The cognitive-behavioral therapy (CBT) approach, which involves an integration of both cognitive and behavioral therapy techniques, has been adapted for use with sexual offenders. The central tenet of CBT is essential that our thoughts, behaviors, and emotions interact with one another in a cyclical manner, such that changing thoughts about a situation or event might change subsequent behaviors that ultimately change our emotions. Purely cognitive interventions used with sex offenders include cognitive restructuring, which is aimed at challenging rationalizations, minimizations, or other offense-supportive beliefs involved in the initiation or maintenance of sexual offending behavior. For example, a therapist using a cognitive restructuring technique might challenge an offender’s minimization that “no one was hurt,” by having the offender examine the veracity of such belief.
Behavioral approaches have also been used in the treatment of aberrant sexual behaviors. Behavioral therapies are premised on the idea that deviancy is a learned behavior that can be unlearned. Thus, inappropriate (or deviant) sexual desire might be reduced if associated with negative consequences, while appropriate sexual desire might be enhanced if paired with rewards or other positive consequences. Masturbatory satiation, for example, involves having an offender masturbate to deviant fantasies for an extended amount of time through the sexual refractory (i.e., postorgasm) period, with the idea that this unrewarded and perhaps aversive masturbatory experience will reduce or eliminate deviant arousal. Although procedures might vary, verbal satiation similarly aims to reduce deviant interest by having an offender repeat aloud deviant sexual fantasies during the post orgasm period. Aversion techniques similarly aim to reduce the deviant sexual response by pairing aversive stimuli (such as mild electric shock or foul odors) with deviant arousal. When the arousal is followed by a shock or other aversive stimuli, the resulting behavior (deviant arousal) is, again, expected to decrease. Just as behavioral strategies might be used to reduce deviant arousal, they are also used to reinforce or enhance “normal” sexual arousal. While there is some limited support for the use of these pure behavioral techniques, these approaches have generally fallen out of favor in preference of more integrative and comprehensive treatment interventions.