Introduction
Sexual addiction is a type of behavioral addiction that has a prevalence of 3%-6% in the general population. In this disorder, fantasies and sexual behaviors are difficult to control and the forced performance of these behaviors causes problems in the lives of sufferers and victims. Considering the significant individual and social complications of this disorder, therapeutic interventions are necessary. To treat sexual addiction disorder, we need to use approaches that are known to treat different types of addictions; that is, a multi-factor treatment plan with a biological, psychological, social, and spiritual approach. Although many of these multifactorial approaches have been effective in treating sexual addiction disorder, they are very long-lasting and time-consuming to the extent that some of them take about 5 years. Their implementation in Iran is associated with major challenges given the economic situation of the clients along with other factors, including cross-sectoral coordination. Therefore, there is a need to develop and use short-term treatment guidelines that are affordable. A review of sources showed that the development and evaluation of a specific short-term guideline to treat people with sex addiction has not been done in Iran. Accordingly, compiling a short-term clinical guide and its clinical evaluation was on the agenda of the addiction department of the Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences. The compilation of guidelines and its clinical study in the form of a doctoral dissertation was assigned to one of the students. The dissertation went through its own legal and scientific stages and the guide was compiled and the study of its effectiveness began. In this article, the results of the study of the effectiveness of clinical guideline to treat sexual addiction (CGTSA) disorder in people with sex addiction is presented.
Methods
This was a randomized clinical trial study with pretest-posttest and follow-up. Using the balance block randomization method, 30 male subjects who were diagnosed with sex addiction disorder based on the cut-off point of the hypersexual behavior inventory (HBI) with a score of 53 and above were randomly divided into two intervention and comparison groups. The intervention group received ten 120-min treatment sessions held weekly. Because of the coronavirus pandemic, the treatment sessions had to be held virtually (Skype). The comparison group was put on hold so that they could benefit from the treatment if the guide was effective. Both groups completed HBI three times. The first time was immediately before treatment, the second time immediately after the intervention, and the third time 3 months later in the follow-up phase. The results were analyzed using the repeated measures analysis of variance (RM-ANOVA) method in the SPSS software, v. 22.
Results
The age range of the participants was between 18 and 35 years and the mean age was 26.4. The level of education and marital status of the members of the studied groups was almost the same. Among the participants in the study, 7 individuals had a diploma (23.33%), 18 individuals had a bachelor’s degree (60%), and 5 individuals had a master’s degree (16.66%). A total of 25 participants in the study were single (83.33%) and 5 participants were married (16.66%).
The results of RM-ANOVA for intragroup and intergroup effects of the treatment-type time CGTSA for the HBI variable are shown in Table 1.


The results of Table 1 show that the effect of measurement time on HBI scores is significant (Sig.=0.002, F=12.212). Under these conditions, regardless of the studied groups, there is a significant difference between the mean scores of HBI in the pretest, posttest, and follow-up. Also, the interactive effect of time and treatment group is significant (Sig.=0.023, F=1.487). In other words, the difference in the mean HBI scores at different times varies according to the intervention and comparison groups.
As Figure 1 shows, the results of RM-ANOVA indicate that the intervention group in the posttest and follow-up stages had a significant decrease compared to the control group in the scores of HBI and the scores and symptoms of sex addiction decreased. The post-test results showed the effectiveness of the treatment; however, the follow-up results showed that the stability of the treatment decreases over time.
Discussion 
The results of the present study showed that CGTSA is effective in treating sexual addiction disorder and can cause a significant and rapid reduction in the symptoms of sexual addiction. Therefore, this low-cost and short-term treatment guideline can be used to treat sex addiction. With CGTSA, clients become aware of the nature of their illness and accept sex addiction as a disorder, can identify internal and external drivers, and resist craving and lapses. These patients can replace any sexual behavior with a healthy one. During treatment, with the diagnosis of comorbid disorders, an appropriate referral is made to follow up on treatment. CGTSA based on people’s perceptions of their experiences, changes in behavior and lifestyle modifications, and regular monitoring of patients’ status made the treatment effective. 
The use of a convenience sampling technique, the selection of male subjects, and the short-time follow-up limited the generalizability of the results. Future studies with larger sample sizes, the random sampling technique, long-term follow-ups, and the selection of both male and female subjects can help generalize the results and confirm the stability of the findings over time. Overall, it can be concluded that CGTSA can significantly affect the dimensions of sex addiction. Accordingly, patients had more control over their thoughts, feelings, and behaviors related to sex addiction after treatment. In the coping dimension, the use of sexual intercourse and behavior as a means to get rid of unpleasant feelings decreased in patients, and in the consequences dimension, job, social, educational, and interpersonal dysfunctions decreased as well.

Ethical Considerations
Compliance with ethical guidelines
The present study was approved by the Ethics Code 945/1399 in the Ethics Committee of the research vice chancellor of Iran University of Medical Sciences and was registered in the Iranian Registry of Clinical Trial (IRCT) (code: IRCT20200905048628N1). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This article was taken from the PhD thesis of Arash Javaheri in the Department of Addiction Studies, Faculty of Behavioral Sciences and Mental Health, Iran University of Medical Sciences. This thesis was conducted in collaboration with the Vice President for Research and Technology, Iran University of Medical Sciences.

Authors contributions
Research, conceptualization, editing, finalization of writing, supervision, and project management: Mohammad Bagher Saberi Zafarghandi, Arash Javaheri. Methodology: Mohsen Shati, Mohsen Roshanpajouh.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to express their gratitude to Mohammad Kazem Najafi, sex therapist, and manager of Kazi and Kazi school and Ali Akbar Ebrahimi, Head of Prevention Welfare of Isfahan Province, and all respected clients who helped to increase the knowledge in diagnosis and treatment of sexual addiction disorder with their participation and cooperation.

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