Nikki Prause on How Porn and Sex are Different in the Brain – Smart Sex, Smart Love with Dr. Joe Kort

There’s been a lot of noise in the media about porn use, with many doomsayers claiming that it triggers dangerous neurochemical changes in the brain. However, newer research says that just isn’t so. This week Joe talks with American neuroscientist, Nikki Prause, who thinks that porn and sex are totally different in the brain. Hear Nikki explain how her brain research debunks the myth that you can have an addiction to sex or porn. Brain science is hot these days, so listen to Nikki and Joe talk about how rigorous studies have not found sex addiction to be a real dependency, or reflective of any brain-related compulsion issues at all….

Dr. Joe Kort:                       Welcome to Smart Sex, Smart Love. I’m Dr. Joe Kort, and today the topic of our podcast is how porn and sex are different in the brain. On today’s show, I’ll be discussing that, because there’s been a tremendous amount of noise about watching porn, with many doomsayers claiming that it triggers dangerous neurochemical changes in the brain. But newer research says that it isn’t so, and that people who state that they have a problem watching porn, otherwise known as porn addicts, are actually people with high libidos, not people whose brains have been warped by sex addiction and porn. Anti-porn advocates argue that porn is a public health issue, and that if individuals in society only knew the damage that porn use was causing to our brains, we would regulate it. These fear-based arguments often invoke brain-related lingo, and throw around terms like “dopamine bursts,” and “de-sensitization,” to describe what allegedly happens in the brains of people who watch too much porn.

But my guest today, American neuroscientist Nikki [Prouse 00:01:15], thinks that this is nonsense, that porn and sex and totally different in the brain. Brain science is hot these days, and rigorous studies have not found sex addiction to be real or reflective of any unique brain-related issues at all. So today I’ll be asking Nikki how the research debunks the myth that anybody can have an addiction to sex or to porn. Welcome, Nikki!

Nikki P.:                                Thanks, Joe. Excuse me. Thank you. [crosstalk 00:01:42]

Dr. Joe Kort:                       Yeah. It’s really good to have you here. I refer to your work all the time, and now I’m going to be able to say in my talks, if you want to learn more, not just to Google you, but to come to my podcast and hear direct questions I’m going to ask you.

Nikki P.:                                Sweet, sweet traffic. Sounds good.

Dr. Joe Kort:                       So could you tell us, just the first part is why don’t you think that sex addiction is an addiction, or porn addiction is an addiction?

Nikki P.:                                There are obviously people who have problems in these areas. You know? They look at porn more than they mean to, or they have sex at times when they didn’t plan to, or it’s inconsistent with their values. So of course I want to recognize it’s not that we’re saying there’s no struggles. But the question is: How do you understand what those struggles are? That is, what kind of model best fits those behaviors, because the model that fits determines how you help.

And so if the problem is mainly, for example, having unusually strict values due to your religious upbringing, that would be important information, and would change how you might treat or help someone. So addiction is a model that is very strict. It has many very specific predictions about things that have to happen in the brain, and in behavior, to call something an addiction. And while sex and porn fit some of those, this is a necessary, but not sufficient argument. That is, it has to fit all of them, and it fails in numerous ways to fit addiction model.

Dr. Joe Kort:                       Okay. And so, and really, even your current research investigates the physiology of orgasm, and sexual touch from a partner, and focuses on how these may benefit general health, like sleep. And then, you’re also the founder of … Is it Liberals? Am I saying that right?

Nikki P.:                                [Liberos 00:03:18], yes.

Dr. Joe Kort:                       Liberos? It’s an independent research study. And so you’re really studying neurological research that actually shows about how people use porn, or watch porn, I should say, and how it’s debunking these myths, right?

Nikki P.:                                Absolutely. So we have people, for example, coming in, interacting with partners in the lab while we monitor both of their brains to try and understand how those brain responses with a partner are different from viewing pornography or masturbating, if they are.

Dr. Joe Kort:                       And so, how is it dismantling or debunking … Like, someone would say, “Well, then, what are you finding that make it not an addiction?”

Nikki P.:                                One of the first big findings was a lack of [curie 00:03:59] activity. And what that means … So curie activity has sometimes been called the biomarker of addiction. It’s so commonly and regularly found in substance addiction. And it basically means that your brain orients more strongly to the substance of behavior to which you’re addicted than other stimuli that we’re presenting you with in the laboratory. So if you are addicted, or that you were addicted to pornography, and we showed you pornographic images, we would expect that your brain would respond more strongly to those images than other people who viewed these images, and do not report having a problem. We actually found the opposite in this case. That’s not habituation evidence. Some people misinterpreted it that way. It just means that the early … and when I say early, we’re talking 300 milliseconds-

Dr. Joe Kort:                       Okay. [crosstalk 00:04:50]

Nikki P.:                                … very, very fast. So this is not talking about later habituation effects, because the early curie activity that needs to be there for an addiction does not exist with respect to pornography.

Dr. Joe Kort:                       Okay. That’s helpful to know, because people don’t understand. They think, you know, people spend all day watching porn. What does that mean? It must mean that they’re addicted to something. What would you say to that?

Nikki P.:                                In each case, you have to think functionally, of course, because it could be that someone is depressed and can’t get out the door, but they can click a mouse. That gives them some pleasure during the day, in which case, I’d think [inaudible 00:05:25] depressed, and they’re using … Porn is either a coping or a distraction. It could be one function or the other.

Some people think it presents more obsessive compulsive presentation, so that every night I get home, and this is my routine. I do three hours of porn, and it upsets my partner, and causes me to miss events that I was supposed to be at, because of this strong habit formation that I’ve created that maybe helps me deal with the stress of the work day, so that I can distract my mind from it.

In both those cases, those people could benefit from help. We have good treatments to help with depression. We have good treatments for OCD. But it’s not the porn, per se, and it’s important to get the focus off of the substance, because that doesn’t seem to be causing it.

Dr. Joe Kort:                       Right. So in this situation … And I want people to know, who are listening, OCD, you mean obsessive compulsive disorder.

Nikki P.:                                Yes.

Dr. Joe Kort:                       Right? So people do have these things. And what’s really always been concerning to me is that the sex addiction industry, instead of just calling it OCD, or just calling it habituation, or calling it erotic tension with one’s partner, or values, or religion, they want to add on. It’s an add on to say it’s a sex addiction. We don’t need that term. We already have the term, right? Erotic tension, OCD, whatever, depression, whatever it is.

Nikki P.:                                That’s exactly it. The question with a new diagnosis is always, do you gain more than you lose? And new diagnoses do cause harm. That is, while some people feel comforted by them, [inaudible 00:06:55] to not have a label for what I have, a large other group of population is distressed, saying, “Oh, god. I didn’t know I had a disease. I’m sick,” and it could actually make them worse.

What I haven’t seen is any demonstration that a porn addiction label doesn’t make more people worse than it makes better. And that’s a big concern.

Dr. Joe Kort:                       It’s a big concern. Sadly, in my office, what I end up seeing is … Now, I tend to see more heterosexual couples who struggle with porn, and usually it’s the wife that says to her husband, “You’re either a sex addict, or you’re a pervert. And I’m not staying married to a pervert. So you better be a sex addict.” Right? What choice does he end up having, if he wants to stay in the relationship with her?

Nikki P.:                                I know two large university clinics, as well, they’re saying all these guys are coming in for porn treatments, and they say they spend half of their treatment getting them out of the addiction mindset, because they’ve gone through these horrible addiction programs that teach them inaccurate information that make them think that they’re going to molest their brother or their child, and that’s simply not true. There’s no evidence for it, but you can imagine how distraught someone would be if they think that’s the path their on because of this addictionology. And so they say they’re having to spend a lot of treatment time undoing the damage from the porn addiction treatment.

Dr. Joe Kort:                       It’s so true. I’ve had clients where they’ve been told … I’ve had multiple clients like this, where they’ve been told by a sex addiction therapist, “If you’re watching porn, and it’s young women, that’s a gateway to abusing children, abusing young women.”

Nikki P.:                                Yep.

Dr. Joe Kort:                       And they-

Nikki P.:                                So many people are being told that, and it’s just horrific. There’s no evidence for that.

Dr. Joe Kort:                       It is a scare tactic. It’s panicdotal. It’s stupid. You know what I mean? And, really, abusive and harmful to someone, because sadly sex addiction therapists, in general, do not receive sex therapy training. So they’re only looking through trauma and addiction. They know nothing about sex.

Nikki P.:                                Yes. It’s important to know [inaudible 00:08:52] took a lot of these things. You know, we have had the statement in a few academic papers, for example, talking about women and BDSM. I just recently responded to a paper talking about the pathology of that. And I thought, “My god, that’s the most common female sexual fantasy,” but they didn’t have exactly the human sexuality background training to know that that was a very common, intentional female fantasy.

So that kind of basic information, sex education, is really important to have, and I don’t think you can accurately treat any of these patients without it.

Dr. Joe Kort:                       Or, just like you said, you can’t even do accurate research without it, because they misunderstand what’s happening.

Nikki P.:                                Absolutely.

Dr. Joe Kort:                       Could you speak to … I’ve been reading a lot of your stuff, and other people, like David Lay, and about the fact that in the porn addiction research, they don’t talk about masturbation, right?

Nikki P.:                                Yes. This is so bizarre.

Dr. Joe Kort:                       Would you talk about that?

Nikki P.:                                The main problem with not talking about masturbation is that it means you cannot attribute any effects in your studies to porn unless you have controlled for the fact that people are always masturbating when they’re viewing porn. What that means is, if I want to say, “Oh, porn caused me not to be able to get erect,” and I say, “How much are you watching?”

“Oh, I watched five hours.”

“Okay. That sounds like a lot for a day, but what were you doing during that?”

“I had five orgasms.”

I was like, “Oh, my god.” There’s nothing to do with the porn. You had five orgasms. That’s the crux of the issue.

So anyone that’s had that much sexual experience in a day, I would expect would struggle, regardless of the partner context, in a partnered context.

So there are those kind of really concrete problems that is, you can’t attribute any of these findings to pornography unless you have controlled for, either statistically [inaudible 00:10:46] the presence of masturbation. We- [crosstalk 00:10:49]

Dr. Joe Kort:                       That makes sense.

Nikki P.:                                We can’t- [crosstalk 00:10:50]

Dr. Joe Kort:                       Oh, go ahead.

Nikki P.:                                Yeah. It’s an absolute essential, and I’m getting to the point now, as a reviewer, if they don’t control for it, I reject the study, because it’s that important. It’s that strong of a correlate. And if you can’t prove that it’s having an effect above and beyond that, you can’t publish.

Dr. Joe Kort:                       That’s awesome. I think it’s so important, because … I don’t know where I heard this. I wish I could remember who taught me this, but I really like it. That while people are watching porn, yes, they’re masturbating. And porn never says no. It never has a headache. It never tells you … It doesn’t judge you. It doesn’t say, “Okay. Now we’ve got to stop.” I mean, it’s really an autoerotic experience, which is why a lot of these guys end up turning to their partners, and then they’re unable to get erections. But it’s not the porn. It’s the masturbation, and getting used to their own self, and their own timing, isn’t it?

Nikki P.:                                I think so. There’s also some data around fantasy, so I’m really interested, exactly, in how porn is used when it’s used. That is, when people do have these longer periods, exactly how many orgasms are they having, and are they imagining themselves in the film, or are they using the film as a jumping off point for fantasy and memory, like recall of pleasant experiences? Because those also really impact what could be happening, potentially, in the brain. If you’re, okay, the porn is up, but because that reminds me of my ex-girlfriend, and the thing we did, and that’s really what I’m fantasizing about when I’m masturbating, that’s a very complex situation, stimulus interaction that is not just porn. And to treat it monolithically like that, it missed all of that information.

I just see a lot of research is reinventing the wheel that’s discovering things that we knew about masturbation 30, 40 years ago, and saying now it’s due to porn, because they’re not properly controlling those things.

Dr. Joe Kort:                       That’s smart. That makes so much sense. And so, in a therapy situation, or even a person listening to this, might start wondering, “What am I looking at? And am I into porn? And am I not into porn?” Because that may be more the issue of their personal life than anything to do with the porn. Isn’t that what you’re saying?

Nikki P.:                                Yeah, absolutely. It’s how are you using it? If you’re masturbating to it, which is what most folks do, are you … some people call it edging, I just say being sexually aroused?

Dr. Joe Kort:                       Yeah.

Nikki P.:                                You know? Are you just having an erection, or being aroused during that whole period? If you’re having an orgasm, when is it happening? Are you saving it for the very last? Just one? Or is it as many times as you can in that period? Those are kind of different struggles. That is, if you’re being aroused for a lot of the time versus having a lot of climax experiences. Are you getting a big dose of the repetitive [prolactin 00:13:38] or not, you know?

Dr. Joe Kort:                       Yes- [crosstalk 00:13:41]

Nikki P.:                                [crosstalk 00:13:41] surges in orgasm. So that’s why it’s important. I think now, the next step in research should be to start characterizing and understanding the nature of the masturbation that’s occurring with porN, that [inaudible 00:13:53] into porn.

Dr. Joe Kort:                       One of my biggest pet peeves are when therapists say, or not even just therapists. It’s in our culture. That porn is a national health crisis. It’s ruining marriages. And then I always say, “Excuse me, but not in gay and lesbian relationships. It’s not ruining our relationships.”

When I met my husband 26 years ago, I knew exactly where his porn was, and what he looked at, and I look nothing like the guys in his porn. When he saw my porn, and knew where I kept my stash … This was before the internet … he looks nothing like the guys I get off on. We had a sex life with each other, and we had a sex life with ourselves, and I call it, we call it now, porn literacy, where we had a conversation around it. Isn’t that what straight couples aren’t having? Porn literate conversations.

Nikki P.:                                Absolutely. I think that hits on … You know, Marty Kline wrote a book recently, His Porn, Her Pain, getting into a lot of concrete examples about this, the interpretation of what porn comes to mean to a couple. So there are the extreme cases where often a woman in a heterosexual relationship will say, “The porn is infidelity to me. Merely looking at that is cheating.” And of course, if you feel and have that value, that is a very difficult value and conversation to overcome, and really puts constraints on your partner.

But that’s what it is. It’s a values conversation. What are we comfortable with? What does this mean to me? And, exactly, in your partner’s case, it’s like, they don’t look like me. Does that mean you don’t like me?

Dr. Joe Kort:                       Yeah, right. Which never- [crosstalk 00:15:27]

Nikki P.:                                That’s the conversation.

Dr. Joe Kort:                       Yes.

Nikki P.:                                It’s really the insecurity, the common relationship concerns people have had for all millennia that are not new to porn.

Dr. Joe Kort:                       So let’s talk about this, because I get this a lot, and I’d love your input on this, your smart, scientific information. Many people start-

Nikki P.:                                Uh-oh.

Dr. Joe Kort:                       … viewing … I know. So heavy on the spot, but it’s so important, and I don’t think I do a good enough job.

Nikki P.:                                Yeah, yeah, yeah.

Dr. Joe Kort:                       All right. So a lot of people start watching porn by the age of 10, when the brain is still developing. Is it true to say that there’s no way to tell whether structural brain differences are a consequence or a cause of porn, or watching porn?

Nikki P.:                                Yes. To be able to tell something like that, you have to do random assignment in a trial. It’s illegal to show youth porn, so we’ll never be able to do that. And the problem, just to draw it out with that, and why we can’t make those conclusions, is that kids self-select. They don’t … Just because their average age of first intercourse is seventeen and a half, they didn’t just start having sex then. You know? The average means a lot they did before then.

So kids are developing sexual interests, and sexual motivations, and they’re expecting that, in part, through looking at pornography. But, of course, the kids who have higher sex drives are going to look more at pornography, probably earlier. So you cannot then separate and say, “Well, the kids who looked at it earlier are having this and that effect.” Because they’re not the same kids who weren’t looking at it. They differ systematically in other ways. You really have to do an experiment to demonstrate that porn was the cause of any of those differences, and we can’t. It’s illegal.

Dr. Joe Kort:                       The other thing that’s missing, and I always say this, is that parents aren’t talking to their kids about porn. They’re trying to prohibit it, which is fine. They’re trying to restrict it, and that’s fine, whatever your family values are. But your kid is still going to look at porn, whether you like it or not. And without having a sexual health conversation of what it means to be watching porn, and what’s happening to them …

You know, I just found out in another lens, they show porn, little clip scenes, to kids in middle school and in high school, and they stop, and they say, “What’s happening here? What’s missing here?” And they educate the kids around it, rather than leaving them at sea. Right?

Nikki P.:                                Yeah. That’s incredibly strong sex ed. I’m surprised we can do that here.

I always remind people that when you look at the sexual values, I think parents are often fearful that they’re talking to their friends, and being influenced by looking at porn with their friends nowadays. But the sexual values of the friends most strongly align with their parents, not their peers- [crosstalk 00:18:07]

Dr. Joe Kort:                       That’s great- [crosstalk 00:18:08]

Nikki P.:                                They’re still influenced, but it really is important that if they don’t know what your sexual values are, they can’t do anything about it.

Dr. Joe Kort:                       Right.

Nikki P.:                                You have to tell them.

Dr. Joe Kort:                       Yes.

Nikki P.:                                So that they know that, and can be influenced by it.

Dr. Joe Kort:                       So what about this? I always say, I started watching porn when I was 11. My father started watching porn when he was 11. His father did. In the stone age, they carved it into the rock, and masturbated to porn. But now people say, “Well, that was different porn. Now we have this … what is it? High speed,” you know, since 2000, right? “It’s different porn which changes the brain more.”

What do you say to that?

Nikki P.:                                There’s currently no evidence that the nature of the porn that we currently have is doing anything different in your brain than when we were testing people using VHS tapes, was my first ever study in grad school. Certainly the nature of it is different. It’s more accessible. There’s wider breadth. And so maybe we will find sometime in the future that we can document some kind of a difference, but sexual arousal is sexual arousal in the brain, and there’s no reason to think … Yeah, maybe we get more activation of visual [cortecese 00:19:18], for example, by more complex visual stimuli. So if we get into the R-porn, which I think is going to have a pretty limited audience, but you’re doing the R, you might have a lot more engagement in visual areas because there’s more visual stimulation. There’s simply more going on.

The question is: does that translate to anything that’s qualitatively different or problematic? And we haven’t seen any evidence for that. So even going all the way out to kind of future tech, I don’t see that the brain is somehow being hijacked or anything is [inaudible 00:19:56] and different about the sexual arousal to one type of more high resolution porn versus the type of VHS porn we used to show. The brain patterns appear to be the same. No one’s ever documented any differences.

That’s not to say there’s not other issues with having the breadth of selection, and those types of things with internet access, but the brain, there’s just no evidence that it’s doing anything remarkably different.

Dr. Joe Kort:                       Okay. So what about people listening to this going, “No, no, no. I’ve been to this website, and that website. It’s all over the internet. And there’re peer reviewed journal articles themselves that say you’re absolutely wrong, that there is a brain hijack, and this is all about changing.” All that research that’s out there, right? What do you say?

Nikki P.:                                Yeah. All those personal essays that people write who don’t do neuroscience research. I am aware.

There are a number of myths that people are capitalizing on to try and make that case. For example, we often see people say, “The dopamine hijacks the brain. It comes in, you get flooded with dopamine.” And, of course, words like, “flooded,” that’s a good way to know you’re reading pseudo-science. We don’t use those words. “Hijacked” is another good way. We don’t generally use those words in science.

With dopamine, there are, of course, changes in dopamine which help us learn and remember things, as a course of being sexually aroused and seeing sexual stimuli. But that’s true of an emotional stimuli, broadly. Also, when we see something disgusting or frightening, we also have an increase in dopamine. And the studies, and they are very, very limited studies, to be fair, but the studies who have looked at orgasms do not find that dopamine spikes at orgasm. It happens before, during the sexual arousal period, but there doesn’t seem to be any flood. When is the flood coming? Where’s the flood?

And so I always kind of laugh when I see that language, because I’m not sure who wrote this. But that’s a common kind of scare word that we see with neurochemicals [inaudible 00:22:09].

Dr. Joe Kort:                       Speaking of dopamine, some people think you can get addicted to your own internal chemicals, and dopamine’s addictive. I keep reading that’s not true, right?

Nikki P.:                                Yeah. That’s not. I mean, so in any kind of a substance addiction, dopamine is involved. I would never say, “Oh, dopamine has no role.” But it’s part of a much larger presentation, and all of those pieces of the constellation have to be present for something to be an addiction. Dopamine’s involved in a lot of things, so just having had a dopamine change tells me very little about whether something’s addictive.

Dr. Joe Kort:                       I love it. So now what we’re really talking about is helping people self-regulate. And what they’re doing is regulating through porn, regulating through sex, regulating through food, regulating through gaming, whatever the hell they’re gambling, but it’s not necessarily … Even in gambling, we don’t even call gambling an addiction. People always say to me, “Well, isn’t gambling an addiction?” No. We call it a disorder, and it’s problematic, and it’s a dysregulation around money, and around dopamine rushes or whatever, but it’s not an addiction. Would you agree?

Nikki P.:                                I would. Yeah. We still have good treatments to help you reduce your use.

Dr. Joe Kort:                       Yes.

Nikki P.:                                That’s, I think, the big crux. It’s like, “Oh, that’s terrible. They’re denying that it’s addictive, that it’s a problem.” And saying something’s not an addiction versus saying something’s not a problem are two completely separate issues, and that often gets lost, I think-

Dr. Joe Kort:                       Yes.

Nikki P.:                                So making the case that this is not an addiction isn’t saying, “Screw you. Get out of my office. We’re not going to help you.” It’s saying, “We’re going to have a more accurate, empirically-supported method for helping you, and addiction is not it.”

Dr. Joe Kort:                       What have we not addressed that you think is a really important point you’d like people to hear?

Nikki P.:                                I think it’s good to know that there are lots of differences in the brain when you’re viewing porn versus interacting with a partner. This is part of why I always say I don’t fear the sex robots, because wherever our technology goes, there are certain things that are special to being with a partner that it can’t really mimic.

Just, for example, one of the easiest ones of those is something called [C-afferent 00:24:14] fibers, that is when your skin, not general, but the skin is stroked by another person in a slow way, that really uniquely activates these fibers that then feed back into social/emotional areas of the brain, and this does not occur when you do pornography. That is, just watching someone do the stroking does not do it. You have to be there with another human being who is not wearing gloves. It really is specific to touch.

So there’s always going to be that major unique feature between the two, so there’s nothing in porn to condition that, or to make it so that a partner would be less effective.

Dr. Joe Kort:                       Okay.

Nikki P.:                                There are other aspects. Like, some people say, “Oh, well, you know, porn activates the mirror neurons, so therefore it’s becoming a partner. It’s a real partner in your brain.”

No. The mirror neurons are, in this case, in [inaudible 00:25:10]. So that is, yeah, if you see a penis being touched, your cortical, that kind of outside back of the brain, does show activation to show, “Yes. I am observing a penis being touched, and my brain also thinks that my penis might be involved.” So there’s activation associated. But that doesn’t mean any of the other aspects of a motivational system are engaged, and there’s no evidence for that. So merely having mirror neurons activated does not mean that your brain is doing the same thing that it does with a partner. We don’t think it does. So do not fear the mirror neurons and the motor cortex. I don’t think those are, maybe, another thing to worry about.

And then the last bit I might say is there’s … We’re just on the cutting edge of studying something we’re preliminarily calling the periorgasmic period that seems to be really unique before you get to climax. That is, the brain seems to reduce cognitive control, and at some point the nervous system drops off. We didn’t know this happens a few years ago, so this is potentially pretty new physiology stuff.

But if that’s true, if there is this periorgasmic period, then I would say you would never get there with porn. If you’re just sitting there watching it and not masturbating, you’re going to stay in the earlier arousal phases. It’s only when you add the masturbation, or add a partner that you can get into this, we think, periorgasmic period. So that may be just another one to keep an eye out for, but just another way in which [inaudible 00:26:50] films and being intimate with another person are probably very distinct.

Dr. Joe Kort:                       Wow. This is so good, and I really appreciate this. Can you tell us, before we stop, where people can find your work, and find you?

Nikki P.:                                The easiest is my website, LiberosCenter.com. L-I-B-E-R-O-S.com, and you can find it out from there, because Twitter’s been [inaudible 00:27:11] and Facebook.

Dr. Joe Kort:                       Thank you. I really appreciate this. You’re so smart. You’re very logical about this stuff, and I hope people got that out of listening to you here. And, I don’t know, I just have to say I have to go, because I have to go watch porn and masturbate to my own. So we got to go!

No, but I appreciate you- [crosstalk 00:27:29]

Nikki P.:                                Nice- [crosstalk 00:27:29]

Dr. Joe Kort:                       Yeah. It’s nice talking to you, and I do appreciate your normalizing this.

Nikki P.:                                Thanks so much.

Dr. Joe Kort:                       See you.

Nikki P.:                                Bye bye.

Dr. Joe Kort:                       All right. Thank you.

Nikki P.:                                Bye.

Dr. Joe Kort:                       Bye.