This research project is for those who are worried about their sexual urges involving children and who have viewed photos or videos of children for sexual purposes (child sexual abuse materials, CSAM) during past six months. This includes for example individuals who have never sexually abused a child but are worried about their urges to do so; individuals who have sexually abused a child or viewed pictures or films of children for sexual purposes and want help with their thoughts and urges; and individuals who are actively using this material or have other ongoing problematic behaviors and want help stopping.  

From our clinical experience, and previous research, we know that having a sexual interest in children can lead to difficulties in different aspects of life, for example anxiety and shame, stressful family situations, fear of being exposed, as well as other potential consequences. 

We are evaluating two different therapeutic interventions in the Bridge research project: 

Mi Bridge: A series of five conversations over three weeks to help participants understand more about themselves and their willingness to change, and to help participants connect with the care they need and want. The conversations are carried out as anonymous text-based chat. Mi Bridge is based on the established and well-researched method of Motivational Interviewing, which has been shown to be effective in helping people achieve the desired changes for several lifestyle related problems. 

ReDirection: A self-help program consisting of five modules and lasting five weeks. The program is based on a cognitive behavioral therapy approach and aims to help participants reduce their use of sexual abuse material by gaining greater understanding of, and skills to manage risky sexual thoughts, feelings, and behaviors. If needed, during the self-help program and at the end, participants have the opportunity to chat anonymously with a practitioner to get support in working with the program. Cognitive Behavioral Therapy (CBT) is an established and well-researched method, helpful for a range of conditions such as anxiety and depression.  

The aim of the interventions is to help participants manage their feelings, thoughts, and behaviors more helpfully so that they can learn how not to act on sexual urges involving children. The interventions can also help participants feel better and get an increased quality of life. 

In this clinical trial, we are comparing against a waitlist control. This means that when the participants are included in the study, they have an equal chance of either being included directly into one of the interventions (Mi Bridge or ReDirection) or being placed on a waiting list for three or five weeks before being able to join an intervention. During those three or five weeks the participants will still receive requests to fill in weekly questionnaires. After this period, participants will access the intervention they are offered. This process is used so that we can thoroughly test our interventions in order to ensure high quality and effective interventions. 

Yes. All participation is anonymous and no identifiable information about you will be collected (e.g. no contact details, personal ID, geographical- or IP-address). The treatment platform is accessible via TOR browser. Onion link to the platform: https://6wvybf7ub3xk5ow66wt7os3aovbzoo2eei6vjirvhvvkmqg4alnezzid.onion/sites/bridge

In the different participating countries, we are subject to different laws.

Sweden: We have to report to the social welfare board when we suspect that a child is at risk or is being harmed. We have to report some crimes which are in preparation or in the process of being committed, such as child rape and serious exploitation of a minor for sexual posing. Concerning crimes in the past, we have a right but not a duty to report. It is not mandatory for us to report CSAM consumption.

Germany: We have to report crimes in the presence or future in cases where the welfare of a child is at stake. Due to a comprehensive duty of medical confidentiality, we don’t have the right to report crimes from the past. It is not mandatory for us to report CSAM consumption.

Spain: We have to report crimes from the past, crimes in the present or future such as sexual offenses that have occurred in Spain or to Spanish people. We also have to report the downloading, possession, and trafficking of CSAM. It is not mandatory for us to report CSAM consumption.

Czech Republic: We have to report crimes in the presence and future such as rape and sexual abuse. It is also mandatory to report abuse of a child for the purpose of the production of CSAM. It is not mandatory for us to report CSAM consumption.

Slovakia: We have to report crimes in the presence and future such as rape and sexual abuse. It is also mandatory to report abuse of a child for the purpose of the production of CSAM. It is not mandatory for us to report CSAM consumption.

Finland: We have to report to the police when we have a reason to suspect that a child has been abused, or if we get knowledge of other crimes in the past, presence or future. This includes rape, grooming, harassment, pandering and solicitation of a child for sexual services from a young person. Concerning cases of CSAM it is mandatory for us to report disseminating and possessing CSAM (incl. gaining access) and following a sexual performance of a child.

Yes, the platform is programmed so that all the main functionality should also work well without enabling JavaScript. Please let us know if you find any important function that does not work without javascript. Nevertheless, the javascript code used on the website is internal, used only for improving the visual functionality, and having javascript activated while browsing our website clearly improves the user experience.

After weighing both the risks and the benefits of having an email attached to the platform, we decided to make it optional for the participants to choose whether they would like to use an email or not. 

The benefits of using an email include us being able to reach participants by email to remind them to take the next step in the program. Another benefit is to be able to help participants with password resets, should they lose their password to the platform. This means that the person who chooses not to leave an email is responsible for keeping their login information safe, as there would be no way to recover the password without an email attached. 

The risks, however, include the identification of participants found through exposure from the use of email. It's relatively hard to obtain an email address anonymously. Using one single email address for more than one purpose, say for Bridge and other email communication, is risky because it makes identification easier if your information is exposed. This is why we encourage participants to create an email just for use in Project Bridge. 

One of the most important and central aspects to us is to keep all information about our participants secure. All potentially person-identifiable data, such as email addresses (if one is being used), chats, and answers to assignments, is stored in encrypted form. The risk of identification based on stored data, even for someone with access to the data in a decrypted form, is under the participant’s control -- by avoiding typing in identifying data (for example in chats), or by avoiding using an email address that can be linked to an individual, there is very little information stored that could make linking possible. 

The only information being stored that could potentially help with a confirmation attack to link a participant to other stored data is timestamps in the database indicating the date and time of a certain action being taken, such as when a message was sent, or an assignment was answered. These timestamps would then have to be correlated with other data somehow obtained outside of the platform, pointing at a person. We consider this risk to be low. 

The platform has functionality for exporting data from the study to excel files, to be stored on the computer of the practitioner performing the export. Only the practitioner/researchers can do this and will do so at the end of the study.  

The way sensitive data is handled once the study is finished affects the long-term privacy for participants. Data is going to be exported from the platform and stored in approved systems at Karolinska Institutet that require two-step authentication or are security-classified to be able to store sensitive personal data. The data will be shared with researchers in the collaborating countries, using a service that requires two-step authentication and makes it possible to securely share and receive data from internal and external users. Data is stored so that unauthorized persons cannot access it. All persons who handle the data are covered by confidentiality obligations, either through their form of employment or via confidentiality agreements established in accordance with the universities’ instructions. The data will be used to do statistical analyses, which will be published and used to see the efficacy of the treatment. 

Using Tor Browser to connect to the platform protects the user from being tracked on the network layer by hindering the IP address from being linked to the web site of the platform. Tor Browser also stops several methods of tracking on the application layer. 

Therapists and administrators of the platform use two-factor authentication (2FA) when logging in to the platform. The second factor is the ability to read incoming text messages to a certain phone number, one per therapist or administrator. 

Feel free to email us at projectbridge@protonmail.com