The Effects of False Positive and False Negative Physiological Feedback on Sexual Arousal

13 Pages·2007·0.3 MB·English

ArchSexBehav(2007)36:518–530
DOI10.1007/s10508-006-9140-5
ORIGINAL PAPER
The Effects of False Positive and False Negative Physiological
Feedback on Sexual Arousal: A Comparison of Women
with or without Sexual Arousal Disorder
KatieM.McCall·CindyM.Meston
Received:22July2005/Revised:18April2006/Accepted:7October2006/Publishedonline:27February2007
(cid:1)C SpringerScience+BusinessMedia,LLC2007
Abstract The effects of false positive and false nega- positiveaffect,positiveexpectancies,andperceivedcontrol
tive physiological feedback (vaginal photoplethymograph of erectile response, whereas men with a history of sex-
response print-out) on women’s sexual arousal were ex- ualdysfunctionrespondtoeroticcueswithnegativeaffect,
amined. Participants included women without sexual dys- negativeexpectancies,andperceivedlackofcontroloferec-
function (n=16) and women with Sexual Arousal Disor- tile response (Abrahamson, Barlow, & Abrahamson, 1989;
der (SAD; n=15). Measures of subjective sexual arousal, Abrahamson,Barlow,Sakheim,Beck,&Athanasiou,1985;
physiological sexual arousal (vaginal pulse amplitude), ex- Barlow,1986).Thesefindingshavebeenexplainedinterms
pectancies,affect,andanxietywereobtainedinresponseto ofapositivefeedbackloopwherebyexpectanciesareshaped
viewing an erotic film. Results indicated that false positive by an individual’s recollections of past sexual experiences
feedback significantly increased subjective levels of sexual (Barlow,1986).InBarlow’smodel,individualswithsexual
arousal, whereas false negative feedback significantly de- dysfunction have responded unsuccessfully, whereas sexu-
creased subjective levels of sexual arousal in both groups. ally functional individuals have responded successfully in
Sexuallyfunctionalwomenhadoverallhigherexpectancies past sexual scenarios and, thus, approach sexual scenarios
for sexual arousal than women with SAD. Unexpectedly, with expectancies and affective responses congruent with
falsepositivefeedbackdidnotsignificantlyimpactphysio- their past experiences. While this model was initially de-
logical sexual arousal in sexually functional women; how- rivedtoexplainmalesexualpatterns,intuitivelyitseemsto
ever,itresultedinsignificantlydecreasedresponsesinphys- also represent female sexual patterns and has been applied
iologicalsexualarousalinwomenwithSAD.Falsenegative assuchbyanumberofresearchersandtheorists(e.g.,Laan,
feedbackhadnosignificanteffectonphysiologicalsexualre- Everaerd,VanAanhold,&Rebel,1993;Meston&Gorzalka,
sponseinsexuallyfunctionalwomenorwomenwithSAD. 1996; Palace & Gorzalka, 1990). That is, critical compo-
nentsofBarlow’smodel,includingaffectandexpectancies,
Keywords Femalesexualarousaldisorder.Sexual have also been shown to play an important role in the fe-
dysfunction.Falsefeedback.Vaginal malesexual response (e.g.,Heiman,1980; Laan, Everaerd,
photoplethysmography van Bellen, & Hanewald, 1994; Palace & Gorzalka, 1990;
Wiegel,Scepkowski,&Barlow,2006).
Based on Barlow’s model of sexual functioning, Bach,
Introduction
Brown,andBarlow(1999)aimedtofurtherunderstandthe
cognitive aspects involved in sexual arousal by investigat-
In a number of laboratory studies, it has been shown that
ing the effects of false negative physiological feedback on
menwithoutsexualdysfunctionrespondtoeroticcueswith
efficacy expectancies andsubsequent sexualarousal.Sexu-
ally functional men were randomly assigned to receive ei-
K.M.McCall·C.M.Meston((cid:1)) ther false negative feedback or no feedback regarding their
DepartmentofPsychology,UniversityofTexasatAustin,One
sexual arousal responses. Men who received feedback evi-
UniversityStationA8000,
denced lowered expectancies for sexual arousal, which led
Austin,Texas78712,USA
e-mail:[email protected] toasignificantdeclineinphysiologicalsexualarousal.False
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ArchSexBehav(2007)36:518–530 519
feedback did not significantly affect subjective arousal, dysfunction,whichisunfortunateasthismayhaveprovided
which is surprising given that most laboratory studies of further insight into the role of expectancies on sexual re-
sexualrespondinginmenshowahighconcordancebetween sponding. For example, expectations for arousal would be
erectileandself-reportedsexualarousal(e.g.,Heiman,1977; expected to differ substantially between women with SAD
Janssen & Everaerd, 1993). Levels of negative affect were versuswomenwhoexperiencepain,butnotarousaldifficul-
alsonotsignificantlychanged,suggestingthataffectandex- tiesduringintercourse.
pectanciesforsexualarousalmayoperateindependentlyin Sipski,Rosen,Alexander,andHamer(2000)investigated
menwithoutsexualconcerns. the effects of both false positive and false neutral feedback
Adding a further dimension to the picture, Weisberg, (vaginalresponseprint-outs)inwomenwithvaryingdegrees
Brown, Wincze, and Barlow (2001) found that attributions ofspinalcordinjuryandable-bodiedwomen.Allparticipants
for sexual arousal responses (or lack thereof) can also im- showedincreasedsubjectiveratingsofsexualarousalfollow-
pact sexual responding. In this study, sexually functional ing the administration of positive feedback. Physiological
menweregivenfalsenegativephysiologicalfeedbackafter sexualarousalalsoincreasedfollowingpositivefeedbackin
viewingeroticfilms,andweregiveneitheranexternal(i.e., able-bodied participants and those with less severe degrees
poor films) or an internal (i.e., problematic thoughts about ofspinalcordinjury(SCIsensoryscoresof0–23).
sex)attributionfortheirsupposedlackofresponse.Partici- Withregardtofalsenegativefeedbackonsexualresponses
pantswhoweregivenfalsefeedbackwithaninternalattribu- inwomen,Delizonnaetal.(2001)presentedsexuallyfunc-
tion evidenced lower erectile responses and reported lower tionalwomenwithfalsenegativephysiologicalfeedback,as
subjective arousal during subsequent erotic films, whereas wellaseitheranexternaloraninternalattributionfortheir
participants given false negative feedback with an external supposedlackofsexualarousalresponsetothefilms.Unlike
attributionappearedrelativelyunaffected.Self-reportedrat- Weisbergetal.’s(2001)findingsinmen,falsenegativefeed-
ingsofaffect,expectancies,andperceivedcontroloferectile backdidnotsignificantlyaffectphysiologicalorsubjective
responses were not significantly affected by the feedback arousalinwomenregardlessofthetypeofattributiongiven
manipulation. Hence, findings in sexually functional men (Delizonnaetal.,2001).
suggest that negative feedback can impair sexual arousal Hence,findingsinwomensuggestthatfalsepositivefeed-
and the mechanisms involved may include attributions and backenhancesphysiologicalandsubjectivesexualarousalin
expectancies,butnotnecessarilyaffectiveresponses.Based able-bodied,sexuallyfunctionalwomenandinwomenwith
onBarlow’smodel,onewouldexpectnegativefeedbackto heterogeneous sexual concerns, and that expectancies may
haveanevenmoredeleteriousimpactonrespondinginmen play a role in this effect. However, false negative feedback
with erectile dysfunction but, to our knowledge, there are doesnotseemtosubstantiallyimpactphysiologicalorsub-
no published studies which report on the effects of false jectivearousalinsexuallyfunctionalwomen.Tofullyunder-
feedbackinmenwithsexualdysfunction. standthedegreetowhichBarlow’s(1986)modelofsexual
To our knowledge, the first study to investigate the ef- functioning can be applied to women’s sexual responding,
fects of false feedback in women was conducted by Palace thefollowingquestionsremainunexplored:(1)Towhatde-
(1995) and reported modifying dysfunctional patterns of gree would negative feedback impact sexual responses in
sexual responding through the use of autonomic arousal womenwithSAD?(2)Towhatdegreewouldpositivefeed-
(exposure to a fear-evoking film) and false positive phys- back impact sexual responses in women with SAD? (3) To
iological feedback. False physiological feedback included whatdegreedofactorssuchasaffect,expectancies,attribu-
showingtheparticipantsapre-recordedgraphfromthevagi- tions,andperceivedcontrolmediatetheseeffects?
nal photoplethysmograph which showed a vasocongestive The purpose of the present study was to begin answer-
(vaginal blood volume) response similar to sexually func- ingthesequestionsbyinvestigatingtheimpactofbothfalse
tionalwomen.Resultsindicatedthatbothautonomicarousal positive and false negative feedback on subsequent sexual
and false positive physiological feedback significantly in- responding in both sexually functional women and women
creased expectancies for sexual arousal, physiological sex- with SAD. The rationale for recruiting women with SAD
ual arousal, and subjective ratings of sexual arousal. The was two-fold. First, given that the feedback is specific to
finding of an increase in both physiological and subjective sexual arousal responses, we felt it would be important to
arousal is noteworthy, given that most laboratory studies investigatetheeffectsoffeedbackinapopulationofwomen
of arousal induction in women with sexual concerns show with primary concerns specific to this stage of sexual re-
a low concordance between these measures (e.g., Laan & sponding.Second,unlikedesireandorgasmconcerns,both
Everaerd, 1995; Meston, 2000). Participants in this study physiologicalandsubjectivelevelsofsexualarousalcanbe
werewomenwithmixedsexualproblems,includingsexual measured with relative ease and accuracy in a laboratory
desire, arousal, orgasm, and/or pain disorders. Palace did setting.Wehypothesizedthatfalsepositivefeedbackwould
not examine sexual response patterns separately by sexual haveagreaterfacilitatoryimpactonbothphysiologicaland
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520 ArchSexBehav(2007)36:518–530
subjective sexual responding among sexually functional noses were disqualified from participating. Sixteen women
women as compared to women with SAD, and that false werecategorizedassexuallyfunctionalbasedonthecriteria
negative feedback would have a greater inhibitory impact of:(1)noself-reportofanycurrentsexualconcernsordis-
on physiological and subjective sexual responding among tress during clinical interviews, and (2) scoring within the
women with SAD as compared to sexually functional normativerangeofhealthycontrolsontheFSFI;15women
women. The former of these hypotheses was based on the were categorized as having SAD based on the criterion of:
notion that for women with no history of sexual difficul- (1)meetingDSM-IV-TRcriterionforSADasself-reported
ties, positive feedback would be consistent with their past duringclinicalinterviews,and (2)scoringwithintherange
sexual experiences, and thus be more believable and more of women with SAD on the FSFI on both the arousal and
likelytobeincorporatedintotheirpresentsexualexperience lubricationdomains.Althoughallofthewomenincludedin
andsubsequentlyenhancesexualarousal.Thelatterofthese the SAD group indicated sexual arousal concerns as their
hypotheses was based on the notion that for women with primary sexual concern during telephone interviews, many
a history of sexual arousal difficulties, negative feedback ofthewomenindicatedconcernswithotherareasofsexual
wouldbemoreconsistentwiththeirpastsexualexperiences, functioning, including low sexual desire, difficulties with
and thus more likely to be incorporated into their current orgasm, and pain related to sexual activity. This is consis-
experienceandsubsequentlydecreasesexualarousal.Based tent with past research indicating a high degree of overlap
onBarlow’smodelofsexualfunctioning,wepredictedthat of sexual dysfunctions in women (e.g., Wiegel, Meston, &
falsephysiologicalfeedbackwouldimpactsexualrespond- Rosen,2005).Specifically,ofthe15womenincludedinthe
ing through changes in expectancies, negative and positive SADgroup,11ofthesewomenfellwithinthedysfunctional
affect,andanxiety.Thisstudyextendspastresearchofthis range on the Desire subscale of the FSFI, seven within the
natureby:(1)examiningsexualresponsesinsexuallyfunc- dysfunctional range for the Orgasm subscale of the FSFI,
tional women and in a sample of women who meet Diag- andtwowithinthedysfunctionalrangeofthePainsubscale
nostic and Statistical Manual of Mental Disorders (DSM- of the FSFI. Further exclusion criteria included: under the
IV-TR;AmericanPsychiatricAssociation,2000)criteriafor age of 18; currently pregnant; and currently receiving any
SAD, and (2) examining the impact of both false positive medicationsknowntoaffectvascularorsexualfunctioning,
feedbackandfalsenegativefeedbackonsexualresponsesin includingantidepressantsandanti-hypertensives.Sixwomen
thesamesampleofwomen. wereexcludedduringthescreeningprocessbecausetheydid
notmeettheinclusioncriteria.
Method A t-test indicated that women with SAD were signifi-
cantlyolderthansexuallyfunctionalwomen,t(29)= −2.30,
Participants p=.03.Achi-squareanalysisindicatedthatthetwogroups
didnotdiffersignificantlyonlevelofeducation,andalike-
Participantswere32womenrecruitedvialocalcommunity lihood ratio analysis indicated that the two groups did not
anduniversityadvertisements.Womenwhorespondedtothe differsignificantlyonrace.T-testsverifiedsignificantdiffer-
advertisements were given a detailed description of the ex- ences between groups for each subscale and total score of
periment,screenedforinclusion/exclusioncriteria,andtold theFSFI(seeTable1).Giventhatallofthewomenincluded
thepurposeoftheexperimentwastoinvestigatetheeffects in the clinical group met DSM-IV-TR criteria for SAD as
ofbriefvisualstimuli(whichmayincludeeroticcontent)on established through clinical interviews, it is not surprising
emotionalandphysiologicalresponses. thatthatthelargestgroupdifferencesontheFSFIsubscales
All participants were evaluated for current sexual func- were for the Arousal and Lubrication domains. The exis-
tioning status using the Female Sexual Function Index tence of desire and orgasm concerns among these women
(FSFI; Rosen et al., 2000) and through DSM-IV-TR based isconsistent withliteraturethatindicates ahigh comorbid-
(AmericanPsychiatricAssociation,2000)clinicalinterviews ityofdesire,arousal,andorgasmdisordersinwomen(e.g.,
conductedviatelephonebyafemaledoctoralstudentinclin- Wiegeletal.,2005).SeeTable1fordemographicvariables
icalpsychologywithprevioustrainingandworkexperience andFSFImeans(±SD)bygroup.
inDSM-IV-TR-baseddiagnosticassessments.Interviewsbe-
ganwithathoroughsemi-structuredassessmentofpossible Measures
sexual concerns based on the DSM-IV-TR criteria for sex-
ual dysfunction. The interviewer asked all callers whether Subjectiveratings
theyhadreceived previous psychological diagnoses froma
healthcareprovider,includingmooddisorders,anxietydis- Subjective levels of sexual arousal and affect were mea-
orders,psychoticdisorders,and/oreatingdisorders.Women sured using our Subjective Ratings Scale, a modified ver-
who responded affirmatively to prior psychological diag- sionofHeimanandRowland’s(1983)filmscale.Thescale
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ArchSexBehav(2007)36:518–530 521
Table1 Participant
Sexuallyfunctional Womenwith
characteristics
women(n= 16) SAD(n = 15)
Age(inyrs) t
M 27.3 35.3
SD 8.9 10.6 2.30∗
Range 19–53 22–55
N(%) N(%) LR
Race .31
African-American 2(13) 1(7)
Caucasian 11(69) 11(73)
Hispanic 3(19) 3(20)
χ2
Education .32
Highschool/Somecollege 8(50) 6(40)
Collegeoradvanceddegree 8(50) 9(60)
MSD MSD t
FSFI
Desire 4.16(.7) 2.57(.9) 5.40∗∗
Arousal 4.28(.6) 2.85(.8) 5.71∗∗
Lubrication 4.70(.3) 3.10(1.0) 6.22∗∗
Note.FSFI=FemaleSexual Orgasm 4.19(.6) 3.09(1.2) 3.31∗∗
Satisfaction 3.79(1.2) 2.89(1.2) 2.08∗∗
FunctionIndex(FSFI;Rosen
etal.,2000). Pain 4.58(.5) 3.76(1.2) 3.08∗∗
∗p<.05,∗∗p<.01. TotalScore 25.70(2.1) 18.25(3.30) 7.61∗∗
consisted of 15 items measuring physical sexual arousal unit (BIOPAC Systems, Inc.) on a Dell Pentium computer.
(4 items), mental sexual arousal (2 items), positive affect Using the same procedures as previous studies of this na-
(4 items), negative affect (4 items), and anxiety (1 item). ture (e.g., Meston & Heiman, 1998), psychophysiological
Participantsratedeachoftheitemsona7-pointLikertscale artifacts related to movement or contractions of the pelvic
accordingtothedegreetowhichtheyexperiencedthesen- musclesweredeletedusingthecomputersoftwareprogram
sations.Twoversionsofthisscalewereused:(1)Apre-film followingvisualinspectionofthedata.VPAscores(inmV)
versionwhichincludedtheprompt,“Rightnow,Ifeel”and werecomputedforboththeneutralanderoticfilmsbyaver-
(2)Apost-filmversionwhichincludedtheprompt,“During agingacrosstheentire180secoftheneutraland300secof
thelastfilm,Ifelt.”Subjectivephysicalsexualarousalwas the erotic film stimuli at each of the four test periods (pre-
definedbythefollowingfouritems:warmthingenitals,gen- positivefeedback,post-positivefeedback,pre-negativefeed-
italwetnessorlubrication,genitalpulsingorthrobbing,and back, and post-negative feedback). Percent-change scores
any genital feelings. Subjective mental sexual arousal was fromneutral-to-eroticfilmsegmentswerecomputedforeach
defined by the following two items: sexually aroused and experimentalconditionforuseinsubsequentVPAanalyses.
sexuallyturned-off(reverse-scored).
Sexualfunctioning
Physiologicalsexualarousal
The FSFI (Rosen et al., 2000) was used to assess for cur-
Physiologicalrespondingwasmeasuredusingavaginalpho- rent levels of sexual functioning. The FSFI iscomposed of
toplethysmographtodetectchangesinvaginalpulseampli- 19 items divided into factor-analytic derived subscales: de-
tude (VPA) (Sintchak & Geer, 1975). VPA is a measure of sire(2items),arousal(4items),lubrication(4items),orgasm
short-term changes in vaginal wall engorgement (Rosen & (3 items), satisfaction (3 items), and pain (3 items). Rosen
Beck, 1988) and has been found to be a sensitive measure et al. reported inter-item reliability values within the ac-
of sexual arousal in women. Vaginal pulse amplitude was ceptable range for sexually functional women (Cronbach’s
sampled at a rate of 60 samples per sec during the entire alpha=0.82–0.92), as well as for women with diagnosed
3 min of neutral film and 5 min of erotic film, band-pass SAD (Cronbach’s alpha=0.89–0.95). Test-retest reliabili-
filtered(0.5–30Hz),andrecordedusingthesoftwarepack- ties assessed using a four week interval ranged between
ageAcqKnowledgeIII,Version3.2(BIOPACSystems,Inc., Pearson’s r=0.79–0.86. In a recent study, Wiegel et al.
SantaBarbara,CA)andaModelMP100WSdataacquisition (2005) provided strong evidence of discriminant validity
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522 ArchSexBehav(2007)36:518–530
between women with and without sexual dysfunction for higherthepeaksyouseehere(experimenterpointingto
FSFItotalscoreandeachsubscalescore,althoughahighde- theanalogchart),thehigherthelevelofsexualarousal.
greeofoverlapwaspresentacrossvariousdiagnosticgroups. Conversely, the lower peaks indicate lower levels of
sexualarousal.
Expectancies
Thefalsepositivefeedbackfirstgroupwasthentold:
Expectanciesforsexualarousalwereassessedusingthefol- Youhaveshownanenormousresponsetotheeroticfilm
lowing question, “If you were in an ideal sexual situation, asyoucanseeherebytheincreaseinthepeaks(onthe
how aroused do you think that you could get right now?” analog chart) when the film changed from the neutral
Participantswereaskedtoscorethisitemona7-pointLik- portiontotheeroticportion.Actuallyrighthereinthe
ertscalewith“1”indicating“notatall”and“7”indicating print-out (experimenter pointing to the highest peak),
“intensely.” you reached the highest level of arousal that the com-
puterissettorecordforthisstudy.Havingseenmany
Stimulusmaterials physiologicalresponses,Iimaginethatifthecomputer
wasabletorecordawiderrangeofresponsesthatthese
Films. Film stimuli consisted of four audiovisual films (re- peakswouldhavegonemuchhigher.Ialsoprintedout
ferred to here as Film Sequence A, B, C, and D) each of whatanaverageresponselookslikesothatyoucould
which included: (a) a 1 min display of the word “relax,” comparethemandasyoucantell,yourespondedwell
(b) 3 min of a travel film (neutral stimuli), and (c) 5 min aboveaverage.Thisisgoodandwhatweliketosee,so
ofaneroticfilm.Theeroticstimulidepictedaheterosexual let’sseehowyourespondtothenextfilm.Doyouhave
coupleengaginginforeplayandsexualintercourseandhave anyquestions?
previously been shown to induce sexual arousal in women
Thefalsenegativefeedbackgroupwastold:
inourlaboratory(e.g.,Meston,2004).Filmsequenceswere
counterbalancedacrossparticipants. Areyou having troublebecoming aroused? Theprint-
outfromthecomputershowsthatyouaren’treallyre-
sponding to the erotic portion of the film as you can
Experimentalmanipulation
seebythechartherewhichshowsnochangeinpeaks
fromtheneutralfilmtotheeroticfilm.Ialsoprintedout
False physiological feedback. Participants were randomly
whatanaverageresponselookslikesothatyoucould
assigned to receive either false positive feedback first or
comparethemandasyoucantell,yourespondedbelow
false negative feedback first. All participants received both
average.Let’sseehowyourespondtothenextfilm.Do
positiveandnegativefeedback.Thefalsefeedbackconsisted
youhaveanyquestions?
of the female experimenter telling the participant (via the
intercom)immediatelyafterviewingFilmAorC(depending
Designandprocedure
on whether appointment 1 or 2) the following statement:
“I am getting the preliminary record of your physiological
Aflowdiagramoutliningtheproceduresoftheexperimen-
responsetothefilmsonthecomputerrightnow.Iamgoing
tal session is depicted in Fig. 1. Following initial tele-
printitoutandIwillcomeintotheroomandshowittoyou.”
phone screening interviews, women who qualified based
Atthispoint,thefemaleexperimenterenteredtheroomand
on the inclusion criteria participated in two experimental
showedtheparticipantapre-recordedanalogchartdepicting
sessions (approximately 1 hour each), scheduled 1–2 days
eitheranextremelyheightenedresponse(positivefeedback
apart.Allsessionswereconductedbyanall-femaleresearch
condition)oralackofanyresponseatall(negativefeedback
staff.
condition).Thefemaleexperimenterthentoldbothgroups:
Whentheparticipantarrived,shewasshownthelabora-
Ok.HereistheprintoutthatIamgettingonthecom- tory and given a review of the general experimental proce-
puterfromthevaginalphotoplethysmograph.Ithought dures. The laboratory room used for data collection had an
thatyoumightbeinterestedinseeingwhatitlookslike adjoining,private,andlockedparticipantroom.Anintercom
so far. As I told you earlier, the vaginal probe records systemallowedforcommunicationbetweentheparticipant
vaginalpulseamplitude.Whenawomanbecomessex- and experimenter at all times throughout the experimental
uallyaroused,thereisanincreaseinbloodflowtothe session.Atelevisionwaspositionedintheparticipantroom
vagina.Thisiscalled“vasocongestion.”Whenaperson with a recliner in front of it so that participants could sit
issexuallyaroused,thusmorebloodflow,thesechanges comfortablywhilehavingafullviewofthescreen.
arereflectedinthepeaksyouseehereontheprint-out. Participants were advised of their complete privacy and
The higher the amplitude of the waves, meaning the givenverbalinstructionsonhowtoinsertthevaginalprobe.
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ArchSexBehav(2007)36:518–530 523
Fig.1 Flowdiagramofthe
methodology.Note.FSFI= Telephone Screening and Clinical
Interview conducted over Telephone
FemaleSexualFunctionIndex,
N–E= neutral-eroticstimuli;
leftsideoffigurerepresents
Session1andrightsideoffigure
Initial Questionnaires:
representsSession2.Thisfigure Demographics, FSFI
representsthepositivefeedback
firstcondition;however,order
offeedbackadministrationwas
counterbalancedacross Randomized to Feedback Order
participantsandconditions
Appointment 1 Appointment 2
Pre-Film Scale, Pre-Film Scale,
Expectancies for Sexual Arousal Expectancies for Sexual Arousal
FILM Sequence A FILM Sequence C
(“Relax”—N—E) (“Relax”—N—E)
Post-Film Scale Post-Film Scale
FALSE POSITIVE FALSE NEGATIVE
FEEDBACK FEEDBACK
Expectancies for Sexual Arousal Expectancies for Sexual Arousal
FILM Sequence B FILM Sequence D
”
(“Relax”—N—E) ( Relax”—N—E)
Post-Film Scale Post-Film Scale
The orientation and depth of probe insertion was standard- After completing the questionnaires, participants were
ized using a 9×2 cm rubber position shield (Instrumen- askedtoinsertthevaginalprobeandnotifytheexperimenter
tation Department of the Academic Medical Hospital in via the intercom system when they were ready to begin.
Amsterdam) which was attached to the cable at a distance Following a 10 min habituation period, Film Sequence A
of 5 cm from the center of the probe. Participants were in- beganontheT.V.screen.Pre-feedbackpercentincreasesin
structed to insert the probe until the position shield was in VPAwereassessedduringFilmSequenceAandattheend
contactwiththeirlabia.Participantswereaskedtoremainas ofthesequenceparticipantsimmediatelycompletedthefirst
stillaspossiblethroughoutthefilmsinordertominimizepo- post-filmSubjectiveRatingsScale.Atthispoint,theexperi-
tentialmovementartifacts.Participantsweretheninstructed mentergavetheparticipanteitherfalsepositivefeedbackfirst
on the sequence of questionnaires, which were labeled and orfalsenegativefeedbackfirst(dependentonrandomgroup
placed in completion order. The experimenter then left the assignment).Aftera10minrestingperiod(inordertoallow
roomandinstructedtheparticipantstocompleteinitialques- timeforarousalresponsestoreturntobaseline),participants
tionnaires,includingademographicquestionnaire,theFSFI, completedtheexpectanciesforarousalquestion.Then,Film
expectanciesforarousal,andthepre-filmSubjectiveRatings SequenceBbeganandparticipantsimmediatelycompleted
Scale. thesecondpost-filmSubjectiveRatingsScaleafterthefilm.
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524 ArchSexBehav(2007)36:518–530
In order to help control for potential practice and/or ativeaffect,orsubjectivelevelsofanxiety,thisvariablewas
boredom effects associated with a repeated-measure de- excludedfromfurtheranalyses.1
sign, the experimental session was divided into two sepa-
rateappointmentsscheduledapproximately1–2daysapart. Subjectiveresponses
Thus, participants only received one type of feedback dur-
ing each appointment. The exact methodological sequence Datasamplingandreduction
was repeated for Film Sequences C and D during the sec-
ond appointment. Participants who received positive feed- For each variable, a pre-feedback score was calculated by
back after Film Sequence A now received negative feed- subtracting initial pre-film Subjective Ratings Scale scores
backafterFilmSequenceCandviceversa.FollowingFilm (baselineresponses)frompost-filmSubjectiveRatingsScale
Sequence D, participants were debriefed and informed re- scores after viewing the first film sequence (no feedback).
gardingtheactualpurposeofthestudythroughthefollowing Post-feedback scores were calculated by subtracting initial
statement: pre-filmSubjectiveRatingsScalescoresfrompost-filmSub-
jectiveRatingsScalescoresafterviewingthesecondfilmse-
The information given to you regarding your arousal
quence(post-feedback;seeFig.1fordetails).Thus,inorder
responses during this study was false and did not ac-
tocontrolforthepotentialinfluenceoffeedbackonbaseline
curately reflect your actual responses. The same feed-
measures of arousal, the initial pre-film baseline responses
back was given verbatim to all participants. I will tell
obtainedfromtheSubjectiveRatingsScalewereusedinthe
you more about why we gave you the false feedback.
calculation of difference scores of both the pre- and post-
However, first I would like to ask you whether you
feedbacksubjectiveratingsscores.Eachscorewasbasedon
feltsuspicious of thefeedback atany point during the
anaveragevalueofallquestionsincludedwithineachvari-
study?
able(e.g.,subjectivephysicalsexualarousalwasdefinedby
Afterthis,thereasonforusingdeceptionwasexplainedand fourquestionsontheSubjectiveRatingsScale;thus,scores
participantswerepaid$50forparticipation.Giventhatpar- for subjective physical arousal were based on the average
ticipants were not debriefed until completion of the entire valueofthesefourquestions).
experiment, as per IRB requirements and in an attempt to
Subjectivereportsofsexualarousal
minimize potential distress in response to receiving feed-
back, no more than two days was allowed to pass between
Effectsofpositivefeedback
eachappointment.
A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
repeated measures ANOVA indicated a significant main
Manipulationcheck
effect of positive feedback on subjective physical sexual
arousal,F(1,29)=5.47,p=.03,andsubjectivementalsex-
Inordertoassurethecredibilityofthefalsefeedback,theex-
ual arousal, F(1, 29)=5.95, p=.02, such that following
perimenteraskedparticipantsduringthedebriefinginterview
positivefeedback,participantsreportedsignificantlyhigher
whethertheyhadbeensuspiciousofthefeedback.Onepar-
levelsofsexualarousal.Nosignificantmaineffectsforgroup
ticipantindicatedthatshehadnotbelievedthefeedbackand,
orinteractionswerefound.
thus,herdatawereexcludedfromallanalyses.Theremain-
ing31womenstatedthattheyhadacceptedthefeedbackas
Effectsofnegativefeedback
reflectionsoftheirownarousalresponses.
A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
repeated measures ANOVA revealed a significant main
Results
effect of negative feedback on subjective physical sexual
arousal, F(1, 29)=18.7, p<.001, and subjective mental
Ordereffects
sexualarousal,F(1,29)=13.4,p=.001,suchthatfollowing
negative feedback, participants reported significantly lower
Inordertodeterminewhethertheorderoffeedbacksequence
levels of subjective sexual arousal. No significant main
significantly affected outcome variables, initial 2 (Group)
effectsforgrouporinteractionswerefound(seeFig.2).
×2(Feedback:Pre-feedbackvs.Post-feedback) ×2(Order
ofFeedbackAdministration:PositiveFeedbackfirstvs.Neg-
ativeFeedbackfirst)MANOVASwereconducted.Because 1Giventhesignificantdifferenceinagebetweenthetwogroups,all
feedbacksequenceorderwasnotshowntoaffectsubjective analyseswereinitiallyconductedwithageaddedasaco-variate.Results
werenotsubstantiallyalteredwhenagewasaccountedfor;thus,the
levelsofsexualarousal,VPA,expectancies,positiveorneg-
resultspresentedinthearticledidnottakeageintoaccount.
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ArchSexBehav(2007)36:518–530 525
.

l
a
ous 3.5 A B A B
r
A 3 Pre-Feedback

ve Post-Feedback
ti 2.5
c
e
j
b
u 2
S

r
o 1.5
f
s
e
r 1
o
c
S
0.5
e
c
n
e 0
r
e
f SH SAD SH SAD SH SAD SH SAD
f
i
D
Positive Feedback Condition Negative Feedback Condition
Fig.2 Meandifferencescoresof(+/−SEM)subjectiveratingsofmentalandphysicalsexualarousal. Note.SH=Sexuallyhealthwomen,
SAD=womenwithsexualarousaldisorder;A=subjectivementalsexualarousal,B=subjectivephysicalsexualarousal
Physiologicalresults Effectsofnegativefeedback
Manipulationcheck A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
repeated measures ANOVA revealed no significant main
To verify that the erotic films facilitated VPA responding, effects for administration of feedback or group and no
a2(Group) ×2(FilmType:Neutralvs.Erotic) ×4(Film significantinteractionswerefound(seeFig.3).
SequenceA,B,CorD)MANOVAwasconductedonVPA
peak-to-peak values within each experimental condition
(positivefeedbackandnegativefeedback).Resultsrevealed Expectancies
amaineffectofFilmTypeindicatingasignificantincrease
in VPA responses across all films with exposure to the Effectsofpositivefeedback
erotic stimulus, F(1, 29)=6.08, p<.05. There were no
significant main effects for film sequence (all ps>.05), A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
and no significant interactions between group and overall repeatedmeasuresANOVAindicatedthatfeedbackdidnot
physiological response to the erotic film. These findings significantly affect reported expectancies, however results
indicate that the experimental films were effective in did reveal a significant main effect for group where sexu-
elicitingsexualresponding. ally functional women reported significantly higher levels
of expectancies for sexual arousal than women with SAD,
Effectsofpositivefeedback F(1,29)=13.24,p=.001.
A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
repeated measures ANOVA was used to examine whether Effectsofnegativefeedback
administrationofpositivefeedbackaffectedVPAresponses.
The Group×Feedback interaction was significant, F(1, A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
29)=4.35,p=.05.Follow-upunivariateanalysesindicated repeatedmeasuresANOVAindicatedthatfeedbackdidnot
thatVPAresponsesofsexuallyfunctionalwomendidnotsig- significantly affect reported expectancies, however results
nificantlychangefollowingpositivefeedback,F(1,15)<1; did reveal a significant main effect of group where sexu-
however,womenwithSADshowedadecreasedresponsein ally functional women reported significantly higher levels
VPA following positive feedback, F(1, 14)=4.99, p=.04. of expectancies for sexual arousal than women with SAD,
Therewerenosignificantmaineffectsoffeedbackorgroup. F(1,29)=11.45,p=.002.
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526 ArchSexBehav(2007)36:518–530
160
Positive Feedback Condition Negative Feedback Condition
140
s . 120 Pre-Feedback
e
r
o
c Post-Feedback
s 100
e
g
n
a
h 80
c
t
n
e
c 60
r
e
p
A
P 40
V
20
0
Sexually Healthy Women with SAD Sexually Healthy Women with SAD
Women Women
Fig.3 MeanVPApercentchangevalues(+/−SEM)acrossfeedbackconditions
Affect effectsforgrouporpositivefeedbackadministrationandno
significantinteractionswerefound.
Effectsofpositivefeedback
Effectsofnegativefeedback
A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
repeatedmeasuresANOVAindicatedthatpositivefeedback A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
did not significantly affect levels of positive affect or neg- repeatedmeasuresANOVAindicatednosignificantmainef-
ative affect. Sexually functional women and women with fectofnegativefeedbackadministration,howeverdidreveal
SAD did not significantly differ on self-reported levels of asignificantmaineffectforgroup,F(1,29)=15.3,p=.001,
positiveaffectorlevelsofnegativeaffectandnosignificant suchthatwomenwithSADreportedsignificantlyhigherlev-
interactionswerefound. elsofanxietythansexuallyfunctionalwomen.Nosignificant
interactionswerefound.
Effectsofnegativefeedback
A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback)
Discussion
repeated measures ANOVA revealed a significant main ef-
fectofnegativefeedbackonpositiveaffect,F(1,29)=7.4,
In an effort to further understand the applicability of
p=.01, such that,following negative feedback, women re-
Barlow’s(1986)modelofsexualdysfunctiontowomen,this
portedlowerlevelsofpositiveaffect.However,administra-
study examined the effects of false positive and false neg-
tion of negative feedback did not have a significant impact
ative physiological feedback on sexual arousal in sexually
onlevelsofnegativeaffect.Sexuallyfunctionalwomenand
functionalwomenandwomenwithSAD.BasedonBarlow’s
womenwithSADdidnotsignificantlydifferonself-reported
model of sexual functioning, we hypothesized that false
levelsofpositiveaffectandnosignificantinteractionswere
positivefeedbackwouldhaveagreaterfacilitatoryeffecton
found.
sexual arousal among sexually functional women as com-
Anxiety paredtowomenwithSAD,andthatfalsenegativefeedback
would have a greater inhibitory effect on sexual arousal
Effectsofpositivefeedback amongwomenwithSADascomparedtosexuallyfunctional
women.
A2(Group)×2(Feedback:Pre-feedbackvs.Post-feedback) Consistent with our hypotheses, false positive feedback
repeated measures ANOVA indicated no significant main increased subjective levels of physical and mental sexual
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ArchSexBehav(2007)36:518–530 527
arousalinsexuallyfunctionalwomen.Inconsistentwithour genitalresponsehasclearrelevanceforcognitive-behavioral
hypotheses, false positive feedback also increased subjec- interventions.
tive physical and mental sexual arousal in women with Inthepresentstudy,sexuallyfunctionalwomenhadsig-
SAD and there were no significant differences between nificantly greater expectancies for sexual arousal than did
groups in the amount of increase. The finding of increases women with SAD and, in the negative feedback condition,
in subjective arousal in women with SAD was consis- women with SAD reported overall higher levels of anxiety
tent with Palace’s (1995) findings in a heterogeneous sam- thandidsexuallyfunctionalwomen.Bothofthesefindings
ple of women with sexual dysfunction and Sipski et al.’s wereconsistentwithBarlow’s(1986)modelofsexualdys-
(2000) findings in a group of women with spinal cord function,whichpositsthatindividualswithsexualdysfunc-
injuries. tion approach sexual scenarios with lower expectations for
Palace(1995)positedthattheincreasedlevelsofsubjec- arousalandhigherlevelsofanxiety.InconsistentwithBar-
tive sexual arousal following positive feedback were medi- low’s model was that the impact of false feedback on sub-
atedbythechangeinexpectanciesofarousal.Inthepresent jective arousal was not associated with changes in anxiety,
study,subjectivephysicalandmentalsexualarousalsignifi- negativeaffect,orexpectancies.
cantlyincreasedfollowingpositivefeedbackinbothgroups, It is possible that lack of changes in negative affect and
whereas there were no significant changes in expectancies anxietywithfeedbackwasrelatedtothefactthatwomenmay
following feedback. This suggests that either the increases not have been concerned with attaining an average level of
insubjectivephysicalandmentalsexualarousalnotedhere VPAresponseduringtheexperimentalassessment.Thatis,a
were mediated by changes in mechanisms other than ex- laboratorysettingsuchasthatusedinthepresentstudymay
pectancies,orthatthemeasureweusedtoassessexpectan- notevokethesamelevelofperformanceconcernsasdoesa
cieswasnotsensitiveorspecificenoughtodetectthechanges real-lifesexualscenarioand,hence,wouldnothavethesame
thatoccurredacrossfeedbackconditions.Withregardtothe levelofimpactonmood.Itisalsopossiblethatdemandor
latter explanation, expectancies for arousal were measured performance-relatedconcernsassociatedwithphysiological
by asking participants, “If you were in an ideal sexual sit- sexual arousal are more important and salient in men as
uation, how aroused do you think that you could get right comparedtowomen.Thatis,aperformance-relatedconcern
now?”Referencetoan“idealsituation”wasusedbasedon forawomanmaybemoretiedtoherbehavioralresponses
the assumption that the laboratory is not the ideal situation in sexual scenarios (e.g., appearing interested, attractive,
forbecomingsexuallyarousedformostwomen.Itislikely or “turned on”) than to a specific physiological response
thatthisquestionwasnotanadequatemeasureforthecon- which is more the case with male erections. From a purely
structofexpectancies.Further,falsephysiologicalfeedback anatomical standpoint, this would make sense given that,
was presented as a “relative” indicator of sexual arousal, unlike women, men are unable to perform sexually with-
meaningthatitwasrankedrelativetohowotherwomenwho out the presence of a visible physiological response (i.e.,
haveparticipatedinlaboratorystudieshaveresponded(i.e., erection). Future studies of this nature might consider ex-
“Ialsoprintedoutwhatanaverageresponselookslikesothat amining the impact of more behavioral (e.g., whether the
you compare them ...”). Thus, assessment of expectancies woman appears “sexy”) versus physiological (e.g., vagi-
relativetohowotherwomenhaverespondedmayhavebeen nalresponding)feedbackonsubsequentsexualresponsesin
moreeffectivefordetectingchangesinexpectanciesacross women.
conditionsinthepresentstudy. Consistent with our hypotheses and with predictions
Thefindingthat,amongwomenwithSAD,positivefeed- based on Barlow’s model, false negative feedback led to
backincreasedsubjective,butdecreasedphysiologicallevels decreased subjective physical and mental sexual arousal
of sexual arousal is intriguing. In a recent study that com- responses in women with SAD. Negative feedback also
paredrelationsbetweensubjectiveandphysiologicalsexual resulted in decreased reports of subjective physical and
arousal in women with and without SAD, Meston, Rellini, mental sexual arousal in sexually functional women and
andMcCall(2005)foundthatwomenwithSADhadsignif- decreasedratingsofpositiveaffectinbothgroupsofwomen.
icantly weaker relationships between these components of The finding that false negative feedback affected sexually
sexual arousal as compared to sexually functional women. functional women was inconsistent with the findings of
Possibly,womenwithanarousaldisordermaybelesslikely Delizonna et al. (2001) in which bogus negative feedback
thansexuallyfunctionalwomentoattendtoordetectgeni- had no effect on physiological (VPA) sexual arousal, sub-
talcues,ortheymaybeequallyaslikelytodetectthecues jective sexual arousal, or affect. These discrepant findings
butbelesslikelytointerpretthemasbeingpsychologically may be explained by the fact that specific attributions
arousing.Thesequestionsareworthyoffurtherinvestigation. were given to women for their low arousal responses in
Knowingtheextenttowhichawomanwhosuffersfroman Delizonna et al.’s (2001) study, but not in the present
arousaldisorderisimpactedpsychologicallybychangesin study.
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