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Journal of Sex Research

Journal of Sex Research

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Published by Varga-Orban Eniko
Sexual modes questionnaire: Measure to assess the interaction among
cognitions, emotions, and sexual response
Sexual modes questionnaire: Measure to assess the interaction among
cognitions, emotions, and sexual response

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Published by: Varga-Orban Eniko on Jun 07, 2010
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This article was downloaded by:
[Canadian Research Knowledge Network] 
22 April 2010 
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Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Sex Research
Publication details, including instructions for authors and subscription information:http://www.informaworld.com/smpp/title~content=t775653667
Sexual modes questionnaire: Measure to assess the interaction amongcognitions, emotions, and sexual response
Pedro J. Nobre
;José Pinto-Gouveia
Universidade de Trás-os-Montes e Alto Douro, Miranda do Douro, Portugal
Rua Amorim deCarvalho, PORTUGAL
Universidade de Coimbra, PortugalOnline publication date: 11 January 2010
To cite this Article
Nobre, Pedro J. andPinto-Gouveia, José(2002) 'Sexual modes questionnaire: Measure to assess theinteraction among cognitions, emotions, and sexual response', Journal of Sex Research, 40: 4, 368 — 382
To link to this Article: DOI:
Full terms and conditions of use:http://www.informaworld.com/terms-and-conditions-of-access.pdfThis article may be used for research, teaching and private study purposes. Any substantial orsystematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply ordistribution in any form to anyone is expressly forbidden.The publisher does not give any warranty express or implied or make any representation that the contentswill be complete or accurate or up to date. The accuracy of any instructions, formulae and drug dosesshould be independently verified with primary sources. The publisher shall not be liable for any loss,actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directlyor indirectly in connection with or arising out of the use of this material.
Sexual Modes Questionnaire: Measure
Assess the Interaction AmongCognitions, Emotions, and Sexual Response
Pedro J. Nobre
Universidade de Trás-os-Montes e Alto Douro, Miranda do Douro, Portugal
José Pinto-Gouveia
Universidade de Coimbra, Portugal
The goal of the present article is to present a new measure developed to assess cognitive and emotional factors of sexu-al function. This instrument was developed especially to test some hypotheses derived from Beck's new theoretical concep-tualization (the modes theory; A. T. Beck, 1996). This model, characterized by its systemic and integrated approach, consti-tutes a remarkable development from a linear to a network perspective of the cognitive-emotional-behavioral processes. Thenew concept of mode, as a composite of schemas (cognitive, emotional, and behavioral) interacting together, is theoretical-ly sound and supported by recent research findings from clinical and experimental sets (see A. T. Beck,
for a revision).Our aim is to develop a new measure specifically created to assess these integrated and interdependent processes in the fieldof sexuality. The Sexual Modes Questionnaire (SMQ; male and female versions) is a combined measure constituted by threeinterdependent subscales: automatic thoughts, emotions, and sexual response presented during sexual activity. Psychometricstudies showed good reliability and validity results in both versions, and high correlations between several dimensions ofthe three subscales support the concept of mode and its interactional
Moreover, the capacity showed by the SMQto discriminate between sexually functional and dysfunctional subjects and its high correlations with measures of sexualfunctioning emphasize the role of cognitive-emotional processes on sexual problems, supporting the clinical value of themeasure.
Recently, a growing body of research on the role of cog-nitions and emotions in sexual response has emerged. Infact, since Barlow's formulation on cognitive-affectivefactors of sexual dysfunction (Barlow, 1986; Cranston-Cuebas & Barlow, 1990; Sbrocco & Barlow, 1996), sever-al laboratory and clinical studies were conducted to analyzethe role of some cognitive and emotional dimensions in thesexual 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), causalattributions (Fichten, Spector, & Libman, 1988; Weisberg,Brown, Wincze, & Barlow, 2001), and perfectionism
This research was partially supported by a grant from PRODEP. The authorswould like to thank to Allen Gomes, M.D., Hospitals da Universidade deCoimbra, Portugal, for making possible the collection of the clinical sample andalso for his comments and suggestions. Thanks also to D. Rijo, M.A., C.Salvador, M.A., M. Lima, Ph.D., Faculdade de Psicologia, Universidade deCoimbra, Portugal; A. Gomes, M.A., L. Fonseca, M.A., A. Carvalheira, M.A., J.Teixeira, M.D., G. Santos, M.D., J. Quartilho, M.D., Ph.D., P. Abrantes, M.D.,and A. Canhao, M.D., Hospitais da Universidade de Coimbra, for their sugges-tions and help in sample collection. H. Ramsawh, M.A., L. Scepkowski, M.A.,and M. Santos, B.A., Center for Anxiety and Related Disorders, BostonUniversity, for reviewing the English version of the measures. John Wincze,Ph.D., Brown University and Center for Anxiety and Related Disorders, BostonUniversity, for his review and suggestions on a previous version of the paper.Thanks also to participants who volunteered to participate in the study.Address correspondence to Pedro Nobre, Rua Amorim de Carvalho, 97,4460SENHORA DA HORA, PORTUGAL; e-mail: pedro.j.nobre@clix.pt.
(DiBartolo & Barlow, 1996) are among the most studiedcognitive dimensions in sexual functioning. In general,results from these studies support the main role performedby cognitive factors in sexual dysfunction processes.For the present discussion cognitive distraction studiesassume a central role. Research with both male andfemale samples suggests that distraction from sexual cuesduring sexual activity decreases subjective and physio-logical arousal in both males and females (J. G. Beck etal., 1987; Dove & Wiederman, 2000; Elliot &O'Donohue, 1997; Farkas et al., 1979; Geer & Fuhr,1976;Przybyla & Byrne, 1984). These psychophysiolog-ical studies support several clinical suggestions that dys-functional subjects, when in sexual situations, focus theirattention on negative thoughts rather than on sexuallyerotic thoughts. In males, these thoughts are mostly relat-ed to performance concerns (erection concerns), antici-pating failure and its consequences (Hawton, 1985;Wincze & Barlow, 1997; Zilbergeld, 1999), whereasfemales orient their attention to self-body-image con-cerns, sexual performance concerns, and failure thoughts(Dove & Wiederman, 2000; Hawton, 1985). Despite theselaboratory findings and clinical suggestions, there is stilla lack of naturalistic empirical studies investigating thecognitive content of sexually dysfunctional males andfemales during sexual activity. With the exception of theDove and Weiderman study (2000), which indicates anegative impact of distraction thoughts (sexual perfor-mance and bodily appearance) on female sexual function-ing, there is no published data about cognitive content
The Journal of
Volume 40, Number 4, November 2003: pp. 368-382368
Nobre and Pinto-Gouveia
during sexual activity and its influence on sexual perfor-mance.Moreover, studies about the role of emotions on sexualfunctioning, although receiving some recent attention, arestill lacking. Research on depressed affect has shown someconsistent results suggesting a negative impact on sexualarousal. Heiman and Rowland (1983) and J. G. Beck andBarlow (1986) found that dysfunctionals reported signifi-cantly more negative affect during erotic exposure.Experimental studies have further supported these findings,showing that manipulated negative affect in sexually func-tional subjects produced a delay in subjective sexualarousal (Meisler & Carey, 1991) and a decrease in peniletumescence (Mitchell, DiBartolo, Brown, & Barlow, 1998).Research on the role of anxiety in sexual functioninghas also shown some consistent results in both men andwomen. Contradicting classic theoretical perspectivesbased on clinical observations (Kaplan, 1974; Masters &Johnson, 1970), results systematically suggest a neutral oreven a facilitative effect of anxiety on both male andfemale sexual arousal (Barlow, Sakheim, & J. G. Beck,
Elliot & O'Donohue, 1997; Laan, Everaerd,Aanhold, & Rebel, 1993; Palace & Gorzalka, 1990).Studies on the impact of anger and worry on sexualfunctioning are lacking and present some inconsistentresults. Yates, Barbaree, and Marshall (1984), studyingthe relationship between anger and deviant sexualarousal, showed that this emotion might facilitate sexualarousal, while Bozman and J. G. Beck (1991) reportedthat anger decreases both desire and arousal. Katz andJardine (1999) analyzed the relationship between a ten-dency to worry and sexual desire and aversion in a non-clinical population, and found some moderate but notconclusive correlations.Despite this growing body of scientific literature, wethink there is a lack of integrated studies on the linkbetween cognitions and emotions and their impact onsexual functioning. Our purpose is to move in that direc-tion using cognitive theory as a preferential frameworkto better understand the processes involved in sexualdysfunction. In fact, cognitive theory has led to a betterunderstanding of the cognitive processes involved in alarge spectrum of psychopathological situations and hasbeen successfully used in the comprehension and treat-ment of several disorders: depression (A. T. Beck, Rush,Shaw, & Emery 1979), anxiety (A. T. Beck & Emery,1985), relationship disorders (A. T. Beck, 1988), person-ality disorders (A. T. Beck & Freeman, 1990), substanceabuse disorders (A. T. Beck, Wright, Newman, & Liese,1993), and hostility (A. T. Beck, 2000).Of particular interest is the later development of A. T.Beck's theoretical thinking (1996). In this recent revi-sion, Beck proposed a new conception for the structureand processes involved in psychopathology. He devel-oped the
theory, substituting the linear schematicprocessing for a more integrated and interactionalmodel. In this new concept, the central role of cognitiveprocessing (mediating emotional and behavioral reac-tions) is substituted by a network of interdependent cog-nitive, emotional, and behavioral dimensions. Modes areconceptualized as specific suborganizations within thepersonality organization composed of cognitive, affec-tive, and behavioral systems. A. T. Beck (1996) suggeststhat the various psychopathological disorders can beconceptualized in terms of modes. For example, specificphobia would be characterized by specific dangerousthoughts, anxiety responses, and a behavioral impulse toescape, whereas depression would be characterized byloss thoughts accompanied by sadness and regressionbehaviors.Our goal is to study sexual dysfunctions using this the-oretical perspective, which, besides its conceptual sound-ness,is largely based in empirical findings and proven tobe clinically effective in a wide range of psychopatho-logical situations (A. T. Beck, 1996). For this purpose,we developed the Sexual Modes Questionnaire (SMQ),specifically oriented to assess the interaction between theautomatic thoughts and the related emotions and sexualresponses. We hypothesized that dysfunctional subjectswhen in sexual situations activate negative cognitiveschemas, which elicit a synchronic and interactionalresponse by the cognitive, emotional, and behavioral sys-tems. This interactional response would be characterizedby negative automatic thoughts and emotions and lowsexual response. Thus, dysfunctional subjects would pre-sent thoughts not relevant to the sexual task (i.e., lack ofsexual or erotic thoughts) but oriented to performancedemands (focus on erection) or anticipating failure andits consequences in males, and sexual abuse thoughts,failure and disengagement thoughts, or low self-body-image thoughts in females. These negative automaticthoughts would be associated with negative emotions(mostly related to depressed mood—lack of pleasure andsatisfaction accompanied by sadness, disillusion, orguilt) and with poor sexual response (i.e., low sexualarousal levels). These three systems, once activated, willfeed each other and maintain the dysfunctional cycle.This study is also part of a more global research pro-ject developed to assess the role of cognitive-emotionalvariables in sexual functioning (Nobre, 2003). For thispurpose, two other measures were also created to studydifferent levels of cognitive interference: a measure ofsexually dysfunctional beliefs (Nobre, Pinto-Gouveia, &Gomes,
meant to assess sexual beliefs hypothe-sized as vulnerability factors to sexual dysfunction) and ameasure of cognitive schemas activated in sexual context(Nobre & Pinto-Gouveia,
assessing the cognitiveschemas activated by nonsucceeded sexual situations).We hypothesized that sexual beliefs would stipulate theconditions for the activation of the cognitive schemas inspecific sexually unsuccessful experiences. Once activat-ed, these cognitive schemas would elicit a systemic struc-ture composed of thoughts, emotions, and sexualresponse. Past research with erectile disorders seems to

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