An international randomized waitlist-controlled trial of internet-delivered cognitive behavioral therapy for sexual urges toward children.

Objective: Test whether Prevent It 2.0, a 9-week, anonymous internet-delivered cognitive behavioral therapy (iCBT) program, reduces the severity of sexual urges and behaviors toward children to prevent acts of child sexual exploitation and abuse.

Method: In a randomized 1:1 waitlist-controlled trial with crossover at Karolinska Institutet, Sweden, N = 203 adults (≥18 years; 92.1% men, 0.5% women, 7.4% other; age 18-70, 66.6% aged 21-40; 49.8% Europe, 38.9% North America) were allocated to iCBT (n = 100) or waitlist (n = 103). The preregistered primary outcome was severity of sexual urges toward children (adapted Sexual Symptoms Assessment Scale). Secondary outcomes included weekly time spent observing children for sexual purposes, including use of child sexual abuse material, and severity of accessed material. The study was preregistered on https://ClinicalTrials.gov (ID: NCT05663047; Karolinska Institutet, 2022) and the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/Y2DC4; Rahm et al., 2022).

Results: iCBT participants reported a significantly greater reduction in sexual urges toward children (-6.41 scale points, 95% confidence interval, CI [-8.26, -4.56]; d = -1.01, 95% CI [-1.30, -0.72]), as well as a significant decrease in time spent observing children for sexual purposes (including use of child sexual abuse material; -1.87 hr weekly, 95% CI [-2.91, -0.82], d = -0.517, 95% CI [-0.806, -0.228]) after 9 weeks compared to the attention-controlled waitlist.

Conclusions: Prevent It 2.0 demonstrated efficacy in reducing sexual urges and offending related behaviors toward children, producing clinically significant reductions over 9 weeks, in an anonymous online sample. (PsycInfo Database Record (c) 2026 APA, all rights reserved).