Abnormal Psychology

Gender and Sexual Disorders 513

FEEDBACK LOOPS IN TREATMENT: Sexual Dysfunctions

Like successful treatment for any psychological disorder, successful treatment of sex-

ual dysfunctions ultimately affects all the neuropsychosocial factors (see Figure 11.5).

For instance, CBT for female orgasmic disorder targets psychological factors (the

thoughts, beliefs, and feelings related to sex or orgasm and behaviors such as mas-

turbation) (Heiman, 2002a). In turn, changes in these factors lead, through feedback

loops, to changes in neurological and other biological factors (which underlie orgasm)

as well as social factors (the meaning for both partners of an orgasm and the changes

in their interactions). A similar set of feedback loops occurs with CBT for vaginismus

(ter Kuile et al., 2007): CBT changes thoughts and feelings about penetration, and the

responses of the vaginal muscles, making vaginal intercourse with a partner possible.

Although all the techniques mentioned may alleviate sexual dysfunctions, the

defi nition of “success” is less clear-cut than for treatments of most psychological

disorders. As we noted at the beginning of this chapter, sexuality and sexual dys-

functions typically involve other people besides the patient, and a treatment that the

patient views as successful may not be perceived that way by the partner. Let’s go

back to the older gentleman whose erectile dysfunction was treated with Viagra. He

may have been pleased by his response to the drug treatment (Althof et al., 2006),

only to discover that his wife was now unhappy about his sustained erections and

more frequent desire for intercourse. She, then, might be diagnosed with a sexual

P S

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Figure 11.5

11.5 • Feedback Loops

in Treatment: Sexual

Dysfunctions

Treatments Targeting

Neurological and

Other Biological

Factors

Medication: Testosterone,

PDE- 5 inhibitors,

estrogen, SSRIs

(depending on the

specific problem)

Changes neural

activity

Increases genital

arousal

Increases control of

orgasm

Changes thoughts,

feelings, and

behaviors

Treatments Targeting

Psychological Factors

Sex therapy and CBT:

Psychoeducation,

sensate focus exercises,

cognitive restructuring,

specific behavioral

techniques

Treatments Targeting

Social Factors

Couples therapy:

Communication,

intimacy, and

relationship skills

Sex therapy with couple:

Specific sexual

techniques

Changes couple’s

communication,

sexual interactions,

and general

interaction patterns