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

Journal of Sex Research, Nov, 2003 by Pedro J. Nobre, Jose Pinto-Gouveia

Recently, a growing body of research on the role of cognitions and emotions in sexual response has emerged. In fact, since Barlow's formulation on cognitive-affective factors of sexual dysfunction (Barlow, 1986; Cranston-Cuebas & Barlow, 1990; Sbrocco & Barlow, 1996), several laboratory and clinical studies were conducted to analyze the role of some cognitive and emotional dimensions in the sexual health field. Cognitive distraction (J. G. Beck, Barlow, Sakheim, & Abrahamson, 1987; Dove & Wiederman, 2000; Elliot & O'Donohue, 1997; Farkas, Sine, & Evans, 1979; Geer & Fuhr, 1976; Przybyla & Byrne, 1984), efficacy expectancies (Bach, Brown, & Barlow, 1999; Creti & Libman, 1989; Palace, 1995), causal attributions (Fichten, Spector, & Libman, 1988; Weisberg, Brown, Wincze, & Barlow, 2001), and perfectionism (DiBartolo & Barlow, 1996) are among the most studied cognitive dimensions in sexual functioning. In general, results from these studies support the main role performed by cognitive factors in sexual dysfunction processes.

For the present discussion cognitive distraction studies assume a central role. Research with both male and female samples suggests that distraction from sexual cues during sexual activity decreases subjective and physiological arousal in both males and females (J. G. Beck et al., 1987; Dove & Wiederman, 2000; Elliot & O'Donohue, 1997; Farkas et al., 1979; Geer & Fuhr, 1976; Przybyla & Byrne, 1984). These psychophysiological studies support several clinical suggestions that dysfunctional subjects, when in sexual situations, focus their attention on negative thoughts rather than on sexually erotic thoughts. In males, these thoughts are mostly related to performance concerns (erection concerns), anticipating failure and its consequences (Hawton, 1985; Wincze & Barlow, 1997; Zilbergeld, 1999), whereas females orient their attention to self-body-image concerns, sexual performance concerns, and failure thoughts (Dove & Wiederman, 2000; Hawton, 1985). Despite these laboratory findings and clinical suggestions, there is still a lack of naturalistic empirical studies investigating the cognitive content of sexually dysfunctional males and females during sexual activity. With the exception of the Dove and Weiderman study (2000), which indicates a negative impact of distraction thoughts (sexual performance and bodily appearance) on female sexual functioning, there is no published data about cognitive content during sexual activity and its influence on sexual performance.

Moreover, studies about the role of emotions on sexual functioning, although receiving some recent attention, are still lacking. Research on depressed affect has shown some consistent results suggesting a negative impact on sexual arousal. Heiman and Rowland (1983) and J. G. Beck and Barlow (1986) found that dysfunctionals reported significantly more negative affect during erotic exposure. Experimental studies have further supported these findings, showing that manipulated negative affect in sexually functional subjects produced a delay in subjective sexual arousal (Meisler & Carey, 1991) and a decrease in penile tumescence (Mitchell, DiBartolo, Brown, & Barlow, 1998).

Research on the role of anxiety in sexual functioning has also shown some consistent results in both men and women. Contradicting classic theoretical perspectives based on clinical observations (Kaplan, 1974; Masters & Johnson, 1970), results systematically suggest a neutral or even a facilitative effect of anxiety on both male and female sexual arousal (Barlow, Sakheim, & J. G. Beck, 1983; Elliot & O'Donohue, 1997; Laan, Everaerd, Aanhold, & Rebel, 1993; Palace & Gorzalka, 1990).

Studies on the impact of anger and worry on sexual functioning are lacking and present some inconsistent results. Yates, Barbaree, and Marshall (1984), studying the relationship between anger and deviant sexual arousal, showed that this emotion might facilitate sexual arousal, while Bozman and J. G. Beck (1991) reported that anger decreases both desire and arousal. Katz and Jardine (1999) analyzed the relationship between a tendency to worry and sexual desire and aversion in a non-clinical population, and found some moderate but not conclusive correlations.

Despite this growing body of scientific literature, we think there is a lack of integrated studies on the link between cognitions and emotions and their impact on sexual functioning. Our purpose is to move in that direction using cognitive theory as a preferential framework to better understand the processes involved in sexual dysfunction. In fact, cognitive theory has led to a better understanding of the cognitive processes involved in a large spectrum of psychopathological situations and has been successfully used in the comprehension and treatment of several disorders: depression (A. T. Beck, Rush, Shaw, & Emery 1979), anxiety (A. T. Beck & Emery, 1985), relationship disorders (A. T. Beck, 1988), personality disorders (A. T. Beck & Freeman, 1990), substance abuse disorders (A. T. Beck, Wright, Newman, & Liese, 1993), and hostility (A. T. Beck, 2000).