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Universidad de Buenos Aires
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Sardar Patel Post Graduate Institute of Dental & Medical Sciences
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We evaluated the responsiveness and treatment sensitivity of the Erection Quality Scale, and provided further psychometric validation of this scale. An 8-week, placebo controlled, randomized clinical trial investigating the efficacy and safety of vardenafil in patients with erectile dysfunction was performed. The Erection Quality Scale, together with a number of other patient and partner questionnaires, was administered at a screening visit, at baseline, and weeks 4 and 8 of treatment. Erection Quality Scale responsiveness was investigated by evaluating treatment induced changes and modeling using ANCOVA. Internal consistency, convergent and discriminant validity, and minimum important difference of the Erection Quality Scale were also assessed. Efficacy evaluations demonstrated that the Erection Quality Scale was sufficiently responsive to differentiate the treatment benefits of vardenafil compared with placebo. Internal consistency for the Erection Quality Scale total score was similar across visits, with values high enough to suggest reliability of items included in the scale. Discriminant validity of the Erection Quality Scale total score was demonstrated, with a high correlation with the erectile function domain of the International Index of Erectile Function (0.88, p <0.0001) and negligible correlations with clinical measures assumed to be unrelated to erection quality. All Erection Quality Scale total score comparisons substantially exceeded the 5-point minimum important difference estimate. The Erection Quality Scale was responsive and internally consistent, and demonstrated convergent and discriminant validity. Furthermore, this instrument provided a unique contribution to the measurement of erection quality compared to the International Index of Erectile Function. This study provides strong evidence supporting the use of the Erection Quality Scale in clinical trials.
The role of psychological and interpersonal factors in the treatment of erectile dysfunction (ED) with sildenafil or other oral therapies has not been sufficiently investigated. We conducted a pilot study of psychosocial predictors of pharmacotherapy treatment outcome and satisfaction in men with ED and their partners. Sixty-nine men with mild to moderate ED and their partners were enrolled in a multicenter, open-label, treatment trial with sildenafil. Treatment measures included a battery of validated self-report measures and questionnaires. Subjects also were interviewed according to a semistructured interview protocol. Partner assessments included self-report measures of sexual function, mood, and relationship satisfaction. Results indicated that, prior to treatment, patients had erectile function scores in the range of mild to moderate ED, with relatively low levels of concomitant depression, anxiety, and psychological stress and high overall levels of relationship adjustment. Partner sexual function was in the normal range of total Brief Index of Sexual Functioning for Women (BISF-W; Taylor, Rosen, Leiblum, 199423. Taylor , J. F. , Rosen , R. C. and Leiblum , S. R. 1994. Self-report assessment of female sexual function: Psychometric evaluation of the Brief Index of Sexual Functioning for Women. Archives of Sexual Behavior, 23: 627–643. [INFOTRIEVE][CSA][CROSSREF] [CrossRef], [PubMed], [Web of Science ®], [CSA]View all references) scores, although more than one third of female partners had specific sexual complaints or problems. Among couples who completed one or both follow-up visits (N = 34), sildenafil treatment resulted in significant improvements in all aspects of sexual function in men, including sexual desire, orgasmic function, erectile function and overall sexual satisfaction. Significant improvements also were noted in partners' ratings of sexual function in most domains, including arousal, pleasure, and orgasm. Higher baseline levels of sex-specific anxiety were negatively associated with improvement in erections following treatment. Relationship adjustment at baseline, contrary to expectations, did not predict erectile or sexual satisfaction following treatment in the men or their partners but was significantly correlated with changes in sexual desire. Baseline levels of depression, anxiety, and stress generally were unrelated to efficacy or treatment satisfaction. However, we observed a curvilinear relationship in the men between baseline levels of stress and treatment discontinuation (i.e., subjects with moderate levels of stress were less likely to discontinue treatment). Because of a high number of dropouts, results of this pilot study await confirmation in a larger and more adequately powered clinical trial.
This study examined the effects of supplementing sildenafil (Viagra) with use of a cognitive-behavioral treatment manual plus minimal therapist contact. Participants were 6 heterosexual couples in which the man met criteria for erectile dysfunction and was using sildenafil. Erectile dysfunction resulted from psychological factors or psychological and organic factors combined. In a multiple baseline design, participants completed a period of 4, 6, or 8 weeks during which they used sildenafil alone and monitored several psychosocial and behavioral variables. The experimental treatment, which lasted 6 weeks, comprised the cognitive-behavioral treatment manual and brief weekly phone contact with a therapist. Results suggest that manualized treatment was associated with increases in sexual satisfaction among men, some improvement in sexual satisfaction among partners, and an increase in the frequency of sexual intercourse. There was some evidence of improvement in sexual functioning among both men and women. Treatment gains were largely maintained at a 4-to-8-week follow-up and a 4-to-10-month follow-up. Results suggest that this cognitive-behavioral intervention may enhance the benefits of sildenafil. Additional research is needed to further test the potential benefits of this treatment approach.
Men with and without sexual dysfunction present with varying patterns of agreement between subjective estimates of sexual arousal and more objective psychophysiological measures of the same construct. This relative accuracy seems to be associated with sexual function, with men who have sexual dysfunction presenting less accurate estimations (mostly reporting below measured arousal levels). The purpose of this study is to clarify the processes underlying sexual arousal and the accuracy of its self-estimation. We looked at potential predictors of sexual arousal (subjective and physiological) and accuracy in estimating objective sexual arousal in a sample of 60 sexually functional males. Predictors included pre-existing sexual attitudes (erotophobia), both trait and state positive and negative affect, self-focused attention, and interoceptive awareness. Results indicate that this sexually functional sample generally reported below their own erection level. Interestingly, trait negative affect was associated with somewhat lower levels of subjective arousal and higher levels of physiological arousal. On the other hand, state positive affect facilitated both subjective and objective arousal and increased somewhat the accuracy of estimates of erectile responding. Pre-existing sexual attitudes as well as variations in self-focused attention and interoceptive awareness evidenced little effect on sexual arousal or the accuracy of its estimation.
The Erection Quality Scale (EQS) is a new, self-report measure for assessing the quality of penile erections. It is intended to complement existing diagnostic and outcome measures (eg, International Index of Erectile Function, Sexual Encounter Profile) in both clinical practice and outcomes research in erectile dysfunction (ED). The initial phases of development and psychometric validation of the EQS are described. Specifically, qualitative research in patients and healthy men was used to generate relevant constructs. On the basis of the findings from these phases, and recommendations from an expert panel, seven constructs were selected for inclusion. Multiple items with different formats were drafted to measure each of the key constructs. An iterative process of cognitive testing, item revision, and item reduction was used to identify the 15 most appropriate items and their optimal response scales. This version of the scale was tested in a 200-subject discriminant validity study designed to gather data for a psychometric evaluation. Participants were classified into ED-untreated, ED-treated, and healthy control groups to evaluate the discriminant validity of the measure in men with different levels of erectile function. The study results supported a robust single-factor structure, indicating that the EQS provides an overall index of erection quality. An intraclass correlation coefficient of 0.85 denotes adequate test-retest reliability. Furthermore, the EQS correlated well with existing measures and differentiated patients from the three ED classifications, a preliminary indication of discriminant validity. The findings presented provide evidence of the scale's potential utility for measuring erection quality in future studies.
After viewing 2 sexually explicit films, 52 sexually functional participants were given bogus feedback indicating a low erectile response. The men were given either an external, fluctuating attribution (i.e., poor films) or an internal, stable attribution (i.e., problematic thoughts about sex) for the low arousal. As hypothesized, participants in the external, fluctuating group evidenced greater erectile response and subjective arousal during a 3rd film than did participants given the internal, stable attribution. This may indicate that after an occasion of erectile difficulty, the cause to which the difficulty is attributed plays an important role in future sexual functioning.
The current investigation explores possible reasons for the poor overall success rates of medical techniques used in the treatment of erectile dysfunction. This is the first study to compare directly the psychological impact of a mechanically produced versus an erotically produced erection. Subjective and objective parameters of sexual arousal were used to compare the experience of a mechanically attained erection versus an erotically stimulated erection. Twenty-eight (28) men without sexual dysfunction were asked to reach a full erection during each of the following two conditions: (a) by using an ErecAid System and (b) by self-stimulating while watching an erotic video. The results of this study suggest that the penile vacuum device was a successful method for attaining penile tumescence; however, the presence of penile tumescence was not accompanied by a subjective state of physical or mental sexual arousal. Thus, the mere physical presence of an erection does not seem to evoke bodily or mental feelings of sexual arousal. It is important to note that these findings suggest that attention to the psychosexual components of the individual's sexual experience are critical to the subjective experience of sexual arousal and reflect once again the multimodal response systems involved in sexual arousal. These results suggest that more effective treatment approaches would be based on a clinical strategy that provides instruction both on the technical use of a mechanical device as well as on the importance of creating an appropriate psychosexual environment.
With the advent of DSM-III in the USA (1), a new disorder termed generalized anxiety disorder (GAD) was established separately from panic disorder. Because GAD was relegated to a residual category, it soon became a confusing diagnosis. Although revisions in DSM-III-R (2) removed GAD as a residual category, they also complicated the clinical examination necessary to arrive at a GAD diagnosis. With the publication of DSM-IV (3), GAD has been further refined in an attempt to improve the reliability and discriminability of the disorder. However, it continues to be controversial, and a number of issues remain unresolved.
This study assessed perceived changes in sexual behavior and body image after weight loss in a clinically obese population. Thirty-two women enrolled in a hospital-based multidisciplinary weight management program completed retrospective questionnaires about their sexual functioning and body image before and after weight loss. Subjects reported significant increases in the frequency of their sexual activity. Subjects also perceived significant improvements in their body image. These findings suggest that obese people experience positive changes in sexual functioning and body image after weight loss.
Despite prohibitions by the ethical codes of all major mental health professions, therapist sexual misconduct remains a serious problem. Over the past 13 years, individual states have enacted laws regarding therapist sexual misconduct with the hope of more successfully curbing this behavior. The laws fall into four categories; civil, criminal, reporting, and injunctive relief statutes. This article discusses the theoretical underpinnings of the laws, examines the provisions of the existing statutes, and provides an overview of the advantages and disadvantages of each category of statute. Preliminary evaluative data are also presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Despite prohibitions by the ethical codes of all major mental health professions, therapist sexual misconduct remains a serious problem. Over the past 13 years, individual states have enacted laws regarding therapist sexual misconduct with the hope of more successfully curbing this behavior. The laws fall into four categories; civil, criminal, reporting, and injunctive relief statutes. This article discusses the theoretical underpinnings of the laws, examines the provisions of the existing statutes, and provides an overview of the advantages and disadvantages of each category of statute. Preliminary evaluative data are also presented.
In this study, the authors surveyed all licensed psychologists in the state of Rhode Island and in the state of Western Australia, Australia, and asked them if they had treated clients who had been sexually abused by a former therapist. Surveys distributed in both states were nearly identical, with only minor differences to conform to local conventions. Despite some very distinct cultural and training differences between the two professional psychology populations, there was remarkable similarity in the percentage of respondents who reported having treated victims of therapist sexual abuse. Both populations of psychologists also judged the effects of such sexual relations to be detrimental to patients, though U.S. psychologists were much more aware of therapist sexual abuse issues than Australian psychologists. This study is the first to provide survey data on this phenomenon in Australia and the first cross-cultural comparison.
In this study, the authors surveyed all licensed psychologists in the state of Rhode Island and in the state of Western Australia, Australia, and asked them if they had treated clients who had been sexually abused by a former therapist. Surveys distributed in both states were nearly identical, with only minor differences to conform to local conventions. Despite some very distinct cultural and training differences between the two professional psychology populations, there was remarkable similarity in the percentage of respondents who reported having treated victims of therapist sexual abuse. Both populations of psychologists also judged the effects of such sexual relations to be detrimental to patients, though U.S. psychologists were much more aware of therapist sexual abuse issues than Australian psychologists. This study is the first to provide survey data on this phenomenon in Australia and the first cross-cultural comparison.
Thermal biofeedback is widely used to treat various clinical disorders. Given its widespread utility, and the variability among the biofeedback systems currently on the market, it is important to investigate which systems are most effective for training various skills. This study compared the performance of normal subjects on two different computer-biofeedback systems. Results indicated a significant difference in subject performance between the two systems. Limitations and implications of these findings are discussed.
Thermal biofeedback is widely used to treat various clinical disorders. Given its widespread utility, and the variability among the biofeedback systems currently on the market, it is important to investigate which systems are most effective for training various skills. This study compared the performance of normal subjects on two different computer-biofeedback systems. Results indicated a significant difference in subject performance between the two systems. Limitations and implications of these findings are discussed.
In this study, the authors surveyed all licensed mental health professionals in the state of Rhode Island and asked them if they had treated clients who had been sexually abused by a former therapist. Twenty-six percent of the respondents reported having treated victims of therapist sexual abuse. In addition, the treating therapists reported 120 incidents of other boundary violations. These data point to a dramatic difference between the actual occurrence of therapy boundary violations and the reporting of violations to state licensing boards. The nature of the violations that do occur and the impact on patient victims are also discussed.
In this study, the authors surveyed all licensed mental health professionals in the state of Rhode Island and asked them if they had treated clients who had been sexually abused by a former therapist. Twenty-six percent of the respondents reported having treated victims of therapist sexual abuse. In addition, the treating therapists reported 120 incidents of other boundary violations. These data point to a dramatic difference between the actual occurrence of therapy boundary violations and the reporting of violations to state licensing boards. The nature of the violations that do occur and the impact on patient victims are also discussed.
Diabetes mellitus, a major health problem afflicting 500,000 Americans each year, is a leading cause of male erectile difficulties. Diabetic women may be susceptible to a similar diabetic pathogenesis for sexual problems but information about the effect of diabetes on female sexual response is sparse and conflicting. Past research has been based upon self-report measures, a methodology flawed by susceptibility to response bias. Whether diabetic women differed from a matched nondiabetic control group in their physiological as well as subjective response to erotic stimulus exposures was investigated. Vaginal photoplethysmographic measures of capillary engorgement were taken while subjects individually viewed counterbalanced erotic and non-erotic videotape presentations. Graphically and statistically analyzed results indicated that diabetic women demonstrated significantly less physiological arousal to erotic stimuli than controls, whereas their subjective responses were comparable. These objective, physiological findings support and extend previous subjectively based research which found potential diabetes-related sexual dysfunction in female diabetics. The groups did not differ, however, in the reported occurrence of sexual difficulties.
Studies on sexual behavior frequently require that subject volunteers engage in intrusive/sensitive assessment procedures. While earlier investigators have found that these demands may result in volunteer bias (volunteers differing from nonvolunteers), these studies were limited to nonclinical samples. The present study involved 182 males admitted to an inpatient alcoholism rehabilitation program. Those patients who volunteered to participate in an intrusive study examining sexual functioning were dissimilar to nonvolunteers. Compared to nonvolunteers, volunteers reported a greater interest in sex, less satisfaction with sex, more concerns about sexual functioning, a greater incidence of premature ejaculation, and a greater incidence of negative sexual experience. Volunteers also had a higher MAST score, used outpatient substance-abuse counseling more often, and more frequently had a diagnosis of cocaine/amphetamine dependence and cannabis dependence. These differences between volunteers and nonvolunteers suggest a need to use caution when generalizing the results of similar studies to the overall population. Procedures that may help to minimize volunteer bias are offered.
A double-blind, partial crossover study on the therapeutic effect of yohimbine hydrochloride on erectile dysfunction was done in 82 sexually impotent patients. All patients underwent a multifactorial evaluation, including determination of penile brachial blood pressure index, cavernosography, sacral evoked response, testosterone and prolactin determination, Derogatis sexual dysfunction inventory and daytime arousal test. After 1 month of treatment with a maximum of 42.0 mg. oral yohimbine hydrochloride daily 14 per cent of the patients experienced restoration of full and sustained erections, 20 per cent reported a partial response to the therapy and 65 per cent reported no improvement. Three patients reported a positive placebo effect. Maximum effect takes 2 to 3 weeks to manifest itself. Yohimbine was active in some patients with arterial insufficiency and a unilateral sacral reflex arc lesion, and in 1 with low serum testosterone levels. The 34 per cent response is encouraging, particularly in a Veterans Administration population presenting with a high incidence of diabetes and vascular pathological conditions not found in regular office patients. Only few and benign side effects were recorded, which makes this medication worth an attempt, often as a first line of treatment even at a dose of 8 tablets.
The erectile responses of 13 nondysfunctional males and 48 dysfunctional males were compared during Nocturnal Penile Tumescence (NPT) and during exposure to erotic videotapes. The results showed distinct patterns of NPT and daytime responding that could differentiate the various subgroups: those displaying (i) no dysfunction; (ii) vasculogenic erectile dysfunction; (iii) high risk for erectile dysfunction (organic and psychogenic); (iv) psychogenic dysfunction; reactive to erotica; and (v) psychogenic dysfunction; nonreactive to erotica. Subjects participating in this study underwent a comprehensive medical and psychological screening to place them in each subgroup. The penile circumference response to erotic stimuli used in conjunction with NPT response appeared useful in differentiating subgroups of erectile dysfunction and suggested the need for further diagnostic refinement in this area. The majority of vasculogenic dysfunctional subjects experienced greater erection responses during exposure to erotic stimulation than during NPT; several of these subjects achieved almost full erections in waking states but were practically flaccid at night. The discussion covers diagnostic and therapeutic implications.
Two hundred twenty-one first-year medical students participated in a voluntary coronary heart disease risk factor self-change project designed to teach the principles of behavioral change. Blood pressure, serum lipids, percentage body fat, cardiovascular fitness, and smoking status were measured prior to the project. Students designed their own programs of behavior modification and, after 8 weeks, repeat measurements were obtained in students whose projects related to coronary heart disease risk (56% of entire group). Despite generally low initial coronary heart disease risk factors, most risk factor groups successfully altered the targeted risk factors. The subgroup attempting to lower serum cholesterol (n = 49) reduced total cholesterol 15 +/- 24 mg/dl (mean +/- SD) and low-density lipoprotein cholesterol 11 +/- 20 mg/dl (P less than 0.001 for both). The blood pressure group (n = 9) decreased systolic blood pressure 8 +/- 10 mm Hg (P less than 0.05), and the weight-loss group (n = 33) lost 3.0 +/- 2.9 kg (P less than 0.001), reducing estimated percentage body fat 1.7 +/- 1.8 (P less than 0.001). The self-change project was well received by the students and appears to be a useful technique for introducing the principles of behavioral medicine to first-year medical students.
Twenty men with incomplete penile erection or inability to maintain an erection were evaluated to determine if venous leakage was a cause. Cavernosography was performed in conjunction with artificial erection induced by infusion of saline into the corpus cavernosa. Thirteen patients requiring higher than normal rates of saline infusion to achieve or maintain erection showed filling of superficial veins in the flaccid state as well as during erection. In five of the seven patients with normal saline requirements there was no filling of superficial veins, and two showed filling in the flaccid state only. Of the thirteen patients whose conditions were diagnosed as venous leakage, seven underwent surgical ligation of superficial veins and deep penile vein arterialization by a saphenous vein bypass graft between the superficial femoral artery and deep penile vein. All these patients had reduced saline requirements postoperatively. When cavernosography is performed in the flaccid state only, filling of superficial veins can occur normally; therefore, these studies should be performed with artificial erection.
Three chronic pedophiliac sex offenders were treated individually with medroxyprogesterone acetate (MPA) over a minimum of 3 months. Genital and subjective response to erotic stimulation, nocturnal penile tumescence, self-reporting of sexual urges, and testosterone levels were recorded repeatedly throughout the study. A single-subject reversal design was used and medication was administered through a double-blind procedure. The results showed that self-report of arousal outside of a laboratory setting was unreliable as a measure of the drug effect. In a laboratory setting, however, there appeared to be a significant reduction in the report of arousal to erotic stimuli while genital arousal decreased only slightly. Reversal of these responses occurred in only one subject during a final placebo phase. Nocturnal penile tumescence was significantly decreased during MPA administration and appeared to be related to decreases in total testosterone.
Eleven impotent men underwent deep-penile-vein arterialization after preoperative assessment by a multidisciplinary team. Penile Doppler pressures, testosterone levels, and nocturnal penile tumescence were used to establish a vasculogenic etiology. Cavernosography, artificial erection by saline infusion, and selective hypogastric arteriography were obtained to delineate whether arterial, venous, or mixed (arterial/venous) factors predominated. Penile revascularization consisted of femoral artery to deep-penile-vein saphenous bypass, with ligation of superficial veins at the base of the penis in patients with venous leakage. Cumulative graft patency was 91% up to 20 months. There were no deaths. The average preoperative flow requirement of values greater than 250 mL/min was reduced to 59 mL/min postoperatively. Follow-up results of nocturnal penile tumescence were excellent in four of four patients with venous (venous leakage), two of three patients with arterial, and one of four patients with mixed factors. Deep-penile-vein arterialization appears to be beneficial for impotence secondary to venous leakage, with inconsistent results for arterial and mixed factors.
Patterns of sexual arousal were examined for eight male and eight female homosexuals. Comparisons were made in terms of physiological and subjective arousal. The results indicate that for each group there exists very distinct arousal responses, with each group showing the greatest response to same-gender homosexual activity. Results are discussed in relationship to establishing normative data for assessment and clinical function.
A behavioral self-change project appears to be a useful means of integrating behavioral medicine into the medical school curriculum. Students were encouraged to learn measurement principles, sources of error, and how their risk factor values compared with population values. At the same time, students were exposed to behavioral principles and were able to observe first-hand the biologic integration of behavior and physiology. Since students evaluated their own coronary heart disease (CHD) risk and used themselves as subjects, the project became a personally relevant exercise.
The structural patterns of sexual arousal are examined for eight male and eight female heterosexuals. Comparisons are made in terms of physiological and subjective arousal. The results indicate (1) that males and females differ in both the direction and magnitude of their arousal response to a variety of erotic stimuli and (2) that there is a stronger correspondence between subjective and physiological measures of sexual arousal for males than for females. A social acceptability and/or unacceptability theory is suggested to account for similarities and differences between the male and female structural patterns of arousal. Several methods of assessing subjective arousal are included to represent those most frequently used in clinical research settings. It is demonstrated that each of the subjective measures discriminates between erotic conditions and that the information provided by each of the measures are comparable.
Describes a behavioral model that is used as a framework for the assessment and treatment of sexual disorders. The model emphasizes a multidisciplinary approach leading to the development of individually tailored treatment programs. The following assessment techniques and procedures are discussed: self-report measures, behavioral measures, and physiological/medical measures. (56 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Clinical programs for the treatment of impotence generally have been successful but without experimental verification of their individual components or factors associated with the development of impotence. Twenty-four normal males participated in an investigation comparing factors believed to inhibit or facilitate penile tumescence. The effects of demand for performance, self-monitoring of erection, and increased SNS activity, were evaluated. Subjects were exposed to sexual stimuli under these conditions and measurements of penile responses were taken. Results indicated that there were no differential effects on penile responses between demand and no-demand or between self-monitoring and no self-monitoring. Increased SNS activity appeared to facilitate loss of erection, but only after, and not during, the sexual stimulus. The clinical and theoretical implications of these findings are discussed, and suggestions are made for future research.
Serum testosterone concentration of 24 human males was correlated with penile diameter changes in response to erotic stimuli. Mean testosterone concentration was significantly and negatively correlated with latency to maximum tumescence and it is hoped that this finding will shed light on the psychophysiological mechanisms involved in normal and impaired erectile function.
The effect of emotional arousal on subsequent sexual arousal was assessed in 14 18–34 yr old men. Ss initially viewed either 1 of 2 emotionally arousing videotapes (depression-and-anger or anxiety-and-anger producing) or a neutral videotape (a travelogue), each of which was followed by an erotic videotape. Sexual arousal was measured physiologically with a penile strain gauge. Although there were no differences in the level of sexual arousal during the antecedent emotionally arousing or neutral videotapes, sexual arousal during the subsequent erotic videotapes was differentially affected by them. Sexual arousal following the anxiety-and-anger videotape was greater than that following either the depression-and-anger videotape or the travelogue. Prior exposure to the travelogue resulted in greater sexual arousal than did the videotape producing depression and anger. (10 ref)
Instrumentation has been developed which promises to further our understanding of the relationship between cognitive and physiological factors in the sexual arousal process. Past research has examined this relationship by continuous measurement of genital response, and discrete posttest measurement of subjective arousal. The self-report or cognitive lever allows individuals to rate feelings of arousal continuously throughout a stimulus interval by positioning a lever device along a calibrated scale. In this way, structural patterns of physiological and cognitive response can be examined. However, since attention has been shown to be an important cognitive operation in the processing of sexual stimuli, there is concern that this subjective measuring task may confound laboratory assessment by altering genital responsivity through distractive or possibly facilitative mechanisms. In order to test the methodological limitations of the cognitive lever, 14 male and female college students were exposed to duplicate viewings of erotic videotapes while alternately using and not using the self-report device. Results indicated that lever usage was not obtrusive in females, but was in males to the point of altering physiological response. In addition, the study took advantage of the continuous, concurrent measurements and examined patterns of convergence and divergence between the two. Results of correlational analyses indicated, in line with past research, that for men greater degrees of erection result in significantly higher subjective-objective agreement. Patterns for women as a group were much less clear, with only two significant correlations appearing. Finally, the limitations of the cognitive lever were discussed.
Five women experiencing low sexual arousal were exposed to a multiple measures analysis of their sexual behavior before and after undergoing a comprehensive sex therapy program. Measures included: (1) clinical interview, (2) behavioral record, (3) self-reported ratings of sexual and anxiety arousal, and (4) physiological records. Results showed that though all women reported very positive attitudes toward the therapists and substantial therapeutic benefits in post-therapy and two year follow-up interviews, none of the objective measures showed any clinically significant changes at post-therapy. The implications of this finding were discussed.
An infrared-light measure was used to compare three methods of producing vaginal blood volume (VBV) increases: (a) VBV increases alone, (b) erotic fantasy alone, and (c) VBV biofeedback in combination with erotic fantasy and knowledge of the target response. A single-subject experimental design was used with two subjects, and time-series analyses were made. Biofeedback alone did not produce VBV increases in either subject. Erotic fantasy produced VBV increases in one subject. Erotic fantasy in combination with both VBV biofeedback and knowledge of the target response produced VBV increases in both subjects.
Six sexually normal women were exposed to a wide variety of erotic video tapes while vaginal, groin, and breast vasocongestion measures were tkane. The women indicated their level of sexual arousal while viewing the tapes by positioning a lever device along a calibrated scale. The results indicated highly significant positive correlations among the cognitive and physiological measures for five out of six individual subjects, although the pooled group data failed to show significance. The methodology described in this research shows promise as a diagnostic and research tool.
Tested J. Wolpe's (1958) prediction that autonomic sexual and anxiety arousal states are mutually inhibitory. Using a new physiological measure of female sexual arousal (vaginal blood volume), changes in 7 sexually experienced Ss (mean age 27 yrs) were compared during erotic video stimulation following anxiety and control stimulus preexposure and during anxiety and control stimulation following erotic stimulus preexposure. Consistent with reciprocal inhibition theory, when Ss were sexually aroused by erotic preexposure, anxiety arousal inhibited sexual arousal more rapidly than did an attention control stimulus. However, contrary to reciprocal inhibition theory, Ss became more rapidly aroused sexually following anxiety preexposure than following neutral preexposure. In the case of heart rate, changes were compared during erotic and neutral stimulation following anxiety preexposure and during anxiety arousal following erotic and neutral preexposure. Consistent with the literature to date, there were no heart rate changes that could be attributed to differential preexposure. Taken together, the results do not support Wolpe's reciprocal inhibition theory but do suggest a context interpretation: The way in which sexual and anxiety arousal states interact with each other may depend on the context in which Ss perceive the stimuli that generate these respective arousal states. The clinical implications of the findings are discussed. (27 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This report describes the development of a self-report Sexual Arousability Inventory (SAI) for women. Sexual arousability was defined as the sum of a respondent's ratings of 28 erotic experience along a 7-point Likert arousal dimension. Multiple-regression and factor analyses were used to select valid items from a 131-item pool and build in factorial purity. The SAI has concurrent validity with respect to sexual experience, activity, and satisfaction, and discriminates between clinical and normal populations. In addition, the SAI is easy to administer and score, may be used with single, married, or lesbian women, is available with norms and in alternate forms, and possesses exceptional internal consistency. Although the SAI was designed primarily for clinical use, the construct it measures may have theoretical significance in future research.
Twenty-one women complaining of essential sexual dysfunction were treated by either systematic desensitization or video desensitization. In a cross-over design, seven subjects experienced a no-treatment control phase before receiving therapy. Video desensitization was more effective than systematic desensitization and both desensitization procedures resulted in significant reductions in heterosexual anxiety compared to no-treatment control subjects. Only about 25% of the nonorgasmic subjects were orgasmic at the conclusion of the study.
The purpose of this investigation was to validate the use of vaginal photoplethysmography along with six other physiological measures for the assessment of sexual arousal in women. Six women in counterbalanced order were presented control, dysphoric, and sexually arousing videotapes. Subjective ratings revealed that subjects experienced moderate levels of sexual and anxiety arousal during the videotapes, and comprehension quizzing at the end of the experiment showed that subjects attended to the content. Heart rate, heart rate variability, and skin conductance response failed to discriminate between any of the videotapes. In order from highest to lowest sensitivity, vaginal blood volume, skin conductance, systolic and diastolic blood pressure, and forehead temperature showed significant increases during the erotic videotape. Though sensitive, skin conductance appeared to he unreliable. Areas for further research were identified.
Four self-referred adult male homosexuals were provided with therapy to increase their level of heterosexual responsiveness. Three underwent 40 sessions of orgasmic reconditioning using both visual and fantasied stimuli, in counterbalanced treatment sequences; one underwent 19 sessions of orgasmic reconditioning with visual stimuli and 17 sessions of shock aversion therapy. Assessment included measurement of physiological and behavioral sexual arousal patterns throughout the study. Subjects reported that their sexual adjustment had improved, but objective physiological and behavioral measures of arousal were not changed. This fails to support many previous case reports of success with the technique. The aversion therapy procedure produced no change in arousal to deviant stimuli and only slight increases in arousal to heterosexual stimuli. The lack of objective data to corroborate the subject's allegations of improved condition following treatment with orgasmic reconditioning is discussed, and the implications for the use of subjective measures of improvement in therapy outcome research examined.
The purpose of this investigation was to determine how sexually dysfunctional and normal women differ in their physiological responsivity during, and subjective responsivity shortly after, exposure to an erotic stimulus. Utilizing analysis of covariance, subjects were equated on physiological basal measures as well as other relevant demographic and sexual activity measures. Normal subjects showed increases in diastolic blood pressure and vaginal capillary engorgement, but the groups did not differ on electrodermal activity, systolic blood pressure, heart rate, and subjective ratings of sexual or anxiety arousal. There were significant positive correlations for the combined groups between vaginal capillary engorgement and Sexual Arousability Inventory scores, awareness of physiological changes during sexual activity, day in menstrual cycle, and frequency of intercourse.
The effects of a new systematic desensitization procedure were evaluated in a case of sexual frigidity. Videotaped cassettes of heterosexual behavior were arranged in a hierarchy and shown to a 24-yr-old female by her husband who acted as therapist. Following seven sessions of this, significant improvement in the couple's heterosexual behavior was reported. Therapeutic gains were maintained at a 9-month follow-up.
Prior research with token reinforcement in the psychiatric population has been directed at work adjustment, more than at major symptomatic behaviors. The purpose of the present research, on the other hand, was to investigate the effects of feedback and token reinforcement on the modification of delusional verbal behavior in chronic psychotics. Six male and four female paranoid schizophrenic patients participated in the study. The results indicated that the effects of feedback were effective about half the time in reducing percentage delusional talk, but in at least three cases produced adverse reactions. Token reinforcement, however, showed more consistency and reduced the percentage of delusional verbal behavior in seven of the nine subjects exposed to this procedure. The effects of both feedback and token reinforcement were quite specific to the environment in which they were applied and showed little generalization to other situations. It would appear that using token reinforcement can reduce the percentage delusional speech of chronic paranoid schizophrenics.
Systematic desensitization was compared to “vicarious extinction” therapy in treating frigidity in a 29-year-old married female. Films of heterosexual behavior were shown to S during “vicarious extinction”. In spite of expectations of therapeutic improvement under both treatment conditions, S showed improvement only during systematic desensitization. Greatest improvement was noted in her report of subjective anxiety related to sexual behavior. Improvement was also indicated by the husband's independent report of their sexual behavior and by the Willoughby Scale. Reasons for the lack of effect of “vicarious extinction” are considered.
Obtained simultaneous measures of heart rate and approach behavior in the feared situation during treatment of 9 15-56 yr. Old phobic ss. In some cases heart rate increased as phobic avoidance behavior decreased. In other cases there was a parallel decline, a decline in phobic behavior without any change in heart rate, or a decreased heart rate only after phobic behavior had declined. Results suggest that physiologically defined anxiety need not always be inhibited in order to obtain desired behavioral change during treatment of phobia. In fact, anxiety reduction may sometimes be a consequence rather than a cause of behavioral change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Two studies are reported concerning the effectiveness of positive reinforcement of approach behavior or “shaping” in reducing college girls' fears of snakes, an analogue of clinical phobia. In the first study, “shaping” was found to be more effective than Systematic Desensitization in reducing behavioral avoidance of snakes, and equally effective in reducing anxiety as measured by GSR. In the second, shaping was facilitated by the presence of a therapist and to a lesser extent by modelling. The results suggest that shaping may be a useful treatment for “neurotic” fears and that social variables enhance the effectiveness of the procedure.
The technique of experimental analysis of a single case employing a sequential design and quantifiable behavioral measures was used to study the contribution of instructions and reinforcement to the modification of severe neurotic behavior. The overall effect of instructions was small or transient compared to that of reinforcement procedures which produced stable changes of clinical relevance.
discuss the problem of male erectile disorder / provide a working definition of the problem, discuss its prevalence, and give an overview of the conceptual [biopsychosocial] model that guides our intervention / discuss the context of our clinical work, present our approach to assessment and treatment, and illustrate this approach with a recent clinical case (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The effect of systematic desensitization upon snake fearful subjects was compared in two conditions. In the first, relaxation was paired with imagined scenes of the snake, and in the second with a real snake. The second group improved more in a behavioral approach test and evidenced less anxiety as measured by GSR than the first group. The results point to an inefficiency of the imaginative process, and the possibility that behavioral change is enhanced by contact with the feared object.
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