DTIC AD1012248: The Effects of False Physiological Feedback on Sexual Arousal in Sexually Dysfunctional and Functional Males PDF
Preview DTIC AD1012248: The Effects of False Physiological Feedback on Sexual Arousal in Sexually Dysfunctional and Functional Males
Theauthor herebycertifies thatthe useofany copyrighted material in thedissertation entitled: "TheEffects ofFalsePhysiological Feedbackon Sexual Arousal in SexuallyDysfunctional and Functional Males" beyond briefexcerpts is with thepermission ofthecopyrightowner, and will save and hold harmlessthe Uniformed Services UniversityoftheHealth Sciences fromany damage which may arise from suchcopyrightviolations. ABSTRACT TitleofDissertation: The EffectsofFalsePhysiologicalFeedbackon SexualArousal in Sexually Dysfunctional and Functional Males Capt.Jay M. Stone.DoctorofPhilosophy, 1999 Dissertationdirected by: Tracy Sbrocco. Ph.D. Assistant Professor Department ofMedical andClinical Psychology According toa recentmodel ofpsychogenic erectiledysfunction (Sbrocco& Barlow, 1996),dysfunctional performanceresults from focusingon negative outcomeexpectancy and low confidence following a discrepancy betweenexpected and actual performance. Thepurposeof the currentstudy was to manipulatetheexperience ofsexually functional anddysfunctional males toproduceadiscrepancy between expectedand actual performance. Fifty-sixsexuallyfunctional and 57 sexuallydysfunctional men were assignedto oneoffourgroups (negativefeedback, neutral feedback. inflated feedback, or no feedback). Penile tumescence was recorded while viewingtwo5-minuteerotic videotapes. All participants viewed film 1without feedback. Next. the feedback subjects weretold the average scoreforan erection and were asked topredictthe score they would receiveduring film2 and how confidentthey were. While viewingfilm 2, the negativefeedback group received feedback that theirscores were below theirprediction,the neutral feedbackgroup received feedback that their scores were whattheypredicted. andthe inflatedfeedbackgroup was shown theirscores were higherthan predicted. Afterfilm 2, they wereagain asked topredicttheirscoresonasubsequent(bogus) filmand ratetheirconfidence. Contrarytothe SbroccoandBarlowmodel, positivefeedback decreased tumescence for both thedysfunctionals and functionals. Thisoccurred.despite an increase inexpectancy, confidence,and self-reported arousal. Alsoincontrast with the SbroccoandBarlow model, ii negativefeedback resulted indecreased outcomeexpectancybutdidnot induceachange in tumescence for the dysfunctionals. Finally,negative feedback unexpectedly resulted in decreased tumescencefor the functionals. Theonly variable thatpredictedchanges in tumescence was the self-reported levelof surpriseconcerningthe feedback. Forboththedysfunctionalsand functionals, the feedback groups thatexperiencedadecrease in tumescencewere moresurprised by the feedback thanthe groups thatexperienced nochange in tumescence. In conclusion, thepresentstudyfound thatpositiveexpectationsforand confidence in functional sexual performance may be necessary but notsufficient factors forsuccessful tumescence. Positiveoutcomeexpectanciesand confidence may only be useful ifthe man is not surprised by his performance. iii THEEFFECfS OFFALSEPHYSIOLOGICALFEEDBACKON SEXUALAROUSAL IN SEXUALLY DYSFUNCTIONALAND FUNCTIONALMALES by JayM. Stone, Capt, USAF DissertationsubmittedtotheFacultyofthe DepartmentofMedical andClinical PsychologyGraduateProgramofthe Uniformed Services UniversityoftheHealth Sciences In partialfulfillment ofthe requirements forthedegree of DoctorofPhilosophy 1999 iv TABLE OFCONTENTS ListofFigures ListofTables ListofAppendices PartI: Introduction Definitions ofSexualFunction and Dysfunction TheCurrentDiagnostic Scheme Prevalence ParlII: TheoriesofEtiology ofErectile Dysfunction Sociocultural Factors PsychologicalFactors MastersandJohnson's Model ofthe Sexual Response Cycle Masters and Johnson SexTherapy Barlow'sCognitive-Physiological Process Models ofMaleSexual Arousal and Response Anxiety FacilitatesArousal Control ofPerformanceand PerformanceDemand Distractionand Sexual Arousal AffectandSexual Arousal CognitiveRegulation ofSexualArousal Schematic Content Skill Deficit NegativeOutcomeExpectancies Avoidance: Covertand Overt Disengagement Self-Focused Attention, Distraction, andTaskEngagement DefiningSelf-Focus DefiningDistraction Palace's Cognitive-Physiological Process Model ofFemale Sexual Arousal and Response Summary ofPsychologicalFactors Biological Factors PhysiologyofErection Theories ofEtiology Endocrine Deficiencies VascularProblems Neurological Impairment Drug-InducedErectileDysfunction Non-Specific MedicalTreatments VacuumConstrictionDevices DirectDeliveryofVasoactive Agents Oral Medications PenileProstheses SummaryofBiological Factors Psychophysiological Assessment Nocturnal PenileTumescence v DaytimeArousalEvaluation Biopsychosocial Factors SummaryofCurrentKnowledge Part III:Specific Aims RelevanceofStudy Purpose ofThis Study Hypotheses PartIV:Research Design and Methodology Subjects Measures ClinicianRated Phone Screen Sexual Dysfunction Interview StructuredClinical Interview forAxis IDSM-IVDisorders OrganicitylPsychogenicRating Scale Physiological PenileCircumference PenilePlethysmograph HeartRate Self-Report Medical Information Form BeckDepression Inventory BeckAnxiety Inventory ConfidenceandExpectancy Ratings ErectionPrediction Questionnaire Erection ScorePredictionQuestionnaire Subjective Response SexualArousal Questionnaire Sexual Arousal andFeedbackQuestionnaire AttentionalMeasure FilmQuiz TimelineforMeasures Procedure ScreeningProcedure PhoneScreen Intake Interview OrganiclPsychogenic Rating Physiological Assessment DebriefingSession Apparatus StimulusMaterial Data Sampling and Analysis Sample Sizeand PowerConsiderations Timelinein Months PartV: Results PartVI: Discussion vi References Figures Tables Appendices vii LISTOFFIGURES Figure 1. Crosssection ofmale pelvic region andcrosssectionofpenis Figure2. Barlow's (1986, 1988) model ofsexual dysfunction Figure3. Barlow, Sakheim,and Beck's(1983)shock threat paradigm Figure4. Abrahamson, Barlow, Sakheim, Beck, and Athanasiou's(1985) study ofeffects ofdistraction on sexual functioning Figure 5. Beck, Barlow,Sakheim,and Abrahamson's (1987) shock threatparadigm Figure6. Jones, Bruce, andBarlow's(1986) shockthreat paradigm Figure7. Carverand Scheier's (1988) self-regulatorymodel ofsexual arousal Figure 8. Cranston-Cuebas,Barlow, Mitchell, andAthanasiou's (1993) misattribution paradigm Figure 9. Sbroccoand Barlow's (1996) model ofsexual dysfunction Figure 10. Bach,Brown,andBarlow's(1999) false feedback paradigm Figure 11. Palace's(1995a) false feedback paradigm Figure 12. Schematic diagram ofmercury-in-rubberstrain gauge Figure 13. Meanstraingaugeresponses, averaged across stimulusduration,duringfour feedbackconditionsduring Film 1andFilm2 forthedysfunctional subjects Figure 14. Meanchange in penilecircumferenceofthedysfunctional subjects byepoch across fourfalse feedback conditions (negative, neutral,positive, and none) duringFilm2 Figure 15. Mean straingauge responses, averaged across stimulus duration, during four feedbackconditionsduringFilm 1andFilm2 for thefunctional subjects Figure 16. Meanchange in penile circumferenceofthefunctional subjects byepoch across four false feedback conditions(negative, neutral, positive, and none)duringFilm 2 Figure 17. A revised model ofsexual dysfunction: implications forexaminingattentional processes viii LIST OFTABLES Table I. Physical Changes in theMaleDuringtheSexual ResponseCycle Table2. DSM-IV Categories ofSexual Dysfunction Table3. DSM-IVDiagnostic Criteriafor Male ErectileDisorder Table4. Zilbergeld's(1992) Myths ofMaleSexuality Table5. VacuumDevices,Patients with ErectileDysfunction ofMixedEtiology Table6. Vacuum Devices,Patients with ErectileDysfunction ofSelected Populations Table7. Timeline ofInformation Collected During the Study Table8. Information Collected DuringthePhysiological Assessment Table9. StatisticalPowerAnalysis (ANCOVA) Table 10. Expectancy and ConfidenceRatings Table II. Expectancyand ConfidenceRatings (Controlledfor Pre-FILM2) Table 12. Post-FUm I Questionnaire(All Subjects) Table 13. Post-Film2Questionnaire (All Subjects) Table 14. Post-Film2 Questionnaire (Controlled forPost-Film 1Questionnaire) Table 15. Additional Post-Film2 Questionnaire(FeedbackSubjects) Table 16. FilmQuizScores Table 17. VariablesThatIncreasedFromFilm 1toFilm2 Table 18. VariablesThatDecreasedFromFilm 1toFilm2 ix LIST OFAPPENDICES AppendixA Subject RecruitmentandSelection AppendixB NewspaperAdvertisementforRecruitment ofSexuallyFunctional Subjects AppendixC PhoneScreenForms Appendix D InformedConsentForms AppendixE Sexual DysfunctionInterview AppendixF Semi-Structured Clinical Interview forAxis IDSM-IV Disorders, Screening Questions AppendixG Medical Information Form AppendixH Authorization for ExchangeofInformation Appendix I OrganicityRatingScale AppendixJ PsychogenicRatingScale Appendix K BeckDepression Inventory Appendix L BeckAnxiety Inventory AppendixM Procedurefor Physiological Assessment AppendixN Erection Prediction Questionnaire Appendix0 Erection ScorePredictionQuestionnaire Appendix P Sexual Arousal Questionnaire AppendixQ Sexual Arousaland FeedbackQuestionnaire AppendixR FilmQuiz x
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