Pedro Nobre

Differences in Automatic Thoughts Presented During Sexual Activity Between Sexually Functional and Dysfunctional Men and Women

The study is aimed at investigating the differences between individuals with and without sexual dysfunction on the automatic thoughts content (reported as usually presented) during sexual activity. A total of 491 individuals (163 women and 232 men without sexual problems and 47 women and 49 men with a DSM-IV diagnosis of sexual dysfunction) answered the Sexual Modes Questionnaire (SMQ; Nobre and Pinto-Gouveia (J Sex Res 40:368–382, 2003). Results indicated that men and women with sexual dysfunction reported having had significantly more negative thoughts during sexual activity compared to sexually healthy individuals. Failure and disengagement thoughts (I’m not satisfying my partner, I’m not getting turned on, when will this be over?), sexual abuse thoughts (this is disgusting, he only wants to satisfy himself), and lack of erotic thoughts were significantly more common in women with sexual dysfunction compared to sexually healthy women. Additionally, men with sexual dysfunction presented significantly higher scores on erection concern thoughts (I must be able to have intercourse, I must achieve an erection), failure anticipation thoughts (this is not going anywhere, I’m condemned to failure), and lack of erotic thoughts compared to men without sexual dysfunction. Overall, findings support clinical observations and experimental findings, indicating that cognitive distraction from erotic cues is strongly associated with sexual dysfunction. The increased use of cognitive techniques on the treatment of sexual dysfunction is a major implication of the study.

Sexual Dysfunctional Beliefs Questionnaire: an instrument to assess sexual dysfunctional beliefs as vulnerability factors to sexual problems

The aim of the present article is to present a new instrument, specially developed to assess beliefs about sexuality that are supposed to be closely related with the development of sexual disorders. Using a cognitive theory perspective we hypothesized that sexual behaviour and its problems are in someway related to the way we think about sexuality, our beliefs and our expectations. Although some questionnaires of sexual attitude, information and beliefs already exist, there is, until now, no specific measure oriented to assess both male and female sexual dysfunctional beliefs related to aetiology. The Sexual Dysfunctional Beliefs Questionnaire is a 40-item self-reported measure constituted by two versions (female and male) rated on a five point likert scale. Both male and female versions present satisfactory test-retest reliability (r=0.73 and r=0.80 respectively), and internal consistency (Cronbachs alpha=0.93 for male and 0.81 for the female version). Studies of convergent validity show a relationship with other measures of sexual and more general beliefs, as well as with measures of sexual functioning. Discriminant validity studies support its capacity to discriminate functional from sexual dysfunctional subjects. It is expected that these measures could be useful in both clinical practice and educational programmes serving as an indicator of vulnerability to sexual dysfunction.

Cognitive and Emotional Predictors of Female Sexual Dysfunctions : Preliminary Findings

The influence of cognitive and emotional variables on specific female sexual dysfunctions was investigated. A total of 207 women (160 without sexual problems and 47 with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis of sexual dysfunction) answered a set of questionnaires assessing cognitive and emotional variables (cognitive schemas activated in sexual context – Questionnaire of Cognitive Schema Activation in Sexual Context (QCSASC); sexual beliefs – Sexual Dysfunctional Beliefs Questionnaire (SDBQ); automatic thoughts and emotions presented during sexual activity – Sexual Modes Questionnaire (SMQ)); and sexual functioning (Female Sexual Function Index (FSFI)). Results indicated that most women with sexual dysfunction activate incompetence schemas when facing unsuccessful sexual situations. Additionally, lack of erotic thoughts and increased attentional focus on failure and disengagement thoughts during sexual activity were also common in the clinical sample. Besides these common factors, results showed that some specific cognitive and emotional factors are associated with different clinical presentations. Sexual conservative beliefs seem to be closely related to hypoactive sexual desire and to a certain extent to arousal difficulties in women. Body image beliefs and automatic thoughts focusing on self-body appearance seem to be strongly associated with orgasmic disorder. Regarding emotions, fear was one of the best predictors of vaginismus, whereas sadness, disillusion, guilt, and lack of pleasure and satisfaction were closely associated to hypoactive sexual desire. Overall, these findings may contribute to the discussion regarding the treatment strategies used for the different female sexual dysfunctions.

Sexual modes questionnaire: Measure to assess the interaction among cognitions, emotions, and sexual response

The goal of the present article is to present a new measure developed to assess cognitive and emotional factors of sexual function. This instrument was developed especially to test some hypotheses derived from Becks new theoretical conceptualization (the modes theory; A. T. Beck, 1996). This model, characterized by its systemic and integrated approach, constitutes a remarkable development from a linear to a network perspective of the cognitive‐emotional‐behavioral processes. The new concept of mode, as a composite of schemas (cognitive, emotional, and behavioral) interacting together, is theoretically sound and supported by recent research findings from clinical and experimental sets (see A. T. Beck, 1996, for a revision). Our aim is to develop a new measure specifically created to assess these integrated and interdependent processes in the field of sexuality. The Sexual Modes Questionnaire (SMQ; male and female versions) is a combined measure constituted by three interdependent subscales: automatic thoughts, emotions, and sexual response presented during sexual activity. Psychometric studies showed good reliability and validity results in both versions, and high correlations between several dimensions of the three subscales support the concept of mode and its interactional character. Moreover, the capacity showed by the SMQ to discriminate between sexually functional and dysfunctional subjects and its high correlations with measures of sexual functioning emphasize the role of cognitive‐emotional processes on sexual problems, supporting the clinical value of the measure.

Prevalence and Comorbidity of Sexual Dysfunctions in a Portuguese Clinical Sample

We investigated the prevalence and comorbidity of sexual dysfunction in a clinical Portuguese sample. A total of 96 participants (47 females and 49 males with a diagnosis of sexual dysfunction (DSM-IV; American Psychological Association, 1994) assigned by a group of trained sex therapists) answered the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the International Index of Erectile Function (IIEF; Rosen et al., 1997). Results indicated erectile dysfunction (70%) and female hypoactive sexual desire disorders (40.4%) as the most prevalent complaints, with premature ejaculation (22.4%), vaginismus (25.5%), and female orgasmic disorder (21.3%) also showing relevant prevalences. Comorbidity studies indicated higher levels of overlapping among female sexual difficulties with strong associations between desire, subjective arousal, and orgasmic disorders, as well as between dyspareunia and vaginismus.

Biopsychosocial Determinants of Men's Sexual Desire: Testing an Integrative Model

INTRODUCTION There is a severe lack of studies on male sexual desire and its biopsychosocial determinants. Most of the studies are focused on female sexual interest and are based on the contribution of single dimensions instead of the interaction between them. AIM The aim of the present study was to test a conceptual model considering the interrelated role of biopsychosocial factors on male sexual desire. This model allowed us to test not only the unique impact of predictors that are traditionally related to sexual desire, but also how their interaction affects sexual desire in men. METHODS Two hundred and thirty seven men from the general population were assessed according to age (mean age = 35, standard deviation = 11), medical problems, psychopathology, dyadic adjustment, and cognitive-emotional factors. MAIN OUTCOME MEASURES Psychopathology measured by the Brief Symptom Inventory, dysfunctional sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions in sexual context measured by the Sexual Modes Questionnaire, dyadic adjustment measured by the Dyadic Adjustment Scale, medical condition measured by the Medical History Formulation, and sexual desire measured by the Sexual Desire subscale of the International Index of Erectile Function. RESULTS Results showed that cognitive factors (sexual beliefs and automatic thoughts during sexual activity) were the best predictors of sexual desire in men. Specifically, beliefs related to restrictive attitudes toward sexuality, erection concerns, and lack of erotic thoughts in sexual context, had a significant direct effect on reduced sexual desire. Moreover, this set of cognitive-emotional factors also mediated the relationship between medical problems, age, and sexual desire. CONCLUSION Results from this integrative approach highlighted the role of cognitive factors related to cultural values (dysfunctional sexual beliefs) and distraction mechanisms during sexual context (automatic thoughts) in male sexual interest. Findings support the need to include cognitive dimensions in the assessment and treatment of sexual desire problems, considering their involvement as vulnerability or resiliency factors for deficient sexual desire in men. Moreover, these factors surpassed the importance of the remaining factors (particularly, of medical factors and psychopathology), showing that, despite the lack of studies, male sexuality is better conceptualized from a biopsychosocial perspective.

Cognitive Schemas Associated with Negative Sexual Events: A Comparison of Men and Women with and Without Sexual Dysfunction

The association between cognitive schemas activated during sexual events and sexual functioning was studied. A total of 376 participants (47 women and 49 men with a DSM-IV diagnosis of sexual dysfunction and 160 women and 120 men from a control group) answered the Questionnaire of Cognitive Schema Activation in Sexual Context, the International Index of Erectile Function, and the Female Sexual Function Index. Results showed that participants with sexual dysfunction activated significantly more negative schemas when exposed to sexually unsuccessful situations compared to sexually healthy individuals (after controlling for the frequency of negative sexual events experienced by both groups). Most men and women with sexual difficulties interpreted negative sexual events according to an incompetence self-schema (I’m powerless, I’m incompetent, I’m a failure). These findings were congruent with recent research indicating the tendency shown by individuals with sexual dysfunction to give attributions of an internal, stable, and global nature to negative sexual experiences. Overall, results suggest specific faulty cognitive constructions underlying sexual dysfunctions and encourage the development of models and treatment approaches based on cognitive theory.

Psychological Determinants of Erectile Dysfunction: Testing a Cognitive–Emotional Model

INTRODUCTION Recent studies have shown the impact of sexual dysfunctional beliefs, negative cognitive schemas, negative automatic thoughts, and depressed affect on male erectile dysfunction. Despite this fact, there are only few conceptual models that try to integrate these findings, and more importantly, there is a lack of studies that test the validity of those conceptual models. AIM The aim of the present article was to test a cognitive-emotional model for erectile dysfunction. Taking previous research findings into account, we developed a cognitive-emotional model for erectile disorder (ED) and used path analysis to test it. METHODS A total of 352 men (303 participants from the general population and 49 participants with a DSM-IV diagnosis of sexual dysfunction) answered a set of questionnaires assessing cognitive and emotional variables. MAIN OUTCOME MEASURES Erectile Function measured by the EF subscale of the International Index of Erectile Function, cognitive schemas measured by the Questionnaire of Cognitive Schema Activation in Sexual Context, sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions measured by the Sexual Modes Questionnaire. RESULTS The effects of the main proposed direct predictors explained 55% of the erectile function variance (R = 0.74). Most remaining direct effects proposed in the model were also statistically significant. The analysis of the absolute residuals showed that most of the implied correlations were close to the observed zero order correlations, indicated the adjustment of the model to the observed data. CONCLUSIONS These findings support the role played by cognitive and emotional factors on the predisposition and maintenance of male erectile dysfunction and suggest important implications for assessment and treatment of ED.

Predictors of Women's Sexual Desire: The Role of Psychopathology, Cognitive‐Emotional Determinants, Relationship Dimensions, and Medical Factors

INTRODUCTION Deficient sexual desire is a common sexual difficulty among women, often related to medical and psychiatric problems, lack of adjustment in a relationship, or age. However, the relative contribution of each one of these dimensions is not yet well establish. AIM The aim of this study was to evaluate the main predictive factors of female sexual desire. METHODS A total of 237 women from the general population answered to a set of questionnaires assessing psychopathology, cognitive-emotional factors, dyadic adjustment, presence of medical pathologies, and menopause. MAIN OUTCOME MEASURES Psychopathology measured by the Brief Symptom Inventory (BSI), dysfunctional sexual beliefs measured by the Sexual Dysfunctional Beliefs Questionnaire, thoughts and emotions in sexual context measured by the Sexual Modes Questionnaire, dyadic adjustment measured by the Dyadic Adjustment Scale, medical condition measured by the Medical History Formulation, and sexual desire measured by the Sexual Desire subscale of the Female Sexual Function Index. RESULTS Findings indicated that psychoticism was the only psychopathological dimension that significantly predicted sexual desire (beta = 0.37). Conservative beliefs (beta = -0.33) and age-related beliefs (beta = -0.25) were also significant predictors of desire. Additionally, lack of erotic thoughts (beta = -0.28), failure and disengagement sexual thoughts (beta = -0.64), and thoughts related to female passivity (beta = 0.31) during sexual activity were significant predictors of desire. Regarding relationship dimensions, dyadic cohesion (beta = 0.37), and dyadic affection (beta = 0.45) were the best predictors of sexual desire. Moreover, postmenopausal women and women with medical problems presented reduced sexual desire. A multiple regression analysis (enter method) including all these variables plus age, indicated that failure/disengagement thoughts during sexual activity was the only significant predictor of sexual desire in women (beta = -0.52). CONCLUSIONS Results support the role of cognitive dimensions in the maintenance of womens sexual interest, and suggest implications for assessment and treatment of sexual desire difficulties.

Determinants of Sexual Desire Problems in Women: Testing a Cognitive-Emotional Model

Recent studies have shown the impact of sexual dysfunctional beliefs, negative cognitive schemas, negative automatic thoughts, and depressed affect on female sexual functioning. Taking these findings into account, the aim of the present article was to develop and test a cognitive-emotional model for sexual desire problems in women. A total of 310 women (263 participants from the general population and 47 participants with a DSM-IV diagnosis of sexual dysfunction) answered a set of questionnaires assessing cognitive and emotional variables. The conceptual model proposed hypothesized that dysfunctional sexual beliefs work as predisposing factors, stipulating the conditional rules for the activation of negative cognitive schemas. These schemas, once activated, would elicit negative automatic thoughts and emotions impairing the processing of erotic stimuli and interfering negatively with sexual desire. A path analysis was conducted to test the theoretical model proposed. Results supported the relevance of the model and its adjustment to the observed data, indicating the main role performed by cognitive and emotional factors on the predisposition and maintenance of sexual desire problems in women, and suggesting important implications for treatment.