FSFI; emotion regulation; internet; internet-based; intervention; psychosexual intervention; randomized controlled trial; sexual disorder; sexual dysfunction; sexual health; Medicine (miscellaneous); Health Informatics; sexual; disorder
Résumé :
[en] [en] BACKGROUND: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet.
OBJECTIVE: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women.
METHODS: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up.
RESULTS: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings.
CONCLUSIONS: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177.
Disciplines :
Traitement & psychologie clinique
Auteur, co-auteur :
JOBIM FISCHER, Vinicius ✱; University of Luxembourg > CRC > Student department > Student Services
Rossato Holz, Maila ; Conectare Neuropsi, Porto Alegre, Brazil
Billieux, Joël ; Institute of Psychology, University of Lausanne, Lausanne, Switzerland
Andersson, Gerhard ; Department of Behavioural Science and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA. American Psychiatric Association; 2013.
Willi J, Burri A. Emotional intelligence and sexual functioning in a sample of Swiss men and women. J Sex Med. Oct 2015;12(10):2051-2060. [FREE Full text] [doi: 10.1111/jsm.12990] [Medline: 26395993]
Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. Apr 2010;7(4 Pt 2):1598-1607. [doi: 10.1111/j.1743-6109.2010.01778.x] [Medline: 20388160]
Mitchell KR, Mercer CH, Ploubidis GB, Jones KG, Datta J, Field N, et al. Sexual function in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet. Nov 2013;382(9907):1817-1829. [doi: 10.1016/s0140-6736(13)62366-1]
Barlow DH. Causes of sexual dysfunction: The role of anxiety and cognitive interference. J Consult Clin Psychol. 1986;54(2):140-148. [doi: 10.1037/0022-006x.54.2.140]
Fischer VJ, Andersson G, Billieux J, Infanti A, Vögele C. The role of emotion regulation strategies for sexual function and mental health: a cluster analytical approach. J Sex Marital Ther. Oct 12, 2023.:1-14. [doi: 10.1080/0092623x.2023.2264863]
Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol. Sep 06, 2011;67(9):942-968. [FREE Full text] [doi: 10.1002/jclp.20816] [Medline: 21647882]
Madioni F, Mammana LA. Toronto Alexithymia Scale in outpatients with sexual disorders. Psychopathology. Mar 2, 2001;34(2):95-98. [doi: 10.1159/000049287] [Medline: 11244381]
Michetti PM, Rossi R, Bonanno D, De Dominicis C, Iori F, Simonelli C. Dysregulation of emotions and premature ejaculation (PE): alexithymia in 100 outpatients. J Sex Med. Sep 2007;4(5):1462-1467. [doi: 10.1111/j.1743-6109.2007.00564.x] [Medline: 17651386]
Berenguer C, Rebôlo C, Costa RM. Interoceptive awareness, alexithymia, and sexual function. J Sex Marital Ther. May 20, 2019;45(8):729-738. [doi: 10.1080/0092623X.2019.1610128] [Medline: 31018783]
Dubé JP, Corsini-Munt S, Muise A, Rosen NO. Emotion regulation in couples affected by female sexual interest/arousal disorder. Arch Sex Behav. Nov 29, 2019;48(8):2491-2506. [doi: 10.1007/s10508-019-01465-4] [Medline: 31468243]
Jonusiene G, Griffioen T. Psychiatric disorders and sexual dysfunctions. In: The EFS and ESSM Syllabus of Clinical Sexology. Amsterdam, the Netherlands. Medix; 2013;890-927.
Parsons JT, Rendina HJ, Moody RL, Gurung S, Starks TJ, Pachankis JE. Feasibility of an emotion regulation intervention to improve mental health and reduce HIV transmission risk behaviors for HIV-positive gay and bisexual men with sexual compulsivity. AIDS Behav. Jun 29, 2017;21(6):1540-1549. [FREE Full text] [doi: 10.1007/s10461-016-1533-4] [Medline: 27573858]
de Ornelas Maia ACC, Sanford J, Boettcher H, Nardi AE, Barlow D. Improvement in quality of life and sexual functioning in a comorbid sample after the unified protocol transdiagnostic group treatment. J Psychiatr Res. Oct 2017;93:30-36. [doi: 10.1016/j.jpsychires.2017.05.013] [Medline: 28575646]
Rosen NO, Bergeron S. Genito-pelvic pain through a dyadic lens: moving toward an interpersonal emotion regulation model of women's sexual dysfunction. J Sex Res. Sep 25, 2019;56(4-5):440-461. [doi: 10.1080/00224499.2018.1513987] [Medline: 30252510]
Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. Aug 5, 2013;42(6):915-933. [FREE Full text] [doi: 10.1007/s10508-012-0062-0] [Medline: 23559141]
Kingsberg SA, Althof S, Simon JA, Bradford A, Bitzer J, Carvalho J, et al. Female sexual dysfunction-medical and psychological treatments, committee 14. J Sex Med. Dec 2017;14(12):1463-1491. [doi: 10.1016/j.jsxm.2017.05.018] [Medline: 29198504]
Meana M, Jones S. Developments and trends in sex therapy. Adv Psychosom Med. 2011;31:57-71. [doi: 10.1159/000328808] [Medline: 22005204]
McCabe MP, Price E, Piterman L, Lording D. Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction. Int J Impot Res. Feb 28, 2008;20(3):324-330. [doi: 10.1038/ijir.2008.3] [Medline: 18305485]
McCabe M, Price E. Internet-based psychological and oral medical treatment compared to psychological treatment alone for ED. J Sex Med. Oct 2008;5(10):2338-2346. [doi: 10.1111/j.1743-6109.2008.00885.x] [Medline: 18554261]
Cooper A, Scherer C, Mathy RM. Overcoming methodological concerns in the investigation of online sexual activities. Cyberpsychol Behav. Aug 2001;4(4):437-447. [doi: 10.1089/109493101750526999] [Medline: 11708723]
Taylor CB, Luce KH. Computer- and internet-based psychotherapy interventions. Curr Dir Psychol Sci. Jun 24, 2016;12(1):18-22. [doi: 10.1111/1467-8721.01214]
Hummel SB, van Lankveld JJ, Oldenburg HS, Hahn DE, Broomans E, Aaronson NK. Internet-based cognitive behavioral therapy for sexual dysfunctions in women treated for breast cancer: design of a multicenter, randomized controlled trial. BMC Cancer. Apr 28, 2015;15(1):321. [FREE Full text] [doi: 10.1186/s12885-015-1320-z] [Medline: 25927495]
Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry. Jan 02, 2019;18(1):20-28. [doi: 10.1002/wps.20610] [Medline: 30600624]
Andersson G, Berger T. Internet approaches to psychotherapy: mpirical findings and future directions. In: Handbook of Psychotherapy and Behavior Change. Hoboken, NJ. Wiley; 2021;749-772.
Van Diest SL, Van Lankveld JJDM, Leusink PM, Slob AK, Gijs L. Sex therapy through the internet for men with sexual dysfunctions: a pilot study. J Sex Marital Ther. May 2007;33(2):115-133. [doi: 10.1080/00926230601098456] [Medline: 17365513]
van Lankveld JDM, Leusink P, van Diest S, Gijs L, Slob AK. Internet-based brief sex therapy for heterosexual men with sexual dysfunctions: a randomized controlled pilot trial. J Sex Med. Aug 2009;6(8):2224-2236. [doi: 10.1111/j.1743-6109.2009.01321.x] [Medline: 19493295]
Andersson E, Walén C, Hallberg J, Paxling B, Dahlin M, Almlöv J, et al. A randomized controlled trial of guided Internet-delivered cognitive behavioral therapy for erectile dysfunction. J Sex Med. Oct 2011;8(10):2800-2809. [doi: 10.1111/j.1743-6109.2011.02391.x] [Medline: 21797983]
Fischer VJ, Andersson G, Billieux J, Vögele C. A randomized controlled trial of an Internet-based emotion regulation intervention for sexual health: study protocol. Trials. Oct 15, 2021;22(1):706. [FREE Full text] [doi: 10.1186/s13063-021-05586-x] [Medline: 34654460]
Gonzáles AI, Sties S, Wittkopf P, Mara LS, Ulbrich AZ, Cardoso FL, et al. Validation of the International Index of Erectile Function (IIFE) for use in Brazil. Arq Bras Cardiol. Aug 2013;101(2):176-182. [FREE Full text] [doi: 10.5935/abc.20130141] [Medline: 23842798]
Hentschel H, Alberton DL, Capp E, Goldim JR, Passos E. Validação do Female Sexual Function Index (FSFI) para uso em língua portuguesa. Rev HCPA. Rev HCPA. 2007;27(1):10-14.
Rosen RC, Cappelleri JC, Gendrano N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. Aug 05, 2002;14(4):226-244. [doi: 10.1038/sj.ijir.3900857] [Medline: 12152111]
Jakobsen JC, Gluud C, Wetterslev J, Winkel P. When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts. BMC Med Res Methodol. Dec 06, 2017;17(1):162. [FREE Full text] [doi: 10.1186/s12874-017-0442-1] [Medline: 29207961]
Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. Jan 2005;31(1):1-20. [doi: 10.1080/00926230590475206] [Medline: 15841702]
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. Jun 1997;49(6):822-830. [doi: 10.1016/s0090-4295(97)00238-0] [Medline: 9187685]
Ferraz M, Ciconelli M. Tradução e adaptação cultural do índice internacional de função erétil para a língua portuguesa. Rev Bras Med. 1998;55(1):35-40.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. Feb 02, 2000;26(2):191-208. [doi: 10.1080/009262300278597] [Medline: 10782451]
Abdo C. Elaboração e validação do quociente sexual, versão feminina: uma escala para avaliar a função sexual da mulher. Rev Bras Med. 2006;63(9):477-482.
Abdo CH. The male sexual quotient: a brief, self-administered questionnaire to assess male sexual satisfaction. J Sex Med. Mar 2007;4(2):382-389. [doi: 10.1111/j.1743-6109.2006.00414.x] [Medline: 17367433]
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. Nov 10, 1999;282(18):1737-1744. [doi: 10.1001/jama.282.18.1737] [Medline: 10568646]
de LOF, Vilela MA, Crippa JA, Loureiro SR. Study of the discriminative validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care. Perspect Psychiatr Care. Jul 2009;45(3):216-227. [doi: 10.1111/j.1744-6163.2009.00224.x] [Medline: 19566694]
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. May 22, 2006;166(10):1092-1097. [doi: 10.1001/archinte.166.10.1092] [Medline: 16717171]
Moreno AL, DeSousa DA, Souza AMFLP, Manfro GG, Salum GA, Koller SH, et al. Factor structure, reliability, and item parameters of the brazilian-Portuguese version of the GAD-7 questionnaire. Temas Psicol. 2016;24(1):367-376. [doi: 10.9788/TP2016.1-25]
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. J Psychopathol Behav Assess. Mar 2004;26(1):41-54. [doi: 10.1023/B:JOBA.0000007455.08539.94]
Miguel FK, Giromini L, Colombarolli MS, Zuanazzi AC, Zennaro A. A Brazilian investigation of the 36- and 16-item difficulties in emotion regulation scales. J Clin Psychol. Sep 2017;73(9):1146-1159. [doi: 10.1002/jclp.22404] [Medline: 27717003]
Cancian ACM, Souza LASD, Silva VHPE, Machado WDL, Oliveira MDS. Psychometric properties of the Brazilian version of the Difficulties in Emotion Regulation Scale (DERS). Trends Psychiatry Psychother. Mar 2019;41(1):18-26. [FREE Full text] [doi: 10.1590/2237-6089-2017-0128] [Medline: 30234889]
Hill DB. Differences and similarities in men's and women's sexual self-schemas. J Sex Res. May 11, 2007;44(2):135-143. [doi: 10.1080/00224490701263611] [Medline: 17599271]
Lucena B. Fatores cognitivos na função sexual: adaptação transcultural e estudo psicométrico de instrumentos de medida em sexualidade [Doctoral thesis]. São Paulo, Brazil. University of São Paulo; 2019;1-124.
Nobre PJ, Pinto-Gouveia J. Sexual modes questionnaire: measure to assess the interaction among cognitions, emotions, and sexual response. J Sex Res. Nov 11, 2003;40(4):368-382. [doi: 10.1080/00224490209552203] [Medline: 14735411]
Vlaescu G, Alasjö A, Miloff A, Carlbring P, Andersson G. Features and functionality of the Iterapi platform for internet-based psychological treatment. Internet Interv. Nov 2016;6:107-114. [FREE Full text] [doi: 10.1016/j.invent.2016.09.006] [Medline: 30135819]
Kirana PS, Tripodi F, Reisman Y, Porst H. The EFS and ESSM Syllabus of Clinical Sexology. Amsterdam, the Netherlands. Medix; 2013.
Barlow D, Farchione T, Sauer-Zavala S, Latin H, Ellard K, Bullis J. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. New York, NY. Oxford University Press; 2018.
Berking M, Schwarz J. Affect Regulation Training: Handbook of Emotion Regulation. New York, NY. Springer; 2014.
Berking M, Whitley R. Affect Regulation Training: A Practitioners Manual. New York, NY. Springer; 2014;A.
Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. Feb 2012;141(1):2-18. [doi: 10.1037/a0024338] [Medline: 21823805]
Andrews G, Basu A, Cuijpers P, Craske M, McEvoy P, English C, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J Anxiety Disord. Apr 2018;55:70-78. [FREE Full text] [doi: 10.1016/j.janxdis.2018.01.001] [Medline: 29422409]
Andersson G, Carlbring P, Titov N, Lindefors N. Internet interventions for adults with anxiety and mood disorders: a narrative umbrella review of recent meta-analyses. Can J Psychiatry. Jul 16, 2019;64(7):465-470. [FREE Full text] [doi: 10.1177/0706743719839381] [Medline: 31096757]
Díaz-García A, González-Robles A, García-Palacios A, Fernández-Álvarez J, Castilla D, Bretón JM, et al. Negative and positive affect regulation in a transdiagnostic internet-based protocol for emotional disorders: randomized controlled trial. J Med Internet Res. Feb 01, 2021;23(2):e21335. [FREE Full text] [doi: 10.2196/21335] [Medline: 33522977]
Meston CM, Buss DM. Why humans have sex. Arch Sex Behav. Aug 3, 2007;36(4):477-507. [doi: 10.1007/s10508-007-9175-2] [Medline: 17610060]
Brotto LA, Bitzer J, Laan E, Leiblum S, Luria M. Women's sexual desire and arousal disorders. J Sex Med. Jan 2010;7(1 Pt 2):586-614. [doi: 10.1111/j.1743-6109.2009.01630.x] [Medline: 20092454]
Beck A. Beyond belief: A theory of modes, personality, and psychopathology. In: Frontiers of Cognitive Therapy. New York, NY. The Guilford Press; 1996;1-25.
Nobre PJ, Pinto-Gouveia J. Cognitions, emotions, and sexual response: analysis of the relationship among automatic thoughts, emotional responses, and sexual arousal. Arch Sex Behav. Aug 25, 2008;37(4):652-661. [doi: 10.1007/s10508-007-9258-0] [Medline: 17960474]
McCabe MP, Price E. Attrition from an internet-based psychological intervention for erectile dysfunction: who is likely to drop out? J Sex Marital Ther. 2009;35(5):391-401. [doi: 10.1080/00926230903065963] [Medline: 20183006]
van DS, Sluijs E, van DL, de RD, Heerdink R, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007;7:55. [FREE Full text] [doi: 10.1186/1472-6963-7-55] [Medline: 17439645]
Donkin L, Glozier N. Motivators and motivations to persist with online psychological interventions: a qualitative study of treatment completers. J Med Internet Res. Jun 2012;14(3):e91. [FREE Full text] [doi: 10.2196/jmir.2100] [Medline: 22743581]
Covid-19: casos sobem para 21,6 milhões e mortes, para 602 mil. Agencia Brasil. URL: https://agenciabrasil.ebc.com.br/saude/noticia/2021-10/covid-19-casos-sobem-para-2161-milhoes-e-mortes-para-602-mil [accessed 2022-12-02]
Otufowora A, Liu Y, Young H, Egan KL, Varma DS, Striley CW, et al. Sex differences in willingness to participate in research based on study risk level among a community sample of African Americans in North Central Florida. J Immigr Minor Health. Feb 23, 2021;23(1):19-25. [FREE Full text] [doi: 10.1007/s10903-020-01015-4] [Medline: 32328873]
