The study will evaluate whether the TCS intervention and Selfhelp modules, independently
or combined, effectively reduce CSAM use or risk of CSAM consumption and improve mental
well-being among self-referred participants.
Objectives 1.1 Primary objectives
To compare the effectiveness in reducing CSAM behaviours between the TD only group
and the waitlist group four weeks after the baseline assessment.
To compare the post-intervention effectiveness in reducing CSAM behaviours of the
Selfhelp modules versus TCS alone and Selfhelp modules followed by TCS.
1.2 Secondary objectives
To assess the reduction in severity, time and self-rated risk of CSAM consumption
among participants in the intervention groups (Selfhelp modules, TCS, or Selfhelp +
TCS) compared to the waitlist control group, at post-intervention.
To compare the impact of the interventions (Selfhelp modules, TCS, or Selfhelp +
TCS) on mental wellbeing, in contrast to the control group, at the end of the
intervention period.
To evaluate the effect of the interventions (Selfhelp modules, TCS, or Selfhelp +
TCS) on total sexual outlet compared with the waitlist control group after the
intervention period.
To identify any adverse effects associated with the interventions (Selfhelp modules,
TCS, or Selfhelp + TCS).
Hypotheses
2.1 Primary hypothesis
Participants in the Selfhelp-only modules group will show a statistically
significantly higher proportion of reduction in CSAM behaviours four weeks after
baseline, as compared to participants in the waitlist control group.
Participants in the Selfhelp modules followed by TCS group will show a statistically
significantly higher reduction of CSAM behaviours compared to participants in the
Selfhelp-only and TCS-only groups, post-intervention.
2.2 Secondary hypothesis
Participants in the intervention groups (Selfhelp modules, TCS, or Selfhelp + TCS)
will show a statistically significant reduction in the severity, time and self-rated
risk of CSAM consumption compared to participants in the waitlist control group,
four weeks after the initial intervention. Among the intervention groups, it is
expected that the Selfhalp + TCS group will show the greatest reduction in CSAM
consumption, followed by the TCS group and then the Selfhelp-only group.
Participants in the intervention groups (Selfhelp modules, TCS, or Selfhelp + TCS)
will show a statistically significant improvement in their mental well-being
(measured using the Warwick-Edinburgh Mental Wellbeing scale). compared to
participants in the waitlist control group, at post-intervention. Among the
intervention groups, the Selfhelp + TCS group is expected to show the greatest
improvement, followed by the TCS group, and then the Selfhelp-only group.
Participants in the intervention groups (Selfhelp modules, TCS, or Selfhelp + TCS)
will show a statistically significant reduction in total sexual outlet (measured
using a self-reported measure) compared to participants in the waitlist control
group, after the intervention. Among the intervention groups, the Selfhelp + TCS
group is expected to show the greatest reduction, followed by the TCS group, and
then the Selfhelp-only group.
All intervention groups (Selfhelp modules, TCS, or Selfhelp + TCS) will experience
adverse effects (psychological and emotional distress) to a similar extent, with no
significant differences in the number or type of adverse effects reported. Adverse
effects are expected to primarily involve mild to moderate psychological and
emotional distress, such as feelings of anxiety or frustration, but are not expected
to lead to severe distress or long-term harm.
3.Trial design
This is a prospective, randomised, multicentre, open-label, parallel-group, superiority
trial designed to compare stratified, pair-matched CSAM users across three intervention
groups and one wait-list control group, with an allocation ratio of 1:1:1:1. Following
participant agreement to the terms of the study, demographic information, measures for
stratified randomization, and baseline outcome data will be collected. Additionally, data
collected from the four groups Selfhelp modules, TCS, Selfhelp + TCS, and waitlist) of
the TD-CHAT study will be compared with data from a fifth group (waitlist + TCS) sourced
from the "Scalable Technology for Online Prevention of Child Sexual Abuse and Child
Sexual Abuse Materials" (STOP-CSAM) project.