Cognitive Behavioral Strategies in the Treatment of Sexual Problems

  • Jeffrey C. Steger


The importance of cognitive mediation in the experience of sexual sensations has long been an accepted, albeit marginally comprehended, tenet among scholars and laymen. The symbolic nature of most aphrodisiacs, designed to stimulate the imagination more than the physiology (e.g., ground rhinoceros’ horns, powdered lions’ penises), further attests to the significance of cognitive processes in sexual activities. The progression of systematic investigation regarding sexuality has followed that of the other behavioral sciences: beginning with external, more easily observable events and eventually including thoughts, feelings, or attitudes as part of the investigatory realm. This strategy has yielded a set of effective therapeutic techniques focusing primarily upon sexual behavior change, which only recently have included specific cognitive interventions.


Sexual Dysfunction Sexual Satisfaction Sexual Problem Premature Ejaculation Female Sexual Dysfunction 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Annon, J. The behavioral treatment of sexual problems. Vol. 1. Brief therapy. Honolulu: Enabling Systems, Inc., 1974.Google Scholar
  2. Annon, J. The behavioral treatment of sexual problems. Vol. 2. Intensive therapy. Honolulu: Enabling Systems, Inc., 1975.Google Scholar
  3. Ard, B. Treating psychosexual dysfunction. New York: Jason Aronson, 1974.Google Scholar
  4. August, R.V. Libido altered with the aid of hypnosis: A case report. American Journal of Clinical Hypnosis, 1959, 2, 88.CrossRefGoogle Scholar
  5. Bally, H. Studies in depression, II: Treatment of the depressed, frigid woman. The Medical Journal of Australia, 1973, 1, 834–837.Google Scholar
  6. Bandura, A. Principles of behavior modification. New York: Holt, Rinehart and Winston, 1969.Google Scholar
  7. Barbach, L. Group treatment of preorgasmic women. Journal of Sex and Marital Therapy, 1974, 1, 139–145.PubMedCrossRefGoogle Scholar
  8. Beck, A. Cognitive therapy: Nature and relation to behavior therapy. Behavior Therapy, 1970, 1, 184–200.CrossRefGoogle Scholar
  9. Bindrim, P. A report on a nude marathon: The effect of physical nudity on the practice of interaction in marathon groups. Psychotherapy: Theory, Research, and Practice, 1968, 5, 180–188.Google Scholar
  10. Bindrim, P. Nudity as a quick grab for intimacy in group therapy. Psychology Today, 1969, June, 24–28.Google Scholar
  11. Brady, J. Brevital-relaxation treatment of frigidity. Behavior Research and Therapy, 1966, 4, 71–77.CrossRefGoogle Scholar
  12. Callahan, E., and Leitenberg, H. Aversion therapy for sexual deviation: Contingent shock and covert sensitization. Journal of Abnormal Psychology, 1973, 81, 60–73.PubMedCrossRefGoogle Scholar
  13. Cautela, J.R. Covert sensitization. Psychological Reports, 1967, 20, 459–468.PubMedCrossRefGoogle Scholar
  14. Cautela, J.R. Covert reinforcement. Behavior Therapy, 1970, 1, 33–50.CrossRefGoogle Scholar
  15. Cautela, J., Walsh, K., and Wish, P. The use of covert reinforcement in the modification of attitudes toward the retarded. Journal of Psychology, 1971, 77, 257–260.PubMedCrossRefGoogle Scholar
  16. Coulton, D. Hypnotherapy in gynecological problems. American Journal of Clinical Hypnosis, 1960, 3, 95–100.CrossRefGoogle Scholar
  17. Curtis, R., and Presly, A. The extinction of homosexual behavior by covert sensitization: A case study. Behavior Research and Therapy, 1972, 10, 81–83.CrossRefGoogle Scholar
  18. Davison, G. Systematic desensitization as a counterconditioning process. Journal of Abnormal Psychology, 1968, 73, 91–99.PubMedCrossRefGoogle Scholar
  19. Deutsch, R. The key to feminine response in marriage. New York: Random House, 1968.Google Scholar
  20. Ellis, A. Reason and emotion in psychotherapy. New York: Lyle Stuart, 1962.Google Scholar
  21. Ellis, A. The treatment of frigidity and impotence. In H. Greenwald (Ed.), Active psychotherapy. New York: Atherton Press, 1967, 328–336.Google Scholar
  22. Ellis, A. The treatment of sex and love problems in women. In V. Frank and V. Burtle (Eds.), Women in therapy. New York: Brunner/Mazel, 1974, 284–306.Google Scholar
  23. Ellis, A. An informal history of sex therapy. The Counseling Psychologist, 1975a, 5, 9–13.CrossRefGoogle Scholar
  24. Ellis, A. The rational-emotive approach to sex therapy. The Counseling Psychologist, 1975b, 5, 14–21.CrossRefGoogle Scholar
  25. Eysenck, H., and Rachman, S. The causes and cures of neuroses. San Diego: Robert A. Knapp, 1965.Google Scholar
  26. Flowers, J. Imagination training in the treatment of sexual dysfunction. The Counseling Psychologist, 1975, 5, 50–51.CrossRefGoogle Scholar
  27. Franks, C. Pavlovian conditioning approaches. In D. Levis (Ed.), Learning approaches to therapeutic behavior change. Chicago: Aldine, 1970, 108–143.Google Scholar
  28. Freud, S. The basic writings of Sigmund Freud. A. Brill (Ed. and Translato ), New York: Modern Library, 1938.Google Scholar
  29. Friedman, D. The treatment of impotence by brietal relaxation therapy. Behavior Research and Therapy, 1968, 6, 257–261.CrossRefGoogle Scholar
  30. Friedman, D. An interpersonal aspect of psychogenic impotence. American Journal of Psychotherapy, 1973, 17, 421–429.PubMedGoogle Scholar
  31. Geisinger, D. Controlling sexual interpersonal anxieties. In J. Krumboltz and C. Thoreson (Eds.), Behavioral counseling: Cases and techniques. New York: Holt, Rinehart and Winston, 1969, 454–469.Google Scholar
  32. Gunther, B. Sensory awakening and sensuality. In H. Otto (Ed.), The new sexuality. Palo Alto, Calif.: Science and Behavior Books, 1971.Google Scholar
  33. Hartman, W., and Fithian, M. Desert retreat. In J. and J. Robbins (Eds.), An analysis of human sexual inadequacy. New York: Signet, 1970.Google Scholar
  34. Haslam, M. The treatment of psychogenic dyspareunia by reciprocal inhibition. British Journal of Psychiatry, 1965, 111, 280–282.PubMedCrossRefGoogle Scholar
  35. Hogan, R. Implosively oriented behavior modification: Therapy considerations. Behavior Research and Therapy, 1969, 7, 177–183.CrossRefGoogle Scholar
  36. Hussain, A. Behavior therapy using hypnosis. In J. Wolpe, A. Salter, and L. Reyna (Eds.), The conditioning therapies: The challenge in psychotherapy. New York: Holt, Rinehart and Winston, 1964, 54–61.Google Scholar
  37. Husted, J. Desensitization procedures in dealing with female sexual dysfunction. The Counseling Psychologist, 1975, 5, 30–37.CrossRefGoogle Scholar
  38. James, B. Case of homosexuality treated by aversion therapy. British Medical Journal, 1962, 1, 768–770.PubMedCrossRefGoogle Scholar
  39. Kanfer, F. Self-regulation: Research issues and speculation. In C. Neuringer and J. Michael (Eds.), Behavior modification in clinical psychology. New York: Appleton-Century-Crofts, 1970, 178–220.Google Scholar
  40. Kanfer, F. and Saslow, G. Behavioral diagnosis. In C. Franks (Ed.), Behavior therapy: Appraisal and status. New York: McGraw-Hill, 1969, 417–444.Google Scholar
  41. Kaplan, H. The new sex therapy. New York: Brunner/Mazel, 1974.Google Scholar
  42. Kaufman, J. Organic and psychological factors in the genesis of impotence and premature ejaculation. In C. Wahl (Ed.), Sexual problems: Diagnosis and treatment in medical practice. New York: The Free Press, 1967, 133–148.Google Scholar
  43. Kazdin, A. Covert modeling and the reduction of avoidance behavior. Journal of Abnormal Behavior, 1973, 81, 87–95.Google Scholar
  44. Kegel, A. Sexual functions of the pubococcygens muscle. Western Journal of Surgical and Obstetrical Gynecology, 1952, 60, 521.Google Scholar
  45. Kelly, G. Impotence. In A. Ellis and A. Abarbanel (Eds.), The encyclopedia of sexual behavior (Vol. 1). New York: Hawthorn Books, 1961, 515–527.Google Scholar
  46. Kendrick, S., and McCullough, J. Sequential phases of covert reinforcement and covert sensitization in the treatment of homosexuality. Journal of Behavior Therapy and Experiemental Psychiatry, 1973, 3, 229–231.CrossRefGoogle Scholar
  47. Klein, M., Dittman, A., Parloff, M., and Gill, M. Behavior therapy: Observations and reflections. Journal of Consulting and Clinical Psychology, 1963, 33, 259–266.CrossRefGoogle Scholar
  48. Knight, R. Functional disturbance in the sexual life of women: Frigidity and related disorders. Bulletin of the Menninger Clinic, 1943, 7, 25–35.Google Scholar
  49. Kraft, T., and Al-Issa, I. The use of methohexitone sodium in the systematic desensitization of premature ejaculation. British Journal of Psychiatry, 1968, 114, 351–352.CrossRefGoogle Scholar
  50. Kroger, W. Comprehensive approach to ecclesiogenic neuroses. Journal of Sex Research, 1969, 5, 2–11.CrossRefGoogle Scholar
  51. Lazarus, A. The treatment of chronic frigidity by systematic desensitization. Journal of Nervous and Mental Disease, 1963, 136, 272–278.CrossRefGoogle Scholar
  52. Lazarus, A. In support of technical eclecticism. Psychological Reports, 1967, 21, 415–416.PubMedCrossRefGoogle Scholar
  53. Lazarus, A. Learning theory and the treatment of depression. Behavior Research and Therapy, 1968, 6, 83–89.CrossRefGoogle Scholar
  54. Lazarus, A. (Ed.) Clinical behavior therapy. New York: Brunner/Mazel, 1972.Google Scholar
  55. Lazarus, A., and Rachman, C. The use of systematic desensitization in psychotherapy. In H.J. Eysenck (Ed.), Behavior therapy and the neuroses. New York: pergamon, 1960, 181.Google Scholar
  56. Lobitz, W., and LoPiccolo, J. The role of masturbation in the treatment of sexual dysfunction. Paper presented at the joint Oregon Psychological Association and Washington State Psychological Association, Gleneden Beach, Oregon, 1971.Google Scholar
  57. Lobitz, W., and LoPiccolo, J. New methods in the behavioral treatment of sexual dysfunction. Journal of Behavior Therapy and Experimental Psychiatry, 1972, 3, 265–271.CrossRefGoogle Scholar
  58. LoPiccolo, J. A behavioral approach to sexual dysfunction: Sexual dissatisfaction groups. Workshop presented at the annual meeting of the American Association of Behavior Therapy, Miami, December, 1973.Google Scholar
  59. LoPiccolo, J., and Lobitz, W. The role of masturbation in the treatment of orgasmic dysfunction. Archives of Sexual Behavior, 1972, 2, 163–171.PubMedCrossRefGoogle Scholar
  60. LoPiccolo, J., and Lobitz, W. Behavior therapy of sexual dysfunction. In L. Hammerlynck, L. Handy, and E. Mash (Eds.), Behavior change: Methodology, concepts, and practice. Champaign, Ill.: Research Press, 1973.Google Scholar
  61. LoPiccolo, J., and Miller, V. A program for enhancing the sexual relationship of normal couples. The Couseling Psychologist, 1975, 5, 41–45.CrossRefGoogle Scholar
  62. LoPiccolo, J., Stewart, R., and Watkins, B. Case study: Treatment of erectile failure and ejaculatory incompetence in a case with homosexual etiology. Journal of Behavior Therapy and Experimental Psychiatry, 1972, 3, 233–236.CrossRefGoogle Scholar
  63. Marquis, J.M. Orgasmic reconditioning: Changing sexual object choice through controlling masturbatory fantasies. Journal of Behavior Therapy and Experimental Psychiatry, 1970, 1, 263–271.CrossRefGoogle Scholar
  64. Masters, W., and Johnson, V. Human sexual inadequacy. Boston: Little, Brown, and Company, 1970.Google Scholar
  65. Maultsby, M. Rational counseling handbook. Lexington, Ky.: Univ. of Kentucky Press, 1971.Google Scholar
  66. Maultsby, M., and Ellis, A. Techniques for using rational-emotive imagery (REI). New York: Institute for Rational Living, 1974.Google Scholar
  67. Max, L. Breaking up a homosexual fixation by the conditioned reaction technique: A case study. Psychological Bulletin, 1935, 32, 734.CrossRefGoogle Scholar
  68. McGovern, K., Stewart, R., and LoPiccolo, J. Secondary orgasmic dysfunction: 1. Analysis and strategies for treatment. Archives of Sexual Behavior, 1975, 4, 265–275.PubMedCrossRefGoogle Scholar
  69. Meichenbaum, D. Cognitive modification of test anxious college students. Journal of Consulting and Clinical Psychology, 1972, 39, 370–380.PubMedCrossRefGoogle Scholar
  70. Meichenbaum, D. The clinical potential of modifying what clients say to themselves. Psychotherapy: Theory, Research, and Practice, 1974, 11, 103–117.CrossRefGoogle Scholar
  71. Mirowitz, J. Utilization of hypnosis in psychic impotence. British Journal of Medical Hypnotism, 1966, 17, 25–32.Google Scholar
  72. O’Connor, J., and Stern, L. Results of treatment in functional sexual disorders. New York State Journal of Medicine, 1972, 72, 1927–1934.PubMedGoogle Scholar
  73. Ovesey, L., and Meyers, H. Retarded ejaculation: Psychodynamics and psychotherapy. American Journal of Psychotherapy, 1968, 22, 185–201.PubMedGoogle Scholar
  74. Rehm, L., and Rosensky, R. Multiple behavior therapy techniques with a homosexual dient: A case study. Journal of Behavior Therapy and Experimental Psychiatry, 1974, 5, 53–57.CrossRefGoogle Scholar
  75. Richardson, R. Hypnotherapy in frigidity. The American Journal of Clinical Hypnosis, 1963, 5, 194–199.CrossRefGoogle Scholar
  76. Rimm, D., and Masters, J. Behavior therapy. New York: Academic Press, 1974.Google Scholar
  77. Rubin, I. Sexual life after sixty. New York: New American Library (Signet edition ), 1965.Google Scholar
  78. Sarason, I. Test anxiety and cognition. Journal of Personaity and Social Psychology, 1973, 28, 58–61.CrossRefGoogle Scholar
  79. Sayner, R., and Durrell, D. Multiple behavior therapy techniques in the treatment of sexual dysfunction. The Counseling Psychologist, 1975, 5, 38–41.CrossRefGoogle Scholar
  80. Semans, J. Premature ejaculation: A new approach. Southern Medical Journal, 1956, 49, 353–362.PubMedCrossRefGoogle Scholar
  81. Singh, H. Therapeutic use of thioridizine in premature ejaculation. American Journal of Psychiatry, 1963, 119, 891–898.PubMedGoogle Scholar
  82. Snyder, A., LoPiccolo, J., and LoPiccolo, L. Secondary orgasmic dysfunction. II. Case study. Archives of Sexual Behavior, 1975, 4, 277–283.PubMedCrossRefGoogle Scholar
  83. Staats, A. Social behaviorism, human motivation, and the conditioning therapies. In. B. Maher (Ed.), Progress in experimental personality research (Vol. 5). New York: Academic Press, 1970, 111–168.Google Scholar
  84. Stampfl, T., and Levis, D. Essentials of implosive therapy. Journal of Abnormal Psychology, 1967, 72, 496–503.PubMedCrossRefGoogle Scholar
  85. Stone, A., and Levine, L. Group therapy in sexual maladjustment. American Journal of Psychiatry, 1950, 107, 195–202.PubMedGoogle Scholar
  86. Tinling, D. Auto-desensitization to phobic fears with an audio-visual instructional aid. In R. Rubin and C. Franks (Eds.), Advances in behavior therapy, 1968. New York: Academic Press, 1969, 11–15.Google Scholar
  87. Ullmann, L., and Krasner, L. Case studies in behavior modification. New York: Holt, Rinehart and Winston, 1965.Google Scholar
  88. Willy, A., Vander, I., and Fisher, O. The illustrated encyclopedia of sex (Rev. ed.) New York: Cadillac Publishing, 1967.Google Scholar
  89. Wilson, G. Innovations in the modification of phobic behaviors in two clinical cases. Behavior Therapy, 1973, 4, 426–430.CrossRefGoogle Scholar
  90. Wish, P. The use of imagery-based techniques in the treatment of sexual dysfunction. The Counseling Psychologist, 1975, 5, 52–55.CrossRefGoogle Scholar
  91. Wittels, F. The sex habits of American women. New York: Eton, 1951.Google Scholar
  92. Wolpe, J. Psychotherapy by reciprocal inhibition. Stanford, Calif.: Stanford University Press, 1958.Google Scholar
  93. Wolpe, J. The practice of behavior therapy. New York: Pergamon, 1969.Google Scholar
  94. Wolpe, J., and Lazarus, A. Behavior therapy techniques: A guide to the treatment of neuroses. New York: Pergamon, 1966.Google Scholar
  95. Wolpin, M. Guided imagining to reduce avoidance behavior. Psychotherapy: Theory, Research, and Practice, 1969, 6, 122–124.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1978

Authors and Affiliations

  • Jeffrey C. Steger
    • 1
  1. 1.Department of Rehabilitation MedicineUniversity of Washington School of MedicineSeattleUSA

Personalised recommendations