The Psychophysiology of Sex

Cognitive-Affective Processes in Sexual Arousal and Sexual Dysfunction

Cognitive-Affective Processes in Sexual Arousal and Sexual Dysfunction markus wiegel, lisa a. scepkowski, and david h. barlow In 1986, Barlow published his model of sexual dysfunction. CranstonCuebas and Barlow (1990) summarized the early empirical work supporting this model. The present paper brie®y reviews the original model and details the empirical and theoretical work since 1990, after which an updated version of the model is presented based on the reviewed studies as well as advances in anxiety research (see Barlow, 2002, for a detailed review of anxiety research). Barlow’s model can be conceptualized as concerning itself with three broad areas of cognitive and emotional processes in which individuals with and without sexual dysfunction differ: (i) cognitive schemata and affective associations with which an individual enters a sexual situation, (ii) differences in cognitive processing of sexual stimuli including the person’s own arousal, and (iii) cognitive, affective, and behavioral responses to their sexual performance and the experience of sexual arousal. Review of the Original Model of Sexual Dysfunction Barlow (1986) conceptualized early efforts aimed at understanding and treating sexual dysfunction in his model of cognitive and affective contributions to sexual functioning (Figure 1). In this model, dysfunctional sexual performance is seen as being maintained by means of a negative feedback loop (Barlow, 1986; Cranston-Cuebas & Barlow, 1990; van den Hout & Barlow, 2000). Individuals with and without sexual dysfunction approach sexual situations differently. In response to implicit or explicit (i.e., implied or expressed) demands for sexual performance, men and women without sexual dysfunction experience positive affect, success expectancies , and perceptions of control. In contrast, in individuals with sexual dysfunction, implicit or explicit demands for sexual performance evoke a state of anxious apprehension that is characterized by heightened tension and arousal, negative affect, and failure expectancies. In essence, from experience of prior sexual dif¤culties, sexual stimuli elicit anxiety and expectancies of poor performance in the individual with sexual dysfunction. In all individuals, heightened autonomic arousal is associated with 143 a narrowing of the attentional focus (for a discussion of this process in anxiety disorders see Barlow, 2002). However, differences in the emotional and cognitive aspects of how individuals with and without sexual dysfunction enter the sexual situation result in the two groups responding differently . Since individuals with sexual dysfunction expect failure and negative consequences, their focus of attention narrows to sources of threat, setting the stage for additional distortions in the processing of informaFigure 1. Barlow’s 1986 model of sexual dysfunction. 144 l Theoretical Perspectives and Models tion, either through attentional or interpretive biases (re®ecting preexisting hypervalent cognitive schemata). A variety of cues or propositions, to use the terms of Lang (1985, 1994a, 1994b), would be suf¤cient to evoke anxious apprehension. These cues may be broad based or very narrow, such as a highly responsive partner (Abrahamson, Barlow, Sakheim, Beck, & Kelly, 1985). Importantly, this process could occur without the necessity of a conscious, rational appraisal. For example, one might experience anxiety without awareness of the speci ¤c trigger or cue, such as an object or situation that represents a past sexual failure experience, or an internal somatic sensation, as is seen in patients with panic disorder. Janssen, Everaerd, Spiering, and Janssen (2000), using a preattentive priming paradigm, demonstrated that such automatic (preattentive) processing of sexual stimuli in®uenced both genital (erectile tumescence) and behavioral (decision time) measures. At suf¤cient intensity, the shift to nonerotic cues in conjunction with the narrowing of the attentional focus results in disruption of performance (e.g., sexual arousal). Thus, at low levels of autonomic arousal an individual may still be able to attend to sexual cues while attention is focused on sexual performance concerns; however, as autonomic arousal increases, whether resulting from sexual arousal or anxious arousal, the focus of attention narrows, increasing the salience of the attended to stimuli. In individuals with sexual dysfunction, this process increases the salience of nonerotic cues and results in further decreases in sexual arousal (e.g., erectile tumescence). In contrast, for individuals without sexual dysfunction, increased arousal ampli¤es the salience of erotic cues and results in greater sexual arousal. This focus on nonerotic, task-irrelevant stimuli and the resulting disruption in performance is analogous to cognitive interference models of test anxiety in which preoccupation with task-irrelevant thoughts concerning inadequacy, helplessness, failure, and its consequences diminish performance in test-anxious students (e.g., Arkin, Detchon, & Maruyama , 1982; Arkin, Kolditz, & Kolditz, 1983...