Compulsive Sexual Behaviour and the CBT Approach

This chapter introduces a cognitive behavioural therapy (CBT) framework for understanding and addressing compulsive sexual behaviour (CSB), merging theoretical background with practical clinical techniques. Tracing the evolution of CBT through behavioural, cognitive, and third-wave approaches, the chapter illustrates how therapists can adapt core principles to meet the complex needs of individuals with CSB. Key components include collaborative case formulation, functional analysis, and assessment methods that examine early experiences, core beliefs, emotional regulation, and metacognitive processes. The chapter presents a range of intervention strategies, such as cognitive restructuring, behavioural experiments, urge management, psychoeducation, and self-compassion exercises, aimed at addressing the sustaining factors of CSB, including shame, avoidance, and negative self-schema. Emphasis is placed on normalising sexual diversity, investigating clients’ erotic templates, and aligning behaviour with personal values. A composite case example demonstrates how CBT can be tailored to the client’s goals, identity, and broader socio-cultural context. Instead of framing CSB as a pathology, the chapter advocates for an integrative, formulation-driven approach that emphasises psychological flexibility, emotional resilience, and relational authenticity.