key: cord-0838243-r5w786ks
authors: Gillespie, Steven M.; Jones, Andrew; Uzieblo, Kasia; Garofalo, Carlo; Robinson, Eric
title: Coping using sex during the coronavirus disease 2019 (COVID-19) outbreak in the UK
date: 2020-11-27
journal: J Sex Med
DOI: 10.1016/j.jsxm.2020.11.002
sha: e28fe2f73becc8064a815118fc71f44789cd1d13
doc_id: 838243
cord_uid: r5w786ks

BACKGROUND: The use of sex to cope with negative affective states during the coronavirus disease 2019 (COVID-19) pandemic may be influenced by various socio-demographic and psychological characteristics. Aim: We aimed to examine the effects of social distancing, loneliness, difficulties in emotion regulation, and self-regulation on participants self-reported coping using sex during lockdown in the UK. METHODS: Participants had to be residents of the UK, aged between 18 – 60 years, fluent in English, and had to have an internet connection. Participants were instructed not to participate if they had consumed alcohol in the previous 24 hours. A total of 789 participants aged 18-59 completed an online survey. Participants completed self-report measures of social distancing, loneliness, and difficulties in emotion regulation. A Go/No-Go task was used to assess self-regulation. Outcomes: Participants self-reported their use of sex to cope over a 14-day period during lockdown, as well as retrospectively for a 14-day period immediately preceding lockdown. Coping using sex items included consensual and non-consensual themes. RESULTS: Overall, there was no increase in coping using sex during compared with before lockdown. Findings showed that 30% of participants reported increased coping using sex during lockdown compared with before, 29% reported decreased coping using sex, and 41% reported no change. All regression models included age, gender, ethnicity, diagnosis of psychiatric condition, level of education, being at high-risk for difficulties relating to COVID-19, living alone, and diagnosed or suspected COVID-19 as covariates. Being younger, being male, and greater emotion dysregulation were associated with higher coping using sex total and consent subscale scores during lockdown. Being younger, being male, not living alone, and less adherence to social distancing advice was associated with coping using sex with a theme of rape/violence during lockdown. Clinical Translation: A proportion of participants used sex to cope more often during lockdown compared with before. Less adherence to social distancing advice and emotion dysregulation were associated with using sex to cope during lockdown. Strengths and Limitations: Strengths of this study were the large sample size and inclusion of key socio-demographic characteristics as covariates. The main limitations were the cross-sectional design and a sample that was mostly white, educated, and female. CONCLUSION: Participants who had difficulty regulating emotions were more likely to use sex to cope. It is important that support is available for people who have problems regulating their emotions during the pandemic and that they have access to appropriate help and advice.

The coronavirus disease 2019 (COVID- 19) outbreak presents a variety of economic, psychosocial, and health related stressors that are likely to have a considerable impact on mental health and well-being for some individuals 1, 2 . The rapid spread of COVID-19 has led to the introduction of social distancing measures in countries all over the world in an effort to reduce the spread of infection. However, these measures are also expected to have short-and long-term adverse consequences for mental health and well-being 3 , and it is likely that some people will use problematic coping behaviors 4 . In the present study, we investigated the prevalence and correlates of coping using sex during COVID-19 lockdown in the UK.

A review of the evidence on the psychological impact of quarantine, undertaken in response to the COVID-19 outbreak, highlighted a variety of negative impacts observed following quarantines for severe acute respiratory syndrome, Ebola, and H1N1 influenza 5 .

Examining responses to past traumatic, environmental, and natural disasters suggests that the negative consequences of COVID-19 might include higher prevalence of substance use disorder, domestic violence, and child abuse 6 , as well as overeating 7 . Ways of coping with isolation during the period of social distancing are likely to include both health harming (e.g., alcohol use, substance use) and health protective (e.g., exercise) behaviours 7 . This is consistent with the Threat Appraisal and Coping Theory 8 , according to which adaptive and maladaptive coping strategies should be considered as a response to cognitive appraisals of a situation or condition. Coping is defined as the person's cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as stressful or exceeding the person's resources 8 . The evaluation of a coping strategy is tied to its adaptive or maladaptive effect on one's well-being in the short-and/or long-term. Adaptive coping involves behaviors that are linked with positive outcomes; for example, exercise, good sleep J o u r n a l P r e -p r o o f hygiene, and social support seeking [9] [10] [11] [12] [13] [14] . In contrast, maladaptive coping behaviors are associated with negative outcomes; for example, binge eating, self-injurious behaviour and problem gambling 15, 16 . A different strategy to cope with negative situations that has not been studied in the context of COVID-19 is the use of sex to cope, including increased pornography consumption, risky and unlawful sexual behaviours.

An increase in consensual sexual activity during prolonged periods at home with a romantic partner may not be unexpected. However, an increase in sexual fantasising, viewing pornography, masturbation, and engaging in sexual acts with others to cope with difficult, stressful, or challenging situations may be associated with adverse outcomes, including more risky sexual behaviours 17, 18 , and feelings of anxiety, shame, guilt and loneliness 19 . Although a link between sex and coping during COVID-19 has not been examined, statistics have shown dramatically increased traffic to Pornhub and other major providers of Internet pornography during the COVID-19 crisis 20 . This evidence lends support to the hypothesis that for many people, pornography may represent a means to cope with the restrictions imposed by the lockdown measures. Although descriptive, these statistics are consistent with research showing that online pornography can be used as a way to cope with life stressors, including money stress, family stress, and work stress 21 .

Beyond the use of pornography, considerable variation has been reported in the extent to which people experience sexual interest or sexual response during negative affective states 22 . Negative mood states are typically associated with decreased sexual interest and arousal, yet a proportion of heterosexual male participants have reported increased sexual interest when experiencing negative affect 23 . Of those indicating depressed mood, 9.4% reported increased and 42% reported decreased sexual interest when depressed; for anxiety/stress, the percentages were 20.6 and 28.3%, respectively 23 . Similar results have also been reported in a sample of female college students, and it was shown that, in general, sexual interest during J o u r n a l P r e -p r o o f negative mood was more commonly reported by male compared with female respondents 24 .

Qualitative findings indicate that sex when depressed can serve needs for intimacy and selfvalidation, while sex when anxious appears to be more simply related to the calming effect of sexual release 23 .

In relation to COVID-19 in particular, findings from China 25 , and in three South East Asian countries 26 , show tentative support for the hypothesis that while most participants might show either reduced or similar levels of sexual behaviors during the pandemic, a small proportion of participants will report more frequent sex. When considering that the COVID-19 pandemic and associated lockdown measures could contribute to changes in negative affect, it is perhaps unsurprising that some people will resort to problematic ways of coping, including using sex to cope, during the period of lockdown.

Other reports have similarly observed a relationship between negative emotions and sex among people who have sexually offended 27 . Cortoni and Marshall 28 showed that sexual preoccupation was linked with use of sex to cope, and that consensual and non-consensual coping using sex was associated with feelings of loneliness and intimacy deficits in adults who had sexually offended. Other studies have shown that both sexual offenders with adult and child victims engage in offense related fantasies to cope with negative emotions 29, 30 .

As well as negative emotions, some reports have also highlighted feelings of loneliness as a risk factor for sexual offence recidivism 31 , although this evidence remains tentative and inconsistently supported 32 . The role of loneliness may be especially important as it relates to the COVID-19 pandemic, given that limited social contacts due to mobility restrictions could ostensibly trigger feelings of loneliness.

It has been proposed that the use of sex as a means to cope with negative affective states may reflect impairments in general self-regulation and emotion regulation in particular 33, 34 . Emotion regulation refers to the process by which individuals use a range of strategies J o u r n a l P r e -p r o o f to exert control over which emotions they experience and when they experience them 35 , and includes the ability to engage in goal-directed behaviour and refrain from impulsive actions when distressed 36 . There is evidence that difficulties in cognitive reappraisal, that is, in using cognitive resources to construct an emotion eliciting situation in such a way that the emotional impact of the situation is altered, are associated with problems in regulating sexual response 37, 38 . It has also been shown that difficulties in emotion regulation represent 'psychologically meaningful' risk-factors for sexual offending 32 . Emotion regulation also plays an important role in the offence process for sexual offenders 39, 40 , and difficulties in emotion regulation have been identified in men who engage in sexually coercive behaviors [41] [42] [43] [44] [45] .

The current study aimed to examine the use of consenting and non-consenting sex as a means to cope in a UK sample of men and women. We recruited participants online during government enforced lockdown and asked them to report on their use of sex as a means to cope over the last 14 days, and retrospectively over the 14-day period that preceded the introduction of government enforced lockdown. We examined changes in self-reported use of sex as a means to cope following the introduction of strict social distancing measures, and the ways in which physically distancing oneself from people outside of the household, perceived feelings of loneliness, self-regulation and difficulties in emotion regulation were associated with current levels of coping using sex.

Given that sexual coping is not recognised as an adaptive response to negative feelings, and only a small proportion of participants report an increase in sexual interest and response while experiencing low or anxious mood, we did not predict an overall increase in coping using sex during government enforced lockdown in the UK. We predicted that selfreported coping using sex during the period of lockdown in the UK, for both consensual and non-consensual acts, would be associated with increased reports of social distancing and J o u r n a l P r e -p r o o f loneliness, and with more difficulties in self-regulation and emotion regulation. We also examined a series of two-way interactions with social distancing as it was predicted that participants who reported greater social distancing coupled with either feelings of loneliness, difficulties in emotion regulation, or poor self-regulation would show the highest coping using sex scores.

Social distancing and lockdown were officially ordered by the UK Government on 23rd March 2020. Participants were recruited via Prolific Academic on 19/04/2020 -21/04/2020. Prolific Academic provides a platform for conducting paid research 46 .

Participants recruited via Prolific Academic have been found to produce high quality data from a more diverse population than similar recruiting tools (e.g. MTurk, CrowdFlower) 46 .

In order to participate, individuals had to be aged between 18 -60 years, a resident of the UK 

J o u r n a l P r e -p r o o f Social Distancing 47 . We modified a social distancing questionnaire that was designed in the context of COVID-19 to assess the extent to which participants were observing social distancing advice 47 . Participants were asked in the previous two weeks how much time they had spent with friends, immediate family, colleagues and usual social network in person, with the anchors 1 (not at all) to 5 (very often). The original scale, which was designed for use with adolescents, was modified for use with adults by replacing an item that asked about "time spent with others (e.g., teachers or neighbours)" with an item that asked about "time spent with others (e.g., colleagues or neighbours)." Items were reverse scored so greater scores indicated increased social distancing. They were also asked about their social media use to connect / play games with friends and family, individuals/groups outside of their usual contacts using the same anchors. Four items for social distancing (N = 789; ω = .638) were included in the current analyses, and an additional four items asked about social media use (N = 789; ω = .735).

UCLA Loneliness scale 48 . The UCLA loneliness scale is a 20-item Likert scale which measures subjective feelings of loneliness and social isolation (e.g., 'I lack companionship'), with the anchors 'I often feel this way', 'I sometimes feel this way', 'I rarely feel this way', 'I never feel this way'. Participants were asked to think about the 'last two weeks' when responding. A total score for loneliness is used by summing the scores from each question. Evidence suggests the scale has good psychometric properties 48 . The internal consistency in this data set was excellent (N = 789; ω = .952)

Coping Using Sex Inventory (CUSI) 28 . Participants completed the 16-item CUSI, which provides a series of scenarios and asks participants to indicate using a Likert scale from 1 (not at all) to 5 (very often) how often they engaged in these behaviors. The inventory consists of three subscales, asking about sexual thoughts and behaviors with themes of consent, rape, and child sexual abuse. The scale also yields and overall score, with higher J o u r n a l P r e -p r o o f scores indicating more frequent use of sex to cope. An example of a consensual item is 'I have fantasized about having sex with a consenting adult,' while an example of a rape item is 'I have forced my regular partner to have sex.' Two versions of each scenario were asked:

(1) in the two weeks before lockdown was introduced by the UK government, and (2) in the last two weeks. Although reports for the last two weeks were used here to understand predictors of coping using sex during COVID-19, retrospective reports were used to estimate the proportion of participants who reported increased or decreased coping using sex. The scale had good internal consistency for both scenarios (before lockdown N = 760; ω = .803; two previous weeks ω = .698) Worries about COVID19 Questionnaire. Participants were asked to rate on a novel scale how strongly they agree that they were worried about i) catching COVID-19, and ii) they might lose their job due to the COVID-19 crisis (strongly disagree, disagree, unsure, agree, strongly agree). Participants were also asked to rate how worried they were about their i) overall health, ii) financial security and iii) food access compared to before the COVID-19 J o u r n a l P r e -p r o o f crisis (a lot more worried, more worried, no more or no less worried, less worried, a lot less worried). Scores were summed across the five items. Each item had a maximum possible score of five. The internal consistency was good (N = 789; ω = .653).

Go/No-Go task 51 . Participants completed a Go/No-Go task to assess general selfregulation skills. Specifically, the Go/No-Go task was used to assess participants' behavioral ability to withhold a prepotent motor response. Although general self-regulation and emotion regulation share functional overlaps, these constructs are nonetheless etiologically and biologically distinguishable, and are differentially associated with psychopathology 52 . Thus, the Go/No-Go task was used to measure a function that is separable to that measured by the DERS-16, supported by the finding that cognitive and behavioural measures of selfregulation are weakly correlated and provide unique information 53 . Each trial began with a fixation cross ('+') presented in the centre of the screen for 50 ms followed by a blank screen for 150 ms. Following this, a shape (circle or square) appeared in a random spatial location on the screen for 1000 ms or until a response was made. On 'Go trials' participants were required to press SPACE in response to the shape as quickly as possible, on 'No-Go' trials participants were required to withhold their response to the shape. 

All measures and the main analyses were preregistered using AsPredicted (#39502), an online platform that allows the authors to pre-register hypotheses, procedures, and planned analyses, and to separate these from exploratory tests, on 19 April 2020. Upon signing up to the study, participants were presented with a landing page discussing the sensitive nature of some of the questionnaires, before reading the information sheet and providing consent. They 

J o u r n a l P r e -p r o o f First, we tested the interrelationships between all variable using Spearman's rank correlations. We created binary variables for ethnicity (white -other), psychiatric diagnosis (present -absent), education (educated to degree level and above -not educated to degree level), being in a high risk group for difficulties resulting from COVID-19 (e.g., presence of diabetes) (present -absent), and living status (alone -with others). To examine whether participant characteristics were associated with variability in coping using sex, we used CUSI total and consent subscale scores over the last 14 days as dimensional outcome variables in multiple linear regressions. Because scores on the rape subscale of the CUSI were highly positively skewed (towards zero), we used logistic regression to predict membership based on a binary variable (0 = endorsed none of the rape items, 1 = endorsed at least one rape item). Scores on the CUSI child subscale were also heavily skewed toward zero, with only 1% of participants endorsing at least one of the items. As such, this variable was not used as an outcome measure. Table 1 shows the minimum and maximum score, mean, standard deviation and median score on each of the key variables. Scores indicated that participants, on average, engaged in high levels of physical social distancing. Coping using sex scores during COVID-19 were minimal for the two non-consensual subscales, with median scores on the rape and child subscales equivalent to the minimum score possible.

There were no statistically significant differences in the age of completers vs non- J o u r n a l P r e -p r o o f Differences in coping using sex Figure 1 shows that there was no overall increase in coping using sex during COVID-19, comparing retrospective reports for the two weeks immediately preceding government enforced lockdown in the UK with reports for 14 days during lockdown t(752) = .38, p = .707. Overall, 30% of participants (n = 223) reported increased coping using sex during lockdown compared with before, 29% (n = 222) reported decreased coping using sex, and 41% (n = 308) reported no change.

Participants who reported more social distancing reported less coping using sex (total, consent) over the last 14 days, and were less likely to endorse a rape item. However, the converse was observed for loneliness and difficulties in emotion regulation, with higher scores associated with greater coping using sex over the last 14 days (CUSI total, CUSI consent), and greater likelihood of endorsing a rape item. Participants who made more errors on the Go/No-Go task also reported feeling lonelier and experiencing more difficulties in emotion regulation. Similarly, participants who were more worried about COVID-19 also reported feeling lonelier and experiencing greater difficulties in emotion regulation. See Table 2 .

For coping using sex total score, the first step accounted for 21% of the total variance (Adj. R 2 = .21, F(8, 730) = 25.54, p < .001). As indicated in Table 3 , being younger and being male were associated with reporting increased coping using sex. After the second step was added, the overall model accounted for 22% of the total variance and was associated with a 

For scores on the consent subscale, the first step of the model accounted for 21% of the total variance (Adj. R 2 = .21, F(8, 748) = 25.99, p < .001). As indicated in Table 4 , being younger, being male, and being white were associated with higher scores on the consent subscale. After the second step was added, the overall model accounted for 22% of the total variance and was a better fit to the data compared to the first model (Adj. A series of generalized linear models that included the two-way interactions of gender with social distancing, loneliness, difficulties in emotion regulation and Go/No-Go errors again revealed a significant interaction of loneliness with gender, with higher loneliness scores associated with greater coping using sex in men but not women (see Supplementary Material Three).

Logistic regression was used to predict endorsement of items related to rape or violence. Overall, 92 participants (12%) endorsed at least one item on the rape subscale. Table 5 . The Chi-square likelihood ratio test suggested that the model was a good fit of the data. Being younger and being male were associated with having endorsed at least one item on the rape subscale (Table 6) .

Adding the second step to the model led to a better fit to the data compared with the first step only, with lower values for Deviance and AIC, and a higher Nagelkerke R² value. Engaging in less social distancing predicted having endorsed at least one rape item. Being younger and being male remained significant predictors, and not living alone also predicted endorsing at A series of generalized linear models that included the two-way interactions of gender with social distancing, loneliness, difficulties in emotion regulation and Go/No-Go errors revealed a significant interaction of loneliness with gender, and a significant interaction of difficulties in emotion regulation with gender. Simple effects analyses showed that higher loneliness scores were associated with a greater likelihood of endorsing one or more items on the rape/violence subscale in men but not women, while higher difficulties in emotion regulation scores were associated with a greater likelihood of endorsing one or more items on the rape/violence subscale in women, but not men (see Supplementary Material Three).

In this study, we examined the associations of physical social distancing, loneliness, difficulties in emotion regulation, and general self-regulation with the tendency to cope using sex during difficult or challenging situations over a 14-day period during lockdown in the UK. Our findings showed that, overall, there was no significant change in mean levels of coping using sex during lockdown compared to retrospective reports relating to the 14-day period immediately preceding lockdown. For 30% of participants, using sex to cope increased during lockdown compared with before, but for a similar proportion of participants, using sex to cope decreased. The observation of similar numbers of participants increasing and decreasing their frequency of sexual behaviors would be expected over the course of 28 days irrespective of COVID-19 lockdown.

Zero-order correlations showed that participants who reported being lonelier, experiencing greater difficulties in emotion regulation, and who adhered less to physical social distancing advice reported higher coping using sex scores. When looking at predictors of coping using sex during lockdown, we showed that being male, being younger, and J o u r n a l P r e -p r o o f experiencing more difficulties in emotion regulation were associated with higher total reports of coping using sex. The same pattern occurred for the subscale assessing consensual coping using sex. Although social distancing was associated with overall levels of coping using sex, as well as with consensual coping using sex, these associations were no longer significant in the regression analyses. A small proportion of participants reported coping using sex around themes of rape or violence (12%) over the 14-day period during lockdown and these data were strongly positively skewed (toward zero). However, we nonetheless found that participants who reported less social distancing, and those who reported being male, being younger, and not living alone, were more likely to have endorsed at least one rape item on the CUSI. Overall, the effect sizes reported were small and we would urge some caution around over-interpretation of results.

Our findings support earlier research by showing that sexual interest during negative mood (as measured by the CUSI) was more commonly reported by male compared with female respondents 24 . Although the underlying reasons for why some people experience increased sexual interest during negative affect are unclear, it has been reported that sex may serve needs for intimacy and self-validation, and that feelings of sexual release may have a calming effect 23 . Across both female and male respondents, participants in this study who reported greater coping using sex also experienced more difficulties in emotion regulation.

Our findings are consistent with earlier work showing that difficulties in cognitive reappraisal of emotion, that is, in restructuring the emotional experience in such a way that the emotional impact is altered, were associated with problems in regulating sexual response 37, 38 . Further, our exploratory analyses examining gender interactions, presented in Supplementary Material Three, revealed that loneliness was associated with greater coping using sex (overall and for the consent subscale) only in men, tentatively suggesting that, when feeling lonely, men and J o u r n a l P r e -p r o o f women resort to different coping strategies, and that coping using sex is motivated by loneliness in men more so than in women.

In order to deal with the potential adverse mental health effects of COVID-19, immediate actions that have been identified include improved monitoring and reporting of mental health and determining the efficacy of mechanistically based digital and non-digital interventions 58 . In line with these recommendations, participants who experience difficulties in emotion regulation may be encouraged to engage with online or offline mindfulness practice, which is associated with benefits in regulating negative affective states 39, 40 . As highlighted by others, a priority for COVID-19 research should be to establish the benefits of different online interventions for improving mental health and resilience 58 . A limitation of the results reported here is that it remains unclear whether or not coping using sex when experiencing negative mood was associated with any adverse outcomes. Future research should seek to examine this possibility, especially when considering that coping using sex was reported more often among people who were experiencing more difficulties in emotion regulation.

For the rape/violence subscale, being male, being younger, and not living alone predicted having endorsed items related to rape/violence. Participants who engaged in fewer physical social distancing behaviors were more likely to have endorsed items relating to rape/violence. Even though emotion dysregulation was associated with endorsement of rape items at the zero-order level, this association was no longer significant in the multiple regression analyses. The finding that less social distancing predicted endorsement of rape items could indicate that these participants were more likely to cross social boundaries and defy social norms more generally. Indeed, recent findings show that empathy represents a basic prosocial motivation for engaging in social distancing during COVID-19 59 . This interpretation is also supported by findings that antisociality is associated with aggressive J o u r n a l P r e -p r o o f sexual fantasy and sexual coercion against women 60 , and represents a psychologically meaningful risk factor for sexual offending 32 . In addition, our exploratory analyses, presented in Supplementary Material Three, suggested that predictors of having endorsed at least one rape item on the CUSI may differ across gender. In particular, we showed that men who feel lonely, and women who reported difficulties in emotion regulation, were more likely to endorse rape items, but not the other way around. This may indicate that rape fantasies or behaviors could have different motivations in men and women. The extent to which these findings are specific to pandemic conditions is difficult to ascertain. Earlier research has shown that rates of intimate partner violence increased during emergencies and natural disasters, including hurricanes, floods, and oil spills 61 . A similar increase has emerged during the period of lockdown to prevent the spread of COVID-19 infections 62, 63 . It is possible that similar motivations that may underpin increased coping using sex with a theme of rape/violence among men (e.g., loneliness) also contribute to higher rates of intimate partner violence, including sexual violence. Future research should seek to explore this possibility.

In contrast to our hypotheses, for the total score and the subscale scores of the CUSI, none of the effects of social distancing were moderated by feelings of loneliness or difficulties in self-or emotion regulation. Worries about COVID-19 were also unrelated to CUSI total or consent subscale scores, suggesting that any effects of adhering (or not) to social distancing regulations are independent of experienced feelings of loneliness or emotion regulation.

Although our findings are revealing about some of the correlates of coping using sex in a period of lockdown to prevent the spread of COVID-19, they are subject to limitations.

First, participants only completed measures at one timepoint during lockdown, and data corresponding to a 14-day period immediately preceding the introduction of lockdown was J o u r n a l P r e -p r o o f based on retrospective accounts. As such, data for this period may lack some degree of accuracy and make comparisons of CUSI scores for before and during lockdown more difficult. Similarly, our cross-sectional design also means that causal relations of physical social distancing and difficulties in emotion regulation with coping using sex cannot be established. Second, most participants were female (66.2%), white (80%), and educated to degree levels or higher (65%), and as such our sample is not overly representative of the general population of the UK. Third, although 12% of participants endorsed at least one item related to rape/violence, the extent to which these scores are a true reflection of participants' coping use sex is difficult to estimate. Although participants were ensured of their anonymity, some may have experienced fear of reprisal for responding positively to non-consensual items.

Conclusions. Overall, our findings suggest that difficulties in emotion regulation increase the likelihood of using sex to cope with a consensual theme, while less adherence to social distancing was associated with using sex to cope with a theme of rape/violence. A series of exploratory analyses provide some support for gender differences in the factors associated with coping using sex. For example, loneliness was consistently associated with greater coping using sex (total, consent subscale, rape/violence subscale) in men but not women. Conversely, greater difficulties in emotion regulation were associated with greater likelihood of endorsing items related to rape/violence in women, but not men. Our main findings are generally in-line with the pattern of results that would be expected outside of the COVID-19 pandemic. However, with concerns expressed by charitable and law enforcement agencies that lockdown represents a period of increased risk for vulnerable women and children, both in the home and online 64 , it is important that people who are concerned about their sexual thoughts and behaviors can seek appropriate support. Coping using sex, including excessive pornography use, may also be associated with adverse consequences in J o u r n a l P r e -p r o o f the long term 19, 65 . As such, it is important that the long-term effects of coping using sex during the COVID-19 pandemic are investigated and understood.

J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f

Addressing the COVID-19 pandemic in populations with serious mental illness

Suicide Mortality and Coronavirus Disease 2019-A Perfect Storm? Jama Psychiat

The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention

Chinese public's knowledge, perceived severity, and perceived controllability of the COVID-19 and their associations with emotional and behavioural reactions, social participation, and precautionary behaviour: A national survey

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Post-traumatic stress disorder following disasters: a systematic review

Weight-related lifestyle behaviors and the COVID-19 crisis: An online survey study of UK adults during social lockdown

Stress, appraisal, and coping

The relationship between coping, self-esteem and health on outdoor walking ability among older adults in Norway

Behaviour and burnout in medical students

Getting a Good Night's Sleep in Adolescence: Do Strategies for Coping With Stress Matter?

Perceived social support buffers the impact of PTSD symptoms on suicidal behavior: Implications into suicide resilience research

Exploring the role of sleep and coping in quality of life in fibromyalgia

The Association Between Mental Health, Stress, and Coping Supports in Mothers of Children with Autism Spectrum Disorders

Self-injurious behavior and gamblingrelated attitudes, perceptions and behaviors in adolescents

Effects of stress and coping on binge eating in female college students

Sexual activity and risk taking in young heterosexual men: The relevance of sexual arousability, mood, and sensation seeking

Sexual Risk-Taking in Gay Men: The Relevance of Sexual Arousability, Mood, and Sensation Seeking

Viewing Internet Pornography: For Whom is it Problematic, How, and Why?

The Economist. Pornography is booming during the covid-19 lockdowns

Perceived powerlessness as a mediator between life stressors and deviant behaviors

Individual differences in the effects of mood on sexuality: The revised mood and sexuality questionnaire (MSQ-R)

The Relation Between Mood and Sexuality in Heterosexual Men

The relationship between negative mood and sexuality in heterosexual college women and men

Changes in sexual behaviors of young women and men during the coronavirus disease 2019 outbreak: A convenience sample from the epidemic area

Does COVID-19 pandemic affect sexual behaviour? A cross-sectional, cross-national online survey

Risk factors for the perpetration of child sexual abuse: A review and meta-analysis

Sex As a Coping Strategy and Its Relationship to Juvenile Sexual History and Intimacy in Sexual Offenders

Relationships between conflict, affect and deviant sexual behaviors in rapists and pedophiles

Relationships between affective components and sexual behaviors in sexual aggressors

Assessing the risk of sexual offenders on community supervision: The Dynamic Supervision Project

Assessing risk for sexual recidivism: Some proposals on the nature of psychologically meaningful risk factors

Rehabilitation, etiology, and self-regulation: The comprehensive good lives model of treatment for sexual offenders

A self-regulation model of the sexual offense process

Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being

Multidimensional assessment of emotion regulation and dysregulation:Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale

Sexual desire, not hypersexuality, predicts self-regulation of sexual arousal

Conscious regulation of sexual arousal in men

Treating disturbed emotional regulation in sexual offenders: The potential applications of mindful self-regulation and controlled breathing techniques

The Wiley Handbook on the Theories

Emotion regulation, mindfulness, and alexithymia: Specific or general impairments in sexual, violent, and homicide offenders

The Impact of Sexual Arousal and Emotion Regulation on Men's Sexual Aggression Proclivity

Exploring the Relationship Between Childhood Maltreatment and Intimate Partner Abuse: Gender Differences in the Mediating Role of Emotion Dysregulation

Impulsivity and Sexual Assault in College Men

An Examination of the Association between Difficulties with Emotion Regulation and Dating Violence Perpetration

Beyond the Turk: Alternative platforms for crowdsourcing behavioral research

Psychological correlates of news monitoring, social distancing, disinfecting, and hoarding behaviors among US adolescents during the COVID-19 pandemic

Developing a Measure of Loneliness

Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16

Three approaches to individual differences in affect regulation: Conceptualization, measures, and findings

Go -No Go Learning After Frontal Lobe Lesions in Humans

Emotion Regulation, and Developmental Psychopathology: Specificity Versus Generality of Linkages

Correlation Database of 60 Cross-Disciplinary Surveys and Cognitive Tasks Assessing Self-Regulation

Reporting and Interpreting Task Performance in Go/No-Go Affective Shifting Tasks

Optimal go/no-go ratios to maximize false alarms

The jamovi project. jamovi (Version 0.9) [Computer Software

R: A Language and envionment for statistical computing

Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

The emotional path to action: Empathy promotes physical distancing during the COVID-19 pandemic

The developmental antecedents of sexual coercion against women: Testing alternative hypotheses with structural equation modeling

Home is not always a haven: The domestic violence crisis amid the COVID-19 pandemic

Changes in intimate partner violence during the early stages of the COVID-19 pandemic in the USA. Injury Prevention

Violence against women during covid-19 pandemic restrictions

Law enforcement in coronavirus online safety push as National Crime Agency reveals 300,000 in UK pose sexual threat to children

A Qualitative Study of Cybersex Participants: Gender Differences, Recovery Issues, and Implications for Therapists