
Sad 0.79
Anxious 0.66
Worthless 0.86
Upset 0.86
Angry 0.81
Despair 0.80
Disgusted 0.85
Ashamed 0.83
Figure 4. Involvement with NoFap and feeling negative emotions with last “relapse.”
16 Sexualities 0(0)
forums, the more anxiety (rho (375) = 0.20, p< 0.001), depression (rho (377) = 0.18, p<
0.001), and erectile (rho (318) = 0.15, p= 0.007) difficulties they reported (see Figure 9). To
explore why participants might feel helped despite worse symptoms, we explored belief in
conspiracies. A shared belief in false conspiracies, such as “The porn industry is targeting
NoFap,”might have supported a feeling of belongingness to this group despite poorer actual
measures of health. Those who reported that NoFap had been more helpful also were more
likely to believe in conspiracies (r(328) = 0.26, p<0.001, see Figure 10).
Discussion
This cross-sectional, preregistered survey examined associations with “Reboot”treatments for
pornography addiction, including abstinence goals and online forums. Many (28.9%) Reboot
participants reported that their most recent failure to maintain/reach the Reboot abstinence
goal caused them to feel suicidal. The more engaged a participant was with NoFap, the more
(1) negative emotions they experienced at their most recent relapse, (2) likely they had been
told to “harm or kill themself,”and (3) restrictive (disapproving of casual sex) their sexuality.
Predictors of identifying as a “pornography addict”in this sample included being more
narcissistic, higher anxiety, and more erectile dysfunction. Very few participants sought care
from licensed professionals for their pornography concerns. Finally, the more a participant
believed that NoFap had helped them, the more anxiety and erectile problems they reported.
Figure 5. Involvement with NoFap and being told to “harm or kill myself.”
Prause and Binnie 17
Relatedly, participants who reported more engagement in NoFap forums also reported more
current depression, anxiety, and erectile problems in contrast to previous research on treatment
engagement associated with fewer symptoms.
Evaluating any treatment requires considering the spontaneous recovery rate of the
problem behavior. In a study that followed a large sample of randomly selected
persons for 5 years, 95% of men who reported pornography concerns at baseline
spontaneously recovered within 5 years (Konkol¨
y Thege et al., 2015). Recent data
show sex/pornography problems over 5 years were not chronic (Gooding et al., 2022).
While some have advocated research into abstinence (Fernandez et al., 2020),
continuing to spend limited research resources for clinical trials (Heiman, 2002)
developing abstinence Reboot programs now appears wasteful, especially given the
spontaneous recovery rate.
Figure 6. Involvement with NoFap and sociosexual orientation score.
18 Sexualities 0(0)
While still lacking a random-assignment, controlled clinical trial (Floyd et al., 2021), a
number of potentially effective interventions for distress regarding pornography have been
tested. Two smaller trials of Acceptance and Commitment Therapy (ACT) reduced distress
regarding pornography viewing (Crosby and Twohig, 2016;Twohig and Crosby, 2010).
When a romantic partner is available, empirically supported treatments for couples’distress
are appropriate (Sniewski et al., 2018). A case series of meditation for pornography viewing
distress specifically sought (mostly unsuccessfully) to reduce guilt and shame following
pornography viewing (Sniewski et al., 2020). None of these treatments used abstinence or
community support touted by Reboot coaches. Thus, Reboot treatments create additional
harms by leading the public away from these evidence-based treatments.
Exploratory analyses suggested those who are more engaged with NoFap also
report more belief in conspiracies. Belief in conspiracies is thought to be a response to
Figure 7. Predictors of identity as a pornography addict.
Prause and Binnie 19
experiencing uncertainty, presumably as a mechanism to feel in control (Adam-Troian
et al., 2021). If a man is anxious about his erections, the conspiracy beliefs in Reboot
forums likely provide a way for the man to feel he is unique/special (not simply
anxious) and/or paranoia that the pornography industry conspired against him (Pierre,
2020). These individuals tend to have low science literacy, possibly consistent with
younger age of those participating in Reboot (Landrum and Olshansky, 2019).
Further, these conspiracies may drive some of the threats to harm others that were
witnessed by participants. Specifically, “activists within the anti-pornography
movement have not, for the most part, faced violence, discrimination, or mistreat-
ment, where sex workers and their allies, especially queer people of color, have”
(Burke, 2022). The role of conspiratorial thinking was not a focus of this study, but
appears possibly useful to explore in future research.
Figure 8. Belief NoFap helped and symptoms of erectile dysfunction and anxiety.
20 Sexualities 0(0)
Reboot/NoFap treatment is usually administered by unlicensed “coaches”who refer to
followers as “clients”(e.g., Church, 2015). Lifestyle coaches lack clear or standardized
credentials, and their claimed expertise usually is solely experiential (George, 2013).
They often do not have any occupational history that informs client relationships (Murphy
and Kreiner, 2020). Despite this lack of training, strong claims of expertise
26
and
guarantees of a cure
27
are common among Reboot coaches. Coaches reassure clients that
they can cure a variety of concerns by remaining porn-abstinent.
28,29,30
Coaches have no
relevant education, training, licensing, or supervision requirements, offering no real legal
protections for clients who are harmed (Aboujaoude, 2020). Unlike licensed mental health
care professionals, a coach is under no legal obligation to protect the confidentiality of
their clients’disclosures (Anderson et al., 2012) and cannot discern when a mental health
care referral is needed (Anderson et al., 2012). Such pseudo-practitioners are known for
Figure 9. The more involved with NoFap online forums, the more symptoms of anxiety,
depression, and erectile dysfunction.
Prause and Binnie 21
pushing their clients into acts that are inappropriate (Giraldez Hayes, 2021). However,
even “certified sex addiction therapists”have no published efficacy for their claimed
treatments (Grubbs et al., 2020b). These licensed therapists vested in addiction models
may be unable or unwilling to direct clients away from iatrogenic addiction therapies
(Speers et al., 2022). The results in the current study cannot definitively apportion blame
to the pseudo-practitioners or the Reboot treatment modality: both appear faulty.
The data regarding suicidality are concerning given that Reboot treatments are mostly
administered by untrained coaches. Although even licensed professionals debate the best
course of action to reduce the risk of suicide (e.g., Rudd et al., 2006), Reboot coaches and
communities have neither the training nor authority to respond adequately to self-harm
reports. Narcissists are more likely to become suicidal when shamed (Gabbard, 2022).
Given that Reboot is a shame-based treatment, narcissists may be the participants
Figure 10. The more involved in NoFap online forums, the greater the belief in conspiracies.
22 Sexualities 0(0)
reporting feeling most suicidal in response to the Reboot treatment. They may be unable
to reconcile their self-concept as “king”and “soldier”with experiences described by
Reboot coaches as personal failures. As with any study, this study had limitations. The
sample suffers from the same problem of low ethnic and sexual orientation diversity as
studies of sexual compulsivity (Jennings et al., 2021). However, this might reflect the
nature of these particular men, many following a program with forums commonly as-
sailing LGBT persons. It may be that the low diversity actually is representative of men
who have heard of Reboot, who appear to seek reassurance that they are not gay from
viewing gay pornography or wish to avoid LGBT persons due to prejudice (Hartmann,
2020). Treatment programs for sex and pornography “addiction”also are well-known to
primarily include white clients (Ley et al., 2014).
Several of the measures, while peer-reviewed and well-characterized psychometrically,
were very brief. For example, a single-item measure of narcissism was used. Some scientists
have suggested that narcissism has multiple, differentiable components, such as grandiose or
vulnerable narcissism (e.g., Foster et al., 2015). The single item used in this study does have
predictive validity thought to reflect both grandiose and vulnerable narcissism (Konrath et al.,
2014). Future research may explore whether current findings with brief scales can be
replicated with longer measures, or may be specific to facets of the constructs studied.
Harmful therapies are well-documented in clinical science (Lilienfeld, 2007;Williams
et al., 2021). They can slip through unnoticed for years because therapists often struggle to
catch when their clients are deteriorating (Hatfield et al., 2010) and do not use instruments
designed to monitor for client harms (Gilbody et al., 2001). Reboot treatments are most
similar to iatrogenic, anti-LGBT conversion therapies. These also shame sexual behaviors
and promote suicidal ideation (Glassgold, 2022). Additional research into Reboot/NoFap
treatment efficacy appears unwarranted, as it is unethical to expose participants to iat-
rogenic treatments. Therapists who refer clients to Reboots/NoFap will most likely harm
their clients. Given decades of research on pornography concerns without evidence-based
treatment literature (Grubbs et al., 2020b), scientists also should not waste further time
and resources testing harmful Reboot abstinence treatments.
Declaration of conflicting interests
The author(s) declared the following potential conflicts of interest with respect to the research,
authorship, and/or publication of this article: NP receives fees to provide continuing education
workshops for mental health professionals concerning sex therapy. NP received death threats on
Reboot platforms. JB has no conflicts of interests to declare.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this
article.
ORCID iD
Nicole Prause https://orcid.org/0000-0002-1420-9177
Prause and Binnie 23
Notes
1. “He found NoFap and was able to make a full recovery”(Church, 2015).
2. “Treatment for porn [addiction] and the related side effects is simple and involves removing just
one variable from your life, using porn”(Rhodes, 2017).
3. “There’s probably maybe anywhere from 10 to 50 pornographic things posted on NoFap every
day”attributed to a conspiracy of a single scientist “just trolling everywhere, just posting
millions of different aliases every day”(Rhodes, in Church, 2015).
4. “The 12 weeks mark in my reboot, I was terrified, had suicidal ideation, um, just depressed,
anxious, and horrified”(The Reboot Nation, 2021b).
5. “Cut porn out of your life that’s going to make life worth really living”(Queppet, in Church, 2015).
6. “I just typed in suicide. I got 26 pages of guys contemplating killing themselves”(Deem, 2017).
7. “I get super depressed when I go on the forums”(Deem, 2020a).
8. “If you’re going through hell, keep going”(The Reboot Nation, 2021a).
9. “This biological warfare we’re in is hard and there are casualties. As long as you have living
breath to fight in you, you are a hero”(Olsen and [Not given], 2021).
10. “I relapsed after 8 days. I knew it was inevitable but I never thought I was going to nut 8 days
into my streak. I have never felt so regretful. I really hate the porn industry. Who’s fucking idea
was it. To make people like us suffer. I ever meet a nsfw artist or a pornographer i will make sure
to bash their skull in to wall and make sure they stay dead. I wouldn’t mind getting caught by the
authorities. I will make sure that no one will suffer the same pain I am going through, nutting to
frickin pixels on a damn screen. The toughest part of failing a streak is getting back from the
filth of the mud and starting over again. But I am going to do that. I will not let myself be pushed
around by fools. I hope that one day I meet a nsfw artist so that dirty my hands with scummy
blood and paint the walls of their apartment with. Thank you for reading this all.”(No_Tap_,
2021).
11. “I would also recommend taking down MindGeek founder Fabian Thylmann last I heard he
owns both pornhub and xvideo to be honest I have never killed someone but I would end that
guy for humanity for justice!”(CleetusJoe, 2019).
12. “Also bro... cmon how much we have been pussyfied that we see a lil rape and “ooh im
traumatized i im damaged”.... not saying anything against the boy, but since when did we
became so weak ??? Just a couple of years there were wars and people were seeing such a shit
and not complaned, now u see ooh he punched him, ooh he raped her a lil bit, that traumatized
me, i need a therapy... xDDD Peoplein the medieval have been trought such shit daily and didnt
need anti-depresants or other shit, cuz ‘life is too hard’its just redicilous, masculinity and
strenght have diminished those days.”(TheBibleIsTheTruth, 2022).
13. “I blame women for everything. Keep in mind your kind is mainly responsible for over-
population and mental problems faced by most males due to ‘your’inability to raise children.
truth of the matter is every woman should be killed 3–4 years after childbirth, for sake of human
race”(mi9Celibacy, 2016).
14. “propaganda mouthpieces”for pornography companies (Deem and Van Maren, 2021).
15. A scientist who speaks to the media about pornography effects “pretty much is the arch enemy
of all of us”(Rhodes, in Church, 2015).
16. “showing experts”how wrong the experts were (Wilson et al., 2010,inHelfer, 2016)
24 Sexualities 0(0)
17. “Free porn is a business. It helps to sell pills to fix your limp dick.”(Deem, 2020b).
18. The results of this test were reported in a separate, published paper (Prause and Binnie, 2022).
19. Only n= 56 (9.5%) of the sample reported visiting a professional, leaving this test under-
powered. It was excluded from further reporting.
20. “Some political and social events are debated (e.g., 09/11 attacks, the death of Lady Diana, the
assassination of John F. Kennedy). It is suggested that the “official version”of these events
could be an attempt to hide the truth to the public. This “official version”could mask the fact
that these events have been planned and secretly prepared by a covert alliance of powerful
individuals or organizations (e.g., secret services or government). What do you think? Please
indicate to what extent the sentence below represents how you think about this: I think that the
official version of the events given by the authorities very often hides the truth.”
21. Participants could not select more than “over 90 days,”which 63 participants chose.
22. Our planned analysis was consistent (t(232) = 8.0, p< 0.001).
23. We also conducted this analysis including the option “Was involved at some level in the past,
but have not been involved for several months”as the most involved option. The pattern of
result was the same (rho = 0.16, p= 0.01).
24. We also conducted this analysis including the option “Was involved at some level in the past,
but have not been involved for several months”as the most involved option. The pattern of
result was the same (r
boot
= 0.31, p< 0.001).
25. When straightlining was removed, the MANOVA remained significant (F(1,173) = 1.9, p=
0.046). Follow-up one-way ANOVA’s identified “told to harm or kill myself”was observed
more often the more someone visited the NoFap forums (F(1,173) = 5.9, p= 0.02).
26. “Yes, I am an expert on quitting porn”(Rhodes, 2018).
27. “Everyone that’s been successful in staying away from porn has seen improvement and ul-
timately recovered”(Deem, 2020c).
28. “guys recover from sexual dysfunction simply by removing the single variable of Internet porn”
(Deem and Van Maren, 2021).
29. “...what changing one single variable can do”(Wilson et al., 2010,inHelfer, 2016).
30. “...truly commit to never viewing porn again”(Church, 2014).
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Nicole Prause, PhD completed this work as a Biostatistician II at Children’s Hospital, Los
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Department of Medicine. Dr. Prause also is a licensed psychologist in California
(#27778). Her research includes the neuroscientific study of sexuality, orgasm physiology,
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James Binnie, MSc, is a senior lecturer in counselling psychology at London South Bank
University and a senior therapist in private practice. His teaching and research both focus
upon psychotherapy and mental health.
Prause and Binnie 33
