Re:CBT for compulsive masterbation

It sounds as though he has told you why he does it. You said "he worries that if he doesn't masterbate, he will be proccupied during the day and this will impair his concentration and his ability to study" and "He has a strong desire to succeed in school". This seems to provide a concise explanation of why he masturbates.

As far as a treatment approach, it sounds like it would be quite useful to set up a behavioral experiment where he refrains from masturbating after seeing an attractive woman and then observes whether he becomes so preoccupied with her that it is a serious distraction or not. He may well discover that the masturbation is unnecessary because he doesn't become as distracted as he expects.

If he does indeed become preoccupied with her, then it would be useful to monitor his thoughts and feelings in order to sort out whether to treat this as OCD, a paraphilia, or something else. If he has pleasurable sexual fantasies which are enjoyable but distracting, this is not OCD. If he has intrusive thoughts which are anxiety-provoking rather than being pleasurable, it may be OCD.

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