SEXUAL PROBLEMS: PHOBIC REDUCTION TECHNIQUES
If we consider the sexual phobic reaction to be any automatic, disturbed response of the autonomic nervous system to sexual stimuli, and if we use phobic reduction methods regardless of the subjective experience of this disturbed response, we can markedly increase the usefulness of this behavioral approach. However, the question must now be raised as to whether the phobic response should be limited solely to disturbed responses. Perhaps any out-of-control automatic response, even pleasurable sexual responses, may be considered to be phobic. Rachman, for example, has demonstrated that an automatic sexual response can be conditioned to pictures of boots. If this were so, certain of the sexual variants may be treated by phobic reduction techniques. Three cases, two of them currently in treatment, are examples of this.
1. A nineteen-year-old woman had a sexual response to chewing gum. Whenever she was in the presence of anyone chewing gum (the stimulus could be either visual or auditory), her sexual response was so strong that she would either have an orgasm then and there or she would have to rush to the nearest bathroom to masturbate. She herself traced this reaction to her early adolescence when she had trained her dog to masturbate her by licking her clitoris. The sexual response, however, was limited to the middle range of the phobic stimuli. At a lower level, pictures of a chewing gum pack would set off slight but definite anxiety. At higher levels, the sight of a dog or cat licking itself would set off panic.
This sexual response responded to a phobic reduction approach. Actually, systematic de-sensitization both to imagined situations and to the therapist chewing gum in her presence had no effect. She did respond to in-vivo-flooding with response prevention (Marks). She exposed herself to situations in which people were chewing gum and remained in that situation while actively inhibiting the sexual response and practicing deliberate muscle relaxation. In a telephone contact six months after termination of treatment, the patient stated that despite repeated exposure to chewing gum situations, only once was there any sign of sexual response.
2. A twenty-eight-year-old man was a fetishistic transvestite. At age thirteen he became attracted to his mother’s lingerie, particularly to the tactile sensations, and he would masturbate with the lingerie as a stimulus. At age nineteen he performed his first cross-dressing with the intent of heightening the tactile sensations. Over time he became more enamored of the visual impact of his appearance, although his greatest thrill was when walking in the street cross-dressed, someone would brush against his clothing. He would always cross-dress alone, never in the presence of his girlfriend with whom there was a normal pattern of heterosexual behavior.
He was treated with phobic reduction methods. A desensitization tape was prepared for him to play at home. With this tape, he first relaxed, then he imagined a transvestite or fetishistic scene. Upon the first feelings of any sexual arousal, he would then relax again. The tape has eight repetitions of such scenes, takes about twenty minutes to run, and he plays it once a day. A somewhat similar procedure is followed during his office visits. At the present time he reports a complete cessation of all transvestite thoughts or feelings. This in itself is not conclusive, for on a number of occasions these have spontaneously disappeared for periods of up to two-and-a-half months. This time, however, he reports that there is a different feeling; he has a feeling of being in control. Further follow-up is of course necessary to determine if the phobic reduction method really did work.
3. This patient was a twenty-six-year-old man with a history of sexual exhibitionism. Since age fourteen he has had exhibitionist urges a minimum of three times a week (by his report). He has acted them out on a number of occasions, usually using girls in the six-to-eight year range as targets. On several occasions he moved into actual pedophilic behavior by having the child stroke his penis. He had been arrested twice and is currently on probation. Several years of traditional treatment had no effect on this behavior. He too has a girlfriend and has an apparently normal pattern of heterosexual behavior with her.
The urges tended to come about under similar circumstances, some in actuality, some imagined. He would be bored or would have nothing special to do. There would be an opportunity or a possible opportunity for contact with suitable girls. In the office, when he imagined being in such situations, he would experience a sexual arousal which, by his subjective estimate, went up to a sixty-percent level.
The phobic reduction method used was aversion relief desensitization (Wolpe). He was given a moderately uncomfortable electric shock to the forearm. When the shock ceased, he imagined being in the excitement-arousing situation. With repetition of this procedure, the intensity of the sexual reaction decreased. After five to fifteen repetitions for each imagined situation, there was no feeling of sexual arousal at all. In other words, pairing an image of the excitement eliciting situation with relief from shock brought about exactly the same kinds of reduction in sexual feeling as we find when we use aversion relief desensitization with fear-eliciting situations and automatic fear reactions.
This conditioning was carried over to the life situation. The patient reported that for the first time in twelve years (his words), he has been completely free of exhibitionistic impulses for as long as one week. At this writing he has had no such urges for six weeks but is being monitored on a regular basis.
In each of these cited cases the variant behavior does indeed appear to be a true phobia. This does not mean that all sexual variant behavior falls into the phobic category. As always, a careful evaluation and formulation is necessary.
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