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P.A.W.S. - what are they, cure, duration

Discussion in 'Rebooting - Porn Addiction Recovery' started by Fenix Rising, May 12, 2019.

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  1. Hi,

    That is very surprising. I can't say why they didn't find lower D2's. As you said, it may involve D1's or opioid receptors, or the sensitivity of receptors, rather than density of the receptors. Or it could be dynorphin levels, etc.

    Other studies on addictions have been mixed when it comes to D2 receptors - such as gambling and obesity (even drug addictions). Sometimes yes, sometimes no. I sent your email to one of the top neuroscientists in the world (who has done many studies on behavioral addictions), and he said the following (I was waiting on his answer before emailing you back):
    I am not surprised – findings in gambling disorder (and obesity) and multiple SUDs are not clearly linked to D2/D3 receptor availability. Can read:



    Potenza MN (2018) Searching for replicable dopamine-related findings in gambling disorder. Biol Psychiatry 83:984-986.


    Nutt, D. J., Lingford-Hughes, A., Erritzoe, D., & Stokes, P. R. A. (2015). The dopamine theory of addiction: 40 years of highs and lows. Nature Reviews Neuroscience, 16, 305. doi:10.1038/nrn3939


    Potenza MN (2013) How Central is Dopamine to Pathological Gambling or Gambling Disorder? Frontiers in Behavioral Neuroscience 7:206. (PMC3870289)

    So, I really have no comment as of yet. However, every other neurological study on porn users or sex addicts has reported brain changes consistent with the addiction model. This page lists 53 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal). Eight of the 53 studies point towards desensitization or habituation in porn users/sex addicts: 1, 2, 3, 4, 5, 6, 7, 8.


    I just noticed that you posted on reboot nation the following:

    Gary Wilson might be wrong about the whole D2 receptor downregulation/desensitization as well. So he could also be wrong about the "permanent" damage.

    I wonder where you got the idea that I said porn addiction causes "permanent damage". I have never said that. In fact, YBOP has an FAQ where I say that I believe it doesn't cause permanent damage - Does porn addiction cause irreversible damage to the brain? Everything about YBOP is based on the fact that brains can heal.
    Best,
    gary
     
  2. Questions I had for Gary Wilson:

    Hello Gary,

    You might be wrong about the whole D2 receptor down regulation since a new study (that is yet to come out, debunks this..

    In 2017 I participated in a porn addiction study at University Medical Center Groningen in The Netherlands to investigate if porn addiction downregulates D2 receptors in the nucleus accumbens by using radioactive raclopride (selective dopamine D2 antagonist) in a PET scan and an fMRI scan to scan the reward pathway VTA – NAcc – PFC.

    Quoted from Dutch wikipedia:


    "One of the hypothesized mechanisms that may underlie the development or maintenance of addictive behavior is a disturbed processing of dopaminergic signals. Dopamine is a substance that sends signals in the brain. In addicts, receiving dopamine does not go well. This so-called reduced dopamine 2 (D2) receptor availability has often been demonstrated in various addictions, including substance abuse (cocaine), gambling addiction [8] and obesity [9]. Currently [(since) when?], Imaging studies are being conducted at the University Medical Center Groningen (UMCG) to determine whether this mechanism also exists in porn addiction. [10]



    Guess what, today I called the with the doctor to ask him the results, because I was losing patience, and wanted to know the results, which is: there was no D2 receptor down-regulation in any of the addicted participants, including me. They all had issues with low motivation, anhedonia, social anxiety, fear, insomnia, anxiety and severe PAWS, otherwise known as prolonged withdrawal. (including me). My brain showed normal D2 binding and normal blood flow to the prefrontal cortex. No sign of hypofrontility. The MRI also showed no sign of abnormalities in the nucleus accumbens of all participants.

    The study is about to be published on pubmed, but it can take some time.

    About myself: I have relapsed multiple times and no real bad withdrawal symptoms have come back. I still believe PAWS (withdrawal) from this addiction is real and it's a dopaminergic problem, but D2 receptors are not involved according to this study. My brain showed normal D2 density just as the controls. Maybe there are other systems involved. I hypothesize opioid and dopamine anomalies in the VTA (ventral tegmental area), but not with D2 receptors in the NAcc (nucleus accumbens) I also think there are other dopaminergic subtype receptors that could be involved (maybe D1 and D3?) has something to do with our problems. Just a hypothesize.



    I was kind of disappointed and also a bit sceptical, because I was hoping to see some changes in my brain. To prove that this porn addiction really is a thing and can be measured with scans. It's strange that people with other behavior addictions like gambling, do show this blunted D2 binding… This study can be used as fuel by the porn addiction naysayers. So I hope this study gets peer reviewed and more faculties perform more and advanced studies on the matter.

    I think it's a bit strange that people with proven D2 low receptor density, like behavior addictions like eating and gambling addiction do show D2 decreased binding. While most porn addicts face a whole lot more of mental, physiological, mental and psychological problems than gambling and eating addicts. Never heard about a gambling addiction that developed severe withdrawal (PAWS)

    I know many cocaine and other drug addicts (with low D2 receptor expression) That have zero problems getting their dicks up. So maybe for us porn addicts it works a little different. A lot of research needs to be done on this subject. That is for sure.

    What is your say on this? Was this a flawed study to begin with?

    I hope you read this and respond to me!
     
  3. This is what Gary Wilson to me said about 'permanent' damage:

    "Hi Peter,

    When I gave that talk in Istanbul (it wasn't a TED talk). Not my best talk. I was trying to help the audience understand what a serious problem porn-induced sexual dysfunctions are becoming for today's porn users. In the decade since I first started monitoring self-help forums, recovery times have increased to a disturbing degree. The younger the age that people regularly start using porn, the more stubborn the conditioning. Even more disturbing, some of the men I know who have recovered sense that their sexual response to real partners may still not be what it would have been had they not detoured into porn. Of course, they will never know for sure.

    Any type of deep conditioning can be difficult to reverse, or to reverse entirely. But it's not brain "damage". Our brains are built to retain "important" lessons. Think of the results of childhood trauma, for example. Some people will not succeed in overcoming its effects, even though brains are unquestionably plastic. In the case of some sexual conditioning, some people will have created such powerful pathways tied to screens that their sexual response to partners may never be what it would have been had they not deeply conditioned themselves to porn. Others simply won't do the work, or won't be consistent enough, to recondition their sexual response to real partners.

    In short, I was referring to the possibility of collateral damage from the human experiment in youthful sexual conditioning with today's porn. Somehow this point was turned into the story that I claim the conditioning "is permanent." In short, in trying to sound the alarm for the benefit of young men worldwide, some of those same, anxiety-prone young men have taken out of context a remark I made to a specific audience of healthcare professionals, and become obsessed with it.

    Just to clarify, I was not suggesting that withdrawal symptoms are permanent. By definition, withdrawal is temporary...even the PAWS variation.

    No doubt there is more to be discovered about the mechanics of brain plasticity in addiction and sexual conditioning. One of my goals was to inspire other generations to ask better questions and gather better information. For too long, sexologists from my generation have assured us "porn addiction" is not real, and that sexual tastes are innate and immutable. Every day on the forums, forum members prove both statements to be false. If my work encourages brilliant young minds to do better research, I will be content.

    Your hypotheses about the misery of withdrawal sound very promising, and some of those possibilities are mentioned in my book. I hope you will stay in this field and help encourage/produce sound research that helps elucidate the phenomena associated with internet porn conditioning. It's long overdue.

    Keep me informed of what you learn.

    Kind regards,
    Gary"
     
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  4. TheRetainer

    TheRetainer Fapstronaut

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    Day 171

    Pretty average, still motivated, functioning quite well. Sleeping long hours most night, like 9 hours solid without any waking really. Feeling pretty tired in the day but motivated enough to get up and do everything that needs to be done. Socializing is quite easy, I did choose to go see my brother and parents and friend the other day.

    Just not joy, happiness, no libido. But thats ok I guess.. Anhedonia rules.

    Ive been up and down throughout this but the ups and downs are less violent now and a slow progression to the good. I am in a place where I feel a bit negative and doubt the process and that I will get any better. But I seem to be thinking negatively in general.

    Definite changes from the start...

    Stopped waking up in the night to urinate
    Voice deeper and stronger
    More consistent motivation to work (I dont really have to work)
    Less social anxiety, better eye contact etc
     
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  5. Dave G 123

    Dave G 123 Fapstronaut

    It sounds like he's listening, and that he gets it. Which is great news as far as I'm concerned.
     
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  6. Excellent post man!
     
  7. Chakancha

    Chakancha Fapstronaut

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    Hello, Sorry for my English,.
    Thank you to all of you for your testimonials. i have been in paws for 1 year now. I quit pmo after a long session (5-6 orgasms in a short period of time) and a panic attack where I thought I was going to die. I was so traumatized by this panic attack that I felt like I had developed an anxiety disorder. In fact I feel like the paws are over for me but I get stuck in the fear of my anxiety that comes back every time I am calm ... Someone lives where has been through what I feel and can advise me ?
     
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  8. A conversation between me, Gary Wilson and the neuroscientist that conducted the study:

    "Hi Peter,

    Thanks for adding this conversation. I have read Gary’s book and I agree with him that there are limitations involved, e.g. sample size. Also we did not perform a challenge to see differences in dopamine response. These will be mentioned in the manuscript. However I can guarantee that the tracer was of good quality, and that the measurements seemed quite robust with relatively low standard deviations. Maybe in the future PET imaging will become available at our institute to investigate other systems as well.

    Best regards,

    Gilles"

    "Thanks for your work in this area Gilles. It's much needed.
    Here are a few questions that come to mind:
    How do you reconcile these 2 simultaneous observations:
    a. Internet addiction reduces dopamine d2 receptors and
    b. Internet porn is the most addictive subtype (application) of internet addiction, with a denial of effects. You would expect the most potent of internet addictions to be the best representative of the trend, and not an exception to the rule.
    Evidence:

    https://www.researchgate.net/public...2_receptors_in_people_with_Internet_addiction (general internet)

    https://pubmed.ncbi.nlm.nih.gov/24737115/ (validated or replicated in internet gaming subtype)

    Given that porn addiction causally increases delay discounting, which is a facet of impulsivity, how would you explain, at the neurological level, greater impulsivity while there are no changes in dopamine receptors (given evidence that correlates both)?
    Evidence:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106030/

    What about dopamine transporters instead of receptors? It might be useful to look at them as well.
    Evidence:

    https://pubmed.ncbi.nlm.nih.gov/22505818/ (general internet)

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6876827/ (validated and replicated in internet gaming subtype)

    Prediction: One might reasonably expect the same for internet porn, right? Depression is not exclusive of gaming, it occurs in porn as well.

    Important: Have you looked at the orbitofrontal cortex? In gaming it has been implicated (same paper cited above):
    https://pubmed.ncbi.nlm.nih.gov/24737115/

    Compulsions match very well with orbitofrontal deficits (either OCDs or addictions), so compulsive sexual behavior should not be an exception, that would be rather strange. I would expect the higher CSB levels, the lower sugar metabolism in OFC. So do a PET study looking with especial interest at the OFC.

    Kind regards,

    Gary Wilson"

    "Hi Gilles,

    I remember we had to fill a questionnaire before the scans. There was no question about how much porn I had watched, what kind of porn I watched and the frequency of the orgasms I had. I think the porn addicted group, needs standard protocols like:


    Need to have watched porn for multiple months and long sessions at a time
    Needs to be real sensitive for cues and is triggered into relapse very easily after just a couple of abstinent days
    Needs to have shifted to a different porn genre (tolerance)
    Needs to have some erection problem (PIED), premature ejaculation or anorgasmia
    Can't get his mojo up with a hottie, but can jack it to porn with no limits
    Needs to have psychological problems and (severe) withdrawal symptoms when stopping the habit
    All participants need to overindulge into porn the days before and right before the scans are taken.

    I think a lot of the scanned "porn addicts" really did not have the severe reaction to porn addiction, and maybe therefore had normal D2 levels.
    I remember you guys had a really hard time finding the real severe addicted porn addicts. You guys even made a TV "commercial" on Powned TV, to find the real addicts, and it took a long time to find them. The Netherlands is a very small country, and with this addiction, there is a lot of shame involved. You might have not found the real deal addicts that are roaming the forums of nofap.com et al. We need this research done worldwide to find the hardcore addicts. (which I know is impossible)

    As for me: I was already 40 days clean from porn, and only watched some porn the night before the scan. So maybe my D2 system already went through a phase of healing.


    I had my own theory about porn addiction and withdrawal in 2018:

    "I hear a lot of talking about dopamine receptors, there are a lot more things at play here. The ventral tegmental area is not projecting enough dopamine to the nucelus accumbens. The tyrosine hydroxylase producing neurons need recovery here. (Like opioid addicts) The VTA overall needs to be repaired. There is possible a change in the amount of dopamine transporters too. There is an increase in the amount of dynorphins. The kappa opioid receptors also need to regain homeostasis.

    They have been upregulated and are very sensitive for dynorphins. Dynorphins are the main opioids that cause you to feel bad during withdrawal. Dynorphins work antagonistic with endorphins at the mu-opioid receptor and decrease extracellular dopamine levels. The anti-reward pathway stress circuit releases a lot of CRF and this increases the anxiety even more. The amygdala is also extra active this time. The anti reward pathway remains active until everything reaches homeostasis.

    To upregulate dopamine receptors you can use l-tetrahydropalmatine and forskolin. To upregulate endorphins you can use low dose naltrexone or use the sauna."
    "A lot of drug/medication withdrawal symptoms resemble eachother. SSRI's, opioids, benzos, NMDA antagonists, cannabinoids, gabapentinoids, GABA B agonists and dopaminergics share the same symptoms. But they all have their own unique feelings, symptoms and mechanisms.

    During our withdrawal we have decreased dopamine projection from the ventral tegmental area to the nucleus accumbens and prefrontal cortex, have decreased dopamine receptor expression, have increased dynorphins and dynorphin receptors in the amygdala (kappa opioid) that decrease dopamine even more. I hypothesize that we have increased or decreased dopamine transporters that changes dopamine levels in the extracellular synaps space and disturbs the action of the dopamingergic presynaptic neuron.
    So we have 4 x an antidopaminergic action going on. We are in a hypodopaminergic state.

    On top of that our amygdala is overactive and signals our hypothalamus (CRF)->pituitary (ACTH)->adrenals to pump out stresshormones (cortisol, dynorphins, noradrenaline) Our GABA levels also drop making us even more anxious. HPA dysfunction. If one neurotransmitter system is out of whack, a lot more interconnected systems follow.

    Kind regards,

    Peter Groen (SleepIsLost)"

    "Indeed, good point. It may be the case that D2 receptors were not downregulated yet. We did not check for the duration of the addiction and included the ‘best’ subjects we could get. Of course there are many limitations in our study, and there will be in this type of research, because there are no validated criteria to identify someone with this addiction. We hypothesized that a decrease in D2 receptors would mostly be linked to compulsive aspects of the behavior and therefore used a screening tool focusing on these aspects. But for now the manuscript is still with the reviewers, will have to wait for their feedback as well.

    Kind regards,

    Gilles"
     
    Last edited by a moderator: Sep 23, 2020
  9. DGZ

    DGZ Fapstronaut

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    In what way do you think we should recondition ourselves? Socializing, exercise, positive mindset?
     
  10. humbleone

    humbleone Fapstronaut

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    In the sake of transparency, at nearly 19 months, I am in a state of limbo, I've had tons of relapses recently. Lots of sex apps, 2 escorts, 3 sex with tinder girls, even did a little bit of cocaine partying with one girl.

    I don't feel like Im reset to beginning, but progress has stopped. Constant brain ache, and anxiety that comes and goes.

    I am now back on monk mode, I just need to get to 90-180 days monk mode again to see how I end up. I fear I could end up becoming one of those 3-4 year full cycle cases if Im not careful.

    The issue with PAWS is, the suffering becomes so normalized, that the idea of any other normal is a distant vague concept
     
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  11. clapas

    clapas Fapstronaut

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    In my opinion, withdrawal symptoms and trauma are hard to tell apart.

    You write about "fear of anxiety". In some languages, e.g. german Angst means both fear and anxiety. So your fear could be due to withdrawal symptoms or trauma. You combat the former with abstinence and the latter with therapy.
     
    Last edited: Sep 23, 2020
  12. humbleone

    humbleone Fapstronaut

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    What about cravings for sex, this is my downfall, porn I don't crave, real life porn style sex I always end up craving and giving into. Granted all our journeys are unique, I was also a sex addict as well as porn (many hundreds of partners), but I always seem to crave an old sex partner or crazy porn style sex, and that causes me to go on tinder etc.

    How do you cope with sexual craving and fantasies at this point?
     
  13. DerJogge

    DerJogge Fapstronaut

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    Thanks Don for taking your time to give us a lot of insight. I try my best to put myself in new situations and force myself out of old habits/thought patterns and at the moment I often question myself if these are PAWS symptoms or if it’s just the trauma that left. But the last days have just been awful. My mood, depression are just constantly going up and down, coming and going and the anedonia is giving me the rest. I feel like shit although I try my best. Really vivid and scaring dreams don’t help with the fatigue either. Also I’m so detached from everything. The brain fog and derealisation disconnects you from the here and now - I just look forward to the day I feel connected to reality again. Just today I felt really guilty as I thought I’m doing something wrong and that I should get my mindset fixed but in the end I came to the realisation that I can’t do shit at the moment and just ride out this insane wave I’m currently in.

    In conclusion: I think it’s important to be aware of the danger of getting caught up in a trauma but after 12 months it’s way to early to be stressed out about it. For me it didn’t „click“ yet where I felt like there is something fundamentally changing and where I’m only left with a few symptoms. In many (ongoing) recovery stories there seem to be a certain breakingpoint where the person itself realises a big change in things while the person is still left with a few leftover symptoms that slowly disappear. This is the part where letting go of your old thought patterns and conditioned pathways is really important. For me it’s just a side note that I have to remember until it’s time and not to fully emerge and identify with these thought patterns as they hit my consciousness. I just write this out that clearly as I found myself getting stressed out about doing things wrong in recovery although I do my very best but my brain is just doing repairing big time at the moment. Maybe there are other guys beating themselves up over things they can’t change and them being also to deep into the woods to realise that they are on the right path and just have to keep going no matter what.
     
  14. ruso

    ruso Fapstronaut

    For me, my PAWS have come in short bursts if I don’t get dopamine elsewhere. The symptom is this shakespearian internal drama of “oh no! what shall compare to porn. Whatever shall I do? Nothing compares to the thrill of it”. But now whenever it hits me, I write on my own experience, watch a show and if I’m still feeling this, nap. Also I guess helping others and reading how others go through it, helps.
     
  15. Overhaul

    Overhaul Fapstronaut

    A lot of stuff here on NoFap is relentless bollocks but this is not. Interesting and thoughtful, thanks. A much wiser prescription than god or cold showers.
     
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  16. clapas

    clapas Fapstronaut

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    It is not wise to disregard the grace of God —call it God or whatever you want.
    And it is not wise to dismiss cold showers. Its efficacy is proven.
     
  17. humbleone

    humbleone Fapstronaut

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    Thanks. I actually agree with all of what you say. To be a human, is to have certain archetypal energies, like one of worship, and it makes sense to have healthy goals, ambitions and idols.

    Specifically though, how is fantasies and cravings for you. I feel like we could have similiar personalities, and similiar ability to produce fantasies. Does this still happen to you, or have they all but left for good? Do you ever have images of porn style sex come in your mind, or are they long but gone?
     
    Don Quixote likes this.
  18. humbleone

    humbleone Fapstronaut

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    And what about the content? In the last 19 months I've had small periods where sexuality has returned to normal i.e. normal missionary sex, with a cute girl I like has turned me on, but this will escalate to sick porn style gangbangs etc etc pretty quickly, and always ends up there for me, into the fetish extreme content. Did this type of extreme fantasies dissappear for you and if so at which point?
     
  19. Big Lebowski

    Big Lebowski Fapstronaut

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    I am starting to sleep much better now and am nearly cured from all the symptoms, even the anhedonia is lifting. The lack of sleep that comes with the stress of this all fucks you up. If you guys cant sleep right look into CBT-I.

    Edit: I should note that watching porn in my bedroom conditioned the room to feel like a prison with all the stress and worries and especially relapsing and hence I could not sleep in there. It's known as Psychophysiological insomnia and severely impact's your sleep. I was recently staying round my grandparents where I could sleep better, enter REM sleep and dream 4-5 different dreams and erectile health was visible everyday. This was the catalyst that enabled me to deal with this symptom and conditioned behavior that porn and other stressors plagued me with.

    Look into stimulus control and sleep restriction if you struggle with your sleep, I know a load us will.
     
    Last edited: Sep 25, 2020
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