Sexual Modes Questionnaire: Measure to Assess the Interaction Among Cognitions, Emotions, And Sexual Response‪.‬

Recently, a growing body of research on the role of cognitions and emotions in sexual response has emerged. In fact, since Barlow's formulation on cognitive-affective factors of sexual dysfunction (Barlow, 1986; Cranston-Cuebas & Barlow, 1990; Sbrocco & Barlow, 1996), several laboratory and clinical studies were conducted to analyze the role of some cognitive and emotional dimensions in the sexual health field. Cognitive distraction (J. G. Beck, Barlow, Sakheim, & Abrahamson, 1987; Dove & Wiederman, 2000; Elliot & O'Donohue, 1997; Farkas, Sine, & Evans, 1979; Geer & Fuhr, 1976; Przybyla & Byrne, 1984), efficacy expectancies (Bach, Brown, & Barlow, 1999; Creti & Libman, 1989; Palace, 1995), causal attributions (Fichten, Spector, & Libman, 1988; Weisberg, Brown, Wincze, & Barlow, 2001), and perfectionism (DiBartolo & Barlow, 1996) are among the most studied cognitive dimensions in sexual functioning. In general, results from these studies support the main role performed by cognitive factors in sexual dysfunction processes. For the present discussion cognitive distraction studies assume a central role. Research with both male and female samples suggests that distraction from sexual cues during sexual activity decreases subjective and physiological arousal in both males and females (J. G. Beck et al., 1987; Dove & Wiederman, 2000; Elliot & O'Donohue, 1997; Farkas et al., 1979; Geer & Fuhr, 1976; Przybyla & Byrne, 1984). These psychophysiological studies support several clinical suggestions that dysfunctional subjects, when in sexual situations, focus their attention on negative thoughts rather than on sexually erotic thoughts. In males, these thoughts are mostly related to performance concerns (erection concerns), anticipating failure and its consequences (Hawton, 1985; Wincze & Barlow, 1997; Zilbergeld, 1999), whereas females orient their attention to self-body-image concerns, sexual performance concerns, and failure thoughts (Dove & Wiederman, 2000; Hawton, 1985). Despite these laboratory findings and clinical suggestions, there is still a lack of naturalistic empirical studies investigating the cognitive content of sexually dysfunctional males and females during sexual activity. With the exception of the Dove and Weiderman study (2000), which indicates a negative impact of distraction thoughts (sexual performance and bodily appearance) on female sexual functioning, there is no published data about cognitive content during sexual activity and its influence on sexual performance.