Rewarding News

No. 18 Summer 2023

Hello, everyone, welcome to the summer 2023 edition of Rewarding News.

We have a big announcement to make: The Reward Foundation has partnered with the Royal College of General Practitioners to produce the world’s first ever, professional online course on sexual dysfunctions and pornography. It’s now available. See below for more details.

Our spotlight on research brings a review of research from 42 countries about compulsive sexual behaviour disorder along with a paper providing a clearer understanding of sexual addiction.

To keep our knowledge fresh, the TRF team are off to Incheon in South Korea in August to participate in the International Conference on Behavioural Addictions.

As part of our dedication to keeping you informed, we recommend a brilliant set of free podcasts by a gifted teacher and neuroscientist, Dr Andrew Huberman from Stanford University Medical School.

Enjoy the sunshine and if you have the chance, connect more often with real people in real life.

Warmest wishes,

Mary Sharpe, CEO

Sexual Dysfunctions & Pornography

Reward Foundation Logo RCGP

This RCGP-accredited online course for healthcare and other professionals is the world’s first ever one for healthcare and other professionals on sexual dysfunctions and pornography. There are 8 interactive modules.

It was developed by the TRF team during the CEO’s time as a visiting scholar at the University of Cambridge. We use the term “dysfunction” in a broad sense. The course is evidence-based and does not show pornography.

Meet the experts
Reward Foundation experts

You will learn from experts in the field to give you confidence to ask appropriate questions and offer the latest treatment options to clients, patients or service users.

 What is in the course?

There are 8 interactive modules

  • The basics – pornography’s impact on the brain
  • Screening tools for compulsive sexual behaviour disorder and sexual dysfunctions
  • Sexual dysfunctions in men who are pornography users
  • Sexual dysfunctions in women who are pornography users
  • Pornography use in stable couples
  • Pornography and intimate partner violence
  • Pornography and adolescents
  • Treatment options

Learn more about the course here.

Introductory price:  £120.00. Sign up here. Please spread the word.

Spotlight on research

Research yes okay

In this edition of Rewarding News, we introduce two major pieces of research. The first one is a milestone, reporting on the project to take the science of CSBD global.  It had contributions from 71 different authors. The second sees Professor Fred Toates from the Open University demonstrating the reality of sex addiction.

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools


Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice.


Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD.


A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability.

Discussion and Conclusions

This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Citation: Bőthe, B., Koós, M., Nagy, L., Kraus, S.W., Demetrovics, Z., Potenza, M.N., Michaud, A., Ballester-Arnal, R., Batthyány, D., Bergeron, S. and Billieux, J., 2023. Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools. Journal of Behavioral Addictions.

Professor Fred Toates

Read this important paper by Professor Fred Toates, “A motivation model of sex addiction”:

Highlight: “Scrutiny of the criticisms of the notion of sex as addiction reveals them to be invalid.”


An integrative model of sexual addiction is presented, involving a combination of models based upon (i) incentive motivation theory and (ii) the dual organisation of the control of behavior. The model is related to ongoing arguments about the validity of the notion of addiction when applied to sexual behavior. It is suggested that the evidence strongly favors the viability of an addiction model of sex.

Strong similarities to the classical addiction to hard drugs are observed and features can be better understood with the help of the model. These include tolerance, escalation and withdrawal symptoms. It is argued that other candidates for accounting for the phenomena, such as obsessive-compulsive behavior, faulty impulse control, high drive and hypersexuality do not fit the evidence. The role of dopamine is central to the model. The model’s relevance to stress, abuse, development, psychopathy, fantasy, sex differences, evolutionary psychology and the interaction with drug-taking is shown.

Citation: Toates, F., 2022. A motivation model of sex addiction–Relevance to the controversy over the concept. Neuroscience & Biobehavioral Reviews, p.104872.

TRF to speak in South Korea at 2023 ICBA conference

Songdo Convensia South Korea

In August 2023 TRF will present at the 8th International Conference on Behavioral Addictions at Incheon, South Korea.  Our CEO, Mary Sharpe, and Chair, Dr. Darryl Mead, will offer two joint papers.

First: The global health implications of compulsive sexual behaviour disorder

This paper will help initiate a conversation linking the large and increasing number of people consuming internet pornography with its potential implications for healthcare in future decades.

Second: Raising awareness of behavioural addictions among professionals: a non-profit case study

Here we will discuss the approaches taken by education charity, The Reward Foundation, in the last nine years to help healthcare, legal, education and other professionals understand why learning about behavioural addictions can have a valuable role in their work.

Copies of our presentations should appear on The Reward Foundation website in early September.

Recommended Health Podcast for 2023

Andrew Huberman Lab

We strongly recommend the podcasts put out by Stanford University’s friendly and highly watchable neuroscientist, Dr Andrew Huberman. They are called Huberman lab podcasts and are available free on YouTube and at The talks are suitable for the lay person with little knowledge about science. They use experts to cover how the brain works in regard to motivating behaviour and addiction. They are also worthwhile for those with more in depth knowledge. Relevant research is provided for every episode.

The most recent one, Dr. Robert Malenka: How Your Reward Circuits Drive Your Choices covers our central area of interest, the reward system, along with another emerging area of study, autism spectrum disorders. We set up The Reward Foundation to help people understand how the reward circuits drive our behaviour. In other editions Dr Huberman has also covered pornography. How Porn Addiction Destroys Men’s Brains and romantic relationships in The Science of Love, Desire, and Attachment.

Please follow us on Twitter for regular updates throughout 2023.