ORIGINAL RESEARCH
published: 05 July 2021
doi: 10.3389/fpsyg.2021.673023
The Impact of Negative Mood on
Event-Related Potentials When
Viewing Pornographic Pictures
Charlotte Markert 1,2,3, Andreas M. Baranowski 1,2,3, Simon Koch 1,2, Rudolf Stark 1,2,3 and
Jana Strahler 1,2,3*
1 Department of Psychotherapy and Systems Neuroscience, Psychology and Sport Science, University of Giessen, Giessen,
Germany, 2 Bender Institute of Neuroimaging, University of Giessen, Giessen, Germany, 3 Center for Mind, Brain and
Behavior, Universities of Marburg and Giessen, Giessen, Germany
Background: Negative affective states may increase the risk for problematic
pornography use. Underlying neurophysiological mechanisms are, however, not
completely understood. Previous research suggests that the participants’ emotional state
may affect neural processing of sexual stimuli. The aim of this study was to investigate
neural correlates of negative affect-induced alterations in sexual cue reactivity in healthy
men. The moderating effects of habitual porn consumption, trait sexual motivation, and
symptoms of cybersex addiction were also considered.
Method: Sixty-four healthy men engaged in a sexual cue reactivity task (passive viewing
Edited by: of explicit sexual pictures and neutral pictures depicting scenes of social interaction)
Tillmann H. C. Kruger, during negative (n = 32) vs. neutral affect (n = 32), induced via tailored feedback
Hannover Medical School, Germany
on a performance task. Self-reported sexual arousal and event-related brain potentials
Reviewed by:
Robertas Damasevicius, indicated cue reactivity and motivated attention. Symptoms of cybersex addiction and
Silesian University of trait sexual motivation were assessed with the help of the short Internet Addiction Test,
Technology, Poland
adapted to online sexual activities, and the Trait Sexual Motivation Questionnaire.
Jannis Engel,
Hannover Medical School, Germany Results: Negative feedback increased negative affect after the performance task. While
*Correspondence: sexual pictures compared to neutral pictures elicited significantly larger P300 and late
Jana Strahler
jana.strahler@gmail.com positive potential (LPP) amplitudes, there was no general effect of negative feedback
on sexual stimuli-related P300 and LPP amplitudes. In the negative feedback group,
Specialty section: men with higher solitary sexual motivation levels showed higher P300/LPP difference
This article was submitted to
amplitudes for sexual stimuli compared to men with lower levels of solitary sexual
Human-Media Interaction,
a section of the journal motivation. The opposite effect was found in the group with neutral feedback. There was
Frontiers in Psychology no link to other aspects of trait sexual motivation and symptoms of cybersex addiction.
Received: 26 February 2021
Accepted: 02 June 2021 Conclusions: Results suggest that higher levels of solitary sexual motivation may
Published: 05 July 2021 enhance motivated attention toward sexual stimuli among men receiving negative
Citation: performance feedback. Other characteristics of sexual behaviors and traits provided no
Markert C, Baranowski AM, Koch S,
exploratory value. Future studies extending onto men suffering from compulsive sexual
Stark R and Strahler J (2021) The
Impact of Negative Mood on behavior disorder will have to closer look at the neurophysiological bases of why and
Event-Related Potentials When when some men develop an addictive pornography consumption.
Viewing Pornographic Pictures.
Front. Psychol. 12:673023. Keywords: event-related potentials, motivated attention, negative affect, pornography addiction, pornography
doi: 10.3389/fpsyg.2021.673023 use, sexual cue reactivity
Frontiers in Psychology | www.frontiersin.org 1 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
INTRODUCTION Different models have been proposed to better understand
mechanisms underlying addictive pornography use, including
Digitalization has an impact on a wide range of areas models of motivation, emotion regulation, stage models, and
of life, including sexual behaviors. Through mobile devices integrated models. Reid et al. (2011) outline typical motives for
such as tablets or smartphones it is possible to consume pornography use, that is emotional avoidance, sexual curiosity,
pornography almost anytime and everywhere. Cooper (1998) excitement seeking and sexual pleasure. In their sample of
described the three key characteristics of the Internet (“Triple- treatment-seeking hypersexual men, emotional avoidance, that
A Engine”: access, affordability, and anonymity), which increase is to use pornography to avoid unpleasant feelings and relieve
the attraction and usage of internet pornography. Today, men stress, correlated positively with trait measures for emotional
between the ages of 35–50 are the largest consumer group (Blais- distress, anxiety, depression, and impulsiveness. This association
Lecours et al., 2016; Rissel et al., 2017), but regular usage is also has since been confirmed by other survey studies in non-
seen among other groups including women (Baranowski et al., treatment seeking young adults and men with hypersexual
2019; Herbenick et al., 2020), younger adults and adolescents disorder (Engel et al., 2019b; Pettorruso et al., 2020). In
from various socio-economic backgrounds (Mattebo et al., 2013, a longitudinal study with adolescents, higher baseline levels
2016; Bothe et al., 2020b). This previous research is not free for negative emotions and impulsivity predicted addictive
from methodological shortcomings such as small and biased pornography use 3 years later (Rousseau et al., 2020). Another
samples or questionable validity of assessment measures. Still, study investigated changes of mood and sexual arousal before
the increase of pornography consumption, particularly among and after self-determined internet pornography use in a non-
younger people (Price et al., 2016), goes along with rising clinical male sample (Laier and Brand, 2017). The results showed
numbers of individuals who report a problematic or an addictive usage-related mood and arousal changes suggesting reinforcing
use with psychopathological consequences (Duffy et al., 2016). effects of pornography use. Additionally, participants with a
This calls for increased efforts to better understand the transition stronger tendency toward cybersex addiction reported a generally
from a recreational to a pathological use, and to provide worse mood, but greater mood increases were positively linked
improved preventive and therapeutic interventions. to the degree of addictive pornography use (Laier and Brand,
Several reviews have shown that, among healthy and clinical 2017). Overall, data support theories which suggest emotional
samples, visual sexual stimuli are perceived as highly rewarding instability, impaired stress regulation and impulse control as a
(Gola et al., 2016b) and that brain areas associated with reward prominent pattern in hypersexual individuals (Reid et al., 2014).
learning respond to sexual stimuli in a similar manner as they The Interaction of Person-Affect-Cognition-Execution (I-
respond to other biologically relevant stimuli (Georgiadis and PACE) model of specific internet-use disorders (Brand et al.,
Kringelbach, 2012; Stoléru et al., 2012; Poeppl et al., 2014; Strahler 2016, 2019) distinguishes between earlier and later phases
et al., 2018). While recreational pornography use focusses on of addiction development with emotion regulation playing a
experiencing satisfaction (Ross et al., 2012; Gola et al., 2016a; pivotal role in all of them. In earlier phases, pornography
Wordecha et al., 2018), some people develop a shift toward use contributes to gratification (e.g., in the form of pleasure).
over-frequent, uncontrolled use, which persists even though Based on this experience, pornography use may be increasingly
it causes disadvantages in interpersonal relationships or for used for emotion regulation and thus becomes a reinforcing or
work or leisure activities. If this reaches a clinically relevant perpetuating mechanism of pornography use (Laier and Brand,
level, Compulsive Sexual Behavior Disorder (CSBD) can be 2017). Through repeated and possibly increased pornography
diagnosed according to the new classification in ICD-11 (World use, conditioning processes strengthen associations between
Health Organization, 2018). Main characteristic of CSBD is the external triggers and affective/cognitive responses which may
persistent inability to control intense, repetitive sexual impulses lead to compensatory pornography use in response to negative
or urges resulting in recurring sexual behavior. This pattern affect and craving in later stages of addiction development.
negatively affects personal, familial, social, educational and/or Different models of addiction development [see also A-
occupational areas of functioning. Indeed, the vast majority B-C model of hypersexual disorder from Stein (2008), or
of consumers show a purely recreational use and problematic the Brain Disease Model of Addiction from Volkow et al.
symptoms are exhibited in only a small minority. Most studies (2016)] emphasize and specify the role of neural substrates
show a male preponderance regarding prevalence rates for for emotion regulation and adaptation to negative affect
CSBD with a sex ratio of ∼1:4 (prevalence in women: 1–3%; and stress in the development of addiction. Research on
prevalence in men: 4–11%; Rissel et al., 2017; Grubbs et al., neurobiological and neural underpinnings of (addictive)
2019; Bothe et al., 2020a; Kowalewska et al., 2020). Studies pornography use is, however, still rare. Initial neurobiological
show that addictive internet pornography use (for which there studies in individuals with addictive sexual behaviors suggest
are numerous other terms, e.g., excessive pornography use, hypothalamic pituitary adrenal (HPA) axis dysregulation
pornography addiction, pathological pornography use, etc.) is (Chatzittofis et al., 2016), oxytocin signaling (Boström et al.,
reported as the most frequent manifestation of CSBD (Reid 2020), and heightened neuroinflammation (Jokinen et al., 2017)
et al., 2012; Engel et al., 2019a; Bothe et al., 2020a). In the as possible pathophysiological mechanisms. In terms of neural
present work, the term “addictive internet pornography use” correlates, studies focused on the activity in brain regions located
is therefore used, except when similar but different constructs in the reward network and the limbic system. Such studies
are addressed. revealed similar activation patterns for sexual stimuli as for
Frontiers in Psychology | www.frontiersin.org 2 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
other drug stimuli (Love et al., 2015; Gola et al., 2016b; Kühn As described above, prolonged pornography use in healthy men
and Gallinat, 2016). Longer hours of internet pornography is associated with lower activity in response to pornographic
use correlated with lower gray matter volume in the right pictures in the left putamen (Kühn and Gallinat, 2014). Whether
caudate nucleus and lower activity to sexual images in the left something similar is also seen in CSBD individuals still remains
putamen in healthy men (Kühn and Gallinat, 2014). According to be investigated. Concerning sexual motivation, the findings
to the authors, these findings may indicate a tolerance that has are heterogeneous. In an all-female healthy sample, Demos et al.
developed due to desensitization. Even fewer studies compared (2012) showed a positive association between higher sexual
individuals with and without addictive pornography use. Voon motivation and greater sexual cue reactivity in the brain’s reward
et al. (2014) showed higher anterior cingulate cortex (ACC), networks. By contrast, the P300 was inversely related to sexual
ventral striatal, and amygdala activity as well as higher functional motivation in individuals with addictive pornography use (Steele
connectivity of the ACC–striatal–amygdala network during et al., 2013). However, the authors did not examine sexual
watching of sexually explicit cues in hypersexual individuals. motivation as a trait but as a current state. In a previous
Subjective sexual arousal ratings of pornographic pictures study in healthy men and women, our group demonstrated
(Brand et al., 2011) as well as the ventral striatal response to that trait sexual motivation correlated with nucleus caudatus
preferred pornographic pictures were predicted by symptoms of activity (but no other ROI) when watching pornographic pictures
cybersex addiction as measured by the short Internet Addiction (Strahler et al., 2018). But there were no significant associations
Test Adapted to Online Sexual Activities (s-IATsex). A study between trait sexual motivation, the extent of porn use and
by Klucken et al. (2016) found increased amygdala activity neural responses of the nucleus accumbens toward pornographic
during appetitive conditioning with sexual stimuli in men pictures in healthy men (Stark et al., 2019).
with compulsive sexual behavior vs. healthy controls. This To summarize, studies implicate considerably similar
may be indicative of emotional dysregulation in individuals brain regions involved in addictive pornography use that
with addictive pornography use. In comparison, the results of is reward-associated brain regions like the striatum and
a study by Gola et al. (2017) indicate that the anticipation of nucleus accumbens, but also the amygdala, hippocampus,
pornographic pictures is associated with stronger activation of and hypothalamus. Whether there is also a critical role for
the ventral striatum in persons with addictive pornography use, the temporal dynamics underlying salience formation and
but not the response to the pornographic pictures themselves. attention allocation to sexual stimuli remains unclear. Evidence
In addition to fMRI results, electroencephalography (EEG) of emotion regulatory use of pornography playing a role in
studies confirm the arousing and motivationally salience addiction development implies that a negative affective state may
nature of pornographic pictures. Presentation of those pictures cater into the salience of and attention directed at pornographic
compared to neutral pictures lead to heightened positive material. Yet, negative mood related alterations in sexual cue
EEG components known to reflect stimulus salience and reactivity as indicated by electrocortical potentials have not
attentive processing, namely the P300 and the Late Positive been studied. The purpose of the current study was therefore
Potential (LPP) in both healthy individuals and individuals to investigate the neural correlates of negative affect-induced
self-identifying as having problems with regulating their sexual alterations in sexual cue reactivity in healthy heterosexual men
stimuli consumption (van Lankveld and Smulders, 2008; Steele via recording electro-cortical brain response during watching
et al., 2013; Prause et al., 2015a). While the P300 appears 300– pornographic pictures. We hypothesized that negative affect will
500ms post stimulus and is partly generated in the ACC, thus induce higher motivational attention, operationalized through
best measurable at centroparietal recording sites, the LPP extends the EEG parameters LPP and P300. Our second aim was to
beyond this and reflects sustained increases in attention (Hajcak examine the moderating effects of habitual porn use, trait
et al., 2010). The LPP can best be localized at central, parietal, sexual motivation, and symptoms of cybersex addiction. Our
and occipital sites (Foti et al., 2009). Enhanced P300 and LPP hypothesis was that these moderators influence cue reactivity to
elicited by addictive cues are well-replicated in other substance- pornographic pictures under negative affect. This may provide
related and behavioral addictions (Dunning et al., 2011; Wölfling further evidence for the relevance of affect regulation in the
et al., 2011). Such a hypersensitivity to pornographic pictures development and maintenance of addictive porn use and CSBD.
has been proposed to underlie addictive pornography use (Voon
et al., 2014; Brand et al., 2019). The only two studies using EEG to MATERIALS AND METHODS
investigate individuals with self-reported addictive pornography
use, could however not find support for this assumption. In Participants
one study, addictive pornography use was unrelated to the Healthy male adults were recruited for this EEG study via
P300 (Steele et al., 2013). Another study of the same research university e-mail newsletters, social media advertisement, and
group found lower LPP amplitudes after passively watching by directly addressing pedestrians on the university campus.
pornographic pictures in individuals with addictive pornography The study was publicly labeled as study on “General cognitive
use compared to healthy controls (Prause et al., 2015b). ability and processing of sexual images.” Affect manipulation
In the search for possible psychological correlates of sexual was not mentioned to the applicants. The true aims of the study
cue reactivity and risk factors of addictive pornography use, were explained after completion of all experimental procedures.
symptoms of cybersex addiction, habitual porn use and trait Eligibility criteria were proficiency in the German language
sexual motivation appear most relevant given available literature. to ensure comprehension of instructions and questionnaires,
Frontiers in Psychology | www.frontiersin.org 3 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
male gender, absence of acute or anamnestic psychological, they were asked whether they questioned their test result during
neurological, or somatic disorders and medication, right- the examination and believed the cover story for the study
handedness, body-mass-index between 18 and 35 kg/m², age (yes/no). A schematic depiction of the experimental protocol is
between 18 and 45 years to minimize the impact of age-related shown in Figure 1.
changes in EEG (Hashemi et al., 2016), sexual attraction to
females, and no daily alcohol consumption or illegal substance Affect Manipulation
use within the last 6 months. Further, volunteers who underwent Participants completed three subtests of a German diagnostic
diagnostic assessment of their general cognitive ability in the past tool for assessing general cognitive ability (Leistungsprüfsystem
were excluded to ensure effectiveness of the affect manipulation 2, LPS-2; Kreuzpointner et al., 2013). To mime an authentic
using tailored feedback on a test for general cognitive ability. execution, the LPS-2 subtests were conducted as instructed by
Usual EEG contraindications applied (being unable to sit still the test manual. Completion of the subtests took 13min in total.
for a long time, wearing a pacemaker, hearing aids, suffering Participants’ performance, however, was not evaluated in real
from claustrophobia, bald head or rasta curls). Initially, 72 terms. After a latency of 2min, the participants were handed
men (mean age 24.81 years) were recruited into this trial a predefined standardized feedback sheet. In the negative affect
and completed all study procedures. Due to poor EEG data condition, participants received negative feedback, that is they
quality, n = 8 data sets (n = 4 negative affect condition, n received a feedback sheet indicating they had scored 2.9 out of
= 4 control condition) had to be excluded resulting in a final 10.0 points coupled with the verbal statement that the result was
sample of 64 (mean age 24.94 years). Excluded participants below average. Participants in the neutral feedback group (neutral
did not differ significantly in age, body-mass-index, relationship condition) received a feedback sheet indicating 6.8 out of 10.0
status or any of the analyzed moderators from the remaining points coupled with the verbal statement that their result was
sample (all p > .05, using Mann-Whitney-U test and χ2-test, slightly above average.
respectively). Participation was voluntary and all participants
provided written informed consent. Data was collected in Sexual Cue Reactivity Paradigm
pseudonymized form with individual code words. Participants Thirty neutral and thirty pornographic pictures were presented
were compensated with either 8.00e per hour or course credits. in a passive viewing paradigm programmed with Presentation
All experimental procedures were conducted in compliance with Version 20.0 (Neurobehavioral System Inc., Albany, CA, USA).
national legislation and the Declaration of Helsinki and approved All pictures were 31 cm wide, presented in color on a black
by the local ethics committee (reference number: 2019-0005). background on a 27-inch monitor with 1,920 × 1,080 pixel
resolution. All stimuli were derived from Kagerer et al. (2014).
Procedures and Design Pornographic pictures showed one male and one female adult
Interested men were first contacted via phone for the screening engaging in partnered sexual behavior, that is oral, vaginal, or
of eligibility criteria. Eligible men were invited for individual anal intercourse. No fetish-relevant content was depicted. In
laboratory assessment and asked to avoid use of hair spray/hair half of the pornographic pictures genitalia were clearly visible
gel on the date of the assessment. Study procedures took ∼2 h whereas in the other half genitalia were masked by bodies
and were conducted by two male experimenters in a quiet or objects. Female breasts were visible in all sexual pictures.
windowless room. Participants were randomly assigned into two Neutral pictures showed two or more fully clothed adult(s) in
equal-sized groups with one group undergoing negative affect an everyday situation (e.g., engaging in conversation). Pictures
induction and the other one remaining in neutral mood. Affect were presented in three blocks. Each block contained all pictures
manipulation was conducted with tailored feedback on a test in randomized order with the restriction that the same stimulus
for general cognitive ability. Except for the differently tailored category could be presented a maximum of three times in
feedback, procedures were the same for both groups. Participants succession. Therefore, each picture was presented three times
were neither aware which group they were assorted to nor that for 1,000ms, resulting in 180 stimulus presentations in total.
the cognitive test targeted at affect manipulation. Pictures were intercepted with a jittered presentation of a
After giving informed consent, momentary affect as well white fixation cross on black background between 2,000 and
as craving for pornography and masturbation was assessed 3,000ms. In total, the paradigm lasted between 9 and 12min, on
as a baseline. Participants were prepared for EEG recording. average 10min and 30 s.
Hereafter, affect manipulation was conducted by means of a
negative feedback paradigm as described below. Subsequently, EEG Recording and Event Related
momentary affect and craving were assessed a second time. Potential Data Reduction
Participants, then, viewed the sexual cue reactivity paradigm Participants’ electrocortical activity was continuously recorded
while EEG was continuously recorded. Followingly, the EEG with an active 32-channel amplifier (BrainVision actiChamp,
cap was removed and after that, momentary affect and craving Brain Products GmbH, Gilching, Germany) and 32 Ag/AgCl
were assessed a third time, stimuli were rated, and several electrodes (EASYCAP GmbH, Herrsching, Germany). For
questionnaires were answered by the participants. Finally, attachment of electrodes participants wore an EEG cap
participants were compensated for participation, they were (EASYCAP GmbH, Herrsching, Germany) which assured
clarified about the tailored feedback and that their general location of the electrodes in accordance with the international
cognitive ability has not been evaluated for real. In this context, 10–20 system (Klem et al., 1999). Electrodes were attached to
Frontiers in Psychology | www.frontiersin.org 4 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
FIGURE 1 | Depiction of the experimental protocol.
the participants’ scalp with an electrolyte paste. Impedances ERP components are measurable best at centroparietal recording
of all electrodes were kept below 10 k. Electrode signal sites (Hajcak et al., 2010).
was recorded via BrainVision Recorder software (Brain
Products GmbH, Gilching, Germany). Sampling rate was Self-Report Measures
500Hz, no software filters were applied during recording. Momentary Affect
Ground electrode was Fpz and electrodes were referenced Momentary affect was assessed with sum scores of the Positive
at Cz. Line noise was kept at minimum by instructing and Negative Affect Schedule (Watson et al., 1988) prior to
participants to remain calm and relaxed during the paradigm, EEG cap placement, following tailored feedback, and following
and to let their gaze rest on the fixation cross between the the sexual cue reactivity paradigm. The two PANAS subscales,
image presentations. namely positive affect and negative affect, consist of ten items
Data were processed using BrainVision Analyzer 2.2 software each. The 20 items (negative e.g.,: upset, guilty, distressed,
(Brain Products GmbH, Herrsching, Germany). First, a high- positive e.g.,: excited, inspired, proud) were each rated on a 5-
pass filter of 0.001Hz and a low-pass filter of 30Hz were point scale ranging from 1 = “very slightly or not at all” to 5
applied. Data were then corrected for ocular artifacts caused by = “very much.” Internal consistency of the positive affect scale
eye blinks or saccades by computing Independent Component was acceptable to satisfying throughout assessment (baseline:
Analysis (ICA) and exclusion of components reflective of Cronbach’s α = .771; after affect manipulation: α = 0.814; after
ocular artifacts. Following reverse ICA, data were visually the sexual cur reactivity paradigm: α = 0.857) and internal
inspected for remaining artifacts caused by body movements consistency of the negative affect scale was acceptable to satisfying
and corresponding epochs were excluded. EEG channels were throughout assessment as well (baseline: Cronbach’s α = .735,
then re-referenced to linked mastoid activity (TP9, TP10). Data after affect manipulation: α= 0.870, after the sexual cur reactivity
were segmented, i.e., stimulus-locked from−500 to 2,499ms post paradigm: α = 0.835, respectively).
stimulus. Segments were baseline corrected from −500 to 0ms
(stimulus onset) and then averaged for the two image categories Craving
separately. On average, 85.43 (SD= 6.23) out of 90 segments were Participants’ momentary craving for pornography and
used to compute individual ERP. Taking into consideration that masturbation was assessed by one question each (“To
P300 and LPP temporal windows do partially overlap (Hajcak what extent do you currently feel the need to consume
et al., 2010), P300 was defined as mean ERP amplitude from 300 pornography/masturbate?”) added to the paper-pencil version of
to 500ms and LPP as mean ERP amplitude from 500 to 800ms the PANAS. The two questions were answered using the same
post-stimulus onset. Defined intervals are in line with studies five-point scale ranging from 1 = “very slightly or not at all” to
examining both ERP components following visual sexual stimuli 5= “very much.”
(van Lankveld and Smulders, 2008; Han et al., 2018). Mean ERP
amplitudes in the respective temporal windows were averaged Stimuli Ratings
across electrodes CP1, CP2, P3, Pz, P4. Electrode selection was Following the sexual cue reactivity paradigm, participants rated
based on visual inspection and is in line with findings, that both all pictures on 9-point Likert scales regarding valence (very
Frontiers in Psychology | www.frontiersin.org 5 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
unpleasant to very pleasant), arousal (calm and relaxed to very heterosexual orientation [Kinsey score 0: n = 52 (81.3%); Kinsey
excited), and sexual arousal (not at all to very much). Pictures score 1: n= 9 (14.1%); Kinsey score 2: n= 2 (3.1%), Kinsey score
were rated in randomized order across participants. Participants 3: n = 1 (1.6%)]. Exclusion of the man indicating heterosexual
viewed the pictures one by one again for a maximum of 10 s each, and homosexual behaviors of about the same frequency (Kinsey
which were then succeeded by the three rating scales. Valence and score 3; negative affect condition) did not change results. This
arousal scales were visually anchored with the Self Assessment data set was therefore retained in the final analyses.
Manikin Scale (Bradley and Lang, 1994). Rating of sexual arousal An accompanying questionnaire gathered data on age,
was visualized by blocks of increasing size. body mass index (BMI), partnership status, smoking (yes,
no), and alcohol consumption measured using the Alcohol
Trait Measures of Sexual Behaviors Use Disorders Identification Test (AUDIT, Babor et al., 2001;
Participants’ symptoms of cybersex addiction were assessed with Cronbach’s α = .68).
the short version of the Internet Addiction Test (Pawlikowski
et al., 2013) adapted to online sexual activities (s-IATsex; Laier Statistical Analyses
et al., 2013). Twelve items (e.g., “How often do you find that
Descriptive statistics are reported as mean and standard
you stay on sex sites on the internet longer than you intended?”)
deviation (SD) or numbers and frequency. Group comparisons of
were answered on a scale from 1 = “never” to 5 = “very often”
continuous data were performed with Student’s t-test, categorical
resulting in sum scores ranging from 12 to 60. Sum scores
variables were examined with the Fisher’s exact test. To test for
exceeding 30 are classified to be indicative of problematic sexual
differences in sexual cue reactivity, mixed-model ANOVAs were
internet use. Internal consistency was acceptable with Cronbach’s
performedwith the between-factor group (negative affect, neutral
α = .788. Trait sexual motivation was examined by means of
affect) and the within-factor picture category (pornographic,
the 45-item Trait SexualMotivationQuestionnaire (TSMQ, Stark
neutral). Separate models were run for each EEG component
et al., 2015). Out of 45 items in total only 35 items are analyzed
(P300, LPP) and stimulus rating (valence, arousal, sexual
to compute mean scores of trait sexual motivation. Participants
arousal). Effect sizes were reported as Cohen’s d, ϕ, and
were instructed to indicate to which extent each item described
η2p, respectively.their sexual motivation using a six-point Likert scale ranging
The moderating effects of habitual porn use, trait sexual
from 0 = “not at all” to 5 = “very much.” The analyzed items
motivation, and symptoms of cybersex addiction on neural
make up four subscales of trait sexual motivation, namely Solitary
responses toward pornographic pictures were exploratively
Sexuality (10 items, Cronbach’s α = .856), Importance of Sex
evaluated.We used three-stage hierarchical regressions to predict
(15 items, Cronbach’s α = .901), Seeking Sexual Encounters
neural responses toward pornographic pictures with group
(4 items, Cronbach’s α = .838), and Comparison with Others
included at step 1, the group mean-centered trait sexual behavior
(6 items, Cronbach’s α = .871). The scale Solitary Sexuality
factor (moderator) entered regression at step 2, and step 3
indicates interest in sexual activities independent of a sexual
included the group X group mean-centered moderator product
relationship. Most of this scale’s items relate to masturbation and
term. As criterion, we calculated the difference amplitudes
the interest to be sexually aroused by pornographic material.
between neural responses toward pornographic pictures minus
The scale Importance of Sex includes several items about the
neutral pictures. Plotting two-way interaction effects using the z-
need to be sexually active. The scale Seeking Sexual Encounters
standardized scores and procedures described by Dawson (2014)
includes items asking about behaviors with the intention to get
eased interpretation of the assumed moderation. The relation
in contact with new potential sex partners. The scale Comparison
between P300/LPP and trait sexual behavior factor was plotted for
with Others consists of items asking how an individual perceives
both conditions, neutral and negative feedback. All assumptions
their own sexual motivation compared to others’. Participants’
for regression analyses were met (linearity assumption; VIF
answers were averaged across corresponding items to indicate
< 2.39; Cook’s distance < 0.02; normally distributed residuals
an individual’s mean score on each subscale. Participants’ mean
as indicated from normal P-P-plots; homoscedasticity, i.e., no
scores on each subscale were then averaged again to compute
clear distribution pattern in scatterplot of residuals vs. predicted
an individual’s mean trait sexual motivation. Mean trait sexual
values). Each moderator was tested in a separate model. The level
motivation had excellent internal consistency with Cronbach’s
of significance was set at α = 0.05 for all testing. All statistical
α = .918. The single item “How much time did you spend
analyses were carried out using SPSS v.23 forMac (IBM Statistics,
viewing pornographic material within the last month” was used
IBM Corporation).
to assess habitual porn use (h/month). Participants were given
the option to indicate the time spent viewing pornography either
per day, per week, or per month. Answers were then transformed RESULTS
into hours per month (h/month) based on the definitions that
a month consists of 30 days, a week of 7 days, a day of 24 h Sample Description
and an hour of 60min. Sexual orientation of the participants The negative feedback group and the neutral feedback group
was assessed with the seven-item Kinsey scale (Kinsey et al., did not differ in age, BMI, partnership, smoking status, alcohol
1948) ranging from 0 = “exclusively heterosexual fantasies consumption or pornography use (Table 1). The neutral feedback
and behaviors” to 6 = “exclusively homosexual fantasies and group reported significantly higher scores on the subscale
behaviors.” All participants but one reported a predominantly Importance of Sex as well as the total score of the TSMQ, and
Frontiers in Psychology | www.frontiersin.org 6 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
TABLE 1 | Baseline characteristics of total sample and separately for both groups.
Total group (N = 64) Negative affect group (N = 32) Neutral affect group (N = 32)
Age (years), M ± SD 24.94 ± 4.92 24.97 ± 5.19 24.91 ± 4.73
BMI (kg/m2 ), M ± SD 23.60 ± 2.89 23.12 ± 2.70 24.08 ± 3.03
Partnership (yes), n (%) 27 (42.2) 11 (34.4) 16 (50.0)
Smoking (yes), n (%) 16 (25.0) 8 (25.0) 8 (25.0)
AUDIT sum score, M ± SD 7.75 + 4.62 8.25 + 4.77 7.25 + 4.49
Pornography use (h/month) M ± SD 6.29 ± 6.61 4.99 ± 4.11 7.58 ± 8.27
s-IATsex, M ± SD 19.89 ± 5.09 19.97 ± 4.46 19.81 ± 5.73
s-IATsex > 30, n (%) 3 (4.7) 0 (0) 3 (9.4)
TSMQ, M ± SD
Solitary sexuality 3.44 ± 0.81 3.33 ± 0.74 3.56 ± 0.88
Importance of sex* 3.68 ± 0.76 3.49 ± 0.88 3.87 ± 0.58
Seeking sexual encounters 1.27 ± 1.05 1.03 ± 0.92 1.51 ± 1.12
Comparison with others 1.68 ± 1.09 1.51 ± 1.02 1.85 ± 1.15
Total score* 2.52 ± 0.66 2.34 ± 0.67 2.70 ± 0.61
Sexual image, M ± SD
Valence 5.67 ± 1.03 5.52 ± 1.13 5.82 ± 0.91
Arousal 3.42 ± 1.67 3.29 ± 1.63 3.55 ± 1.72
Sexual arousal 4.33 ± 1.86 4.06 ± 1.97 4.60 ± 1.74
Neutral image, M ± SD
Valence 5.05 ± 0.66 5.03 ± 0.69 5.08 ± 0.64
Arousal* 1.70 ± 1.01 1.43 ± 0.78 1.98 ± 1.13
Sexual arousal 1.05 ± 0.09 1.03 ± 0.06 1.07 ± 0.11
BMI, Body Mass Index in kilograms per weight squared; s-IATsex, short version of the Internet Addiction Test adapted to online sexual activities; TSMQ, Trait Sexual Motivation
Questionnaire. *p < .05.
higher arousal during the rating of neutral pictures. Other group The analyses regarding craving for pornography (of note:
comparisons did not reach significance. 3 missings in the negative feedback group) revealed small
but significant changes over time [Ftime(1.6, 96.7) = 28.71, p <
Manipulation Check .001, η2p = 0.327] without differences between the feedback
Performance-based feedback was believed by significantly fewer groups [F 2time∗group(1.6,96.7) = 1.92, p = .160, ηp= 0.031]. Simplepeople in the negative feedback group (N = 22; 68.8%) than in contrasts confirmed a small decrease from baseline to post-
the neutral feedback group [N = 31; 96.9%; X2(1) = 8.89, p = feedback, but an increase after the sexual cue reactivity paradigm
.003, ϕ = 0.373]. There was no difference in baseline negative (Figure 2C). There were small but significant changes over time
affect between the groups [t(62) = −0.44, p = .665], but we regarding the craving for masturbation [of note: 3 missings in
found an increase in negative affect [Ftime(1.7,108.7) = 15.65, p the negative feedback group; Ftime(1.4, 84.5) = 16.65, p < .001,
< .001, η2p= 0.202], particularly in the negative feedback group η2p= 0.220] without differences between the feedback groups
[F 2time∗group(1.7,108.7) = 8.94, p < .001, ηp= 0.126]. Subsequent [Ftime∗group(1.4, 84.5)= 1.55, p= .220, η2p= 0.026]. Subsequent
simple contrasts confirmed an increase from baseline to post- simple contrasts indicated stable levels from baseline to post-
feedback, and a return to baseline level after the sexual cue feedback, but an increase after the sexual cue reactivity paradigm
reactivity paradigm in the negative feedback group while levels (Figure 2D).
in the neutral feedback group appeared stable (see Figure 2A).
Regarding the manipulation of positive affect, there was no
difference in baseline levels between groups [t(62) = 0.36, p Sexual Cue Reactivity
= .720]. We found a decrease in positive affect [Ftime(2.0,122.8) The mixed-model ANOVA with the between-factor group
= 32.75, p < .001, η2= 0.346], particularly in the negative (negative affect, neutral affect) and the within-factor picturep
feedback group [F = 6.14, p= .003, η2= 0.090]. category (pornographic picture, neutral picture) showedtime∗group(2.0,122.8) p
Subsequent simple contrasts confirmed a decrease from baseline substantial stronger P300 amplitudes toward pornographic
to post-feedback, and still declining levels after the sexual cue pictures compared to neutral ones [Fcategory(1.0, 62.0) =
2
reactivity paradigm in the negative feedback group. Levels in the 362.5, p < .001, ηp= 0.854], but the groups did not differ
neutral feedback group appeared stable from baseline to post- [F = 2.06, p = .157, η2category∗group(1.0,62.0) p= 0.032; see Figure 2].
feedback, but there was a decline after the sexual cue reactivity In general, the P300 levels were comparable between the groups
paradigm (see Figure 2B). [Fgroup(1, 62) = 2.58, p= .114, η
2
p= 0.040].
Frontiers in Psychology | www.frontiersin.org 7 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
FIGURE 2 | Time courses for affect and craving in both groups over the three measurement time points of the experiment. (A) Negative affect, (B) positive affect, (C)
craving for pornography, (D) craving for masturbation. T1: baseline; T2: after the affect manipulation; T3: after the sexual cue reactivity paradigm.
The results of the mixed-model ANOVA for LPP amplitudes 3.2% (R2adjusted = 0.017) of the variation in P300 difference
displayed analogous results with substantial stronger LPP amplitude. Introducing TSMQ Solitary Sexuality did not explain
amplitude toward pornographic pictures compared to neutral significant additional variation (2.3%), F(1,61) = 1.51, p =
ones [F 2category(1.0, 62.0) = 251.20, p < .001, ηp= 0.802], no .224. When the interaction was added in stage three of the
significant differences between groups [Fcategory∗group(1.0, 62.0) = regression model, the interaction was predictive of the P300
0.42, p = .522, η2p= 0.007; see Figure 3], and comparable LPP difference amplitude. Together, the predictors accounted for
levels between the feedback groups [Fgroup(1, 62) = 2.28, p= .136, 15.0% (R2adjusted = 0.108) of the variance in P300 difference
η2p= 0.036]. amplitude, F(3,60) = 3.54, p = .020 (Table 2). Likewise, LPP
Compared to neutral pictures, pornographic pictures were difference amplitudes were not predicted by the groups. The
rated asmore positive, more arousing andmore sexually arousing stage one regression model was not significant, F(1,62) = 0.42, p
(all F > 15.1, p < .001; valence: η2p= 0.196; arousal: η
2
p= 0.519; = .522, accounting for 0.7% (R2adjusted ≤ 0.001) of the variation.
sexual arousal: η2p= 0.767). None of the picture ratings differed No significant additional variation (4.4%) was explained when
between the groups (all F < 1.23, p> .273). adding TSMQ Solitary Sexuality, the change in R2 was not
significant, F(1,61) = 2.36, p = .129. In step 3, the interaction
Moderator Analyses was predictive of the LPP difference amplitude and all three
2
Hierarchical multiple regressions indicated that neither predictors explained 10.6% (Radjusted = 0.061) of the variation
pornography use (hours/month) nor symptoms of cybersex in LPP difference amplitudes, F(3,60) = 2.36, p = .080. Figure 4
addiction (s-IATsex) or their interaction with group contributed illustrates that in the negative feedback group, men with higher
significantly to the regression model (all p > .100, not shown). solitary sexual motivation levels showed higher P300/LPP
The same was true for TSMQ subscales (all p > .078) except difference amplitudes compared to men scoring lower on this
the Solitary Sexuality subscale. Here, step-wise regression first subscale. This was contrasted by results for the neutral feedback
revealed that group did not contribute significantly to the group. Here, higher solitary sexuality was related to lower
regression model, F(1,62) = 2.06, p = .157, accounting for difference amplitudes.
Frontiers in Psychology | www.frontiersin.org 8 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
FIGURE 3 | The grand average waveforms averaged across channel CP1, CP2, P3, Pz, and P4 showing the potentials produced in response to the presentation of
sexual vs. neutral images depending on group allocation.
DISCUSSION feedback and a slight increase after the sexual cue reactivity
paradigm. However, the groups did not differ in affect and
In this healthy and heterosexual male sample, results confirmed craving responses. This may be traced back to a bottom effect and
the effectiveness of both negative affect manipulation and sexual relatively low scores for negative affect and craving, respectively.
cue reactivity as indicated by time-dependent changes in self- Despite this rather low subjectively rated cue reactivity, stronger
reported affect and craving ratings. While there were stronger positive ERP components (for both the P300 and LPP) emerged
neural responses toward pornographic pictures as compared to in response to pornographic pictures compared to neutral
neutral ones, there was no effect of negative feedback. Of the pictures. This was consistent with our hypotheses and with prior
moderators examined, only Solitary Sexuality as an aspect of studies (Schupp et al., 2004, 2006; Hajcak et al., 2010). Both the
trait sexual motivation had a moderating effect on the neural LPP and the P300 are discussed as indicators of motivational
response, whereas symptoms of cybersex addiction or the extent attention (van Lankveld and Smulders, 2008; Steele et al., 2013;
of pornography use were unrelated. In the neutral feedback Prause et al., 2015a), which in this study argues for higher
group, individuals with higher levels of Solitary Sexuality showed attention toward pornographic pictures compared to neutral
smaller amplitude differences of the P300 and the LPP to pictures. Correspondingly, pornographic pictures were rated as
pornographic pictures in relation to neutral pictures, whereas the more pleasant, more arousing, and more sexually arousing than
opposite was true for individuals with higher levels of Solitary neutral pictures. However, we did not find significant differences
Sexuality in the negative feedback group. between the two feedback groups (neutral, negative) for either
The significant increase in negative affect and decrease in ERPs or picture ratings. Consequently, negative affect induction
positive affect following negative performance feedback provide had no significant effect on motivational attention or subjective
significant evidence that the affect manipulation succeeded in a evaluation of pornographic pictures in our study.
hypothesis-consistent way. In both groups, there was a decrease The findings that negative affect has no effect on ERPs
in craving for pornography and masturbation after performance and subjective ratings when viewing pornographic pictures
Frontiers in Psychology | www.frontiersin.org 9 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
TABLE 2 | Multiple regression on late positive potential amplitudes for their study investigating individuals with self-reported addictive
pornographic minus neutral pictures based on TSMQ solitary sexuality. pornography use, Steele et al. (2013) also found that the P300
2 2 did not correlate with addictive pornography use. In anotherB SE β p R R change
study, participants with self-reported addictive pornography use
P300 showed lower LPP amplitudes than control participants (Prause
Step 1 0.032 0.032 et al., 2015b). However, the latter study involved participants who
Group −0.620 0.432 −0.179 0.157 reported relatively low levels of addictive pornography use who
Step 2 0.055 0.023 either already had less pronounced levels from the onset of their
Group −0.620 0.430 −0.179 0.155 addiction or had already reduced their use. Another study from
Solitary Sexuality 0.331 0.269 0.153 0.224 Stark et al. (2019) showed no significant correlations between the
Step 3 0.150 0.095* level of pornography use and neural responses to sexual stimuli
Group −0.620 0.412 −0.179 0.137 in young health men and women. The authors discuss that the
Solitary Sexuality 0.235 0.338 0.109 0.489 processing of sexual stimuli in healthy individuals may be subject− −
Interaction 1.351 0.522 0.404 0.012 to a strong evolutionary biological influence. Given previous
assumptions on addictive pornography use, we would have
LPP
expected a correlation between hypersensitivity to pornographic
Step 1 0.007 0.007
stimuli and measures of cybersex addiction (Voon et al., 2014;
Group −0.029 0.457 −0.082 0.522
Brand et al., 2019). But sexual traits such as habitual pornography
Step 2 0.044 0.037
use or addictive symptoms may only slightly influence the
Group −0.294 0.452 −0.082 0.518
processing of sexual stimuli in healthy individuals and clinical
Solitary Sexuality 0.435 0.283 0.193 0.129
samples would be needed to investigate these abnormalities. Of
Step 3 0.106 0.062*
note, the scores for cybersex addiction in the current study
Group −0.294 0.441 −0.082 0.507
are comparable to the scores in the validation study (Laier
Solitary Sexuality −0.042 0.362 −0.019 0.908
et al., 2013). Three participants (all from the neutral feedback
Interaction 1.138 0.559 0.384 0.046
group) reported values that, according to Pawlikowski et al.
N = 64; Group is coded neutral feedback = 0 and negative feedback = 1; B, (2013), indicate problematic pornography use. This result creates
unstandardized coefficient; SE, standard error of B; β, standardized coefficient; P300, variance between groups that is not attributable to the affect
positive potential 300–500ms post stimulus; LPP, late positive potential 500–800ms post
* manipulation and thus reduces its effect. As a note, excludingstimulus. p < .05.
these individuals did not change mixed-model ANOVA findings
or regression analyses of the moderators pornography use and
cybersex addiction.
complements the findings of previous studies using other For trait sexual motivation, the current study showed a
methods. Carvalho et al. (2017) also found no effect of negative significant interaction between the Solitary Sexuality subscale
affect on visual attention toward pornographic pictures, assessed of the TSMQ and group membership (neutral feedback group
via eye-movement tracking, in a healthy sample of men and vs. negative feedback group) with regard to the amplitude
women. In addition, Janssen et al. (2020) found no effects of difference between pornographic and neutral pictures. In the
negative affect induction on physiological (penile tumescence), neutral feedback group, individuals with higher expression of
nor on subjective sexual arousal in hypersexual as well as non- Solitary Sexuality responded with smaller amplitude differences
hypersexual homosexual men. These null findings may be related (pornographic picture minus neutral picture) of the P300
to the flexibility of coping mechanisms in healthy participants, and the LPP component, whereas in the negative feedback
so that an affect-induced effect on the attention toward and group, individuals with higher expression of Solitary Sexuality
the rating of pornographic pictures is only evident in samples responded to pornographic pictures with higher amplitude
with a more severe clinical expression of CSBD. From previous differences of the P300 and the LPP. A higher amplitude
studies, it could be argued that negative affective states, like difference could be an indicator of sexual hyperresponsiveness,
depression, generally reduce sexual interest and sexual cue whereas a lower amplitude difference could indicate sexual
reactivity (Bancroft et al., 2003). In some individuals, however, hyporesponsiveness. The Solitary Sexuality subscale consists
negative affect increases sexual behaviors, what may thus be of items assessing the relationship-independent interest in
argued to constitute a symptom of CSBD. Similar to this, missing pornography or sexual fantasies and interest in sexual activities
effects of negative mood on penile tumescence in the Janssen such as masturbation (Stark et al., 2015). The interaction result
study are discussed to be due to the sample’s heterogeneity suggests that individuals with higher levels of Solitary Sexuality
or there may be subgroups of hypersexual men with different may present stronger motivational attention to pornographic
underlying psychopathological mechanisms. stimuli during negative affect, which could be indicative of
The results of the exploratory hierarchicalmultiple regressions higher sexual reward sensitivity. Whether such a link between
revealed that neither the extent of pornography use, nor higher relationship-independent interest in sexual activities and
symptoms for cybersex addiction explained neural variance, i.e., hyperresponsivity to pornographic stimuli under negative affect
neural responses toward pornographic pictures minus neutral underlies addictive pornography use, has now to be shown in
pictures. This finding is consistent with previous study results. In clinical samples. Interestingly, the graphic illustration of this
Frontiers in Psychology | www.frontiersin.org 10 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
FIGURE 4 | Negative feedback and solitary sexuality predicting P300 (left) and LPP amplitudes (right) toward pornographic pictures (minus neutral pictures).
interaction also indicated that men scoring lower on Solitary (Maskeliunas and Raudonis, 2016). For ethical reasons, it was
Sexuality responded with higher amplitude differences under mentioned at the beginning of the recruitment process that this
neutral feedback. For these men, pornographic images seem study is about the processing of sexual images. This may have
to represent a stronger motivationally relevant stimulus than introduced some selection bias as men who feel, e.g., ashamed
for men with a higher relationship-independent interest in when watching pornographic material would not participate.
sexual activities. Overall, the effect of negative affect on cue Whether the current sample felt ashamed throughout testing has
reactivity was found to dependent on the level of Solitary not been evaluated, though the pornographic stimuli were rated
Sexuality. At low levels of this trait, negative affect has a with an average valence of 5.67 indicating neutral to positive
dampening effect on cue reactivity, while at higher levels it feelings. While shame should not have played a role in the
has an enhancing effect. The result of the relationship between testing of our hypotheses, this may limit validity of findings
the neural correlates and sexual motivation is consistent with for the general population. The generalizability of the results
findings of previous fMRI studies. Stark et al. (2019) found is also limited by the fact that this study focused on an all-
a positive association between sexual motivation and neural male, healthy, heterosexual sample given the known gender
responses to the contrast between sexual and neutral stimuli differences in habitual pornography consumption, experienced
in the occipital/parietal region. Consistent with this, the study problems with pornography consumption, and gender-specific
of Strahler et al. (2018) reported positive associations between interactions between negative affect and sexual reactivity (Cooper
sexual motivation and caudate nucleus activity. What needs et al., 1999; Hald, 2006; Lykins et al., 2006; Ross et al.,
to be added here is that the exclusion of the three men self- 2012; Carvalho et al., 2017). In addition, pornographic pictures
reporting problematic pornography use led to an in this case depicted heterosexual content due to known effect of sexual
significant main effect of TSMQ Seeking Sexual Encounters orientation on brain responses toward pornographic pictures
on LPP difference amplitudes (B = −0.671, β = −0.354, (Paul et al., 2008). Moreover, the laboratory setting may not
p = .045). Individuals with higher expression of Seeking only limit the transferability of the results to everyday life but
Sexual Encounters responded with smaller amplitude differences could also bias self-report data (e.g., shame, social desirability).
possibly indicating sexual hyporesponsiveness. We do not want The choice of the affect induction can be regarded as a
to interpret this post analysis too prominently but a process strength. Comparable to everyday situations, the performance
of habituation to greater sexual experiences may explain this test involves ego-involvement of the participants (Nummenmaa
(Bancroft et al., 2009). and Niemi, 2004) and compared to other affect induction
methods (e.g., music, videos) they did not know that their
Limitations and Suggestions for Future affect was manipulated. At the end of the survey, significantly
Studies more participants from the negative feedback group compared
We have to mention some important limitations of the current to the neutral feedback group reported that they did not believe
study. Since participants completed the trait questionnaires the cover story. The hypothesis-compliant decrease in positive
after the cue reactivity paradigm, it cannot be ruled out that affect and increase in negative affect nevertheless suggest that
the affect induction had an impact on the completion of the the cover story even if doubted still affected the participants. A
questionnaires. This should be avoided in future studies by possible explanation for these contradictory data could be that
changing the study procedure accordingly. In addition, it is the questioning of the cover story occurred later. Manipulating
possible that viewing pornographic material evokes feelings of task difficulty instead of manipulating feedback may improve the
shame (or other negative feelings) in recipients which then credibility of such cover stories in future studies (Nummenmaa
again may impact how pornographic material is attended to and Niemi, 2004).
Frontiers in Psychology | www.frontiersin.org 11 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
Conclusions and doi can be found below: JLUpub http://dx.doi.org/10.22029/
The results support a role for solitary sexual motivation in jlupub-12.2.
motivated attention toward pornographic pictures among men
receiving negative performance feedback. From this findings,
some aspects of trait sexual motivation might be understood ETHICS STATEMENT
as factors predisposing to increased motivated attention toward The studies involving human participants were reviewed and
pornographic cue stimuli under negative mood. Findings approved by the local ethics committee of the Department
partly support theories which suggest pornography use to be of Psychology and Sports Science, University of Giessen,
increasingly used for emotion regulation, which then becomes Giessen, Germany (reference number: 2019–0005). The
a reinforcing or perpetuating mechanism for repeated and patients/participants provided their written informed consent to
possibly increased pornography use. Other characteristics of participate in this study.
sexual behaviors and traits provided no exploratory value
and there was no general effect of negative affect in the
processing of pornographic pictures. Since aspects such as AUTHOR CONTRIBUTIONS
the extent of pornography consumption or symptoms of
cybersex addiction only become of relevance at a clinical stage, JS, SK, and RS conceived the study. SK collected the
patient studies are necessary to explore neurophysiological data. JS, SK, and CM analyzed the data and drafted the
mechanisms of CSBD. Overall, findings suggest reinforcing manuscript. JS, SK, AB, CM, and RS interpreted the data
effects of pornography use and contribute to our understanding and revised the article for important intellectual content.
of neuropsychological mechanisms of sexual cue reactivity and All authors contributed to the article and approved the
addiction development. submitted version.
DATA AVAILABILITY STATEMENT ACKNOWLEDGMENTS
The dataset presented in this study can be found in an online The authors would like to thank Constantin Werther for his
repository. The name of the repository and accession link (URL), assistance in data acquisition.
REFERENCES Bradley, M. M., and Lang, P. J. (1994). Measuring emotion: the self-assessment
manikin and the semantic differential. J. Behav. Ther. Exp. Psychiatry 25, 49–59.
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., and Monteiro, M. G. doi: 10.1016/0005-7916(94)90063-9
(2001). AUDIT-The Alcohol Use Disorders Identification Test. Geneva: World Brand, M., Laier, C., Pawlikowski, M., Schächtle, U., Schöler, T., and Altstötter-
Health Organization. Gleich, C. (2011). Watching pornographic pictures on the Internet: role
Bancroft, J., Graham, C. A., Janssen, E., and Sanders, S. A. (2009). The dual of sexual arousal ratings and psychological-psychiatric symptoms for using
control model: current status and future directions. J. Sex. Res. 46, 121–142. Internet sex sites excessively. Cyberpsychol. Behav. Soc. Netw. 14, 371–377.
doi: 10.1080/00224490902747222 doi: 10.1089/cyber.2010.0222
Bancroft, J., Janssen, E., Strong, D., Carnes, L., Vukadinovic, Z., and Brand, M., Wegmann, E., Stark, R., Müller, A., Wölfling, K., Robbins, T.
Long, J. S. (2003). The relation between mood and sexuality in W., et al. (2019). The interaction of person-affect-cognition-execution (I-
heterosexual men. Arch. Sex Behav. 32, 217–230. doi: 10.1023/A:10234095 PACE) model for addictive behaviors: update, generalization to addictive
16739 behaviors beyond internet-use disorders, and specification of the process
Baranowski, A. M., Vogl, R., and Stark, R. (2019). Prevalence and determinants character of addictive behaviors. Neurosci. Biobehav. Rev. 104, 1–10.
of problematic online pornography use in a sample of German women. J. Sex. doi: 10.1016/j.neubiorev.2019.06.032
Med. 16, 1274–1282. doi: 10.1016/j.jsxm.2019.05.010 Brand, M., Young, K. S., Laier, C., Wölfling, K., and Potenza, M. N. (2016).
Blais-Lecours, S., Vaillancourt-Morel, M. P., Sabourin, S., and Godbout, N. Integrating psychological and neurobiological considerations regarding the
(2016). Cyberpornography: time use, perceived addiction, sexual functioning, development andmaintenance of specific Internet-use disorders: an interaction
and sexual satisfaction. Cyberpsychol. Behav. Soc. Netw. 19, 649–655. of person-affect-cognition-execution (I-PACE) model.Neurosci. Biobehav. Rev.
doi: 10.1089/cyber.2016.0364 71, 252–266. doi: 10.1016/j.neubiorev.2016.08.033
Boström, A. E., Chatzittofis, A., Ciuculete, D.-M., Flanagan, J. N., Krattinger, R., Carvalho, J., Pereira, R., Barreto, D., and Nobre, P. J. (2017). The effects of positive
Bandstein, M., et al. (2020). Hypermethylation-associated downregulation of versus negativemood states on attentional processes during exposure to erotica.
microRNA-4456 in hypersexual disorder with putative influence on oxytocin Arch. Sex. Behav. 46, 2495–2504. doi: 10.1007/s10508-016-0875-3
signalling: a DNA methylation analysis of miRNA genes. Epigenetics 15, Chatzittofis, A., Arver, S., Öberg, K., Hallberg, J., Nordström, P., and
145–160. doi: 10.1080/15592294.2019.1656157 Jokinen, J. (2016). HPA axis dysregulation in men with hypersexual
Bothe, B., Potenza, M. N., Griffiths, M. D., Kraus, S. W., Klein, V., Fuss, J., et al. disorder. Psychoneuroendocrinology 63, 247–253. doi: 10.1016/j.psyneuen.2015.
(2020a). The development of the compulsive sexual behavior disorder scale 10.002
(CSBD-19): an ICD-11 based screening measure across three languages. J. Cooper, A., Scherer, C. R., Boies, S. C., and Gordon, B. L. (1999). Sexuality on
Behav. Addict. 9, 247–258. doi: 10.1556/2006.2020.00034 the Internet: from sexual exploration to pathological expression. Professional
Bothe, B., Vaillancourt-Morel, M.-P., Girouard, A., Štulhofer, A., Dion, Psychol. Res. Pract. 30, 154–164. doi: 10.1037/0735-7028.30.2.154
J., and Bergeron, S. (2020b). A large-scale comparison of Canadian Cooper, A. L. (1998). Sexuality and the Internet: surfing into the new millennium.
sexual/gender minority and heterosexual, cisgender adolescents’ pornography Cyberpsychol. Behav. 1, 187–193. doi: 10.1089/cpb.1998.1.187
use characteristics. J. Sex. Med. 17, 1156–1167. doi: 10.1016/j.jsxm.2020. Dawson, J. F. (2014). Moderation in management research: what, why, when, and
02.009 how. J. Bus. Psychol. 29, 1–19. doi: 10.1007/s10869-013-9308-7
Frontiers in Psychology | www.frontiersin.org 12 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
Demos, K. E., Heatherton, T. F., and Kelley, W. M. (2012). Individual Kinsey, A. C., Pomeroy, W., and Martin, C. E. (1948). Sexual Behavior in the
differences in nucleus accumbens activity to food and sexual images Human Male. Philadelphia: Saunders.
predict weight gain and sexual behavior. J. Neurosci. 32, 5549–5552. Klem, G., Lüders, H., and Elger, C. (1999). The ten-twenty electrode system
doi: 10.1523/JNEUROSCI.5958-11.2012 of the international federation. the international federation of clinical
Duffy, A., Dawson, D. L., and das Nair, R. (2016). Pornography addiction in adults: neurophysiology. Electroencephalogr. Clin. Neurophysiol. Suppl. 52, 3–6.
a systematic review of definitions and reported impact. J. Sex. Med. 13, 760–777. Klucken, T., Wehrum-Osinsky, S., Schweckendiek, J., Kruse, O., and Stark,
doi: 10.1016/j.jsxm.2016.03.002 R. (2016). Altered appetitive conditioning and neural connectivity in
Dunning, J. P., Parvaz, M. A., Hajcak, G., Maloney, T., Alia-Klein, N., Woicik, P. subjects with compulsive sexual behavior. J. Sex. Med. 13, 627–636.
A., et al. (2011). Motivated attention to cocaine and emotional cues in abstinent doi: 10.1016/j.jsxm.2016.01.013
and current cocaine users–an ERP study. Eur. J. Neurosci. 33, 1716–1723. Kowalewska, E., Gola, M., Kraus, S. W., and Lew-Starowicz, M. (2020). Spotlight
doi: 10.1111/j.1460-9568.2011.07663.x on compulsive sexual behavior disorder: a systematic review of research on
Engel, J., Kessler, A., Veit, M., Sinke, C., Heitland, I., Kneer, J., et al. (2019a). women. Neuropsychiatr. Dis. Treat. 16, 2025–2043. doi: 10.2147/NDT.S221540
Hypersexual behavior in a large online sample: individual characteristics Kreuzpointner, L., Lukesch, H., andHorn,W. (2013). Leistungsprüfsystem 2. LPS-2.
and signs of coercive sexual behavior. J. Behav. Addict. 8, 213–222. Manual. Göttingen: Hogrefe.
doi: 10.1556/2006.8.2019.16 Kühn, S., and Gallinat, J. (2014). Brain structure and functional connectivity
Engel, J., Veit, M., Sinke, C., Heitland, I., Kneer, J., Hillemacher, T., et al. (2019b). associated with pornography consumption: the brain on porn. JAMAPsychiatry
Same same but different: a clinical characterization of men with hypersexual 71, 827–834. doi: 10.1001/jamapsychiatry.2014.93
disorder in the Sex@Brain study. J. Clin. Med. 8:157. doi: 10.3390/jcm8020157 Kühn, S., and Gallinat, J. (2016). Neurobiological basis of hypersexuality. Int. Rev.
Foti, D., Hajcak, G., and Dien, J. (2009). Differentiating neural responses to Neurobiol. 129, 67–83. doi: 10.1016/bs.irn.2016.04.002
emotional pictures: evidence from temporal-spatial PCA. Psychophysiology 46, Laier, C., and Brand, M. (2017). Mood changes after watching pornography on
521–530. doi: 10.1111/j.1469-8986.2009.00796.x the Internet are linked to tendencies towards Internet-pornography-viewing
Georgiadis, J. R., and Kringelbach, M. L. (2012). The human sexual response cycle: disorder. Addict. Behav. Rep. 5, 9–13. doi: 10.1016/j.abrep.2016.11.003
brain imaging evidence linking sex to other pleasures. Progress Neurobiol. 98, Laier, C., Pawlikowski, M., Pekal, J., Schulte, F. P., and Brand, M. (2013). Cybersex
49–81. doi: 10.1016/j.pneurobio.2012.05.004 addiction: experienced sexual arousal when watching pornography and not
Gola, M., Lewczuk, K., and Skorko, M. (2016a). What matters: quantity or real-life sexual contacts makes the difference. J. Behav. Addict. 2, 100–107.
quality of pornography use? Psychological and behavioral factors of seeking doi: 10.1556/JBA.2.2013.002
treatment for problematic pornography use. J. Sex. Med. 13, 815–824. Love, T., Laier, C., Brand, M., Hatch, L., and Hajela, R. (2015). Neuroscience of
doi: 10.1016/j.jsxm.2016.02.169 Internet pornography addiction: a review and update. Behav. Sci. 5, 388–433.
Gola, M., Wordecha, M., Marchewka, A., and Sescousse, G. (2016b). Visual doi: 10.3390/bs5030388
sexual stimuli - cue or reward? A perspective for interpreting brain Lykins, A. D., Janssen, E., and Graham, C. A. (2006). The relationship between
imaging findings on human sexual behaviors. Front. Hum. Neurosci. 10:402. negative mood and sexuality in heterosexual college woman and men. J. Sex
doi: 10.3389/fnhum.2016.00402 Res. 43, 136–143. doi: 10.1080/00224490609552308
Gola, M., Wordecha, M., Sescousse, G., Lew-Starowicz, M., Kossowski, Maskeliunas, R., and Raudonis, V. (2016). Are you ashamed? Can a gaze tracker
B., Wypych, M., et al. (2017). Can pornography be addictive? An tell? PeerJ Comput. Sci. 2:e75. doi: 10.7717/peerj-cs.75
fMRI study of men seeking treatment for problematic pornography use. Mattebo, M., Tydén, T., Häggström-Nordin, E., Nilsson, K. W., and Larsson, M.
Neuropsychopharmacology 42, 2021–2031. doi: 10.1038/npp.2017.78 (2013). Pornography consumption, sexual experiences, lifestyles, and self-rated
Grubbs, J. B., Kraus, S. W., and Perry, S. L. (2019). Self-reported addiction health among male adolescents in Sweden. J. Dev. Behav. Pediatr. 34, 460–468.
to pornography in a nationally representative sample: the roles of use doi: 10.1097/DBP.0b013e31829c44a2
habits, religiousness, and moral incongruence. J. Behav. Addict. 8, 88–93. Mattebo, M., Tydén, T., Häggström-Nordin, E., Nilsson, K. W., and
doi: 10.1556/2006.7.2018.134 Larsson, M. (2016). Pornography consumption among adolescent girls
Hajcak, G., MacNamara, A., and Olvet, D. M. (2010). Event-related potentials, in Sweden. Eur. J. Contracept. Reproduct. Health Care 21, 295–302.
emotion, and emotion regulation: an integrative review. Dev. Neuropsychol. 35, doi: 10.1080/13625187.2016.1186268
129–155. doi: 10.1080/87565640903526504 Nummenmaa, L., and Niemi, P. (2004). Inducing affective states with
Hald, G. M. (2006). Gender differences in pornography consumption success-failure manipulations: a meta-analysis. Emotion 4, 207–214.
among young heterosexual Danish adults. Arch. Sex. Behav. 35, 577–585. doi: 10.1037/1528-3542.4.2.207
doi: 10.1007/s10508-006-9064-0 Paul, T., Schiffer, B., Zwarg, T., Krüger, T. H. C., Karama, S., Schedlowski, M., et al.
Han, L., Gao, F., Hou, X., Xie, D., Jou, M., and Huang, C.-C. (2018). (2008). Brain response to visual sexual stimuli in heterosexual and homosexual
Do covered nude photographs in the internet induce sexual cognition – males. Hum. Brain Map. 29, 726–735. doi: 10.1002/hbm.20435
A study of event-related potential. Comput. Hum. Behav. 80, 370–378. Pawlikowski, M., Altstötter-Gleich, C., and Brand, M. (2013). Validation and
doi: 10.1016/j.chb.2017.11.039 psychometric properties of a short version of Young’s Internet addiction test.
Hashemi, A., Pino, L. J., Moffat, G., Mathewson, K. J., Aimone, C., Bennett, P. J., Comput. Hum. Behav. 29, 1212–1223. doi: 10.1016/j.chb.2012.10.014
et al. (2016). Characterizing population EEG dynamics throughout adulthood. Pettorruso, M., Valle, S., Cavic, E., Martinotti, G., Di Giannantonio, M., and Grant,
eNeuro 3, 1–13. doi: 10.1523/ENEURO.0275-16.2016 J. E. (2020). Problematic Internet use (PIU), personality profiles and emotion
Herbenick, D., Fu, T. C., Wright, P., Paul, B., Gradus, R., Bauer, J., et al. (2020). dysregulation in a cohort of young adults: trajectories from risky behaviors to
Diverse sexual behaviors and pornography use: findings from a nationally addiction. Psychiatry Res. 289:113036. doi: 10.1016/j.psychres.2020.113036
representative probability survey of Americans aged 18 to 60 years. J. Sex. Med. Poeppl, T. B., Langguth, B., Laird, A. R., and Eickhoff, S. B. (2014). The functional
17, 623–633. doi: 10.1016/j.jsxm.2020.01.013 neuroanatomy of male psychosexual and physiosexual arousal: a quantitative
Janssen, E., Prause, N., Swinburne Romine, R., Raymond, N., MacDonald, A., meta-analysis. Hum. Brain Map. 35, 1404–1421. doi: 10.1002/hbm.22262
Coleman, E., et al. (2020). Sexual responsivity and the effects of negative mood Prause, N., Steele, V. R., Staley, C., and Sabatinelli, D. (2015a). Late
on sexual arousal in hypersexual men who have sex with men (MSM). J. Sex. positive potential to explicit sexual images associated with the number
Med. 17, 1751–1760. doi: 10.1016/j.jsxm.2020.05.005 of sexual intercourse partners. Soc. Cogn. Affect. Neurosci. 10, 93–100.
Jokinen, J., Boström, A. E., Chatzittofis, A., Ciuculete, D. M., Öberg, K. doi: 10.1093/scan/nsu024
G., Flanagan, J. N., et al. (2017). Methylation of HPA axis related genes Prause, N., Steele, V. R., Staley, C., Sabatinelli, D., and Hajcak, G. (2015b).
in men with hypersexual disorder. Psychoneuroendocrinology 80, 67–73. Modulation of late positive potentials by sexual images in problem users
doi: 10.1016/j.psyneuen.2017.03.007 and controls inconsistent with “porn addiction”. Biol. Psychol. 109, 192–199.
Kagerer, S., Wehrum, S., Klucken, T., Walter, B., Vaitl, D., and Stark, R. (2014). Sex doi: 10.1016/j.biopsycho.2015.06.005
attracts: investigating individual differences in attentional bias to sexual stimuli. Price, J., Patterson, R., Regnerus, M., and Walley, J. (2016). How much
PLoS ONE 9:e107795. doi: 10.1371/journal.pone.0107795 more XXX is generation X consuming? Evidence of changing attitudes
Frontiers in Psychology | www.frontiersin.org 13 July 2021 | Volume 12 | Article 673023
Markert et al. Mood and ERPs Viewing Pornography
and behaviors related to pornography since 1973. J. Sex Res. 53, 12–20. Stoléru, S., Fonteille, V., Cornélis, C., Joyal, C., and Moulier, V. (2012). Functional
doi: 10.1080/00224499.2014.1003773 neuroimaging studies of sexual arousal and orgasm in healthy men and
Reid, R. C., Bramen, J. E., Anderson, A., and Cohen, M. S. (2014). women: a review and meta-analysis. Neurosci. Biobehav. Rev. 36, 1481–1509.
Mindfulness, emotional dysregulation, impulsivity, and stress proneness doi: 10.1016/j.neubiorev.2012.03.006
among hypersexual patients. J. Clin. Psychol. 70, 313–321. doi: 10.1002/jclp. Strahler, J., Kruse, O., Wehrum-Osinsky, S., Klucken, T., and Stark, R. (2018).
22027 Neural correlates of gender differences in distractibility by sexual stimuli.
Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., NeuroImage 176, 499–509. doi: 10.1016/j.neuroimage.2018.04.072
et al. (2012). Report of findings in a DSM-5 field trial for hypersexual disorder. van Lankveld, J. J. D. M., and Smulders, F. T. Y. (2008). The effect of visual
J. Sex. Med. 9, 2868–2877. doi: 10.1111/j.1743-6109.2012.02936.x sexual content on the event-related potential. Biol. Psychol. 79, 200–208.
Reid, R. C., Li, D. S., Gilliland, R., Stein, J. A., and Fong, T. (2011). Reliability, doi: 10.1016/j.biopsycho.2008.04.016
validity, and psychometric development of the pornography consumption Volkow, N. D., Koob, G. F., and McLellan, A. T. (2016). Neurobiologic advances
inventory in a sample of hypersexual men. J. Sex Marital Ther. 37, 359–385. from the brain disease model of addiction. N Engl. J. Med. 374, 363–371.
doi: 10.1080/0092623X.2011.607047 doi: 10.1056/NEJMra1511480
Rissel, C., Richters, J., de, V. R. O., McKee, A., Yeung, A., and Caruana, Voon, V., Mole, T. B., Banca, P., Porter, L., Morris, L., Mitchell, S.,
T. (2017). A profile of pornography users in Australia: findings from the et al. (2014). Neural correlates of sexual cue reactivity in individuals
second Australian study of health and relationships. J. Sex Res. 54, 227–240. with and without compulsive sexual behaviours. PLoS ONE 9:e102419.
doi: 10.1080/00224499.2016.1191597 doi: 10.1371/journal.pone.0102419
Ross, M. W., Månsson, S. A., and Daneback, K. (2012). Prevalence, severity, and Watson, D., Clark, L. A., and Tellegen, A. (1988). Development and validation of
correlates of problematic sexual Internet use in Swedish men and women.Arch. brief measures of positive and negative affect: the PANAS scales. J. Person. Soc.
Sex. Behav. 41, 459–466. doi: 10.1007/s10508-011-9762-0 Psychol. 54, 1063–1070. doi: 10.1037/0022-3514.54.6.1063
Rousseau, A., Bothe, B., and Štulhofer, A. (2020). Theoretical antecedents of male Wölfling, K., Mörsen, C. P., Duven, E., Albrecht, U., Grüsser, S. M., and Flor, H.
adolescents’ problematic pornography use: a longitudinal assessment. J. Sex Res. (2011). To gamble or not to gamble: at risk for craving and relapse- learned
58, 331–341. doi: 10.1080/00224499.2020.1815637 motivated attention in pathological gambling. Biol. Psychol. 87, 275–281.
Schupp, H., Cuthbert, B., Bradley, M., Hillman, C., Hamm, A., and Lang, P. (2004). doi: 10.1016/j.biopsycho.2011.03.010
Brain processes in emotional perception: motivated attention. Cogn. Emot. 18, Wordecha, M., Wilk, M., Kowalewska, E., Skorko, M., Łapiński, A., and Gola, M.
593–611. doi: 10.1080/02699930341000239 (2018). “Pornographic binges” as a key characteristic of males seeking treatment
Schupp, H. T., Flaisch, T., Stockburger, J., and Junghöfer, M. (2006). Emotion and for compulsive sexual behaviors: qualitative and quantitative 10-week-long
attention: event-related brain potential studies. Understand. Emot. 156, 31–51. diary assessment. J. Behav. Addict. 7, 433–444. doi: 10.1556/2006.7.2018.33
doi: 10.1016/S0079-6123(06)56002-9 World Health Organization (2018). International Statistical Classification
Stark, R., Kagerer, S., Walter, B., Vaitl, D., Klucken, T., and Wehrum-Osinsky, S. of Diseases and Related Health Problems. 11th Edn. Geneva: World
(2015). Trait sexual motivation questionnaire: concept and validation. J. Sex. Health Organization.
Med. 12, 1080–1091. doi: 10.1111/jsm.12843
Stark, R., Klein, S., Kruse, O., Weygandt, M., Leufgens, L. K., Schweckendiek, Conflict of Interest: The authors declare that the research was conducted in the
J., et al. (2019). No sex difference found: cues of sexual stimuli absence of any commercial or financial relationships that could be construed as a
activate the reward system in both sexes. Neuroscience 416, 63–73. potential conflict of interest.
doi: 10.1016/j.neuroscience.2019.07.049
Steele, V. R., Staley, C., Fong, T., and Prause, N. (2013). Sexual desire, Copyright © 2021 Markert, Baranowski, Koch, Stark and Strahler. This is an open-
not hypersexuality, is related to neurophysiological responses elicited by access article distributed under the terms of the Creative Commons Attribution
sexual images. Socioaffect. Neurosci. Psychol. 3:20770. doi: 10.3402/snp.v3i0. License (CC BY). The use, distribution or reproduction in other forums is permitted,
20770 provided the original author(s) and the copyright owner(s) are credited and that the
Stein, D. J. (2008). Classifying hypersexual disorders: compulsive, impulsive, original publication in this journal is cited, in accordance with accepted academic
and addictive models. Psychiatr. Clin. North Am. 31, 587–591. practice. No use, distribution or reproduction is permitted which does not comply
doi: 10.1016/j.psc.2008.06.007 with these terms.
Frontiers in Psychology | www.frontiersin.org 14 July 2021 | Volume 12 | Article 673023