Cognitive Behavioural Therapy for sexual concerns

Most of us will experience some form of sexual concern or problem during our lifetime. Many of these are psychological rather than medical in basis (though their symptoms can manifest physically) and can include relationship problems involving sex or infidelity, sex or pornography addiction, sexual avoidance or loss of sexual desire, anorgasmia (an inability to orgasm), painful intercourse (for example vaginismus), and erectile dysfunction or premature ejaculation.

Though some sexual difficulties can emerge in response to traumas such as sexual assault or rape, for many these problems emerge seemingly without cause. Psychological concerns can often manifest physically

A large part of CBT for sexual concerns involves ‘psychoeducation’: providing factual information that can help us to reassess the way we think about our problems. This is especially important for sexual problems because sex and sexuality can often be taboo and shrouded in mystery.

The media or discussions with others can furnish us with misconceptions about what is “normal”, or what sex “should” be like, which can trigger anxieties and related problems with sexual performance. It is important to be furnished with factually correct information about sex and the common nature of sexual problems, as this can relieve some of the feelings of guilt and shame that can be associated with them.

CBT for sexual problems can be conducted on a one to one basis, as part of relationship therapy, online or in group therapy depending on the particular problem and preference of the client. CBT for all sexual problems share some common elements: the focus is on the here and now (current problems rather than delving into our past), attainable goals are established in a step by step manner, and a range of behavioural techniques are used to increase the person’s ability to overcome their problem and its associated thinking patterns.

Common techniques include role playing, practicing relaxation techniques, keeping journals and ‘homework’: by becoming empowered to take lessons learned from breakthroughs in the therapeutic setting home, the person becomes equipped with the tools to spot the signs of relapse and prevent it independently and proactively. In reformulating the way that, they view sex and their problems with it, the person can better understand their triggers and influences and prevent themselves from falling into unhealthy or problematic sexual behaviours again.

Evidence for the efficacy of CBT for sexual problems is strong and growing. Last year a group of Swedish researchers administered a 7 week web-based program of CBT to a group of men with erectile dysfunction, accompanied by e-mail based therapist support. These men reported significant improvements in their symptoms compared to a control group who received no therapy at all.

The results for face-to-face therapy are even stronger: in a study of CBT for 74 couples of whom one female partner met the criteria for hypoactive sexual desire, 74% no longer met these same criterion after only a few weeks of treatment. The women who received CBT also reported significant improvements in sexual satisfaction, perception of sexual arousal, sexual pleasure and self-esteem, as well as general improvements in motivation, mood and anxiety.

CBT’s positive results for the treatment of alcoholism and drug addiction are also beginning to be recognised in the facilitation of recovery from addiction to pornography and sex. Where traditional psychodynamic methods look to family issues and early development as an explanation for sexual addictions, CBT guides the person towards a confrontation with their current thoughts and beliefs about sex, and a recognition of the unhealthy or harmful nature of their behaviours. The focus of therapy is very much in the present, and on adaptive proactive solutions.

Often the person will be tasked with ridding their life of factors that are facilitating their addiction (similar to an alcoholic being asked to pour all the alcohol in their house down the drain): this may involve disposing of pornographic materials, setting up web filters, and developing pleasurable non-sexual activities and relationships. By concentrating on problem-solving in the present (rather than lingering on the past), CBT is able to provide helpful and productive solutions to a range of sexual concerns.

The House Partnership, 29th October 2011