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Erectile dysfunction ED and premature ejaculation PE are two forms of male sexual disorder with both psychological and physical features. While their cognitive, attentional, and affective components have been investigated separately, there is a lack of knowledge about the role played by cognitive attentional syndrome in their onset and maintenance.

The aim of the present study was to investigate the possible contribution of perseverative thinking styles and thought control strategies to the development and maintenance of ED and PE.

The authors hypothesized that such modes of processing might constitute a cognitive attentional syndrome specific to these disorders and sustained by particular metacognitive beliefs. A semistructured interview was administered to 11 participants with ED and 10 with PE in order to assess their metacognitive beliefs and cognitive attentional processes. The results suggest that individuals with ED and PE adopt a range of cognitive attentional strategies aimed at improving their sexual performance, and endorse both positive and negative metacognitive beliefs about these thinking responses.

Overall, their cognitive and attentional patterns worsened negative internal states, reduced sexual excitement, detached them from their bodily sensations, and hindered sexual functioning. These preliminary findings suggest that perseverative thinking, thought control strategies, and metacognitive beliefs may play a key role in the onset and maintenance of male sexual dysfunction. Among psychological factors, the literature places particular emphasis on the association between sexual dysfunction and emotional disorders e.

Furthermore, clinical evidence and empirical research have pointed up a connection between negative affect and sexual dysfunction e. With regard to mood disorders, it has been reported in the literature that depressed men tend to display impaired erective functioning Thase et al.

In addition, a cross-national study reported that depression was associated with ED and that men with ED were 2. Associations between sexual impairment and anxiety have also been widely reported.

With regard to attention, studies have been conducted to investigate its role in sexual arousal e. Informed by the principles of cognitive theories, these studies have investigated what a man thinks, rather than the cognitive and attentional patterns typically displayed by men with sexual dysfunction. In line with this view, Wells and Matthews , in their metacognitive theory of psychological dysfunction, proposed that psychological disturbance is underpinned by a set of metacognitive beliefs that are responsible for the maintenance of maladaptive attentive e.

These maladaptive patterns make up a cognitive attentional syndrome CAS; Wells, that is underpinned by specific metacognitive beliefs and plans controlling the use of thought and attention. Metacognitive beliefs may be defined as the information individuals hold about their own cognition and the coping strategies that affect it.

Particular metacognitive beliefs lead to the activation of CAS and interfere with emotion down-regulation Wells, Some of the components of CAS have been investigated in relation to male sexual dysfunction, without being conceptualized as part of an overarching metacognitive framework.

For example, Hartmann, Schedlowski, and Krüger reported that, compared with normal controls,. Other prevailing cognitions in PE patients referred to the anticipation of a possible failure and the embarrassing situation following a rapid ejaculation.

Men with PE are also significantly more prone to having distracting thoughts and thoughts about maintaining their erections Hartmann et al. As far as the authors are aware, no studies have investigated whether CAS and metacognitive beliefs play a role in maintaining sexual dysfunction.

The key aim of this study was to explore whether CAS thinking styles and related metacognitive beliefs are implicated in the sexual performances of men with PE and ED. In keeping with the metacognitive perspective, it was hypothesized that ED and PE might be triggered, maintained, or even worsened by CAS, a set of factors leading the individual to focus continuously on the problem itself in a maladaptive and unhelpful way during sexual activity.

It was further hypothesized that this mode of processing would be underpinned by specific positive and negative metacognitive beliefs. Given that little is known about CAS and metacognitive beliefs in ED and PE, the semistructured nature of the metacognitive profiling interview allowed the authors to investigate these aspects without imposing preconceived ideas as researchers on the informants.

Thus, the primary aim of the current study was to investigate the nature of metacognitive processes in ED and PE, and more specifically to identify the CAS thinking patterns and positive and negative metacognitive beliefs of individuals with these conditions. Given the preliminary and exploratory nature of the study, no detailed hypotheses were generated. The purposive convenience sample consisted of 11 ED and 10 PE participants. All participants were recruited through an andrology service they had consulted and none presented with a lifelong sexual dysfunction.

Inclusion criteria were as follows: a the absence of organic causes for the sexual disorder, as assessed by andrology professionals; b participants of age 18 or older; c provision of informed consent; d good understanding of spoken and written Italian; e the absence of comorbidity, that is, no diagnoses of other Axis 1 or Axis 2 disorders, as assessed by independent interviewers who were blind to the aims of the study; f no history of past psychotherapy, in order to minimize the likelihood of a psychopathological condition predating onset of the sexual problem.

All participants took part in the study anonymously and on a voluntary basis. The sample was entirely Caucasian. In addition, the study was approved by the institutional review board at Sigmund Freud University of Milan, Italy www. Participants were informed about aims and methods of the research and fully and clearly briefed about the interview in place to protect their privacy and anonymity before the data were gathered. All the participants provided explicit written consent and confirmed their understanding that their anonymity and confidentiality would be protected throughout dissemination of the research findings.

All files will be deleted within 5 years of first storage. The interview was based on the metacognitive profiling template developed by Wells The purpose of metacognitive profiling is to identify metacognitive beliefs and problematic cognitive processing patterns CAS that are activated under conditions of stress.

To this end, the interviewee is asked a set of questions, which in the present study initially focused on a recent episode involving sexual dysfunction. All participants were first assessed by an andrology team to exclude both organic causes and lifelong presence of sexual disorder. Next, the sample was screened by independent interviewers who were blind at the aims of the study to evaluate the possible co-occurrence of another Axis 1 or Axis 2 psychological disorder.

Finally, patients meeting all inclusion criteria were invited to participate in the study on a voluntary and unpaid basis. Informed consent was obtained from all those who volunteered to take part.

All participants were interviewed using the metacognitive profiling template Wells, which had been adapted ad hoc to explore the cognitive aspects of experiencing sexual dysfunction. The interview schedule was designed to elicit data under four main predefined headings: a Cognitive style during a negative sexual experience : Participants were asked to describe a recent episode of negative sexual experience and to identify what triggered their perception of failure e.

What was your first thought? How did you feel? What physical sensations did you have? Participants were also asked to describe how they had attempted to cognitively manage these triggers during the sexual episode and whether this had included negative appraisal e. Did you try to control your thoughts?

Do you think that focusing your attention in that way was helpful or damaging to your performance? Why did you use your thoughts in that way? Did you feel you attained your goals? What was the signal that indicated to you that your goal had been achieved?

Do you think it is helpful for you? Do you think it is damaging? The data were collected over a period of 6 months. Interviews were audio recorded, transcribed, and anonymized. Each interview lasted from 20 to 40 minutes approximately with an average duration of To ensure accuracy of transcription, the texts were randomly checked against original recordings.

Top-down thematic content analysis, based on a deductive method, was applied to the interview data. Once the initial descriptive thematic analysis had been completed, it emerged that there was a strong similarity between the categories derived from the raw data and the four categories making up the metacognitive profile template. The analytical process was therefore extended and the emerging themes grouped together under the metacognitive profile template categories.

The first author held several debriefing sessions with the remainder of the research team to discuss data collection procedures, analytical steps, and interpretation issues. Participants, regardless of the type of dysfunction with which they had been diagnosed, identified two types of trigger: negative bodily sensations 18 participants, e. With regard to cognitive style, participants reported using four different strategies in response to the trigger: a they ruminated about the trigger and its consequences three participants, all with ED , b they worried about negative sexual performance outcomes three participants, all with ED , c they tried to motivate themselves via self-imposed statements three participants with ED, one participant with PE , and d they tried to suppress, and to distract themselves from, negative thoughts or bodily sensations two participants with ED, nine participants with PE.

Seventeen participants reported using their particular strategies with the aim of achieving improved sexual performance 7 ED, 10 PE , two participants with ED stated that their aim was to understand the causes of their problem, and two participants with ED did not report any goal.

Six participants with PE none with ED reported that they had partially reached their goal, while overall 14 participants reported they had not. Eighteen participants identified positive metacognitive beliefs about the usefulness of their cognitive-attentional response in: a enhancing sexual performance five participants with ED, eight with PE , b controlling negative thoughts and emotions three participants with ED, two participants with PE , and c understanding the causes of their sexual problem three participants with ED.

Eighteen participants identified negative metacognitive beliefs, which concerned the following: a the direct negative impact of thought patterns on sexual functioning, that is to say, some of the reported ways of thinking and directing attention were damaging to overall sexual performance six participants with ED, eight with PE ; b an increase in negative thoughts and emotions five participants with ED, three participants with PE ; and c the uncontrollability of their cognitive-attentional response six participants with ED.

The results of this study indicate that metacognitive beliefs and CAS may play a role in the maintenance of sexual dysfunction and in the exacerbation of negative emotional states. The similarities concern triggers, goals, and attentional focus. All individuals activated CAS patterns in response to negative sensations or thoughts associated with their sexual functioning, generally with the aim of improving their sexual performance or, in the case of only a few men with ED, of better understanding their sexual disorder.

For both groups, attentional focus was almost equally distributed between internal bodily sensations and external partner reactions. Both of these attentional strategies may have been applied to monitor what individuals viewed as signals of a threat and b progress toward goals.

On the other hand, a few of the men with ED were committed to reaching a better understanding of their disorder, and it is possible that they tried to attain this goal by worrying or ruminating, as indicated by six of them. The differences between ED and PE mainly concern cognitive style. ED participants predominantly activated a perseverative thinking style in the form of self-imposed statements, rumination, or worry.

In contrast, PE participants reported more negative appraisal of triggers, and the activation of thought control strategies e. The participants with PE also reported a higher incidence of partial goal achievement than those with ED, despite admitting that they were unable to solve their problem. Positive metacognitive beliefs identified by participants concerned the contribution of their cognitive and attentional responses to improving sexual functioning and to understanding and controlling negative sensations and thoughts.

Such metacognitive beliefs may be involved in the activation of perseverative thinking and thought control strategies, and are in line with those of patients with chronic fatigue syndrome Maher-Edwards et al. Taken together, these findings support application of the metacognitive model to sexual dysfunction.

The CAS is activated on the basis of positive metacognitive beliefs with the aim of regulating emotions and improving sexual functioning; subsequently, however, CAS thinking patterns and styles worsen negative internal states, reduce sexual excitement, promote detachment from bodily sensations, and encourage recurrent negative thinking. This in turn leads to a perseveration in CAS because attempted goals are never or only partially reached.

Consistently with this hypothesis, men with ED, who reported more negative metacognitive beliefs about uncontrollability, were also more inclined to adopt perseverative thinking styles such as worry and rumination.

On the other hand, no men with PE reported negative metacognitive beliefs about uncontrollability, or worried, or ruminated about a trigger. This is consistent with the metacognitive model of generalized anxiety disorder Wells, in which negative metacognitive beliefs concerning uncontrollability play an important role in triggering meta-worry, which in turn exacerbates both worry and negative emotions. The limitations of this research include the small sample size and the possibility that individual participants may have been affected by more than one kind of sexual dysfunction.

In fact, it is possible that following the onset of a particular dysfunction e. Consequently, the sample may have been contaminated by the presence of participants with concurrent symptoms, thus undermining the evidence for differential metacognitive profiles corresponding to single diagnoses.

Nonetheless, from a therapeutic perspective, the findings suggest that the techniques and principles of metacognitive therapy e. In particular, men with ED would benefit from developing more flexible control over their perseverative thinking style, while men with PE should reduce their need to control negative thoughts and to monitor the negative implications of their sexual functioning.

Future studies investigating the role of CAS and related metacognitive beliefs should adopt specific psychometric measures for all variables with a view to collecting robust data to compare with these preliminary findings, and should recruit a large number of participants in order to confirm or disconfirm the pattern identified here.

National Center for Biotechnology Information , U. Am J Mens Health.

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  • Sexual dysfunctions and disorders. Välj fliken General i Settings fönstret. Båda metoderna kommer bidra till att skapa en renare utsänd signal genom att denna hela tiden ligger mellan Hz till Hz. Qualitative Research in Psychology , 3 , Huvudfönstret kommer att omkonfigurera sig själv för att inkludera alla nödvändiga kontroller för varje trafiksätt. Standard är 6 minuter.
  • Materials The interview was based on the metacognitive profiling template developed by Wells Allow Tx frequency changes while transmitting : Tillåter att utsändningsfrekvensen ändras undertiden en utsändning pågår. Program som t. Andra utsändningar under ett QSO kan använda standardmeddelanden utan prefix eller suffix. Denna information är tillräcklig för att komma igång.
  • ED participants predominantly activated a perseverative thinking style in the form of self-imposed statements, rumination, or worry. ISCAT använder sig av meddelande i fritt format upp till 28 tecken, medans MSK använder samma strukturerade meddelande som de långsamma trafiksätten och valfritt en förkortad format. För att ändra både Rx och Tx-frekvensen, håll inte "Ctrl"-tangenten samtidigt som man dubbelklickar. Meddelanden kommer att genereras för att kunna utföra ett standard QSO. Association of sexual problems with social, psychological, and physical problems in men and women: A cross sectional population survey.

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