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He who will not work, neither shall he eat" : German Social Democratic attitudes to labor, 1890-1914 Neufeld, Michael John 1976

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TREATMENT OF FEMALE SEXUAL DYSFUNCTION THROUGH THE USE OF SYMBOLIC MODELING WITH GRADUATED BEHAVIORAL TASKS by GEORGIA HELEN NEMETZ B.A., University of British Columbia, 1973 A THESIS SUBMITTED IN PARTIAL FUI^ TLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in the Faculty of Graduate Studies Department of Psychology We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA March, 1976 (a) Georgia Helen Nemetz. 1976 In presenting th i s thes is in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i l ab le for reference and study. I further agree that permission for extensive copying of th is thes is for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion of th is thes is for f inanc ia l gain sha l l not be allowed without my wr i t ten permission. Depa rtment The Univers i ty of B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 Date SfrlOAM 19, /9?t ABSTRACT A t t i t u d i n a l and behavioral indices of sexual adjustment and sexual anxiety measures were obtained from twenty-two subjects i n order to assess the e f f e c t s of i n d i v i d u a l and group graduated symbolic modeling with con-current behavioral tasks as a treatment, procedure for female sexual dys-function. A l l of the women serving as c l i e n t s had reported severe anxiety towards sexual behavior which precluded t h e i r enjoyment of and or engage-ment i n t h i s area. Sixteen of the c l i e n t s were randomly divided into two groups; one receiving i n d i v i d u a l treatment and the other receiving group treatment. Treatment consisted of i n i t i a l r e l a x a t i o n t r a i n i n g followed by the viewing of 45 video-taped vignettes depicting various graduated sexual behaviors. Sessions were held twice weekly for approximately two and one-half weeks. The other s i x women served as a control group and were subjected to i d e n t i c a l measurement without the benefit of treatment. S t a t i s t i c a l l y s i g n i f i c a n t decreases i n anxiety and increases i n behavioral and a t t i t u d i n a l measures were evidenced to the same extent i n both t r e a t -ment conditions; however, a trend towards greater improvement was observed for those' r e c e i v i n g group treatment. S i g n i f i c a n t improvements appeared simultaneously i n a l l three areas around the t h i r d treatment session. These riesults remained stable through the three week follow-up period. The contro c l i e n t s showed no improvement and trends toward d e t e r i o r a t i o n were evidenced on a l l three measures. It would appear that graduated symbolic modeling with concurrent behavioral tasks e f f e c t s p o s i t i v e changes i n a t t i t u d i n a l , behavioral and anxiety indices simultaneously. The extent and relevant contribution of i i these changes during sexual dysfunction therapy requires f u r t h e r i n v e s t i -gation i n c l u d i n g the refinement of behavioral measures and the examination of the e f f e c t s of time on waiting l i s t c l i e n t s . i i i TABLE OF CONTENTS Page ABSTRACT i LIST OF FIGURES i v . LIST OF APPENDICES v i . ACKNOWLEDGEMENT v i i INTRODUCTION 1 Li t e r a t u r e Review 8 Derivation of Present Treatment Procedure 14 METHOD 23 Subjects 23 Apparatus 24 Procedure 26 RESULTS 30 The Sexual Anxiety Card Sort 30 The Bentler Heterosexual Behavior Hierarchy 32 The Sexual Semantic D i f f e r e n t i a l 34 The Rotter Sex Attitude Scale 56 The Sexual Behavior Index 58 DISCUSSION 75 The Sexual Anxiety Card Sort 75 The Bentler Heterosexual Behavior Hierarchy 76 The Sexual Semantic D i f f e r e n t i a l 76 The Rotter Sex Attitude Scale 78 The Sexual Behavior Index 78 Implications f o r Future Research 81 CONCLUSIONS 84 REFERENCES 85 APPENDICES 89 LIST OF FIGURES Page Figure 1. Mean scores over administrations for Sexual Anxiety Card Sort. 31 Figure 2. Mean scores over administration f o r The Bentler Heterosexual Behavior Index. 33 Figure 3. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l Anxiety Dimension. 35 Figure 4. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l Evaluation Dimension, 38 Figure 5. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l Sexual Dimension. 40 Figure 6. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l A c t i v i t y Dimension. 42 Figure 7. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l Potency Dimension. 45 Figure 8. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l : Concept 1 Sex. 47 Figure 9. Mean scores over administration f o r The Semantic D i f f e r e n t i a l : Concept 2 Nudity. 49 Figure 10. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l : Concept 3 Male Bodies. 51 Figure 11. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l : Concept 4 S e l f -Exploration. 52 Figure 12. Mean scores over administrations f o r The Semantic D i f f e r e n t i a l : Concept 5 Ve r b a l i z i n g My Sexual Desires to My Partner, 53 Figure 13. Mean scores over•administrations for The Semantic D i f f e r e n t i a l : Concept 6 My Role i n Sexual A c t i v i t y . 55 Figure 14. Mean scores over administrations for The Semantic D i f f e r e n t i a l : Concept 7 Orgasm. 57 V Page Figure 15. Mean scores over administrations f o r The Sexual Behavior Index: Category 1 V i s u a l Sexual Exposure. 59 Figure 16. Mean scores over administrations f o r The Sexual Behavior Index: Category 2 Non-Sexual Sensate Focus. 61 Figure 17. Mean scores over administrations f o r The Sexual Behavior Index: Category 3 Sexual Sensate Focus. 63 Figure 18. Mean scores over administrations f o r The Sexual Behavior Index: Category 4 Fore*-play 10 Minutes. 65 Figure 19. Mean scores over administrations f o r The Sexual Behavior Index; Category 5 Fore-play 20 Minutes. 67 Figure 20. Mean scores over administrations for The Sexual Behavior Index: Category 6 Fore-play 30 Minutes. 68 Figure 21. Mean scores over administrations f o r The Sexual Behavior Index: Category 7 Inter-course. 69 Figure 22. Mean scores over administrations f o r The Sexual Behavior Index: Category 8 Orgasm. 71 Figure 23. Mean scores over administrations f o r The Sexual Behavior Index: Category 9 Number of Female I n i t i a t e d Sexual Behaviors. 73 LIST OF APPENDICES Appendix I Appendix II Appendix I I I Appendix IV Appendix V Appendix VI Appendix VII Appendix VIII Appendix IX Appendix X Appendix XI Appendix XII Appendix XIII Appendix XIV Appendix XV Appendix XVI Appendix XVII Items on the Sexual Anxiety Card Sort., The Bentler Heterosexual Behavior Index. Items on the Sexual Behavior Index. Categorization of the Sexual Behavior Index. The Rotter Sex Attitude Scale. The Sexual Semantic D i f f e r e n t i a l Analyses f or the Sexual Anxiety Card Sort. Analyses f or the Bentler Heterosexual Behavior Hierarchy. Analyses f o r the Semantic D i f f e r e n t i a l Anxiety Dimension. Analyses f or the Semantic D i f f e r e n t i a l Evaluation Dimension. Analyses for the Semantic D i f f e r e n t i a l Sexual Dimension. Analyses f o r the Semantic D i f f e r e n t i a l A c t i v i t y Dimension. Analyses f or the Semantic D i f f e r e n t i a l Potency Dimension. Analyses by Concept for the Semantic D i f f e r e n t i a l . Analyses f o r the Rotter Sex Attitude Sea I n t e r c o r r e l a t i o n Matrix of Male and Female Responses on the Sexual Behavior Index. Analyses by Categories on the Sexual Behavior Index. Appendix XVIII Descriptions of Video-tape Sequences. v i i ACKNOWLEDGEMENT I would l i k e to express my deep appreciation to the following people who have aided me ei t h e r d i r e c t l y or i n d i r e c t l y i n t h i s research: Dr. Kenneth Craig, f o r serving as senior advisor and lending much needed support; Dr. Gunther Reith, f o r serving on my committee and for supplying the f a c i l i t i e s f o r my research; Dr. Kathleen Waddell, f o r serving on my committee; Sheena Bowman, f o r help i n analyzing my data and for being patient with a n o n - s t a t i s t i c i a n ; Campbell Clarke, f o r h i s patient explanations of s t a t i s t i c a l p r i n c i p l e s ; Judy Hawkins, f o r typing the manuscript; and Morrie Lercher, my husband, for putting up with me during t h i s research. 1 The l a s t f i f t e e n years have seen a growing s c i e n t i f i c awareness and concern with the nature of human sexuality. This trend has been mani-fested i n the p r o l i f e r a t i o n of publications, both investigatory and i n s t r u c -t i v e , and i n the founding of numerous c l i n i c s devoted to the examination of a l l facets of human sexuality. Concomittant with s c i e n t i f i c awareness there has developed an immense public enlightenment which while dealing with the t r a d i t i o n a l realm of male sexuality has p r i m a r i l y served to under-score the r o l e and functioning of the female as a sexual being. Women, for the f i r s t time, have been p u b l i c l y sanctioned to examine and i f neces-sary c r i t i c i z e t h e i r sexual responsiveness. With t h i s expanding s e l f -exploration, the area of female sexual dysfunction has come into prominence. Questions of d e f i n i t i o n a l c r i t e r i a , incidence of dysfunction i n the popu-l a t i o n , implications for m a r i t a l accord and the e f f i c a c y of therapeutic techniques have formed the nucleus for numerous inv e s t i g a t i o n s . It i s to t h i s area that the present study has been devoted. Attempts to i s o l a t e causative factors i n the area of female sexual dysfunction are c e r t a i n l y not new. P r i o r to the advent of Masters and Johnson's work i n 1959, the question and discussion of sexuality was f a i r l y synonomous with Freudian psychoanalytic theory. Lack of sexual responsive-ness was conceptualized as representing a form of psychological maladjust-ment a t t r i b u t e d to the f a i l u r e to master c o n f l i c t s associated with each of the psychosexual phases that preceded the g e n i t a l stage (Freud, 1963). Masters and Johnson (1970), taking a broader more popular p o s i t i o n , have postulated numerous causative agents including among others the lack and/ 2 or misinformative nature of parental t r a i n i n g , r e l i g i o u s orthodoxy, lack of communication between m a r i t a l partners and the f a i l u r e to become t o t a l l y involved i n sexual a c t i v i t i e s (spectatoring). Kaplan (1974), while es-pousing a multi-dimensional approach, focuses both on immediate and remote agents. The former includes most of the aforementioned, while the l a t t e r encompasses such variables as intrapsychic c o n f l i c t s and pathological patterns of c h i l d - r e a r i n g . Diverse therapeutic techniques have been devised to encompass the plethora of postulated causative fa c t o r s . While the author does not r e j e c t the v a l i d i t y of a multi-causal approach, i t i s t h i s paper's i n t e n t i o n to focus upon one v a r i a b l e i n t h i s complex network. The present study views anxiety towards sexual functioning as a basic p r o h i b i t i v e factor to the enactment and enjoyment of sexual a c t i v i t y . As anxiety, defined and/or measured a f f e c t i v e l y , behaviorally, or p h y s i o l o g i c a l l y , i s a highly learnable response, i t i s postulated that one or a ser i e s of negative sexual incidents are more than s u f f i c i e n t to generate female sexual dysfunction. These "i n c i d e n t s " may range from rape and parental molestation to f a i l u r e to achieve "expected orgasm" and pre-occupying concern with p h y s i c a l a t t r i b u t e s . As anxiety i s r e a d i l y attached to previously n o n - e l i c i t i n g s t i m u l i on the basis of simple c o n t i g u i t y , the e n t i r e gamut of sexual behavior i s often affected. To i l l u s t r a t e , the woman who has become incr e a s i n g l y anxious as a r e s u l t of her repeated f a i l u r e to achieve orgasm may cease a l l forms of physical contact as she i s c e r t a i n that any sexual communication and/or mere physical proximity w i l l d e f i n i t e l y lead to intercourse. It i s f e l t that anxiety toward i n t e r -course and/or any s p e c i f i c form of sexual behavior generalizes s u f f i c i e n t l y to disrupt and/or preclude e f f e c t i v e sexual habits. While acknowledging 3 the importance of such components as f a u l t y communication, lack of a f f e c -t i o n and "habitual" type responding, the present study has chosen to focus on the diminuition of anxiety as a major p r o h i b i t i n g factor to the enact-ment of sexual behavior. Although a number of behavior t h e o r i s t s question the mediating r o l e of anxiety i n t h e i r t h e o r e t i c a l formulations, the majority of behaviorists have r e l i e d upon Wolpe's (1958) d e s e n s i t i z a t i o n paradigm to reduce anxiety and achieve a concurrent increase i n desireable behavior. While desensi-t i z a t i o n elements are apparent i n both Masters and Johnson's (1970) and Kaplan's (1974) approaches, some authors (Kraft and A l - I s s a , 1967; Brady, 1966; Lazarus, 1963) have u t i l i z e d i t as the sole therapeutic v a r i a b l e . A thorough discussion of t h e i r r e s u l t s w i l l be presented i n a l a t e r section. In response to the ever growing demand for new therapeutic tech-niques, numerous investigators have turned to Bandura and Walters (1963) conclusion that " v i r t u a l l y a l l learning phenomena r e s u l t i n g from d i r e c t experiences can occur on a v i c a r i o u s basis through observation of other persons' behavior and i t s consequences for them" (Bandura, 1969, p. 118). In examining the operative elements of the modeling process, Bandura (1965b) emphasized the r o l e of stimulus contiguity and associated symbolic processes during a c q u i s i t i o n and the importance of reinforcement procedures i n the actual performance of the behavior. Bandura (1969) postulated the existence of four psychological systems including a t t e n t i o n a l , r e t e n t i o n a l , motor reproduction and incentive and motivational processes as responsible "for observational learning and suggested that optimal l e a r -ning conditions would focus on t h e i r i n d i v i d u a l requirements. Numerous inves t i g a t i o n s designed to discover f a c i l i t a t i v e conditions have examined 4 observer c h a r a c t e r i s t i c s , multiple models (Bandura and Menlove, 1968), model-observer s i m i l a r i t y and other v a r i a b l e s . Bandura (1969) postulated three major e f f e c t s of modeling influences on behavior which can be viewed as p o t e n t i a l consequences of the video-taped d e s e n s i t i z a t i o n procedures u t i l i z e d i n the present study. These are: 1. Observational learning e f f e c t — observers may acquire new patterns of behavior that did not previously e x i s t i n integrated form within t h e i r behavioral r e p e r t o i r e . 2. Response i n h i b i t i o n or d i s i n h i b i t i o n — modeling may serve to strengthen or weaken i n h i b i t i o n s of responses that already e x i s t i n the observer's rep e r t o i r e — influence i s determined by observa-t i o n of rewarding and punishing consequences ac-companying models' responses. 3. Response f a c i l i t a t i o n — the behavior of others may serve as di s c r i m i n a t i v e s t i m u l i f o r obser-vers and f a c i l i t a t e the occurrence of e x i s t i n g responses i n the same general c l a s s . While i t can be t h e o r e t i c a l l y argued that the present treatment procedure u t i l i z e s a l l three of the e f f e c t s mentioned above, i t i s f e l t that response d i s i n h i b i t i o n has the most relevance. Within the s o c i a l learning framework i t i s assumed that e x t i n c t i o n of fear arousal, deriving from conditioned aversive s t i m u l i , through observational experiences w i l l reduce defensive behavior. For a d e t a i l e d e l u c i d a t i o n of the theory behind the above statement the reader i s referred to Bandura (1969, p. 670-72). Modeling procedures have been credited with extinguishing fear arousal (Bandura, Grusec and Menlove, 1967b; Blanchard, 1969; Bandura, Blanchard and R i t t e r , 1969) by having persons observe models performing fear-provoking behavior without experiencing adverse consequences. 5 Blanchard (1969), i n d e a l i n g w i t h snake phobics, concluded that the more thoroughly f e a r a r o u s a l was v i c a r i o u s l y e x t i n g u i s h e d , the greater the r e -duction i n avoidance behavior and the more ge n e r a l i z e d the b e h a v i o r a l changes. Again v a r i o u s attempts have been made to d e l i n e a t e optimal c o n d i t i o n s . The f o l l o w i n g i s a summary of these f i n d i n g s . With respect to the e f f i c a c y of l i v e versus symbolic modeling a comparison of Bandura, Grusec and Menlove (1967b) and Bandura and Menlove (1968) i n d i c a t e d that the i n i t i a l l y l e s s powerful nature of symbolic modeling was o f f s e t by the u t i l i z a t i o n of a broad sampling of models and a v e r s i v e stimulus o b j e c t s . Findings (Bandura, 1968) have a l s o i n d i c a t e d that w h i l e stimulus gradua-t i o n i s not a necessary c o n d i t i o n f o r v i c a r i o u s e x t i n c t i o n , i t adds to the e f f e c t i v e n e s s of the treatment procedures. Modeling w i t h guided p a r t i c i -p a t i o n ( R i t t e r , 1969b; Bandura, Blanchard and R i t t e r , 1969) a l s o appears to optimize v i c a r i o u s e x t i n c t i o n e f f e c t s . Bandura (1969, p. 192) s t a t e s t h a t , " D i r e c t contact w i t h t h r e a t s that are no longer o b j e c t i v e l y j u s t i -f i e d provides a v a r i e t y of new experiences that i f favorable f u r t h e r ex-t i n g u i s h r e s i d u a l a n x i e t y and avoidance tendencies — a f t e r approach i s f u l l y r e s t o r e d r e s u l t a n t experiences give r i s e to s u b s t a n t i a l r e o r g a n i z a -t i o n of a t t i t u d e s . " Credence was l e n t to the above statement by Bandura, Blanchard and R i t t e r ' s 1969 study which i n d i c a t e d that the greatest be-h a v i o r a l and a t t i t u d i n a l change was to be found i n the treatment c o n d i t i o n that most e f f e c t i v e l y extinguished the anx i e t y arousing p r o p e r t i e s of the av e r s i v e s t i m u l i . The r e s u l t s of the study i n d i c a t e d that modeling and graduated symbolic modeling proved more e f f e c t i v e than standard d e s e n s i -t i z a t i o n i n n e u t r a l i z i n g the a n x i e t y arousing p r o p e r t i e s of the a v e r s i v e s t i m u l i . 6 Based upon these findings, the present study has u t i l i z e d graduated symbolic modeling 1 with concurrent behavioral tasks i n the treatment of secondary inorgasmic females 2. It i s postulated that the reduction of sexual anxiety by v i c a r i o u s e x t i n c t i o n w i l l enable the c l i e n t s to s u c c e s s f u l l y complete the behavioral tasks thus exposing themselves to p o t e n t i a l l y p o s i t i v e sexual experiences. It i s also hypothesized that a substantial re-organization of attitudes towards personal sexual behavior w i l l be engendered by increased exposure to p o s i t i v e sexual a c t i v i t y . Implications, mostly se l f - e v i d e n t , of an e f f i c a c i o u s therapeutic intervention f or female sexual dysfunction are manifold. In addition to the d e s i r a b i l i t y of an e f f i c a c i o u s intervention, symbolic modeling requires minimal therapist intervention. The favorable research i n the area of se l f - r e g u l a t e d symbolic modeling (Bandura, Blanchard and R i t t e r , 1969) suggests that a f a i r l y precise s e l f - h e l p program could be offered, thus allowing more c l i e n t s to partake with greater expediency. As the benefits of group treatment are also being assessed, p o s i t i v e r e s u l t s from t h i s area could also lead to increased therapeutic o f f e r i n g s . In the present study, three experimental conditions were con-trasted, i n d i v i d u a l treatment, group treatment and a no-treatment c o n t r o l . Meas ures included the Rotter Sex Attitude Scale (1973), The Bentler Hetero— 1 In the present treatment paradigm, symbolic modeling was achieved through the use of a videotaped graduated hierarchy of sexual scenes. 2 The author has expanded Masters and Johnson's (1970) d e f i n i t i o n of secondary inorgasmic females which en-compassed those who have experienced orgasm, to include those women who have experienced an orgasmic plateau at l e a s t once. 7 sexual Behavior Hierarchy, a sexual semantic d i f f e r e n t i a l , a sexual anxiety card sort and a sexual behavior index. Based upon the assumption that anxiety towards sexual a c t i v i t y i s a major p r o h i b i t i n g factor to the evocation of a normal sexual response (Kraft and A l - I s s a , 1967; Masters and Johnson, 1970; Kaplan, 1974) i t was expected that a decrease i n the scores on both the Bentler Heterosexual Hierarchy and the sexual anxiety card sort would be indicants of treatment e f f i c a c y . As sexual "homework" tasks were an i n t e g r a l part of the program and reduction of anxiety f a c i l i t a t e s approach responses, a s i g n i f i c a n t increase i n the sexual be-havior index, which measures sexual a c t i v i t i e s over and above those i n -cluded i n the treatment, was also expected as a r e s u l t of successful therapeutic intervention. Rotter's Sex Attitude Scale, which taps global at t i t u d e s towards sexual behavior was not expected to be s i g n i f i c a n t l y a ffected by the treatment; whereas, the sexual semantic d i f f e r e n t i a l , which attempts to measure att i t u d e s towards personal sexual behavior, was expected to change s i g n i f i c a n t l y as treatment procedures required an i n -creased sexual r e p e r t o i r e . I t was also hypothesized that group treatment might possibly show a more s i g n i f i c a n t reduction i n anxiety and a trend towards a more p o s i t i v e a t t i t u d e change as group members were exposed to other women with s i m i l a r problems. Incidence of orgasm, while being an ultimate personal goal was not included as an indicant of successful therapeutic intervention as i t was thought that the two to three week treatment period was not of s u f f i c i e n t length to expect t h i s occurrence. 8 LITERATURE REVIEW Nosological dilemnas have continually beleagured c l i n i c a l psychology and i n t h i s respect the area of female sexual dysfunction i s not a t y p i c a l . C o l l e c t i o n of epidemiological data has been severely hampered, i f not rendered t o t a l l y inaccurate, by conceptual ambiguities and lack of diag-no s t i c c r i t e r i a . Both Kinsey (1953) and Fisher (1973) have made attempts at epidemiological i n v e s t i g a t i o n s ; however, i n each instance, no d e f i n i -t i v e statement of problem areas was forthcoming. Estimates on the number of married women able to achieve orgasm through c o i t a l contact alone, ranged from 90% a f t e r ten years of marriage i n Kinsey's study, to 35% i n Fisher's study. Fisher's study of 300 women over a 5 year period indicated that while 85-90% of h i s sample was orgasmic, only 35% preferred vaginal stimulation obtained through coitus as compared to c l i t o r a l stimulation. As these r e s u l t s i n d i c a t e , c r i t e r i a of female sexual dysfunction are highly ambiguous. Some authors f e e l that i f a woman cannot achieve orgasm through c o i t a l contact she i s dysfunctional; whereas, other sources view dysfunction as the i n a b i l i t y to achieve orgasm through any means. H i s t o r i c a l l y the pejorative term " f r i g i d i t y " has been prevasive i n the l i t e r a t u r e and has been used to encompass a l l degrees of female sexual dysfunction. Recently, various nosological attempts have been made to delineate the varying areas of dysfunction. Masters and Johnson have used c l a s s i f i c a t i o n s such as: primary orgasmic dysfunction; s i t u a t i o n a l or secondary orgasmic dysfunction (being further divided into masturbatory, c o i t a l and random orgasmic dysfunction); vaginismus and dyspareunia. Kaplan (1974) has u t i l i z e d the following: general sexual dysfunction; 9 org a s t i c dysfunction, absolute or s i t u a t i o n a l ; vaginismus and sexual anesthesia or conversions. While the plethora of terms i s c e r t a i n l y an improvement over the si n g l e all-encompassing c l a s s i f i c a t i o n , they are at times redundant and confusing. The d i f f e r e n t i a t i o n between c l i t o r a l , vaginal and masturbatory orgasm also provides a well-worn polemic b a t t l e -ground; however, i t i s not the author's intent to enter and or do more than comment on the above disputes, but merely to acknowledge t h e i r existence. The following review of the l i t e r a t u r e focuses on approaches that contain both behavioral and s o c i a l learning elements, as i t i s f e l t that these were the most relevant to the treatment program under discussion. U n t i l 1959 with the advent of Masters and Johnson's c l i n i c f o r the treatment of human sexual dysfunction at the Washington University School of Medicine, therapeutic advances l e t alone acknowledgement of the problem area were scarce. As sexuality was, and i s , an i n t e g r a l part of psycho-a n a l y t i c theory, the major therapeutic emphasis u n t i l 1959 came mainly from t h i s domain. From t h i s perspective a l l sexual problems were seen as unconscious c o n f l i c t s a r i s i n g from c r i t i c a l childhood experiences. Therapy was conducted along t r a d i t i o n a l psychoanalytic themes. Masters and Johnson's contributions to the f i e l d are m u l t i t u d i n a l . Their program e n t a i l s an intensive two week commitment sub-divided into three d i s t i n c t phases. Days one, two and three are e n t i r e l y devoted to hist o r y - t a k i n g , physical examination and discussion of factors operant i n the couple's s p e c i f i c problem. The next phase of treatment, occurring on days three, four and f i v e , i s an attempt to reacquaint the couple with the basic l e v e l s of sensual experience i n the absence of goal oriented 10 behavior. This reinstatement of sexual communication i s achieved through a s e r i e s of graduated therapeutic i n s t r u c t i o n s . Sensate focus, as t h i s approach i s l a b e l l e d , d i f f e r e n t i a t e s between the " g i v i n g " and the "getting" partner. "The giving partner i s to trace, massage or fondle the getting partner with the i n t e n t i o n of giving sensate pleasure and discovering the receiving partner's l e v e l of sensate focus. This gives the couple the f i r s t opportunity to think and f e e l sensuously and at l e i s u r e without i n t r u s i o n upon the experience by the demand for either partner's end point release." (Masters and Johnson, 1971, p. 72). Progression through i n s t r u c - -tions i s contingent upon successful verbal reports at each graduated stage. Treatment then branches out to accomodate s p e c i f i e d dysfunctions. As t h i s study i s p r i m a r i l y concerned with female orgasmic dysfunction, t r e a t -ment modalities f o r the other numerous dysfunctions w i l l not be discussed. The female orgasmic response i s conceptualized more as an "accep-tance of n a t u r a l l y occurring s t i m u l i rather than as a learned response" (Masters and Johnson, 1971, p. 296). Two major i n h i b i t i n g factors to the natural flow of s t i m u l i are anxiety and spectatoring. Both serve to e f f e c t i v e l y block the processing of any p h y s i c a l and or psychological s t i m u l i . Masters and Johnson view the successful i n t e r d i g i t a t i o n of the biophysical and psychosocial systems as the major c r i t e r i o n for adaptive sexual function. To the extent that a dysfunction i n one sphere dominates the other, one can i n f e r e t i o l o g i c a l causation. In addition to the general sensate focus, s p e c i a l i z e d treatment of o r g a s t i c a l l y dysfunctioning women revolves around "teasing, interrupted and non-demanding lovemaking". Genital manipulation i s the next sequen-t i a l exercise. Here permission to enjoy g e n i t a l play i s i n e f f e c t granted 11 to the female. Once again a non-demanding climate i s developed to allow the female to "think and f e e l " sexually without preoccupying concern f o r her partner. The female i s instructed to p o s i t i o n herself between her partner's legs and gently guide hi s hand i n exploratory play. This exer-c i s e both attempts to remove "the spectator r o l e " by t o t a l l y involving the female i n exploration, and to educate the male as to the varying l e v e l s of h i s partner's sensate pleasure. In a subsequent stage further i n c r e -mentation of female sexual tension i s attempted by i n s t r u c t i n g the female to adopt the superior c o i t a l p o s i t i o n . Again i n a non-demanding and non-goal oriented climate she i s able to "think and f e e l " sexually and ex-perience the sensation of penile containment. She i s also instructed to engage i n slow exploratory p e l v i c thrusting with the sole emphasis on how she " f e e l s " . The couple i s instructed to mount and remount as long as neither partner i s fatigued. With t h i s s u c c e s s f u l l y accomplished, i n s t r u c -tions are given for the l a t e r a l c o i t a l p o s i t i o n which provides the maxi-mum f l e x i b i l i t y f o r both partners. Kaplan's approach, an adaptation of the basic Masters and Johnson program, i s b u i l t upon a more e c l e c t i c mulitcausal philosophy. Although she espouses i n v e s t i g a t i o n of both immediate and remote e t i o l o g i c a l f a c t o r s , Kaplan indicates that remote structures are not dealt with unless i t i s necessary i n order to ensure that the d i s a b i l i t y w i l l not recur. Immediate causes are seen as imposing conscious monitoring processes on the " n a t u r a l l y " occurring sexual response. Among immediate causes posited are: f a i l u r e to engage i n e f f e c t i v e sexual behavior; sexual anxiety due to fear or f a i l u r e ; demand f o r performance or excessive need to please partner; perceptual and i n t e l l e c t u a l defenses and the f a i l u r e to communicate. 12 Deeper issues examined include c h i l d rearing p r a c t i c e s and intrapsychic c o n f l i c t . Kaplan views the involuntary i n h i b i t i o n of the orgastic r e f l e x 3 as the e s s e n t i a l component to orgastic dysfunction. Therapeutic goals revolve around the elimination or diminuition of t h i s involuntary over-control. In addition to Masters and Johnson's behavioral tasks, psycho-therapy i s espoused to f o s t e r "awareness and r e s o l u t i o n of the intrapsychic and t r a n s a c t i o n a l c o n f l i c t s which i n i t i a l l y caused the holding back" (Kaplan, 1974, p. 385). Joseph LoPiccolo's Sex Research Program u t i l i z e s a therapeutic model based on Wolpe (1970), Wolpe and Lazarus (1966) and Masters and Johnson (1970). The viewpoint i s summarized s u c c i n c t l y i n the following excerpt from Lobitz and LoPiccolo (1972, p. 265). "In the absence of any ph y s i c a l pathology, sexual dysfunction i s viewed as a learned phenomenon, maintained i n t e r n a l l y by performance anxiety and e x t e r n a l l y by a non-r e i n f o r c i n g environment, p r i n c i p a l l y the partner." In t h i s program i n t e r -course i s prohibited over a period of f i f t e e n sessions while the couple's sexual repertoire i s being r e b u i l t , through the use of graded i n vivo behavioural tasks. In a d d i t i o n to verbal s e l f - r e p o r t , d a i l y record forms specifying each a c t i v i t y , i t s duration and degree of pleasure and or arousal obtained i s recorded by the c l i e n t , both from h i s point of view and how he perceived h i s partner to f e e l . The teaching of interpersonal sexual s k i l l s and the use of r o l e playing to d i s i n h i b i t female response i s also emphasized. LoPiccolo and Lobitz report that t h i r t e e n out of t h i r -3 Kaplan views the sexual response as e s s e n t i a l l y biphasic, the l o c a l vascocongestive response and and an orgastic component which Is p r i m a r i l y muscular. 13 teen treated cases of primary orgasmic dysfunction and three out of nine cases of secondary orgasmic dysfunction were successes according to Masters and Johnson's c r i t e r i a . While behavioral technology has provided the foundations for the broad systematic approaches of Masters and Johnson, Kaplan and LoPiccolo, there have been numerous attempts to employ s p e c i f i c behavioral techniques to sexual disorders. However, t h i s trend has been much more pronounced i n the area of homosexuality and unconventional sexual a c t i v i t i e s (Feldman and Maculloch, 1964; Rachman and Teasdale, 1969), than within the realm of female sexual dysfunction. Lazarus (1963) treated sixteen r e c a l c i t r a n t and persistent cases of f r i g i d i t y with systematic d e s e n s i t i z a t i o n . His program was based on the assumption "that f r i g i d i t y i s usually the r e s u l t of learned habits of anxiety r e l a t i n g to sexual p a r t i c i p a t i o n " (Lazarus, 1963, p. 274). The subjects were instructed i n Jacobson's progressive relaxation technique, hierarchies with respect to sexual functioning were constructed, and anxiety producing items were presented v e r b a l l y i n a h i e r a r c h i c a l fashion. Lazarus reported that, of the 16 patients, nine were discharged as "sexually adjusted" a f t e r a mean of 28.71* sessions over an average period of s i x months. Neither control graoup nor objective measures of success were reported. Again based on the assumption that anxiety surrounding sexual con-tact i s frequently the primary i n h i b i t o r to normal sexual functioning, Kraft and A l - I s s a (1964) employed d e s e n s i t i z a t i o n to a female patient whose "* The author indicates that t h i s mean i s i n f l a t e d due to one patient who took over 70 sessions. 14 f r i g i d i t y was p a r t i a l l y a t t r i b u t e d to s o c i a l anxiety i n s i t u a t i o n s i n -volving men. The authors reported complete recovery a f t e r 84 one and one-ha l f hour systematic d e s e n s i t i z a t i o n sessions. Various authors have modified Wolpe's procedure somewhat and then have applied i t to female orgastic dysfunctions. Clopton and Risbrough (1973) report success i n eliminating sexual anxiety and inducing approach behavior by having patients present sexually aversive s t i m u l i to them-selves at or before masturbation induced orgasm. This approach generously assumed that the c l i e n t can experience masturbation induced orgasm. Brady (1966), i n working with f i v e c l i e n t s s u f f e r i n g from chronic severe f r i g i d i t y used d e s e n s i t i z a t i o n aided by the use of subanesthetic doses of methohexital sodium as a means of producing profound muscular relaxation. His r e s u l t s indicated four out of f i v e improvements i n 11.5 mean sessions. Derivation of Present Treatment Procedure. The treatment procedure i n the present study i s a rather complex amalgam of components. Elements of v i c a r i o u s e x t i n c t i o n (Bandura, Grusec and Menlove, 1967), graduated symbolic modeling (Bandura, Blanchard and R i t t e r , 1969) and video-taped d e s e n s i t i z a t i o n (Woody and Schauble, 1969) are u t i l i z e d . Bandura, Blanchard and R i t t e r (1969) assessed the comparative e f f i c a c y of modeling and d e s e n s i t i z a t i o n paradigms for producing behavioral, a t t i t u d i n a l arid a f f e c t i v e changes i n snake phobics. Pre-measures were taken on a behavioral avoidance task, a fear survey and on a t t i t u d i n a l ratings (six s p e c i f i c snake phobic a t t i t u d e scales and eight evaluative dimensions of the semantic d i f f e r e n t i a l ) . Four experimental conditions were employed. Subjects i n Group 1 were instructed i n relaxation procedures 15 and then were shown how to self-administer symbolic modeling. Subjects could regulate presentation and proceed at t h e i r own pace, thus taking into account varying l e v e l s of anxiety. Group 2 received graduated l i v e modeling with guided p a r t i c i p a t i o n ( R i t t e r , 1968, 1969a). Group 3 r e -ceived t r a d i t i o n a l densensitization (Wolpe, 1958). Group 4 served as the co n t r o l , completing behavioral and a t t i t u d i n a l measurements without re-c e i v i n g treatment. Post treatment measures were taken on the behavioral avoidance task, the fear survey and the a t t i t u d i n a l ratings. The r e s u l t s indicated that modeling neutralized the anxiety arousing properties of the aversive s t i m u l i and extinguished avoidance responses to a greater extent than d e s e n s i t i z a t i o n . The greatest a t t i t u d e change was noted i n the t r e a t -ment condition that most e f f e c t i v e l y extinguished the anxiety arousing properties of the aversive s t i m u l i . The a t t i t u d i n a l and behavioral aspects of t h i s study w i l l be examined i n a l a t e r section. In a s i m i l a r manner to Bandura, although not elaborating upon operative components, Woody and Schauble (1969) u t i l i z e d video-taped de-s e n s i t i z a t i o n . These authors posited two possible hindrances to the suc-c e s s f u l completion of a d e s e n s i t i z a t i o n paragidm: the a c c e s s i b i l i t y of actual s t i m u l i f or i n vivo experiencing and the r e l i a b i l i t y of c l i e n t s ' imaginal c a p a b i l i t i e s i n v i c a r i o u s experiencing. To circumvent the afore-mentioned, the authors video-taped a d e s e n s i t i z a t i o n hierarchy for snake phobics. Three experimental groups were employed. Group 1 was instructed i n r e l axation t r a i n i n g and then asked to view each of the 13 films twice. During the interludes, the subjects were given anxiety reducing suggestions e.g., anxiety i s unnecessary. Group 2 was v i r t u a l l y i d e n t i c a l except f o r the elimination of suggestions for anxiety reduction. Group 3 re-16 ceived continual exposure and re-exposure to snakes. On a behavioral approach task, Groups 1 and 2 showed l e s s fear with Group 1 showing the l e a s t . Caird and Wincze (1971) u t i l i z e d t h i s videotape d e s e n s i t i z a t i o n paradigm i n a case study involving f r i g i d i t y . The c l i e n t , trained i n relaxation techniques using Paul's (1966) abbreviated procedure, was i n -structed to imagine he r s e l f and her partner i n each s i t u a t i o n on the screen and to remain relaxed while doing so. During the i n t e r t r i a l i n -t e r v a l the c l i e n t was instr u c t e d to relax and to r a i s e her hand i f ex-periencing anxiety. In order to create a non-demanding sexual climate (Masters and Johnson, 1971) the male partner was instructed to r e f r a i n from i n i t i a t i n g intercourse for the duration of the treatment (approximately two weeks). Results indicated successful therapeutic intervention. Measurement techniques were not elaborated upon. Wincze(1971) did a s i n g l e comparative study analyzing the thera-peutic e f f i c a c y of systematic densensitization and v i c a r i o u s e x t i n c t i o n i n the treatment of f r i g i d i t y . The c l i e n t , a 29 year old married female was seen twice a week for 21 sessions. The experimental design employed four phases. Measurements included the Sexual Anxiety Card Sort (Barlow, Agras and Leitenberg, 1968) completed before each session, the Willoughby Scale, administered at the beginning of the experiment and at the end of each experimental phase, and a verbal behavioral report given by the male again at the beginning of the experiment and at the end of each experimental phase. Phase 1, serving as the baseline, included three interview sessions at which time i n s t r u c t i o n s and h i s t o r y were discussed. In phases 2 and 4 a t r a d i t i o n a l systematic d e s e n s i t i z a t i o n hierarchy with 16 scenes was ad-17 ministered. During Phase 3, v i c a r i o u s e x t i n c t i o n , subjects viewed (films were u t i l i z e d due to the d i f f i c u l t y of obtaining l i v e models) two twelve minute film s . Although a l l three measures yielded p o s i t i v e change, only the sexual anxiety card sort showed marked improvment. The v i c a r i o u s e x t i n c t i o n phase did not appear to contribute s u b s t a n t i a l l y to the t r e a t -ment e f f e c t s apparently as a r e s u l t of the inappropriate nature of the films and the subjects' lack of control of the presentation. Wincze and Caird (in press) then compared the r e l a t i v e e f f i c a c y of video-taped d e s e n s i t i z a t i o n and standard d e s e n s i t i z a t i o n i n the t r e a t -ment of primary sexual dysfunction. Twenty-one females served as the sample. Selection c r i t e r i a included: strong evidence of primary sexual dysfunction; agreement by husband and or partner to p a r t i c i p a t e i n inde-pendent interviews; absence of evidence of p s y c h i a t r i c psychopathology and absence of organic pathology. Three experimental conditions were u t i l i z e d . Subjects receiving t r a d i t i o n a l systematic d e s e n s i t i z a t i o n were exposed to a t o t a l of t h i r t y items, three to eight items per session, presented imaginally for durations ranging between 15 and 60 seconds. This presenta-t i o n method, u t i l i z e d i n numerous d e s e n s i t i z a t i o n paradigms, served to expose the c l i e n t s to the aversive s t i m u l i i n graduated sequences. The items u t i l i z e d i n the heirarchy were verbal descriptions of the video-tape sequences. Subjects serving under the video-taped d e s e n s i t i z a t i o n paradigm were exposed to the hierarchy items by f i l m for s i m i l a r durations. Subjects i n the c o n t r o l condition completed only pre-test measures and received relaxation t r a i n i n g . Measures u t i l i z e d at the i n i t i a l interview and at each subsequent session included the Sexual Anxiety Card Sort and the Bentler Heterosexual Behavior Hierarchy. S t a t i s t i c a l analyses of co-18 variance u t i l i z e d gain scores as the dependent measure and the pre-test as the co-variate. The r e s u l t s indicated that immediately following therapy the video-taped d e s e n s i t i z a t i o n proved more e f f e c t i v e i n reducing hetero-sexual anxiety. While both the standard d e s e n s i t i z a t i o n and the video-taped d e s e n s i t i z a t i o n d i f f e r e d from the control at the post test on the Sexual Anxiety Card Sort, only the video d e s e n s i t i z a t i o n group was s i g n i -f i c a n t l y d i f f e r e n t on the Bentler Heterosexual Behavior Hierarchy. As the Bentler contained novel sexual items ( i . e . , o r a l sex) the authors interpreted the l a t e r f i n d i n g as i n d i c a t i n g that video d e s e n s i t i z a t i o n induced a more generalized treatment e f f e c t . Twenty-five per cent of a l l couples benefitted from therapy i n terms of orgasmic functioning while a l l couples receiving video-desensitization v e r b a l l y reported b e n e f i c i a l e f f e c t s . Upon close examination, the d i f f e r e n t i a t i o n between video-taped d e s e n s i t i z a t i o n and graduated modeling appears to l i e more i n t h e o r e t i c a l formulation rather than i n actual procedure. Both approaches u t i l i z e r e l a xation techniques and involve the presentation of v i s u a l items gradu-ated i n anxiety producing p o t e n t i a l . As both approaches purport to reduce anxiety toward the aversive s t i m u l i while concurrently increasing approach behavior i t i s p r a c t i c a l l y impossible to delineate the operative elements i n t h i s treatment approach i n terms of one procedure or another. For the purposes of the present study, the term graduated symbolic modeling with concurrent behavioral tasks w i l l be u t i l i z e d . As such, the operative components include: the i n s t r u c t i o n i n relaxation techniques; the v i c a r i o u s e x t i n c t i o n of fear arousal through repeated observations of models performing a v a r i e t y of anxiety provoking a c t i v i t i e s and in c u r r i n g no adverse consequences; and the increase i n sexual behavior f a c i l i t a t e d 19 by both the reduction i n anxiety and the successful completion of the required behavioral assignments. Although i t i s beyond the intended scope of t h i s paper to launch into a scholarly discussion of the i n t e r r e l a t i o n s h i p of attitud e and behavior i n behavior modification, a few pertinent points must be made. An early review of the a v a i l a b l e l i t e r a t u r e undertaken by Festinger (1964) indicated a s c a r c i t y of w e l l - c o n t r o l l e d studies s p e c i f i c a l l y i n v e s t i g a t i n g the e f f e c t of a t t i t u d e change upon behavior. The studies that Festinger did f i n d indicated that changes i n atti t u d e s produced by persuasive com-munication generally had l i t t l e or no e f f e c t upon overt behavior (Fleishmann, Harris and Burtt, 1955; Maccoby, Romney Adams and Maccoby, 1962; Janis and Fesbach, 1953). Greenwald (1965a) found a low p o s i t i v e c o r r e l a t i o n between a t t i t u d i n a l and behavioral changes. Festinger (1969) a t t r i b u t e d these low, inconsistent findings to the fac t that unless the a t t i t u d e changes obtained by persuasive communication are followed by p o s i t i v e contingencies i n the environment they w i l l r a p i d l y d i s s i p a t e . The Bandura, Blanchard and R i t t e r (1969) study described previously also examined the impact of behavioral intervention upon a t t i t u d e s . Using evaluative dimensions of the semantic d i f f e r e n t i a l and at t i t u d e scales dealing with r e p t i l e s , they found that for those whose snake aversions had been eliminated both symbolic modeling and de s e n s i t i z a t i o n also produced e x t e n s i v e - a t t i t u d i n a l change. Bandura (1976), i n commenting on the r o l e of cognitive mediations of the behavior disorders, indicated that treatment focusing on i n s t i g a t i n g behavioral change i s also l i k e l y to induce a t t i -t u d i n a l change. Various models of cognitive consistency (Festinger, 1957) are 20 subsumed under the behavior oriented approach to a t t i t u d e change which views a person's cognitions about himself and h i s environment as being organized into an i n t e r n a l l y consistent system. Research i n t h i s area, Brehm and Cohen (1962) , Festinger (1959) t y p i c a l l y indicated that induced behavioral changes produce a corresponding modification i n subjects' a t t i t u d e s . These t h e o r i s t s hold that the les s compelling the reasons f o r engaging i n the contradictory behavior, the greater the cognitive dissonance and therefore the more a t t i t u d e change required to eliminate the incon-sistency. Kelman (1961) underscores the fact that a change i n behavior w i l l expose the i n d i v i d u a l to new experiences with the at t i t u d e object and that the information gained from these new experiences may be i n i t s e l f s u f f i c i e n t to produce substantial reorganization of atti t u d e s (Bandura, 1969, p. 613). Bern (1970), i n attempting to provide a t h e o r e t i c a l explanation for the at t i t u d e change induced by changing an i n d i v i d u a l ' s behavior, p o s i t s a self-perception hypothesis. This hypothesis states that " i n i d e n t i f y i n g h i s own i n t e r n a l states, an i n d i v i d u a l p a r t i a l l y r e l i e s on the same external cues that others use when they i n f e r h i s i n t e r n a l states" (Bern, 1970, p. 50). These external cues may l i e i n the s o c i a l or ph y s i c a l s i t u a t i o n i n which the i n d i v i d u a l i s placed or more pr i m a r i l y i n h i s overt behavior. Bern states that an i n d i v i d u a l might and indeed does also i n f e r h i s own i n t e r n a l states by observing h i s own overt behavior (Bern, 1965). The present study, u t i l i z i n g a t t i t u d i n a l and behavioral measures administered both before, during and following treatment t h e o r e t i c a l l y exposes the c l i e n t to Kelman's (1961) experimental consequences process, to Festinger's (1964) requirement of p o s i t i v e environmental contingencies and 21 to Bern's self-perception of own overt behavior. Successful therapeutic . intervention again should t h e o r e t i c a l l y extinguish the negative a f f e c t , i n t h i s case anxiety, surrounding the sexual s t i m u l i and should prescribe a s e l f ^ r e i n f o r c i n g sexual behavior regime. If t h i s i s indeed the case, i t would be hypothesized that e x t i n c t i o n of negative a f f e c t and treatment regulated engagement i n p o t e n t i a l l y s e l f - r e i n f o r c i n g sexual behaviors would lead to a p o s i t i v e change i n sexual a t t i t u d e measures. Of the two measurement tools used, the Rotter Sex Attitude Scale measures general, global attitudes towards sexuality while the sexual semantic d i f f e r e n t i a l measures personal a t t i t u d e s towards s p e c i f i c sexual behaviors. It i s hypothesized that changes w i l l be more profound i n the semantic d i f f e r e n t i a l as the i n d i v i d u a l i s being exposed to these behaviors during the course of treatment. The ambiguous nature of the concept of anxiety poses both d e f i n i -t i o n a l and measuremental dilemnas. Ideally, i n the present study i t would be extremely advantageous to monitor the c l i e n t s ' p h y s i o l o g i c a l responses both pre and post and during the viewing of the video-tape. This procedure would provide the author with more information as to the i n d i v i d u a l ' s reaction to the f i l m s . Lacey (1953) stresses the importance of minimal surrounding stimulation when assessing p h y s i o l o g i c a l response systems. As the sexual nature of the films could possibly produce confounding arousal states, the author has r e l i e d on verbal s e l f - r e p o r t standardized by use of the Subjective Units of Distress Scale (Wolpe, 1969) during f i l m presentation. The tools used i n the present study to measure anxiety include the Sexual Anxiety Card Sort (Barlow, Agras, and Leitenberg, 1968) and the 22 Bentler Heterosexual Behavior Hierarchy. It i s hypothesized that concom-mittant with a decrease i n anxiety f a c i l i t a t e d by vi c a r i o u s e x t i n c t i o n and an increase i n p o t e n t i a l l y self-rewarding sexual a c t i v i t i e s as prescribed by the treatment regime, a more p o s i t i v e a t t i t u d e toward sexual a c t i v i t i e s w i l l be engendered. 23 METHOD Subjects The subjects were 22 secondary inorgasmic female c l i e n t s r e-ferred to the Sexual Dysfunction C l i n i c i n the Health Sciences Centre Hos-p i t a l at the University of B r i t i s h Columbia. The subjects ranged i n age from 21 to 39 years with a median of 26.7 years. Sixteen of the subjects were married, four were sing l e and two were separated. Admission procedures included an i n i t i a l interview at which time the c l i e n t ' s s u i t a b i l i t y f o r the program was assessed. In addition to the standardized interview the c l i e n t s were given the Sexual Anxiety Card Sort and the C l i n i c ' s standard battery of relevant forms including: a l i f e h i s t o r y questionnaire; the Minnesota Mulitphasic Personality Inventory; the Bentler Heterosexual Behavior Hierarchy; the Willoughby Personality Schedule and a sexual back-ground questionnaire. Selection c r i t e r i a included: r e f e r r a l by a gyne-c o l o g i s t or general p r a c t i t i o n e r ; presence of anxiety or discomfort to-wards sexual behavior as measured both by interview data and scores on the Sexual Anxiety Card Sort (see Appendix VII); absence of organic causal factors established through gynecological examination; absence of acute marital problems j u s t i f y i n g inference of an unstable marriage; and a v a i l -a b i l i t y and co-operation of the husband or a steady sexual partner. Of the 36 c l i e n t s i n i t i a l l y interviewed, 13 women did not meet the admission c r i t e r i a . The major p r o h i b i t i n g factors to admission included absence of a male partner or minimal sexual anxiety. A l l of the unsuitable c l i e n t s were re f e r r e d to appropriate agencies for treatment. The f i r s t sixteen subjects obtained by successive admissions to the c l i n i c were randomly assigned to one of the two treatment conditions, i n d i v i d u a l or group 24 exposure. The l a s t s i x admissions were assigned to the control condition. This was done to insure s u f f i c i e n t numbers for the two treatment conditions. One of the o r i g i n a l subjects assigned to the i n d i v i d u a l treatment condition dropped out of the program due to resumption of a previous drug dependency and had to be replaced. Apparatus The Sexual Anxiety Card Sort (Barlow, Agras and Leitenberg, 1968) was u t i l i z e d to measure anxiety toward s p e c i f i c sexual behaviors (see Ap-pendix I ) . This instrument consists of twenty-five three by f i v e inch index cards depicting various sexual behaviors ranging from mere physical p r o x i -mity to intercourse and orgasm. The cards are sorted according to the various l e v e l s of anxiety they induce i n the reader i f she were to immedi-ate l y engage i n the depicted behaviors. Scores obtainable for each card range from zero to four, with zero being "no anxiety" and four being "very much anxiety". At any one administration a score of one hundred i s possible. The cut-off score for admission on the Sexual Anxiety Card Sort was t h i r t e e n . I n i t i a l admission scores ranged from t h i r t e e n to seventy with a median of thirty-two. This measure was administered at the i n i t i a l interview, each of the f i v e treatment sessions and at the three week follow-up. The Bentler Heterosexual Behavior Hierarchy (see Appendix I I ) , also an indicant of heterosexual anxiety consists of twenty-five statements of sexual behavior. Each statement i s scored on a zero to four basis with zero being "no anxiety" and four being "very much anxiety". At any one administration a score of one hundred i s possible. The Bentler Hetero-sexual Hierarchy was administered at the i n i t i a l interview and at the three week follow-up. As t h i s measure contains more novel sexual items ( i . e . , o r a l sex) not covered i n the video-taped hierarchy i t i s also viewed as 25 an indicant of treatment generalization. The Sexual Behavior Index was a form devised by the author to measure s p e c i f i c sexual behaviors (see Appendices I II and IV). This instrument which requires both partners to record the frequency of t h e i r sexual be-haviors across seventeen e x p l i c i t categories served as a baseline, follow-up and operational d e f i n i t i o n of the c l i e n t s ' sexual a c t i v i t i e s . In order to achieve scorer r e l i a b i l i t y and an index of v a l i d i t y , both partners were required to f i l l out the index. C l i e n t s were asked to keep the index for one week p r i o r to treatment, i n the i n t e r v a l s between each treatment, and during the three week follow-up period. Both global and s p e c i f i c a t t i t u d e s were assessed. Rotter's Sex Attitudes Scale (see Appendix V) contains one hundred items concerning a v a r i e t y of sexual issues such as sex r o l e s , sex education, marital r e l a -t ionships, etc. Scoring on any one item ranges from p o s i t i v e three, " t o t a l l y agree",to negative three, " t o t a l l y disagree". This measure was administered at the i n i t i a l interview, the f i f t h treatment session and at the three week follow-up. The Sexual Semantic D i f f e r e n t i a l assessed attitudes toward s p e c i f i c sexual behaviors. Nine of the bi p o l a r scales u t i l i z e d (see Appendix VI) came from Marks and Sartorious (1968). These adjectives were categorized by these authors into three dimensions, general evaluation, sexual evalu-ation and anxiety. Four adjectives representing Osgood's a c t i v i t y and potency dimensions were added to the l i s t . The seven concepts rated included both s p e c i f i c sexual a c t i v i t i e s and basic sexual descriptors (see Appendix VI). Each concept was rated on the same t h i r t e e n adjectives us-ing a 7-point b i p o l a r scale. A score on any one concept could range from p o s i t i v e 26 39 to negative 39. The semantic d i f f e r e n t i a l was administered at the i n i t i a l interview, each of the f i v e treatment sessions and at the three week follow-up. Subjects received e i t h e r a tape cassette of Lazarus' progressive r e l a x a t i o n tapes or a shortened typed version reproduced on ten f i v e by eight inch white index cards. F o r t y - f i v e four minute vignettes depicting sexual behavior ranging from mere phys i c a l proximity to intercourse and orgasm were shown on t e l e v i s i o n monitors using a one and one-half inch video-tape recorder (see Appendix XVII). Subjects viewed these tapes on a 14 by 20 inch screen approximately three feet away. Procedure Upon acceptance to the program, an interview with both sexual partners was arranged. At t h i s time the partner's opinions concerning the s i t u a t i o n and h i s supportive p o t e n t i a l were c l i n i c a l l y assessed. The general nature of the problem and the r o l e of anxiety and conditioning i n the development of the sexual dysfunction were described. Treatment pro-cedures and regulations were outlined f o r both partners. The male was instructed to r e f r a i n from i n i t i a t i n g sexual a c t i v i t y f o r the duration of treatment (approximately two to three weeks). The r a t i o n a l e behind t h i s r e s t r i c t i o n was explained. The female c l i e n t f i l l e d out the sexual semantic d i f f e r e n t i a l and Rotter's Sex Attitude Scale. The format of the sexual behavior index was explained and each partner was given an index to be completed and returned at the f i r s t treatment session, one week l a t e r . The r a t i o n a l e f o r r e l a x a t i o n t r a i n i n g was explained to the c l i e n t and she received a tape or card form summary of Lazarus' progressive r e l a x a t i o n procedures. The c l i e n t was instructed to p r a c t i c e the exercises twice a day during sessions of approximately 15 minutes. 27 The f i v e treatment sessions for members of the group, control and i n d i v i d u a l conditions were i n i t i a l l y and o p t i m i s t i c a l l y planned f o r twice a week with a three day in t e r s e s s i o n i n t e r v a l . 5 Extraneous v a r i a b l e s beyond the experimenter's c o n t r o l , such as i l l n e s s and cancelled appoint-ments frequently rendered t h i s r i g i d schedule unattainable. At the begin-ning of each treatment session c l i e n t s completed the sexual anxiety card sort. Previous sexual behavior indices were c o l l e c t e d and i f necessary commented upon and indices f o r the i n t e r v a l before the next treatment session were d i s t r i b u t e d . P r i o r to the video-tape session, the subject, of subjects i n the group, were taken into a soundproof room, where the viewing occurred, made comfortable i n a r e c l i n i n g chair and instructed to l i s t e n to Lazarus' progressive r e l a x a t i o n tape f o r approximately 15 minutes. While the sexual scenes were on, the c l i e n t s were instructed to v i s u a l i z e both themselves and t h e i r partner engaging i n the depicted be-haviors. During i n t e r v a l s between scenes the c l i e n t was instructed to u t i l i z e any b e n e f i c i a l r e l a x a t i o n technique. If at any time the c l i e n t became anxious, she was instructed to r a i s e her hand to signal the thera-p i s t . The S.U.D.S. Scale (Wolpe, 1958) was employed to quantify f e e l i n g s of d i s t r e s s . In t h i s s i t u a t i o n , the tape was stopped and the c l i e n t was instructe d to do her re l a x a t i o n exercises f o r approximately f i v e minutes. The tape was then rerun from the beginning of the anxiety producing scene. Approximately eight, four minute vignettes were presented for 15, 30, 30, 45, 60 and 60 seconds with a 30 second inter-stimulus i n t e r v a l . This 5 In the case of one subject i n the i n d i v i d u a l condition the treatment was scheduled once a week as she only saw her husband three days a week. 28 presentation method, u t i l i z e d i n numerous desensitization. paradigms, served to expose the c l i e n t s to the aversive s t i m u l i i n graduated sequences. Viewing sessions l a s t e d approximately one hour. Once back i n the experi-menter's o f f i c e , the c l i e n t s completed the sexual semantic d i f f e r e n t i a l . A f t e r each session, c l i e n t s were instruc t e d to p r a c t i c e the actions they had seen, at home, with t h e i r partners. At the end of the f i f t h and l a s t session, Rotter's Sex At t i t u d e Scale was completed. At t h i s time, behavioral indices f o r the three weeks p r i o r to the follow-up appointment were d i s t r i b u t e d . It was stressed to a l l c l i e n t s that during the interim i t was t h e i r r e s p o n s i b i l i t y to p r a c t i c e both the r e l a x a t i o n and the sexual exercises. At the three week follow-up, with both partners present, the be-havior a l indices were c o l l e c t e d and a standard inquiry into the treatment and personal progress was made. The c l i e n t again completed the Sexual Anxiety Card Sort, the Rotter Sex Attitude Scale, the Bentler Heterosexual Behavior Hierarchy, a follow-up questionnaire and the semantic d i f f e r e n t i a l . At the i n i t i a l interview, subjects assigned to the con t r o l condi-t i o n : were t o l d that treatment was not a v a i l a b l e f o r approximately s i x weeks. At t h i s time they were asked to p a r t i c i p a t e i n pretreatment i n -ves t i g a t i o n s . None of the s i x women refused. The con t r o l group was main-tained on the same schedule as the treatment conditions. At each "inves-t i g a t o r y " session, c l i e n t s completed the Sexual Anxiety Card Sort and the semantic d i f f e r e n t i a l . Behavioral habits were monitored i n an i d e n t i c a l fashion to those i n the treatment conditions. Partners, while not present at the i n i t i a l interview, completed a l l sexual behavior i n d i c e s . Male partners i n t h i s condition were not seen u n t i l treatmert proper was .. . 29 i n s t i g a t e d , approximately s i x weeks from the females' i n i t i a l i n t e r v i e w s . The f i f t i b s e s s ion and the three week follow-up were conducted i n a manner i d e n t i c a l to that of the treatment program. 30 RESULTS The Sexual Anxiety Card Sort The data were i n i t i a l l y subjected to a two-way analysis of variance with the treatment groups and the control condition comprising the three l e v e l s of the between groups f a c t o r and the pre, f i v e process and follow-up administrations providing the within groups f a c t o r . The analysis (see Appendix VII) revealed a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 6.61, p < .01), time e f f e c t (F (6, 108) = 13.12, p_ < .0001) and treatment by time i n t e r a c t i o n (F (12, 108) = 5.77, p_ < .0001) (see Figure 1). Sub-sequent to t h i s i n i t i a l a n a lysis, a seri e s of planned orthogonal contrasts were performed. The two orthogonal comparisons evaluated the e f f e c t s of the two forms of treatment as contrasted with the control group. These comparisons demonstrated that scores f or i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from co n t r o l c l i e n t s (F (1, 7) = 12.85, p_ < .01). No s i g n i f i c a n t d i f f e r e n c e was found for the i n d i v i d u a l versus group comparison. C i c c h e t i ' s (1972) modified version of the Cornfeld Tukey M u l t i p l e Range comparison technique was u t i l i z e d to examine simple e f f e c t s (a = .05)^ Within the i n d i v i d u a l treatment condition, the follow-up measure d i f f e r e d s i g ^ n i f i c a n t l y from the pre test measure as well as from treatment measures one, two and three (see Appendix VII for c r i t i c a l values). Examination of a l l s i g n i f i c a n t differences as obtained by the Tukey post hoc analysis suggests that p o s i t i v e treatment e f f e c t s manifested themselves a f t e r the t h i r d treatment session. 6 This s t a t i s t i c a l technique bases the q s t a t i s t i c upon the number of unconfounded comparisons only. 31 5d 45 t A® UJ X 2 35 < Q £ 30 O a 251 S 2 C* LU > UJ 15 i d O - o CONTROL © © INDIVIDUAL © ,_@ GROUP "O o-1 PRE 3 4 T R E A T M E N T A D M I N I S T R A T I O N S 6 T FOLLOW UP Figure 1. Mean scores over a d m i n i s t r a t i o n s f o r Sexual Anxiety Card Sort. 32 Within the group condition, the follow-up measure d i f f e r e d s i g -n i f i c a n t l y from the pretest measure as well as from treatment measures one, two and three. Again r e s u l t s of s i g n i f i c a n t differences indicate that p o s i t i v e treatment e f f e c t s manifested themselves a f t e r the t h i r d treatment session. The post hoc analysis of the control condition yielded no s i g n i f i -cant differences. Each administration period was also subjected to a post hoc com-parison (see Appendix VII f o r c r i t i c a l values). Although a s i g n i f i c a n t difference between a l l three groups was noted on the pretreatment measure, t h i s difference disappeared with respect to the i n d i v i d u a l versus group comparison while doubling i n magnitude with respect to the differences between both treatment conditions and the c o n t r o l . As the premeasures were s i g n i f i c a n t l y d i f f e r e n t , the data were subjected to an analysis of covariance with the premeasures as the covariate. The r e s u l t s indicated a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 4.405, p < .05), time e f f e c t (F (5, 85) = 12.81, £ < .0001) and treatment by time i n t e r a c t i o n (F (10, 85) = 6.33, £ < .0001) suggesting that the i n i t i a l r e s u l t s were due to the treatment by time i n t e r a c t i o n and not due to the i n i t i a l premeasure differences. The Bentler Heterosexual Behavior Hierarchy The data were i n i t i a l l y subjected to a two-way analysis of variance with the treatment groups and control condition comprising the between groups fa c t o r and the pre and follow-up administrations providing the within groups factor (see Figure 2). The analysis (see Appendix VIII) revealed a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 4.30, £ < .05), time e f f e c t (F (1, 18) = 15.97, £ < .001) and treatment by time i n t e r a c t i o n 33 PRE FOLLOW UP A D M I N I ST RAT IONS Figure 2. Mean scores over administrations for the Bentler Hetero-sexual Behavior Hierarchy. 34 (F (2, 18) = 6.75, 2. < »01). Subsequent to t h i s i n i t i a l a n a lysis, a series of planned orthogonal comparisons evaluated the e f f e c t s of the two forms of treatment as contrasted with the c o n t r o l group. These comparisons demon-strated that scores for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F (1, 7) = 8.05, p_< .01). No s i g n i f i c a n t difference was found f o r the i n d i v i d u a l versus group comparison. The Tukey post hoc analysis was u t i l i z e d to examine simple e f f e c t s . Within the i n d i v i d u a l treatment condition, the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the pretreatment measure (see Appendix VIII for c r i t i c a l values). Within the group condition, the follow-up measure again d i f f e r e d s i g n i f i c a n t l y from the pretreatment measure. The control condition showed no s i g n i f i c a n t change. The r e s u l t s of the post hoc analysis on time of administration indicated no s i g n i f i c a n t pretreatment differences. The follow-up analysis revealed a s i g n i f i c a n t difference between both t r e a t -ment conditions with respect to the c o n t r o l . The Sexual Semantic D i f f e r e n t i a l Data from the semantic d i f f e r e n t i a l were analyzed both by factor and by concept. To investigate factor data, scores f o r each adjective were collapsed across concepts. A d j e c t i v a l scores were then totaled under t h e i r respective dimensions. Data from the nine adjectives representing Marks and Sartorius' (see Appendix VI) general evaluation, sexual evalua-t i o n and anxiety factors were i n i t i a l l y subjected to three separate analyses of variance with the treatment groups and control condition comprising the between groups fa c t o r and the pre, f i v e process and follow-up adminis-t r a t i o n s providing the within group fa c t o r . The analysis (see Appendix IX) f o r the anxiety dimension (see Figure 35 Figure 3. Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f -f e r e n t i a l Anxiety Dimension. 36 revealed a s i g n i f i c a n t time e f f e c t (F (6, 18) = 7.03, _p_ < .0001) and treatment by time i n t e r a c t i o n (F (12, 108) = 2.45, p_ < .01), Subsequent to t h i s a n a l y s i s , two planned orthogonal contrasts were performed. The r e s u l t s indicated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i -cantly d i f f e r e n t from control c l i e n t s (F (1, 7) = 6,6, p_ < .01). No s i g n i f i c a n t difference was revealed f or the i n d i v i d u a l versus group compari-son. The post hoc a n a l y s i s , u t i l i z i n g the Tukey Mul t i p l e Range technique (see Appendix IX for c r i t i c a l values) indicated that within the i n d i v i d u a l treatment condition the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the pretreatment measure as well as from treatment measures one and two. Examination of a l l s i g n i f i c a n t differences suggest that p o s i t i v e treatment e f f e c t s manifested themselves a f t e r the t h i r d treatment session. The control condition yielded no s i g n i f i c a n t d ifferences. Each administration period was also subjected to a post hoc a n a l y s i s . No s i g n i f i c a n t differences were obtained f o r pretreatment through session three. Sessions four, f i v e and the follow-up yielded s i g n i f i c a n t differences between group and c o n t r o l and between i n d i v i d u a l and control conditions. No s i g n i f i c a n t differences were obtained from the comparison of group treatment to i n d i v i d u a l treatment. The r e s u l t s of the analysis on the anxiety dimension indicated that c l i e n t s i n the two treatment conditions maintained a s t e a d i l y diminishing rate of anxiety as measured by the semantic d i f f e r e n t i a l . Although not achieving s i g n i f i c a n c e on the post hoc analysis, there was an observed tendency for those receiving group treatment to respond more p o s i t i v e l y from treatment session three on. The no treatment c o n t r o l , while showing an i n i t i a l increase through treatment session three, returned r a p i d l y to the baseline measure. 37 The analysis (see Appendix X) f o r the evaluative dimension (see Figure 4) revealed a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 5.96, p_ < .01), time e f f e c t (F (6, 108) = 2.95, £ < .05) and treatment by time i n t e r a c t i o n (F (12, 108) = 2.08, £ < .05). Subsequent to t h i s i n i t i a l analysis a s e r i e s of planned orthogonal comparisons was performed. These comparisons demonstrated that values f o r i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F (1, 7) = 11.48, £ < .01). No s i g n i f i -cant difference was revealed for the i n d i v i d u a l versus group comparison. The Tukey Multiple Range technique was again u t i l i z e d to examine simple e f f e c t s (see Appendix X for c r i t i c a l values). Within the i n d i v i d u a l treatment condition, the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the baseline measure as well as from treatment measure one. Examination of the s i g n i f i c a n t differences suggests that p o s i t i v e treatment e f f e c t s mani-fested themselves during the three week follow-up period. Within the group treatment condition the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the f i r s t treatment session. The r e s u l t s from the control condition yielded no s i g n i f i c a n t differences. Each administration period was also subjected to a post hoc a n a l y s i s . Although a s i g n i f i c a n t difference was noted between group and control conditions on the premeasures, follow-up measures indicated a doubling of the magnitude of t h i s difference i n conjunction with a s i g n i f i c a n t difference between i n d i v i d u a l and c o n t r o l conditions. As the premeasure d i f f e r e d s i g n i f i c a n t l y , the data were subjected to an analysis of covariance with the premeasures serving as the covariate. Results of the analysis of co-variance indicated a s i g n i f i c a n t time e f f e c t (F (5, 85) = 5.87, £ < .0001) and treatment by time i n t e r a c t i o n (F (10, 85) = 3.47, £ < .0001). The 38 45 40 35 30 ID 25 CE o o CO 20 _J < H EN 15 cc LU LL Lu 10 5 5 2 < LU 0 CO z < -5 LU 2 -10: 0 o CONTROL « © INDIVIDUAL © © GROUP •o— V 3 A T R E A T M E N T ADMINISTRATIONS 1 PRE _g r FOLLOW UP Figure 4. Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f f e r e n t i a l E v a l u a t i o n Dimension. 39 r e s u l t s of the analysis of covariance on the evaluative dimension indicated that although there were s i g n i f i c a n t differences between the group and con t r o l conditions on the premeasure, these differences did not a l t e r the reported s i g n i f i c a n c e of the main e f f e c t or i n t e r a c t i o n . C l i e n t s i n the two treatment conditions maintained steady increases i n p o s i t i v e evaluation throughout treatment and follow-up. Although not reaching s t a t i s t i c a l s i g n i f i c a n c e a consistent tendency for group treatment scores to be more p o s i t i v e than i n d i v i d u a l treatment scores was observed throughout the treatment and follow-up. While the post hoc analysis of the control group yielded no s i g n i f i c a n t differences a steady decline towards more negative evaluation was observed a f t e r treatment session three. The analysis (see Appendix XI) f o r the sexual dimension (see Figure 5) revealed a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 5.51, £ < .05), time e f f e c t (F (6, 108) = 8.11, £ < .0001) and treatment by time i n t e r -a c t i o n (F (12, 108) = 4.10, £ < .0001). Results of the preplanned orthogonal comparisons indicated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F (1, 7) = 11.48, £ < .01). No s i g n i f i c a n t difference was revealed for the i n d i v i d u a l versus group comparison. Results of the Tukey post hoc analysis (see Appendix XI f o r c r i t i c a l values) for the i n d i v i d u a l condition found that the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the premeasure as well as from treatment mea-sures one through three. Examination of the s i g n i f i c a n t differences suggests that p o s i t i v e treatment e f f e c t s manifested themselves a f t e r the second t r e a t -ment session. Within the group treatment condition, the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the premeasure as well as from treatment 40 3a LU gas o O O CONTROL @ © INDIVIDUAL © -© GROUP T R E A T M E N T A D M I N I S T R A T I O N S Figure 5, Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f -f e r e n t i a l Sexual Dimension. 41 measures one and two. Examination of the s i g n i f i c a n t differences suggests that p o s i t i v e treatment e f f e c t s were evidenced a f t e r the t h i r d treatment session. Results from the control condition yielded no s i g n i f i c a n t d i f -ferences. Each administration period was also subjected to a post hoc ana l y s i s . Although a s i g n i f i c a n t difference was noted between group and control conditions on the premeasure, follow-up measures indicated a t r i p l i n g of the magnitude of t h i s d i f f e r e n c e i n tandem with the appearance of a s i g -n i f i c a n t difference between i n d i v i d u a l and control conditions. As a s i g n i f i c a n t difference was indicated on the premeasures the data were sub-jected to an analysis of covariance with the premeasures serving as the covariate. Results of t h i s analysis yielded a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 10.8, p < .0001), time e f f e c t (F (5, 85) = 16.02, £ < .0001) and treatment by time i n t e r a c t i o n (F (10, 85) = 12.76, p_ < .0001). The re s u l t s of the analysis of covariance on the sexual dimension indicated that although there were s i g n i f i c a n t differences between the group and cont r o l conditions on the premeasure, these differences did not a l t e r the reported s i g n i f i c a n c e of the main e f f e c t s or the i n t e r a c t i o n . C l i e n t s i n the two treatment conditions maintained steady increases i n p o s i t i v e sexual evaluation throughout treatment and during the three week follow-up. The control c l i e n t s , w h i l e i n i t i a l l y evidencing some minor p o s i t i v e change, r a p i d l y returned to below the premeasure baseline a f t e r session three. In addition to Marks and Sartorius's three dimensions c i t e d above, Osgood's a c t i v i t y and potency dimensions were also included i n the semantic d i f f e r e n t i a l administered. The analysis (see Appendix XII) for the a c t i v i t y dimension (see Figure 6) revealed a s i g n i f i c a n t treatment e f f e c t (_F (2, 18) = 42 O o -CONTROL © © INDIVIDUAL © ©GROUP __j 2 g £ § 6 7 PRE T R E A T M E N T FOLLOW UP ADMINISTRATIONS Figure 6. Mean scores over a d m i n i s t r a t i o n s f o r The Semantic D i f f e r e n t i a l A c t i v i t y Dimension. 43 4.57, p_ <• .05), time e f f e c t (F (6, 108) = 5.21, p_ < .0001) and treatment by time i n t e r a c t i o n (F (10, 85) = 4.06, £ < .0001). Results of the pre-planned orthogonal comparisons indicated that values f o r i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from those assigned to the control condition (F (1, 17) = 8.69, £ <'.01). The r e s u l t s of the Tukey post hoc analysis (see Appendix XII,. f o r c r i t i c a l values) indicated that within the i n d i v i d u a l treatment condition the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the pretreatment as well as from treatment measure one. Examination of a l l s i g n i f i c a n t differences suggests that treatment e f f e c t s became evident a f t e r the second treatment session. Within the group treatment condition the follow-up measure was s i g n i f i c a n t l y d i f f e r e n t from treatment measure two. The control condition yielded no s i g n i f i c a n t d i f -ferences. The r e s u l t s of the post hoc analysis by administration period indicated a s i g n i f i c a n t premeasure difference between i n d i v i d u a l and group and between group and control conditions. S i g n i f i c a n t differences were observed between i n d i v i d u a l and control and between group and control conditions from treatment session three through the three week follow-up. As there were s i g n i f i c a n t premeasure differences, the data were subjected to an analysis of covariance with the premeasure serving as the covariate. The r e s u l t s of t h i s analysis revealed a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 8.24, £ < .001), time e f f e c t (F (5, 85) = 4,5, £ < .05) and treatment by time i n t e r a c t i o n (F (10, 85) = 3.95, £ < .05). The r e s u l t s of the analysis of covariance on the a c t i v i t y dimension indicated that although there were s i g n i f i c a n t d i f f e r e n c e s between a l l three conditions on the pre^ measure, these differences did not a l t e r the reported s i g n i f i c a n c e of the 44 main e f f e c t s or the i n t e r a c t i o n . Although there were i n i t i a l pretreatment differences both treatment conditions appeared to manifest the same degree of p o s i t i v e change as i s evidenced by the follow-up measure. A gradual decline to below the premeasure baseline was evidenced by the control con-d i t i o n . The analysis (see Appendix XIII) f o r the potency dimension (see Figure 7) revealed a s i g n i f i c a n t time e f f e c t (F (6, 108) = 2.89, £ < .05) and treatment by time i n t e r a c t i o n (F (12, 108) = 3.41, £ < .001). Results of the preplanned orthogonal comparisons indicated no s i g n i f i c a n c e . Results of the post hoc analysis within the i n d i v i d u a l treatment condition i n -dicated that the follow-up measure was s i g n i f i c a n t l y d i f f e r e n t from the pre-treatment measure. Within the group treatment condition, the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the premeasure as well as from measures one, two and three. The control condition yielded no s i g n i f i c a n t differences. The r e s u l t s of the Tukey post hoc analysis by administration period indicated a s i g n i f i c a n t premeasure differ e n c e between group and control conditions. Measurements taken from the fourth treatment session through the three week follow-up indicated s i g n i f i c a n t differences between i n d i v i d u a l and control conditions and between group and control conditions. As a s i g n i f i c a n t premeasure difference was obtained, the data were subjected to an analysis of covariance with the premeasure serving as the covariate. Results of the analysis yielded a s i g n i f i c a n t time e f f e c t (F (5, 85) = 2.58, £ < .05) and treatment by time i n t e r a c t i o n (F (10, 85) = 3.73, £ < .05). The r e s u l t s of the analysis of covariance on the potency dimension indicated that although there were s i g n i f i c a n t differences between the group and control conditions on the premeasure, these differences did not a l t e r the 45 O O CONTROL • * INDIVIDUAL © © G R O U P ~1 2 5 * 5 6 7 PRE T R E A T M E N T FOLLOW UP A D M I N I S T R A T I O N S Figure 7, Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f f e r e n t i a l Potency Dimension, 46 reported s i g n i f i c a n c e of the main e f f e c t and the i n t e r a c t i o n . While the pattern of change was s i m i l a r i n both treatment conditions, change not occurring u n t i l a f t e r the t h i r d session, a tendency toward more p o s i t i v e change was observed i n the group treatment condition. An increase was noted i n the control condition u n t i l the t h i r d session a f t e r which a decline to the premeasure baseline was observed. Scores for the nine adjectives were then summated under each of the seven concepts. These cumulative scores ind i c a t e the degree of p o s i -t i v e or negative a f f e c t induced i n the c l i e n t by each s p e c i f i c concept. The data were subjected to seven separate two way analyses of variance with the treatment groups and the control condition comprising the three l e v e l s of the between groups factor and the pre, f i v e process and follow-up administrations providing the within groups f a c t o r . The analysis (see Appendix XIV) for concept one, sex, (see Figure 8) yielded a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 11.66, p_ < .0001), time e f f e c t (F (6, 108) = 10.01, £ < .001) and treatment by time i n t e r -a ction (F (12, 108) = 3.25, p_ < .001). Preplanned orthogonal comparisons designed to investigate the e f f e c t s of the two forms of treatment as con-trasted with the control group indicated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F (1, 17) = 23.23, p_ < .001). No s i g n i f i c a n t difference was found for the i n d i v i d u a l versus group comparison. Within the i n d i v i d u a l treatment condition r e s u l t s of the Tukey post hoc analysis revealed that the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the premeasure as well as from treatment measure one (see Appendix XIV for c r i t i c a l values). Further examination of the s i g n i f i c a n t differences 47 2a UJ cc o o h-z LU CC UJ LL U. 5 o i-' z < UJ z < UJ 13 14 -4 -40 O G CONTROL © INDIVIDUAL © ._© GROUP o o — t — PRE 3 4 5 T R E A T M E N T A D M I N I S T R AT ION S 6 7 FOLLOW UP Figure 8. Mean scores over a d m i n i s t r a t i o n s f o r The Semantic D i f -f e r e n t i a l ; Concept 1 Sex. 48 indicates that p o s i t i v e treatment e f f e c t s were evidenced a f t e r the second treatment session. Within the group treatment condition, the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the premeasure as well as from t r e a t -ment measure one. Treatment e f f e c t s appeared a f t e r the t h i r d session. No s i g n i f i c a n t differences were obtained from the control condition. With respect to administration periods, s i g n i f i c a n t differences between i n d i -v i d u a l and control conditions and between group and control conditions were evidenced at treatment session two and continually increased through the three week follow-up. The r e s u l t s indicated that c l i e n t s i n both treatment conditions evidenced s i m i l a r patterns of increase i n p o s i t i v e a f f e c t to the concept of sex. An i n i t i a l increase i n p o s i t i v e a f f e c t was noted i n the control group; however, t h i s declined to baseline a f t e r session three. The analysis (see Appendix XIV) for concept two, nudity, yielded (see Figure 9) a s i g n i f i c a n t treatment by time i n t e r a c t i o n (F (12, 108) = 2.03, p_ < .05). No s i g n i f i c a n t differences were obtained for the ortho-gonal contrasts. Within the i n d i v i d u a l treatment condition, r e s u l t s of the Tukey post hoc analysis revealed no s i g n i f i c a n t differences. Within the group treatment condition the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the f i r s t and second treatment measures. No s i g n i f i c a n t differences were obtained f o r the control group. The analysis f o r administration periods yielded s i g n i f i c a n t differences for group versus control condi-tions and for i n d i v i d u a l versus control conditions f o r treatment measures four through the three week follow-up. These r e s u l t s indicated that c l i e n t s i n both treatment conditions experienced p o s i t i v e increases i n t h e i r a t t i -tude towards nudity as measured by the semantic d i f f e r e n t i a l . Again the 49 O - _ © CONTROL . @ INDIVIDUAL ~1 2 3 4 5 6 7 PRE T R E A T M E N T FOLLOW UP A'D M IN I STR A T I O N S Figure 9. Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f -f e r e n t i a l : Concept 2 Nudity. 50 control group showed an i n i t i a l increase which returned to the baseline measure a f t e r session one. The analysis f o r concept three, male bodies Csee Appendix XIV), resulted i n a s i g n i f i c a n t time e f f e c t (F (6, 108) = 3.52, £ < .01). No s i g n i f i c a n t differences were obtained for the orthogonal contrasts (see Figure 10). The analysis (see Appendix XIV) for concept four, s e l f - e x p l o r a t i o n (see Figure 11), revealed a s i g n i f i c a n t treatment by time i n t e r a c t i o n (][ (12, 108) = 2.46, £ < .01). No other s i g n i f i c a n t e f f e c t s were found. Within the i n d i v i d u a l condition r e s u l t s of the post hoc analysis indicated a s i g n i f i c a n t follow-up versus treatment measure three difference. No s i g n i f i c a n t r e s u l t s were obtained f r o m the group or control conditions. Post hoc analysis of administration periods found s i g n i f i c a n t differences between group and control conditions and between i n d i v i d u a l and control conditions from session four through follow-up. Results from t h i s analysis in d i c a t e that c l i e n t s i n the group treatment condition maintained a steady increase i n p o s i t i v e a f f e c t towards a concept of s e l f - e x p l o r a t i o n while those receiving i n d i v i d u a l treatment did not maintain steady increases u n t i l a f t e r treatment session three. Again a f t e r an i n i t i a l increase the c o n t r o l group declined to below the premeasure baseline. The analysis (see Appendix XIV) for concept f i v e , v e r b a l i z i n g my sexual desires to my partner (see Figure 12) indicated s i g n i f i c a n t t r e a t -ment (F (2, 18) = 3.75, £ < .05) and time e f f e c t s (F (6, 108) = 4.28, £ < .001). The orthogonal comparisons demonstrated that values for i n d i -v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F (1, 17) = 7.39, £ < .05). No s i g n i f i c a n t difference was revealed f o r 51 ) CONTROL 9 INDIVIDUAL 0 G R O U P __ 1 g g 4- 5 6 " 7 p R E T R E A T M E N T FOLLOW UP A D M I N I S T R A T I O N S Figure 10. Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f f e r e n t i a l : Concept 3 Male Bodies 52 p R E T R E A T M E N T FOLLOW UP A D M I N I S T R A T I O N S Figure .11. Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f f e r e n t i a l : Concept 4 S e l f - E x p l o r a t i o n . 53 O O CONTROL cc 1Q O O CO < z UJ cc LU U. U. 5 o h-z < LU CO z < s 4 d ^ INDIVIDUAL <? © G R O U P / o - - - - o / 1 PRE -3 3 5-T R E A T M E N T 6 r FOLLOW UP A D M I N I S T R A T I O N S Figure 12. Means scores over a d m i n i s t r a t i o n s f o r the Semantic D i f f e r e n t i a l : Concept 5 V e r b a l i z i n g My Sexual Desires To My Partner. 54 the i n d i v i d u a l versus group comparison. Results for the Tukey post hoc analysis (see Appendix XIV f o r c r i t i c a l values) indicated a s i g n i f i c a n t premeasure and follow-up difference within the group condition. The i n d i v i d u a l and control conditions yielded no s i g n i f i c a n t differences. A post hoc analysis over time periods found sessions four through follow-up showing increasing s i g n i f i c a n t differences between i n d i v i d u a l and control conditions and between group and control conditions. The r e s u l t s i n -dicated that while both treatment groups maintained a steady, s i m i l a r pattern of increase i n p o s i t i v e a f f e c t towards the concept of v e r b a l i z a -t i o n of sexual desires, c l i e n t s i n the group treatment condition achieved a higher degree of p o s i t i v e a f f e c t as i s evidenced by the follow-up. Again an i n i t i a l increase then subsequent decline was evidenced i n the con t r o l condition. The analysis of concept six (see Appendix XIV), my r o l e i n sexual a c t i v i t y (see Figure 13) yielded a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 6.41, p_ < .01), time e f f e c t (F (6, 108) = 8.65, £ < -0001) and treatment by time i n t e r a c t i o n (F (12, 108) = 3.22, £ < .001). Results of the pre-planned orthogonal comparisons indicated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F (1, 17) = 12.31, £ < .01). No s i g n i f i c a n t d i f f e r e n c e was revealed for the i n d i v i d u a l versus group comparison. The Tukey post hoc analysis within the i n d i v i d u a l condition i n -dicated that the follow-up measure d i f f e r e d s i g n i f i c a n t l y from the pre-measure as well as from treatment one. An examination of the s i g n i f i c a n t differences indicated that the treatment e f f e c t s manifested themselves a f t e r the t h i r d session. Within the group condition the follow-up measure 55 Figure 13. Mean scores over administrations for the Semantic D i f f e r e n t i a l : Concept 6 My Role i n Sexual A c t i v i t y . 56 was s i g n i f i c a n t l y d i f f e r e n t from the pre as well as from treatment measures one and two. The con t r o l condition yielded no s i g n i f i c a n t differences. Results of the post hoc analysis by administration period indicated s i g n i f i c a n t differences between group and control conditions and between i n d i v i d u a l and control conditions commencing at session four and continuing through follow-up. These r e s u l t s indicated that both treatment conditions maintained a steady s i m i l a r pattern of increase i n a f f e c t towards the concept of t h e i r r o l e i n sexual a c t i v i t y . Again an i n i t i a l increase then subsequent decline was evidenced i n the con t r o l condition. An analysis (see Appendix XIV) of concept seven, orgasm, revealed (see Figure 14) a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 4.05, p_ < .05). No other main e f f e c t s were s i g n i f i c a n t . The orthogonal comparisons demonstrated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (F_ (1, 17) = 7.42, p_ < .05). No s i g n i f i c a n t difference was found f o r the i n d i v i d u a l versus group comparison. The Rotter Sexual Attitude Scale T h i r t y items comprising the adjusted-maladjusted subscale were included i n the analysis. The data were subjected to a two way analysis of variance (see Appendix XV) with the treatment groups and the control condition comprising the three l e v e l s of the between groups factor and the pre, f i n a l session and follow-up administrations providing the within groups factor. The analysis revealed no s i g n i f i c a n t main e f f e c t s or i n t e r a c t i o n . The orthogonal comparisons revealed no s i g n i f i c a n t contrasts. 7 Rotter's c r i t e r i a f o r i n c l u s i o n of items i n t h i s subscale were: (1) there had to be a minimum of 2,00 units between the means and (2) both means had to be on eit h e r side of the 0 (neutral point) by a distance of at least .94 un i t s . 57 _ _ 0 C O N T R O L @ INDIVIDUAL 0 GROUP T R E A T M E N T FOLLOW UP A D M I N I S T R A T I O N S Figure 14. Mean scores over a d m i n i s t r a t i o n s f o r the Semantic D i f f e r e n t i a l ; Concept 7 Orgasm. 58 Mean values for a l l groups were i n the negative range i n d i c a t i n g general sexual adjustment. Results indicated that the treatment had no s i g n i f i c a n t e f f e c t on global sexual a t t i t u d e s . The Sexual Behavior Index As the baseline and the three follow-up measures each evaluated a f u l l week, the four treatment measures were combined to form two one week assessment periods. The 17 categories of sexual experience were judged to be overlapping and were collapsed into nine i n c l u s i v e categories (see Appendices I II and IV for d e t a i l s ) f o r f a c i l i t y of i n t e r p r e t a t i o n . Reported frequencies f o r both male and female partners were obtained. An i n t e r c o r r e l a t i o n matrix of male and female reports over each administra-t i o n of the nine behavioral index categories appears i n Appendix XVI. The i n t e r -c o r r e l a t i o n matrix was transformed to Z scores and an o v e r a l l mean i n t e r -c o r r e l a t i o n of .912 was obtained. This indicates that although there was not a perfect c o r r e l a t i o n between male and female reports, the i n t e r -scorer r e l i a b i l i t y was f a i r l y high and that the separate reports of the two partners would appear to have some v a l i d i t y . Two way analyses of variance were conducted separately f o r each of the nine categories and f o r each sex. Analysis (see Appendix XVII) of category one, v i s u a l sexual exposure (see Figure 15), female, revealed a s i g n i f i c a n t time by treatment i n t e r a c t i o n (F (10, 90) = 2.68, p_ < .01). The preplanned orthogonal comparisons yielded no s i g n i f i c a n t r e s u l t s . Results of the analysis for male responses also yielded a s i g n i f i c a n t time by treatment i n t e r a c t i o n (F (10, 90) = 2.21, £ < ,01) i n d i c a t i n g One. male partner i n the control condition refused to complete the Sexual Behavior Index.. 59 2 J 0 6 i 2 3 PRE T R E A T M E N T A D M.I N I SIR AT I ON S 4 5 F O L L O W U P Figure 15. Mean scores over a d m i n i s t r a t i o n s f o r The Sexual Behavior Index: Category 1 V i s u a l Sexual Exposure. 60 that there was a general consensus between partners as to the frequency of v i s u a l sexual exposure. The Tukey post hoc analysis indicated no s i g n i f i c a n t differences over time within the i n d i v i d u a l or group conditions. Within the control condition, the premeasure baseline d i f f e r e d s i g n i f i c a n t l y from the three follow-up measures i n d i c a t i n g a decline i n v i s u a l sexual exposure. The post hoc analysis by administration periods indicated no premeasure differences. S i g n i f i c a n t differences between both treatments and the control condition were obtained during the three week follow-up. The s i g n i f i c a n t time by treatment i n t e r a c t i o n was apparently the r e s u l t of: (a) c l i e n t s i n the two treatment conditions maintaining stable rates of v i s u a l exposure to t h e i r partners, although a tendency towards those receiving group treatment engaging i n a greater degree of v i s u a l exposure was observed on the l a s t follow-up measure and (b) the no treatment control group a c t u a l l y d e c l i n i n g i n the frequency of v i s u a l exposure over the s i x weeks of behavioral monitoring. The analysis (see Appendix XVII) of category two, non-sexual sensate focus, female, revealed (see Figure 16) a s i g n i f i c a n t time by treatment i n t e r a c t i o n ( J£ (10, 90) = 2.37, £ < .01). No other e f f e c t s or orthogonal comparisons were s i g n i f i c a n t . Results of the male analysis yielded no s i g n i f i c a n t e f f e c t s whatsoever. The Tukey post hoc analysis found no s i g n i f i c a n t differences within the i n d i v i d u a l condition over time. Within the group condition, the measures obtained at the l a s t treatment session and during the f i r s t week of the follow-up showed s i g n i f i c a n t i n -creases i n the incidence of non-sexual sensate focus r e l a t i v e to the base-l i n e measure. Within the control condition the f i n a l follow-up measure d i f f e r e d s i g n i f i c a n t l y from the pretreatment baseline i n d i c a t i n g a decline i n 61 O- CONTROL INDIVIDUAL G © GROUP 4.0 3.3 o ©—. —. ao; CO UJ O 25j z UJ z> a UJ £E U, 2.0 1-9 < UJ 2 1.Q © © o Q 4 5 F O L L O W UP ^ 2 3 PRE T R E A T M E N T AD M I N I STR AT IONS Figure 16. Mean scores over a d m i n i s t r a t i o n s f o r The Sexual Behavior Index: Category 2 Nonsexual Sensate Focus. 62 the incidence of non-sexual sensate focus. The post hoc analysis of admi-n i s t r a t i o n periods indicated a s i g n i f i c a n t difference between group and control conditions during the f i r s t week of follow-up. The s i g n i f i c a n t time by treatment i n t e r a c t i o n was apparently the r e s u l t of those c l i e n t s re-ce i v i n g group treatment engaging i n s i g n i f i c a n t l y more nonsexual sensate focus, r e l a t i v e to the baseline measure, while the c l i e n t s i n the no-treatment control a c t u a l l y experienced a s i g n i f i c a n t decrease i n the monitored behavior. C l i e n t s i n the i n d i v i d u a l treatment condition main-tained a f a i r l y steady rate of non-sexual sensate focus r e l a t i v e to the baseline measure. Analysis (see Appendix XVII) of category three, sexual sensate focus, female, yielded (see Figure 17) a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 6.8, p_ < .01) and treatment by time i n t e r a c t i o n (F (10, 90) = 2.24, p_ < : . 0 5 ) . Results of the two orthogonal comparisons demonstrated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s ( F ( l , 7) = 12.33, p_ < .01). No difference was found be-tween group and i n d i v i d u a l c l i e n t s . Results from the male analysis i n -dicated a s i g n i f i c a n t treatment e f f e c t (F(2, 17) = 5.06, p_ < .05). Results of the orthogonal comparisons indicated that i n d i v i d u a l and group scores were s i g n i f i c a n t l y d i f f e r e n t from those of the controls (F (1, 7) = 9.94, _p_ < .01). The post hoc a n a l y s i s , female, revealed no s i g n i f i c a n t d i f f e r -ences over time within the i n d i v i d u a l or control condition. While c l i e n t s i n the no-treatment co n t r o l maintained a steady incidence of sexual sensate focus over the s i x week period, c l i e n t s receiving i n d i v i d u a l treatment, while appearing to be increasing t h e i r frequency over treatment, reported decreased incidences of sexual sensate focus during the l a s t two weeks of 63 CONTROL IN DI V I DUAL ~ 1 2 3 4 5 5 P R E T R E A T M E N T F O L L O W U P , A D M IN I S T R A T I O N S Figure 17. Mean scores over a d m i n i s t r a t i o n s f o r the Sexual Behavior Index: Category 3 Sexual Sensate Focus. 64 follow-up. Within the group treatment condition the measures obtained during the second week of the follow-up showed a s i g n i f i c a n t increase i n the frequency of sexual sensate focus .relat i v e to the baseline measure. The post hoc analysis by time periods indicated s i g n i f i c a n t differences between both treatment groups r e l a t i v e to the no-treatment control during a l l three weeks of follow-up. The s i g n i f i c a n t time by treatment i n t e r a c -t i o n was apparently the r e s u l t of the increased frequency of those c l i e n t s receiving group and-individual treatment engaging i n s i g n i f i c a n t l y more sexual sensate focus as compared to the r e l a t i v e l y stable lower incidence as reported by the no-treatment controls. Analysis (see Appendix XVII) of category four, cumulative duration of foreplay, ten minutes, female, revealed (see Figure 18) a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 6.1, £ < .001). Results of the orthogonal comparisons indicated that values for i n d i v i d u a l and group c l i e n t s were s i g n i f i c a n t l y d i f f e r e n t from control c l i e n t s (_F (1, 7) = 10.91, £ < .01). Results of the male analysis also indicated a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 4.32, £ < .01) and a s i g n i f i c a n t orthogonal comparison between treatment and control conditions (F (1, 7) = 8.36, £ < .01). Results of the Tukey post hoc analysis (see Appendix XVII for c r i t i c a l values) within the i n d i v i d u a l condition indicated that measures obtained from the l a s t treatment session and during the f i r s t week of the follow-up revealed a s i g n i f i c a n t increase i n the incidence of foreplay, duration ten minutes. This increased frequency declined during the l a s t two weeks of the follow-up. Within the group treatment condition s i g n i f i c a n t decreases i n the incidence of foreplay r e l a t i v e to the baseline were reported during the t h i r d week of the follow-up. No s i g n i f i c a n t differences were found within 65 2.5, 0 0 C O N T R O L INDIVIDUAL © 0 G R O U P to UJ _ 2.0 O z UJ 3 O UJ DC LL z < UJ 5 14 0 _ - — o :o O— o 4 5 F O L L O W U P A D M I N I S T R A T I O N S —~r~ PRE _2_ 3 T R E A T M E N T Figure 18. Mean scores over a d m i n i s t r a t i o n s f o r the Sexual Behavior Index: Category 4 Foreplay 10 Minutes. 66 the control condition. Post hoc analyses by administration periods i n -dicated a s i g n i f i c a n t premeasure difference between group and control conditions. As minimal differences were evidenced between a l l three condi-tions during the three week follow-up an analysis of covariance was not done. Analysis (see Appendix XVII) of category f i v e , cumulative duration of foreplay, twenty minutes, female,revealed (see Figure 19) a s i g n i f i c a n t treatment e f f e c t (F (2, 18) = 6.07, £ < .01). Results of the orthogonal comparisons indicated a s i g n i f i c a n t difference between treatment and control c l i e n t s (F (1, 7) = 11.1, £ < .01). Results of the male analysis also indicated a s i g n i f i c a n t treatment e f f e c t (F (2, 17) = 5.93, £ < ,05). A s i g n i f i c a n t difference was also found between treatment and control c l i e n t s on the orthogonal comparisons (F (1, 7) = 8.61, £ < .01). The post hoc analyses indicated no s i g n i f i c a n t differences within any of the experimental conditions over time. Post hoc analyses by time periods indicated s i g n i f i -cant differences between i n d i v i d u a l and control conditions on the l a s t treatment measure and between group and control conditions during the second week of the follow-up. As reported frequencies i n both treatment conditions were highly e r r a t i c during the s i x weeks of monitoring, few conclusions may be drawn from these r e s u l t s . The analysis of category s i x (see Appendix XVII), cumulative dura-t i o n of foreplay 30 minutes, females and males, revealed no s i g n i f i c a n t main e f f e c t s or i n t e r a c t i o n s (see Figure 20). The o v e r a l l analysis of variance (see Appendix XVII) of category seven, intercourse, female, revealed (see Figure 21) no s i g n i f i c a n t main e f f e c t s or i n t e r a c t i o n . The orthogonal comparison indicated a s i g n i f i c a n t difference between treatment and control conditions (F(1, 7) = 4.97, £ < .05). 67 1 1~ 3 4~~ 5 6 P R E T R E A T M E N T F O L L O W U P A D M ! N I S T R A T I O N S Figure 19. Mean scores over a d m i n i s t r a t i o n s f o r The Sexual Be-havi o r Index: Category 5 Foreplay 20 Minutes. 68 1 2 3 P R E T R E A T M E N T 4 5 F O L L O W UP A D M l N I S T R A T I O N S Figure 20. Mean scores over a d m i n i s t r a t i o n s f o r The Sexual Behavior Index: Category 6 Foreplay 30 minutes. 69 O- - - p C O N T R O L * 0 IND IV IDUAL © — © G R O U P 3.0 2.3 UJ -2.0 O UJ 3 o tg UJ DC LL i d z UJ 5 -5 ©-' o-o ' — • © . _ . © .o o T 3 4 5 g P R E T R E A T M E N T F O L L O W UP A D M I N I S T R A T I O N S Figure 21. Mean scores over a d m i n i s t r a t i o n s f o r the Sexual Behavior Behavior Index: Category 7 Intercourse 70 Results of the male responses I n d i c a t e d a s i g n i f i c a n t treatment e f f e c t CF(2, 17) = 4.28, £ < .05) and treatment versus c o n t r o l orthogonal compari-son (F(l,7)=6.07, p_ < .01). No d i f f e r e n c e was found between i n d i v i d u a l and group treatment i n e i t h e r a n a l y s i s . Post hoc analyses by time periods i n d i c a t e d no s i g n i f i c a n t premeasure d i f f e r e n c e s . S i g n i f i c a n t d i f f e r e n c e s between both treatment groups r e l a t i v e to the no-treatment c o n t r o l group were reported during a l l three weeks of follow-up. These r e s u l t s were apparently due to the increased frequency of i n t e r c o u r s e as reported by those c l i e n t s i n the two treatment c o n d i t i o n s as compared to the r e l a -t i v e l y s t a b l e lower incidence reported by the no-treatment c o n t r o l s . As i n t e r c o u r s e was not recommended by the f i l m s u n t i l the l a s t treatment ses-s i o n , another a n a l y s i s u t i l i z i n g the data from the pre and three follow-up measures was done. The r e s u l t s of t h i s a n a l y s i s revealed a s i g n i f i c a n t treatment e f f e c t (F(2, 18) = 4.46, £ < .05) and treatment by time i n t e r -a c t i o n (F(6, 54) = 5.15, £ < .001). R e s u l t s of the Tukey post hoc a n a l y s i s w i t h i n the i n d i v i d u a l c o n d i t i o n i n d i c a t e d s i g n i f i c a n t increases i n the frequency of i n t e r c o u r s e r e l a t i v e to b a s e l i n e i n the f i r s t two weeks of the follow-up. W i t h i n the group treatment c o n d i t i o n , a l l measures taken during the three week follow-up i n d i c a t e d s i g n i f i c a n t increases i n f r e -quency r e l a t i v e to b a s e l i n e . W i t h i n the c o n t r o l c o n d i t i o n , s i g n i f i c a n t decreases i n the frequency of i n t e r c o u r s e were noted on a l l three f o l l o w -up measures. The s i g n i f i c a n t time by treatment i n t e r a c t i o n was apparently the r e s u l t of the increased frequency of i n t e r c o u r s e of those c l i e n t s r e c e i v i n g group and i n d i v i d u a l treatment as compared to the d e c l i n i n g incidence as reported by the no-treatment c o n t r o l s . The a n a l y s i s (see Appendix XVII) of category e i g h t , orgasm, female, y i e l d e d (see Figure 22) no s i g n i f i c a n t main e f f e c t s or i n t e r a c t i o n . The 71 1 . 2 3 P R E T R E A T M E N T 4 5 F O L L O W U P A D M I N I S T R A T I O N S Figure 22. Mean scores over a d m i n i s t r a t i o n s f o r the Sexual Behavior Index: Category 8 Orgasm. 72 r e s u l t s of the orthogonal comparisons were also nonsignificant. The analysis of the male responses also revealed no s i g n i f i c a n t e f f e c t s . Again, as intercourse was not recommended by the f i l m s u n t i l the l a s t treatment session, a subsequent analysis u t i l i z i n g the data from the pre and three follow-up measures was done. No s i g n i f i c a n t r e s u l t s were obtained. The analysis (see Appendix XVII) of category nine, number of female i n i t i a t e d sexual behaviors, female, revealed (see Figure 23) a s i g n i f i c a n t time e f f e c t (F(5, 90) = 2.38, p_ < .05) and time by treatment i n t e r a c t i o n (F(10, 90)= 1.93, p_ < .05). Results of the orthogonal comparisons yielded no s i g n i f i c a n t d i f f e r e n c e s . Results of the male analysis found a s i g n i -f i c a n t treatment e f f e c t (F(5, 90) = 3.01, £ < .05) and time e f f e c t (F(5, 90)= 3.01, £ < .05). A s i g n i f i c a n t difference between treatment and control conditions was also obtained ( F ( l , 7) = 7.19, £ < .05). Results of the Tukey post hoc analysis found no s i g n i f i c a n t differences within the i n d i v i -dual condition over time. Within the group treatment condition, measures taken during the f i r s t week of the three week follow-up indicated s i g n i f i -cant increases i n the number of female i n i t i a t e d sexual behaviors r e l a t i v e to the baseline measure. No differences were found i n the control condi-t i o n . The post hoc analysis by administration period found no s i g n i f i c a n t premeasure differences. S i g n i f i c a n t differences between both treatment conditions r e l a t i v e to the no-treatment control were evidenced over the three week follow-up. The s i g n i f i c a n t time by treatment i n t e r a c t i o n was apparently the r e s u l t of: (a) c l i e n t s i n the two treatment conditions reporting increases i n the number of female i n i t i a t e d sexual behaviors, although a tendency towards those receiving group treatment i n i t i a t i n g more contact was observed during the l a s t two weeks of the follow-up and 73 T 2 3 ~ 4 5 W PRE T R E A T M E N T F O L L O W UP A O M I N I S T R A T I O N S Figure 23. Mean scores over a d m i n i s t r a t i o n s f o r the Sexual Behavior Index: Category 9 Number of Female I n i t i a t e d Sexual Behaviors. (b) the no-treatment c o n t r o l c o n d i t i o n a c t u a l l y d e c l i n i n g i n the f r e -quency of i n i t i a t i n g sexual behaviors over the s i x weeks of monitoring. 75 DISCUSSION The Sexual Anxiety Card Sort Results from the sexual anxiety card sort were consistent with experimental expectations, with both treatment groups showing a s i g n i f i c a n t decrease i n reported anxiety over treatment and through the three week follow-up period. Although, not achieving s i g n i f i c a n c e , a trend towards increased anxiety was evidenced i n the control group. As control subjects were asked to monitor t h e i r sexual a c t i v i t i e s (via the sexual behavior index) f or a period of s i x weeks i t may be possible to a t t r i b u t e the i n -crement i n reported anxiety to a demand-induced increased awareness of personal sexual habits. While i n i t i a l premeasure differences were found, the subsequent analysis of covariance indicated no a l t e r a t i o n s i n the i n i t i a l findings. These differences cannot be a t t r i b u t e d to experimental expectations on the part of the c l i e n t s as assignment to treatment and cont r o l conditions were revealed at the end of the interview and t e s t i n g session. Again as subjects were randomly assigned to treatment conditions and successively assigned to the control condition, t h i s difference must be accepted as a f a m i l i a r r i s k i n the u t i l i z a t i o n of small subject samples. While the group treatment condition did not succeed i n reducing anxiety to a s i g n i f i c a n t l y greater extent than the i n d i v i d u a l treatment, a trend towards those c l i e n t s i n the group treatment condition reporting l e s s anxiety was observed at the three week follow-up session. The Bentler Heterosexual Behavior Hierarchy As hypothesized, s i g n i f i c a n t decreases i n sexual anxiety as measured by the Bentler Heterosexual Behavior Hierarchy were evidenced i n both treatment conditions. Again, although not achieving s t a t i s t i c a l 76 s i g n i f i c a n c e , there was a tendency towards an increase i n reported anxiety i n the control condition. Examination of the post hoc analysis indicated that while s i g n i f i c a n t decreases i n reported anxiety were obtained i n both treatment conditions, reductions were s l i g h t l y greater for those receiving i n d i v i d u a l treatment. Reductions i n reported anxiety as mea-sured by the Bentler were only s l i g h t l y l e s s than those obtained from the sexual anxiety card sort. As the Bentler describes more novel sexual a c t i v i t i e s than the sexual anxiety card s o r t , i t i s possible to interpret t h i s f i n d i n g as lending credence to the generalization e f f e c t s of the treatment. The Sexual Semantic D i f f e r e n t i a l S i g n i f i c a n t p o s i t i v e changes were evidenced i n both treatment groups with respect to Marks and Sartorius' evaluative, sexual and anxiety dimensions. As t h i s scale was o r i g i n a l l y devised by Marks and Sartorius to be used as a measure of sexual a t t i t u d e i n unconventional sexual ac-t i v i t i e s , these findings comment on i t s f l e x i b i l i t y and usefulness as a se n s i t i v e i n d i c a t o r of c l i n i c a l change during treatment. Results of the post hoc analysis indicated that p o s i t i v e treatment e f f e c t s were evidenced i n both the anxiety and sexual dimensions a f t e r the fourth treatment ses-sion. Changes with respect to a more p o s i t i v e general evaluation were not observed u n t i l the three week follow-up. The time sequence of these changes suggests that the anxiety and sexual dimensions are more basic to the composition of a sexual a t t i t u d e whereas perhaps the general evaluation i s a more peripheral component. Again, p a r t i a l l y consistent with experimental expectations, the r e s u l t s of the orthogonal comparisons indicated that both treatment condi-77 t i o n s were s i g n i f i c a n t l y d i f f e r e n t from the c o n t r o l c o n d i t i o n . Although not a c h i e v i n g s t a t i s t i c a l s i g n i f i c a n c e , tendencies f o r those r e c e i v i n g group treatment to report more p o s i t i v e change were evidenced at the three week follow-up i n both the a n x i e t y and e v a l u a t i v e analyses. Examination of the post hoc a n a l y s i s f o r Osgood's a c t i v i t y d i -mension i n d i c a t e d that p o s i t i v e treatment e f f e c t s manifested themselves at the t h i r d treatment s e s s i o n , e a r l i e r than f o r any of the other four dimensions. These r e s u l t s suggest a p o s s i b l e l i n k between enactment of sexual behavior as p r e s c r i b e d by the treatment and the r a p i d increase i n p o s i t i v e a c t i v i t y o r i e n t e d sexual a t t i t u d e s . The potency dimension a l s o appears to be a v i a b l e component i n the formation of a sexual a t t i t u d e as the r e s u l t s i n d i c a t e d that both treatment c o n d i t i o n s evidenced s i g n i f i c a n t p o s i t i v e changes. These r e s u l t s are d i f f i c u l t to i n t e r p r e t as most c l i e n t s reported u n c e r t a i n t y w i t h respect to the a d j e c t i v a l components of t h i s dimension. In the i n i t i a l t h e o r e t i c a l f o r m u l a t i o n i t was hypothesized that p o s i t i v e increases on the semantic d i f f e r e n t i a l would be more marked f o r those concepts that most c l o s e l y represented b e h a v i o r a l treatment r e q u i r e -ments. The f i n d i n g s of the analyses of variance were p a r t i a l l y c o n s i s t e n t w i t h t h i s e x p e c t a t i o n i n that s i g n i f i c a n t treatment by time i n t e r a c t i o n s were evidenced f o r the concepts of "sex", " n u d i t y " , and "my r o l e i n sexual a c t i v i t y " . Orthogonal c o n t r a s t s demonstrating e f f e c t i v e treatment were found f o r the concepts of "sex", " v e r b a l i z i n g my sexual d e s i r e s to my p a r t n e r " , "my r o l e i n sexual a c t i v i t y " and "orgasm". The two strongest e f f e c t s occurred i n the i n d i v i d u a l c o n d i t i o n i n concepts of "sex" and "my r o l e i n sexual a c t i v i t y " . The two l a r g e s t improvements f o r the group 78 treatment also occurred i n these two concepts, perhaps suggesting the existence of fundamental components of sexual at t i t u d e s . Occurrence of s i g n i f i c a n t differences between the three experimental conditions appeared on the average a f t e r the t h i r d treatment session, with changes on the two above mentioned concepts occurring a f t e r the second session. These r e s u l t s have implications f or time l i m i t e d treatments i n that i t appears that con-s o l i d a t i o n of treatment e f f e c t s within the a t t i t u d i n a l realm occur f a i r l y e a r ly i n the program. The Rotter Sex Attitude Scale In accordance with experimental expectations, no s i g n i f i c a n t changes were evidenced over the three administrations of t h i s scale. It i s i n t e r e s t i n g to note that none of the c l i e n t s scored within the malad-justed range of the scale, suggesting that personal sexual dysfunction may be e n t i r e l y separate from global sexual a t t i t u d e s . The Sexual Behavior. Index Findings from t h i s area are confounded with numerous external va r i a b l e s (see Implications f o r Future Research f o r a further elucidation) and therefore are not as well delineated and clear-cut as had been expected. While the u t i l i z a t i o n of separate analyses for male and female responses revealed some i n t e r e s t i n g differences (to be discussed l a t e r ) , the high i n t e r c o r r e l a t i o n mean obtained indicated that reported frequencies on the sexual behavior index were r e l i a b l e and e s s e n t i a l l y v a l i d . In accordance with experimental expectations, categories measuring the incidence of v i s u a l sexual exposure, non-sexual sensate focus, sexual sensate focus and the number of female i n i t i a t e d sexual behaviors a l l e v i -denced s i g n i f i c a n t time by treatment i n t e r a c t i o n s . It i s possible to 79 a t t r i b u t e the l a c k of s i g n i f i c a n c e of the treatment by time i n t e r a c t i o n s i n c ategories f o u r , f i v e and s i x , d e a l i n g w i t h v a r y i n g durations of f o r e -p l a y , to t h e i r conceptual overlap w i t h the c a t e g o r i e s measuring the i n -cidence of sexual and non-sexual sensate focus. I t i s a l s o p o s s i b l e that the time graduations were not meaningful v a r i a b l e s to the c l i e n t s i n v o l v e d . While i t was expected that the category measuring the frequency of i n t e r c o u r s e , would be s i g n i f i c a n t l y a f f e c t e d , i t must be noted that i n t e r c o u r s e was only recommended v i s u a l l y by the f i l m s at the l a s t t r e a t -ment s e s s i o n ; t h e r e f o r e , even i f the frequency of i n t e r c o u r s e increased during the follow-up i t would be very d i f f i c u l t f o r the o v e r a l l treatment by time i n t e r a c t i o n to reach s i g n i f i c a n c e . The s i g n i f i c a n c e of the r e s u l t s obtained when the data was analyzed u t i l i z i n g only the pre and three f o l l o w -up measures lends credence to t h i s i n t e r p r e t a t i o n . As orgasm, w h i l e being an u l t i m a t e personal g o a l , was not included as a s u c c e s s f u l treatment c r i t e r i o n , the category's f a i l u r e to reach s i g n i f i c a n c e i s not t o t a l l y i n c o n s i s t e n t w i t h experimental expectations. Some i n t e r e s t i n g d i f f e r e n c e s between male and female reports of the frequencies of v a r i o u s sexual behaviors measures were noted. The r e s u l t s of the male analyses i n d i c a t e d that throughout the periods of monitoring, they perceived lower incidence of non-sexual and sexual sensate focus and female i n i t i a t e d sexual behaviors. With respect to the l a t t e r , i t i s e n t i r e l y p o s s i b l e that the male partners were not always aware of the attempt and/or e f f o r t exerted by the female. Credence i s l e n t to t h i s i n t e r p r e t a t i o n by the f a c t that males i n the c o n t r o l c o n d i t i o n , more so than i n e i t h e r treatment c o n d i t i o n , c o n s i s t e n t l y reported lower frequencies of female i n i t i a t e d sexual behavior. As males i n the c o n t r o l c o n d i t i o n 80 had not yet been exposed to any d i s c u s s i o n s about female sexual performance, t h i s r e s u l t i s understandable. The only instance of males r e p o r t i n g a higher frequency than the females was i n the a n a l y s i s of category seven, i n t e r c o u r s e . Examination of treatment means i n d i c a t e s that males i n both the group and i n d i v i d u a l treatment c o n d i t i o n s reported higher .incidences of i n t e r c o u r s e than t h e i r female counterparts. This i n f l a t i o n was not evidenced i n the c o n t r o l c o n d i t i o n . I t i s h i g h l y p o s s i b l e that because the act of i n t e r c o u r s e i s i n t r i c a t e l y interwoven w i t h the concept of "male sexual adequacy", male r e p o r t s may be i n t e n t i o n a l l y i n f l a t e d . As the males i n both treatment c o n d i t i o n s had s e v e r a l t h e r a p i s t contacts i t i s p o s s i b l e that the demand f o r "performance" was more keenly f e l t than f o r those i n the c o n t r o l c o n d i t i o n who had no .therapist contact. While no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s were found between group and i n d i v i d u a l treatments, tendencies f o r those c l i e n t s r e c e i v i n g group treatment to engage i n more v i s u a l sexual exposure, non-sexual sen-sate focus and female i n i t i a t e d sexual behavior was observed. I t i s d i f -f i c u l t to say whether or not these increased frequencies are i n d i c a t i v e of a more e f f i c a c i o u s approach i n general; however, they do increase the v i a b i l i t y of the group treatment as a h i g h l y d e s i r a b l e a l t e r n a t i v e to conventional i n d i v i d u a l treatment. Consistent w i t h the r e s u l t s of other measures, the c o n t r o l condi-t i o n showed trends towards decreased b e h a v i o r a l frequencies and i n two cases, v i s u a l sexual exposure and non-sexual sensate focus, a c t u a l l y achieved s i g n i f i c a n t decreases. S i g n i f i c a n t divergencies between t r e a t -ment and c o n t r o l c o n d i t i o n s appeared on the average around the t h i r d t r e a t -ment se s s i o n which appears to be c o n s i s t e n t w i t h the a t t i t u d i n a l data. 81 Implications for Future Research The i n i t i a l divergences between the three experimental groups, although s t a t i s t i c a l l y r e c t i f i e d by the use of analyses of covariance, were disturbing. As assignment to the two treatment groups was e n t i r e l y random, i t i s assumed that t h i s discrepancy was the consequence of using small treatment samples. The control c l i e n t s were successive acceptable r e f e r r a l s to the c l i n i c . As these s i x women were re f e r r e d from highly divergent sources there was no reason to expect that they would deviate from those c l i e n t s r e ceiving treatment. If small samples are u t i l i z e d i n further research i n t h i s area i t would be advisable to match c l i e n t s on the pertinent variables such as s e v e r i t y and duration of dysfunction as i t i s e n t i r e l y f e a s i b l e that d i f f e r i n g l e v e l s of dysfunction respond d i f f e r e n t i a l l y to alternate forms of treatment. Precise recording of behavioral frequencies was problematic with respect to the number of confounding v a r i a b l e s encountered. The use of a s p e c i f i e d time period f o r measurement proved unsatisfactory i n that extra-neous c l i e n t committments often reduced the time a v a i l a b l e f o r p r a c t i c e of sexual behavior. Examples of various committments included partner on business t r i p , houseguests and studying for examinations. While i t can be argued that the above are normal occurrences which every couple encounter, t h e i r presence impeeds the p r e c i s i o n of the behavioral measurements. Two alternate solutions seem appropriate. F i r s t l y one could elongate the base-l i n e and follow-up periods assuming that the lengthened time period would produce a more representative index. In conjunction with the above, t r e a t -ment would be given l e s s frequently. The other a l t e r n a t i v e would be to measure behavioral frequencies on a r a t i o basis of u t i l i z a t i o n of time over 82 a c t u a l time a v a i l a b l e . This method however places increased r e l i a n c e upon the c l i e n t ' s s u b j e c t i v e i n t e r p r e t a t i o n s . This r e l i a n c e could be p a r t i a l l y a l l e v i a t e d by a compilation of a l l acceptable "occurrences":.into a behavi-o r a l i n t e r r u p t i o n c h e c k l i s t to accompany the sexual behavior index. As the study has chosen to focus only on female secondary orgasmic d y s f u n c t i o n , g e n e r a l i z a t i o n and i n t e r p r e t a t i o n s to other types of dys-f u n c t i o n s can only be made w i t h that c a u t i o n . When compared to a no-treatment c o n t r o l c o n d i t i o n , c l i e n t s r e c e i v i n g group and i n d i v i d u a l graduated symbolic modeling w i t h concurrent b e h a v i o r a l tasks improved s i g -n i f i c a n t l y w i t h respect to sexual a n x i e t y , a t t i t u d e s and enactment of behaviors. While no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s were evidenced between group and i n d i v i d u a l treatments, c l i e n t s r e c e i v i n g group treatment reported l e s s a n x i e t y on the card s o r t and the a n x i e t y dimension of the semantic d i f f e r e n t i a l . As the r e s u l t s of the sexual behavior index i n d i -cated, a tendency f o r group c l i e n t s to report higher frequencies of the described behaviors was a l s o evidenced. I t i s p o s s i b l e that components of the group treatment such as exposure to people w i t h s i m i l a r problems induced lower l e v e l s of a n x i e t y which f a c i l i t a t e d the enactment of more sexual behavior. Further research on a much l a r g e r s c a l e i s needed i n t h i s area to determine the e f f e c t i v e and o p e r a t i v e components of the group approach. The f i n d i n g of c o n t r o l d e t e r i o r a t i o n over a l l i n d i c e s i s an i n -t e r e s t i n g one. The p a t t e r n of i n i t i a l i ncrease and then subsequent r e t u r n to the b a s e l i n e measures i s pervasive. This f i n d i n g may be due to an i n i t i a l enthusiasm which r a p i d l y wanes around the t h i r d session. As these c l i e n t s were c o n t i n u a l l y monitoring t h e i r behavior and a t t i t u d e s , there are no p o s i t i v e i m p l i c a t i o n s to be gleaned f o r the p o t e n t i a l b e n e f i c i a l e f f e c t s 83 of s e l f - m o n i t o r i n g (Kanfer, 1970; Kazdin, 1974). Further research on the s t a t u s of c l i e n t s w a i t i n g f o r sexual d y s f u n c t i o n treatment should a l s o be done to determine i f t h i s trend toward d e t e r i o r a t i o n i s a v a l i d or merely i d i o s y n c r a t i c f i n d i n g . I f t h i s f i n d i n g i s r e p l i c a t e d , the research i n t o the use of group therapy i n t h i s area becomes i n c r e a s i n g l y e s s e n t i a l . As p o s i t i v e changes i n a t t i t u d i n a l , a n x i e t y and b e h a v i o r a l i n d i c e s were a l l manifested, on the average around the t h i r d s e s s i o n , causal i n -t e r p r e t a t i o n s are impossible to espouse. Apparently as t h i s study has i n d i c a t e d , the p o s i t i v e e f f e c t s of t h i s treatment procedure are con-s o l i d a t e d simultaneously i n a t t i t u d i n a l , " b e h a v i o r a l and anxiety realms. 84 CONCLUSIONS Multi-causal approaches espousing divergent therapies have been rampant i n the f i e l d of female sexual dysfunction. A l l too often studies u t i l i z i n g inadequate designs and i n s u f f i c i e n t controls have prevented the adequate assessment of these various techniques. In t h i s study an attempt was made to assess the e f f e c t s of graduated symbolic modeling with concurrent behavioral tasks on women whose anxiety towards sexual a c t i v i t y precluded them from enjoyment of or engagement i n sexual behaviors. P o s i t i v e s i g n i f i c a n t e f f e c t s from both treatment condi-tions were manifested i n behavioral, a t t i t u d i n a l and anxiety indices simultaneously around the second week of treatment. While group treatment did not y i e l d s t a t i s t i c a l l y superior r e s u l t s , tendencies for those c l i e n t s to report le s s anxiety and more p a r t i c a t i o n i n sexual a c t i v i t i e s was observed. The i n t e r e s t i n g observation of the control condition's d e t e r i -o r a t i o n over a l l in d i c e s , i f r e p l i c a t e d , has important implications both f o r future researchers and c l i n i c a l p r a c t i t i o n e r s . 85 REFERENCES Bandura, A. Vicarious processes: A case of n o - t r i a l learning. In L. Berkowitz (Ed.), Advances i n Experimental So c i a l Psychology. Vol. I I . New York: Academic.Press, 1965, pp. l-55(a). Bandura, A. Influence of models' reinforcement contingencies on the ac-q u i s i t i o n of i m i t a t i v e responses. Journal of Personality and S o c i a l Psychology, 1965, 1_, 589-595 (b). Bandura, A. S o c i a l - l e a r n i n g theory of i d e n t i f i c a t o r y processes. In D.A. Goslin (Ed.), Handbook of S o c i a l i z a t i o n Theory and Research. Chicago: Rand McNally, 1968. Bandura, A. P r i n c i p l e s of Behavior Modification. Holt, Rinehart, Winston. 1969. Bandura, A., Blanchard, E., & R i t t e r , B. Relative e f f i c a c y of d e s e n s i t i -zation and modeling approaches for inducing behavioral, a f f e c t i v e and a t t i t u d i n a l changes. Journal of Personality and S o c i a l Psycho- logy, 1969, U, 173-199. Bandura, A., Grusec, J.E., & Menlove, F.L. Vicarious e x t i n c t i o n of avoidance behavior. Journal of Personality and S o c i a l Psychology, 1967, _5, 16-23 (b). Bandura, A. & Menlove, F. Factors determining v i c a r i o u s e x t i n c t i o n of avoidance behavior through symbolic modeling. Journal of Personality  and S o c i a l Psychology, 1968, 8, 99-108. Bandura, A. & Walters, R.H. S o c i a l Learning and Personality Development. New York: Holt, Rinehart & Winston, 1963. Barlow, D., Leitenberg, H. and Agras, S. The experimental control of sexual 86 deviation through manipulation of the noxious scenes i n covert s e n s i t i z a t i o n . EPA Convention, Washington, D.C. 1968. Bern, D.J. B e l i e f s , Attitudes and Human A f f a i r s . Brooks Cole: 1970. Bentler, P. Heterosexual behavior assessment: I I , females. Behavior  Research and Therapy, 1968, 6_, 27-30. Blanchard, E.B. The r e l a t i v e contributions of modeling, informational influences, and phy s i c a l contact i n the e x t i n c t i o n of phobic behavior. Unpublished doctoral d i s s e r t a t i o n , Stanford University, 1969. Brady, J. B r e v i t a l r e l a x a t i o n treatment of f r i g i d i t y . Behavior Research and Therapy, 1966, 4, 71-77. Brehm, J.W., & Cohen, A.P. Exploration i n Cognitive Dissonance. New York: Wiley, 1962. Caird, W. & Wincze, J. Videotaped d e s e n s i t i z a t i o n of f r i g i d i t y . Journal of Behavior Therapy and Experimental Psychiatry, 1974, _5, 175-178. C i c c h e t t i , Domenic V. Extension of multiple range tests to i n t e r a c t i o n tables i n the analysis of variance. A rapid, approximate sol u t i o n . Biometrics, 1972, 77_, 405-408. Clopton, J.R. & Risbrough, R.F. Sexual arousal f o r d e s e n s i t i z a t i o n . Behavior Therapy, 4^  741-743. Festinger, L. A Theory of Cognitive Dissonance. Evanston, 111.: Row, Peterson, 1957. Festinger, L. Behavioral support f o r opinion change. Public Opinion Quarterly, 28, 1964. Fisher, S. The Female Orgasm^ Psychology, Physiology, Fantasy. New York: Basic Books, 1973. 87 Freud, S. Sexuality and the Psychology of Love. New York; C o l l i e r Books, 1963. Greenwald, A.G. Behavior change following a persuasive communication. Journal of Personality, 33, 1965a. 370-391. Kanfer, F.H. Self-monitoring. Journal of Cunsulting and C l i n i c a l Psychology, 35, 2, 1970, 148-152. Kaplan, H. The New Sex Therapy: a c t i v e treatment of sexual dysfunction. New York: Brunner/Mazel, 1974, Kazdin, A.E. Self-monitoring and behavior change, i n Mahoney, M.J. & Thorsen, C.E. Self Control. Holt, Rinehart and Winston, 1974. Kelman, H.C. The induction of action and a t t i t u d e change. Proceedings of the XIV International Congress of Applied Psychology. Copenhagen: Munksgaard, 1961. Kinsey, A.C., Pomeroy, W.B., Martin, C.E., & Geghard, P.H. Sexual Behavior  i n the Human Female. Phila d e l p h i a : W.B. Saunders, 1953. Kra f t , T. & A l - I s s a . Behavior therapy and the treatment of f r i g i d i t y . American Journal of Psychotherapy, 1967, 21^, 116-120. Lacey, J . I . , Bateman, D.E. & Van Lehn, R. Autonomic response s p e c i f i c i t y : an experimental study. Psychosomatic Medicine, 1953, 1_5, 8-21. Lazarus, A. The treatment of chronic f r i g i d i t y by systematic d e s e n s i t i z a -t i o n . The Journal of Nervous and Mental Disease, 1963, 136, 272-278. Lo b i t z , W.C. & LoPiccolo, J . 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The group treatment of children's snake phobias using v i c a r i o u s and contact d e s e n s i t i z a t i o n procedures. Behavior Research and Therapy, 1968, £, 1-6. R i t t e r , B. Treatment of acrophobia with contact d e s e n s i t i z a t i o n . Behavior Research and Therapy, 1969, ]_, 41-45. Rotter, G.S. Sex Attitude Scale. 1973. Wincze, J.P. & Caird, W.K. Treatment of sexual dysfunction. Behavior Therapy, ( i n press). Winer, B. S t a t i s t i c a l P r i n c i p l e s i n Experimental Design. New York: McGraw-Hill, 1971. Wolpe, J. Psychotherapy by Reciprocal I n h i b i t i o n . Stanford University Press; Stanford, C a l i f o r n i a , 1958. Wolpe, J. The P r a c t i c e of Behavior Therapy. Oxford: Pergamon, 1969. Woody, R. & Schauble, P. Videotaped v i c a r i o u s d e s e n s i t i z a t i o n . Journal of Nervous and Mental Disease, 1969, 148, 281-286. 89 APPENDIX I ITEMS ON THE SEXUAL ANXIETY CARD SORT You are seated on a chair i n the l i v i n g room and looking at a catalogue. Your husband enters and s i t s on the couch and picks up a newspaper. You speak to your husband about something i n the catalogue and j o i n him on the couch. Together you leaf through the book, discussing various items, e.g., p i c t u r e s , f u r n i t u r e , and show your husband where these things might go i n the room. Your husband i s s i t t i n g on a chair i n the l i v i n g room reading. You enter, s i t on the couch and check the TV guide. You mention something to your husband and turn on the TV. He comes and j o i n s you on the couch. He s i t s close to you and holds your hand while you both watch TV. Your husband i s s i t t i n g on the couch i n the l i v i n g room reading the newspaper. You enter with your coat on. You speak to your husband, ki s s him b r i e f l y , and take your coat o f f . You s i t beside your husband and you both embrace and k i s s , with increasing enthusiasm, on the l i p s , neck, and tongue. Your husband i s s i t t i n g on a chair watching TV i n the l i v i n g room. You enter, s i t on the couch and ask him to come and s i t with you. He does and you kiss him. You continue k i s s i n g and your husband runs h i s hands up and down your back and fondles your breasts over your clothes. Your husband i s s i t t i n g reading on a chair i n the l i v i n g room. You are s i t t i n g on the couch. You go over to your husband, take h i s book from him and s i t on h i s lap. You kiss him and he responds. You both con-tinue k i s s i n g neck, l i p s , tongue. Your husband undoes your blouse and 90 fondles your breasts over your bra. He then takes o f f your blouse and bra completely and continues fondling your breasts, 6. Your husband i s l y i n g on the couch i n the l i v i n g room watching TV. You enter and turn o f f the TV and l i e beside him. You k i s s with increasing enthusiasm. Your husband fondles your breasts and genitals over your clothes. 7. You and your husband are nude i n bed having sexual intercourse, with you on top of your husband. A f t e r orgasm, you and your husband continue embracing f o r a while. You then move apart and l i e next to each other on your backs, holding hands. You look at each other and smile. 8. Your husband i s s i t t i n g on the chair i n the l i v i n g room reading. You come i n , say something to him and then take him by the hand and lead him to the couch. You both l i e down and k i s s . You stroke your hus-band's geni t a l s over h i s clothes. 9. Your husband i s on the couch reading i n the l i v i n g room. You come i n , s i t beside him and t e l l him you have a sore back. He o f f e r s to give you a back rub. He unbuttons and removes your blouse and you l i e on your stomach on the couch. Your husband then gives you a back rub and chats casually with you while doing so. 10. You are l y i n g on your stomach on your bed, f u l l y clothed except f o r your shoes. Your husband comes i n and l i e s beside you without touching you. You t a l k f o r a short while and then your husband gets up and picks up h i s book. You r o l l on your back and continue t a l k i n g . Your hus-band then leaves the room and a f t e r f i x i n g your h a i r you follow him. 11. You are l y i n g on your bed i n the bedroom reading. Your husband enters, 91 s i t s on the bed for a minute and then l i e s down and.puts h i s arms around you. You respond and you both, k i s s with increasing passion. You each run your hands over the other's back and upper legs over your clothes and you stroke your husband's geni t a l s over h i s clothes. 12. You are i n the bedroom and your husband i s slowly removing a l l your c l o t h i n g . 13. You are alone i n your bedroom. You slowly remove a l l of your clothes and l i e on top of your bed naked. 14. Your husband i s alone i n your bedroom. He begins to get undressed. He takes o f f h i s shoes, socks, s h i r t , pants, shorts. He then l i e s on top of the bed, naked, reading. 15. You are alone i n your bedroom and you remove a l l your clothes. While you are standing naked, your husband comes into the room. You k i s s . You get into bed and your husband begins to undress. 16. You and your husband are l y i n g next to each other on the bed. You are on your back; your husband i s l y i n g on h i s stomach. You are wearing a bra and panties; your husband i s wearing shorts. You embrace and k i s s . Your husband caresses you f i r s t over your panties and then under them. 17. You are s i t t i n g , nude, on your bed combing your h a i r . Your husband, also nude, enters drying h i s h a i r with a towel, which he p l a y f u l l y throws at you. You get up and place your comb on a table and arrange some other scattered items on i t . Your husband walks past you to re-tr i e v e the towel. You t a l k and look at each other , slowly moving closer together. 18. Your husband, nude, i s picki n g out some pajamas from a drawer i n your 92 bedroom. You. also nude, are s i t t i n g on the bed combing your h a i r . You get up and t a l k to your husband and you both look at each other and embrace. 19. You and your husband, both nude, are embracing standing next to your bed. You look at each other and your husband kisses you on the cheek and neck and s l i g h t l y longer on the l i p s . You move apart and go to the bed. You l i e on your back, your husband s i t s next to you and bends down and kisses you again. He then l i e s down next to you and continues k i s s i n g . 20. You and your husband, both nude, are l y i n g next to each other on the bed. You are on your back, your husband i n on h i s stomach. You and your husband embrace warmly and k i s s . You part s l i g h t l y and embrace again, t h i s time tongue k i s s i n g . 21. You and your husband, both nude, are l y i n g on the bed. Your husband i s on h i s back, you are on your stomach. You are embracing and k i s s i n g . Your husband moves h i s hand from your back to your breasts. You move so that you are now on your back and your husband i s on h i s stomach. Your husband continues caressing your stomach and breasts. 22. You and your husband are both nude i n bed. You are on your back, your husband i s on h i s stomach. You are embracing. Your husband i s cares-sing your stomach, breasts, thighs and then moves h i s hand to your g e n i t a l area and stimulates you, at f i r s t s l i g h t l y , then more. 23. You and your husband are nude i n bed; your husband on his stomach, you on your back. You are embracing and k i s s i n g . Your husband i s caressing your thigh and g e n i t a l area. You then both turn on your sides and both caress the g e n i t a l area of the other. 93 24. You and your husband are nude i n bed. You are k i s s i n g and embracing and mutually stimulating the g e n i t a l area of the other. You move so that your husband i s on top of you. You k i s s and have sexual i n t e r -course to orgasm. 25. You and your husband are nude i n bed, embracing and k i s s i n g . You are l y i n g side by side, each stimulating the g e n i t a l area of the other. You move so that you are on top. You continue k i s s i n g and caressing. You then have sexual intercourse with you guiding your husband's penis upon penetration. 94 APPENDIX II BENTLER HETEROSEXUAL BEHAVIOR HIERARCHY Instructions: The s i t u a t i o n s described i n t h i s questionnaire are intended to indic a t e areas of concern to you. I t i s not a test; there are no wrong or ri g h t answers. A f t e r each statement you w i l l f i n d a row of numbers whose meaning i s given below. A l l you have to do i s draw a c i r c l e around the number that best describes your f e e l i n g about the p a r t i c u l a r a c t i v i t y . That i s , how do you f e e l about i t . 0 means i t causes no anxiety 1 means i t causes a l i t t l e anxiety 2 means i t causes a f a i r amount of anxiety 3 means i t causes much anxiety 4 means i t causes very much anxiety 1. Mutual o r a l (mouth, tongue) manipulation of genitals to mutual orgasm 0 1 2 3 4 2. Oral manipulation of male genitals to ej a c u l a t i o n by female 0 1 2 3 4 3. Sexual intercourse, v e n t r a l - d o r s a l (male entering from behind) 0 1 2 3 4 4. Mutual manual manipulation of genitals to mutual orgasm 0 1 2 3 4 5. Mutual o r a l - g e n i t a l manipulation 0 1 2 3 4 6. Oral manipulation of male genitals by female 0 1 2 3 4 7. Oral manipulation of female genitals by male 0 1 2 3 4 8. Sexual intercourse, v e n t r a l - v e n t r a l (face to face) 0 1 2 3 4 9. Oral contact with male geni t a l s by female 0 1 2 3 4 10. Oral contact with female gen i t a l s by male 0 1 2 3 4 11. Manual manipulation of male genitals to ej a c u l a t i o n by female 0 1 2 3 4 95 12. Manual manipulation of female genitals to massive secretions by male 0 1 2 3 4 13. Manual manipulation of male geni t a l s under clothes .by female 0 1 2 3 4 14. Mutual manual manipulation of geni t a l s 0 1 2 3 4 15. Manual manipulation of male geni t a l s over clothes by female 0 1 2 3 4 16. Manual manipulation of female ge n i t a l s under clothes by male 0 1 2 3 4 17. K i s s i n g nipples of female breasts by male 0 1 2 3 4 18. Manual manipulation of female genitals over clothes by male 0 1 2 3 4 19. Manual manipulation of female breasts under clothes by male 0 1 2 3 4 20. Manual manipulation of female breasts over clothes by male 0 1 2 3 4 21. One minute continuous l i p k i s s i n g 0 1 2 3 4 22. One minute continuous embrace with person of the opposite sex 0 1 2 3 4 23. Holding hands with person of the opposite sex 0 1 2 3 4 24. Talking to a person of the opposite sex 0 1 2 3 4 25. Looking at a person of the opposite sex 0 1 2 3 4 96 APPENDIX I I I Male seeing female nude i i i i i i i i i i i i i i i i i i i i Female seeing male nude Male giving female body massage excluding breasts and g e n i t a l i a Female giving male body massage excluding g e n i t a l i a Male caressing female's breast with hands ( Male caressing female's breast with mouth Male caressing female genitals with hands Female caressing male genitals with hands Foreplay 10 minutes Foreplay 20 minutes Foreplay 30 minutes Attempted intercourse Actual intercourse Female orgasm through masturbation Female orgasm through g e n i t a l manipulation by male Female orgasm through intercourse C3 H - * J O 4 Co O r t a to r t O fD l-ti p O r t H H * l - 1 h - 1 O H - O 3 C CO (5 CO CO CO O H-1-h O 3 i -h H 13 ft) H-> -Q fD C 0> fD CO 3 m o rt S fD fD T o t a l number of female i n i t i a t e d sexual encounters 97 APPENDIX IV CATEGORIZATION OF THE SEXUAL BEHAVIOR INDEX 1. V i s u a l Sexual Exposure *1. Male seeing female nude 2. Female seing male nude 2• Nonsexual Sensate Focus 3. Male giving female body massage excluding breasts and g e n i t a l i a 4. Female giving male body massage excluding g e n i t a l s 3. Sexual Sensate Focus 5. Male caressing female breasts with hands 6. Male caressing female breasts with mouth 7. Male caressing female genitals with hands 8. Female caressing male gen i t a l s with hands 4. 9. Cumulative foreplay duration 10 minutes 5. 10. Cumulative foreplay duration 20 minutes 6. 11. Cumulative foreplay duration 30 minutes 7. Intercourse 12. Attempted 13. Actual 8. Orgasm 14. Through masturbation 15. Through g e n i t a l manipulation by partner 16. C o i t a l 9. Number of Female I n i t i a t e d Sexual Encounters * Numbers correspond to o r i g i n a l d i s c r e t e behavioural categories 98 APPENDIX V INSTRUCTIONS FOR ANSWERING THE SEX ATTITUDE SCALE On the following pages are 100 statements concerning a v a r i e t y of sexual issues such as sex r o l e s , sex education, sexual intercourse, m a r i t a l r e l a t i o n s h i p s , etc. Please look over each item and using the s p e c i a l answer sheet, indicate how much you agree or disagree with each one. You are to do t h i s by w r i t i n g down the numerical r a t i n g that comes closest to the wayvyou personally believe or f e e l . As seen, there are seven degrees of agreement, any or a l l of which you may use i n your evaluations. +3 = Suppose you T o t a l l y Agree with a statement. You would then write +3 next to the appropriate item number on the s p e c i a l answer sheet. +2 = Suppose you Agree Very Much with a statement. You would then write +2 next to the appropriate item number on the s p e c i a l answer sheet. +1 = Suppose you Tend to Agree with a statement. You would then write +1 next to the appropriate item number. 0 = Suppose you f e e l Neutral about a statement or Don't Know how you f e e l about i t . You would then write an CJ next to the appropriate item number. -1 = Suppose you Tend to Disagree with a statement. You would then write next to the appropriate item number. -2 = Suppose you Disagree Very Much with a statement. You would then write 2^_ next to the appropriate item number. -3 = F i n a l l y , suppose you T o t a l l y Disagree with a statement. You would then write _^ 3 next to the appropriate item number. These points of agreement are also described at the top of the Answer Sheet. There are no r i g h t or wrong answers. These are your opinions. There w i l l be some ambiguity on many of the items, but please try to answer them the best you can. To say the l e a s t , the value of t h i s i n f o r -mation depends t o t a l l y on your honest and f o r t h r i g h t responses. 99 1, Many chil d r e n have become emotion-a l l y disturbed upon taking courses i n sex education, 2, I hold nothing against parents who have given t h e i r daughters contraceptive devices, 3, I t bothers me to see a young boy k i s s or t r y to k i s s h i s teacher, 4, An i n - s e r v i c e course i n sex education should make us want' to re-examine our b e l i e f s con-cerning sex. 5, Compulsory sex education i s an invasion of privacy, 6, Most high school boys act l i k e apes when i t comes to sex, 7, Teachers of sex education should j u s t teach the fa c t s and forget about changing a t t i t u d e s , 8, As a teacher of sex education I would be prepared to discuss anything a student r a i s e s . 9, I t ' s natural for small c h i l d r e n to display t h e i r sex organs to other c h i l d r e n . 10, Providing contraceptive knowledge to high school students w i l l increase promiscuity. 11, A c h i l d should never see h i s parents nude. 12, When sex education urges c h i l d r e n to a r r i v e at t h e i r own decisions, they are undermining the i n f l u -ence of the parents,. 13, Real long h a i r on boys i s t e r r i b l e , 14, A g i r l ' s reputation i s the most important thing she has. 15, I t ' s pretty^-nigh impossible to change an adult's fee l i n g s about sex, 16, I tend to worry about sexual matters, 17, Most g i r l s w i l l do anything to a t t r a c t or hang onto a guy. 18, Rape should be punishable by death, 19, I t i s healthy and desirable that g i r l s i n i t i a t e love-making , 20, The father should not become d i r e c t l y involved i n the sex education of h i s daughter. 21, The Bible and the Ten Com-mandments provide us with the correct standards of sexual morality. 22, We a l l have a b i t of homo-sexuality i n us, and we a l l should come to recognize and accept i t . 23, Black males seem unable to control t h e i r sex urge. 24, Children should be punished for playing sex games. 25, Sexual immorality i s more wrong for g i r l s than for boys. 26, Were I a parent of a teenage g i r l , I'd be resigned to the idea that s h e ' l l engage i n sexual intervourse before she gets married. 27, In a sex education course for c h i l d r e n under eight, body differences between boys and g i r l s need not be discussed. 100 28. For a g i r l , sex i n marriage w i l l be more " d e l i g h t f u l " i f she remains a v i r g i n than i f she doesn't, 29, A boy should not be t o l d that a g i r l i s having her menstrual period at the time she's having one. APPENDIX VI SEMANTIC DIFFERENTIAL Adjectives Pleasant - Unpleasant E r o t i c - F r i g i d P l a c i d - J i t t e r y Active Passive Emotional - Unemotional Good - Bad Kind - Cruel Strong - Weak Relaxed - Tense Calm - Anxious Hard - Soft Sexy- - Sexless Warm - Cold Concepts - Sex - Nudity - Male Bodies - Self-Exploration - V e r b a l i z i n g my sexual desires to my partner My Role i n sexual a c t i v i t i e s - Orgasm TABLE 1 Four Factor Analyses i n 17 Patients: ( P r i n c i p a l Components Method) Factor Loading of Scales Those < .30 ommitted. General Evaluation Sex Evaluation Anxiety Nonsexual Sexual Nonsexual Sexual Nonsexual Sexual Concepts Concepts Concepts Concepts Concepts Concepts Test Retest Test Retest Test Retest Test Retest Test Retest Test Retest 1. Pleasant-un-pleasant .93 .93 ,66 ,89 2. Good-Bad ,89 ,89 ,76 ,71 3. Kind-Cruel ,97 .96 ,86 ,65 4. Friendly-Un-f r i e n d l y .86 .93 .81 .80 5. Approachable-d i s t a n t ,79 .87 .91 ,63 6. Warm-cold ,65 .65 ,66 ,76 7. Seductive-r e p u l s i v e ,51 ,88 ,73 .70 ,42 8. Sexy-sexless ,73 ,81 ,86 .86 9. E x c i t i n g - d u l l .80 ,48 .57 ,75 ,38 10. E r o t i c - f r i g i d ,62 ,83 ,87 .68 11. P l a c i d - j i t t e r y .85 .87 ,80 .92 12. Calm-anxious ,98 .98 .91 .93 13. Relaxed-tense ,92 .94 .92 .88 From Marks and Sartorius (1968), p, 442, 103 APPENDIX VII Analysis of Variance f o r Sexual Anxiety Card Sort Source dF SS MS Prob. Treat Time TRT*TM Error T o t a l 2 6 12 108 146 13298,0 3288,7 2891,6 4510.8 42103.0 6649.2 6,61 0,0070 584.12 13.12 0,0000 240.97 5.77 0,0000 41.769 Contrast F Prob. 1. Indiv vs Group 0.535 0.47398 2. Indiv + Grp vs C n t r l 12.851 0.00212 Post Hoc Analyses by Condition Tukey c r i t i c a l value K' = 7 = 10.24 Individual : 7 6 5 4 3 1 14,37 18,25 21,62 24.25 6 13,38 16,75 19,37 5 12,37 15.00 4 3 2 1 104 Group ; 7 12,57 13,57 15,71 19,28' 5 11,00 14.59 6 13.28 4 3 1 2 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey c r i t i c a l value K' = 3 = 8,112 -Pre Measure Time 7 -Post Measure 1 vs C = 9,41 I vs C = 37.66 G vs 1 = 10.10 G vs C = 39.23 G vs C = 19.52 Time 2 G vs C = 16.33 Time 3 1 vs C = 10.08 G vs C = 16.33 Time 4 1 vs C = 17.125 G vs C = 20.5 Time 5 1 vs C = 21.25 G v s C n 27,25 Time 6 1 vs C = 27.12 G vs C = 27.58-APPENDIX VIII s i s of Variance f o r Bentler Heterosexual Behavior Hierarchy Source dF SS MS Prob. Treat Time TRT*TM Error T o t a l 2 1 2 18 41 3560,4 1524.0 1288.1 1717.4 15546.0 1780,2 1524.0 664.05 95.10 4,30 15.97 6.75 0.0298 0.0008 0.0065 Contrast F Prob. 1. Indiv vs Group 0.700 0.41373 2. Indiv + Grp vs Control 8.053 0.01091 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 1 = 10.97  Individual - 2 vs 1 = 20.5 Group - 2 vs 1 = 17.285 Control - No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 13.33 Post Hoc Analyses by Administration (cont.) Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 - Post Measure I vs C = 29.53 G vs C = 34.16 APPENDIX IX Analysis of Variance for Semantic D i f f e r e n t i a l - A n x i e t y Dimension Source dF MS F Prob. Treat 2 9779. ,2 4889. .6 3. .32 0. .0591 Time 6 6606. ,7 1101. ,1 7. .03 0. .0000 Trt*TM 12 4603. .8 383. .65 2. .45 0, .0074 Error 108 16917. .0 156. ,64 Tot a l 146 64. .398 Contrast 1. Indiv vs Group 2. Indiv + Grp vs C n t r l F Prob. 0.093 0.76443 6.600 0.01932 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 20.20 Individual: 1 2 4 3 6 5 7 1 2 4 20.875 24.125 27.125 23.80 Group: 1 2 3 4 6 5 7 1 22.00 29.00 2 21.43 28.42 3 26.42 4 6 5 7 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 15.99 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 No s i g n i f i c a n c e Time 5 I vs C = 31.25 G vs C = 33.64 Time 6 I vs C = 26.17 G vs C = 26.52 Time 7 - Post Measure I vs C = 31.75 G vs C = 58.28 APPENDIX X Analysis of Variance for Semantic D i f f e r e n t i a l - E v a l u a t i o n Dimension Source dF SS MS F Prob. Treat 2 33038.0 16519 5.96 0.0103 Time 6 4479.0 746. 51 2.95 0.0106 TRT*TM 12 6314.1 526. 51 2.08 0.0243 Error 108 27364 253. 37 To t a l 146 0.1211OE+06 Contrast F Prob. 1. Indiv vs Group 0.601 0.44843 2. Indiv + Grp vs C n t r l 11.487 0.00327 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 25.66 I n d i v i d u a l : 1 2 4 3 6 5 7 1 2 4 29.25 27.875 Group : 2 3 1 4 5 6 7 2 3 1 4 5 6 7 26.86 Control : No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 20.31 Time 1 - Pre Measure G vs C = 26.97 Time 2 No s i g n i f i c a n c e Time 3 G vs C = 25.73 Time 4 G vs C = 31.51 Time 5 I vs C = 43.792 G vs C = 50.23 Time 6 I vs C = 38.25 G vs C = 46.07 Time 7 - Post Measure I vs C = 50.04 G vs C = 58.23 I l l APPENDIX XI Analysis of Variance f o r Semantic D i f f e r e n t i a l - S e x u a l Dimension Source dF SS MS Prob. Treat Time TRT*TM Error T o t a l 2 6 12 108 146 9559.8 3271.8 3307.1 7262.8 39012 4779.9 545.30 275.59 67.249 5.51 8.11 4.10 0.0136 0.0000 0.0000 Contrast F Prob. 1. Indiv vs Group 2. Indiv + Grp vs C n t r l 0.886 10.340 0.35915 0.00480 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K* = 7 = 13.24 I n d i v i d u a l : 2 1 3 4 5 2 16.125 19.75 24.25 1 15.75 19.375 23.875 3 14.00 4 5 6 7 112 Group: 2 14.71 16.00 1 14.57 16.00 3 14.00 4 5 6 7 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 10.4 Time 1 - Pre Measure G vs C = 13.095 Time 2 No s i g n i f i c a n c e Time 3 I vs C = 11.04 G vs C = 12.59 Time 4 G vs C = 16.33 Time 5 I vs C = 23.75 G vs C = 30.00 Time 6 I vs C = 24.70 G vs C = 29.33 Time 7 - Post Measure I vs C = 29.875 G vs C = 31.43 113 APPENDIX XII Analysis of Variance f o r Semantic D i f f e r e n t i a l - A c t i v i t y Dimension Source dF SS^  MS F Prob. Treat 2 7505.8 3752.9 4.57 0.0249 Time 6 2151.4 358.57 5.21 0.0001 TRT*TM 12 3352.2 279.35 4.06 0.0000 Error 108 7439.2 68.882 To t a l 146 35234 Contrast F Prob. 1. Indiv vs Group 0.593 0.45109 2. Indiv + Grp vs C n t r l 8.695 0.00859 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 13.37 Individual: 1 2 3 4 5 6 7 1 15.13 15.88 20.88 24.38 2 17.63 21.13 3 4 5 6 7 114 Group' 3 15.86 2 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K1 = 3 = 10.58 Time 1 - Pre Measure I vs G = 14.96 G vs C = 13.54 Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 I vs C = 13.71 G vs C = 14.26 Time 5 I vs C = 20.96 G vs C = 25.16 Time 6 I vs C = 23.80 G vs C = 25.46 Time 7 - Post Measure I vs C = 27.63 G vs C = 28.79 115 APPENDIX XIII Analysis of Variance for Semantic D i f f e r e n t i a l - Potency Dimension Source dF SS MS F Prob. Treat 2 1598. ,8 799. 42 3. .47 0.0532 Time 6 346. .23 57. 705 2. ,89 0.0119 TRT*TM 12 • 817. .75 68. 146 3. ,41 0.0003 Error 108 2157. .5 19. 976 T o t a l 146 9068. .7 Contrast Prob. 1. Indiv vs Group 2. Indiv + Grp vs C n t r l 0.637 6.436 0.435 0.2066 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 7.26 Individual : 1 2 4 3 6 1 2 4 3 6 5 7 7.76 Group; 2 3 1 4' 5 6 7 2 3 1 4 5 6 7 8.72 8.15 7.86 7.86 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 5.75 Time 1 - Pre Measure I vs C = 6.55 Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 No s i g n i f i c a n c e Time 5 I vs C = 7.21 G vs C = 8.26 Time 6 I vs C = 9.8 G vs C = 12.73 Time 7 - Post Measure I vs C = 14.46 G vs C = 18.12 117 APPENDIX XIV Analysis of Variance of Concepts on the Sexual Semantic D i f f e r e n t i a l Concept 1: Sex Source dF SS MS Prob. Treat Time TRT*TM Error T o t a l 2 6 12 108 146 6112.9 2644.7 1716.8 4757.0 19948.0 3056.4 11.66 0.0006 440.79 10.01 0.0000 143.07 3.25 0.0005 44.046 Contrast F Prob. 1. Indiv 2. Indiv vs Group + Grp vs C n t r l 0. 23. 227 236 0.63915 0.00014" Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 10.72 Individual: 1 2 3 4 6 5 7 1 11.37 15.00 16.50 18.375 2 13.875 15.37 17.35 3 4 6 5 7 118 Group : 1 2 3 4 5 6 7 1 2 13.28 14.86 11.14 15.57 11.857 Time 1 Time 2 Time 3 Time 4 Time 5 Time 6 Time 7 3 4 5 6 7 Control : No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 8.48 - Pre Measure No s i g n i f i c a n c e No s i g n i f i c a n c e I vs C = 11.125 G vs C = 10.64 I vs C = 11.54 G vs C = 11.52 I vs C = 19.83 G vs C = 19.54 I vs C = 20.5 G vs C = 23.28 - Post Measure I vs C = 23.87 G vs C = 24.-5 Concept 2: Nudity 119 Source dF SS MS F Prob. Treat 2 1084.6 542.29 1.04 0.3743 Error Within 18 9400.1 522.23 1.00 0.5000 Time 6 386.04 64.340 2.08 0.0616 TRT*TM 12 753.72 62.810 2.03 0.0282 Error 108 3343.4 30.957 Tota l 146 14968.0 Contrast F Prob. 1. Indiv 2. Indiv vs Group + Grp vs C n t r l 0.015 2.072 0.90282 0.16723 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 7.098 Individual: No s i g n i f i c a n c e Group: 3 2 1 6 4 5 7 3 10.00 2 9.7143 1 6 4 5 7 120 Control: No Significance Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 8.967 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 No s i g n i f i c a n c e Time 5 I vs C = 9.33 G vs C = 10.33 Time 6 I vs C = 9.1250 Time 7 - Post Measure I vs C = 13.125 G vs C = 14.6429 Concept 3: Male Bodies Source dF SS MS F Prob. Treat 2 1464.7 732.33 1.65 0.2190 Error Within 18 7968.1 442.67 1.00 0.5000" Time 6 642.54 107.09 3.52 0.0032 TRT*TM 12 643.88 53.657 1.76 0.0635 Error 108 3289.0 30.454 Tota l 146 14008.0 121 Contrast F_ Prob. 1. Indiv vs Group 0.069 0.79615 2. Indiv + Grp vs C n t r l 3.270 0.08732 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 8.92 Individual: No s i g n i f i c a n c e Group: 2 1 3 4 6 2 1 3 4 6 5 7 10.14 12.86 10.43 10.43 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 7.06 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 Time 3 No s i g n i f i c a n c e No s i g n i f i c a n c e Time 4 No s i g n i f i c a n c e Time 5 I vs C = 9.7083 G vs C = 12.9762 Time 6 I vs C = 8.6250 G vs C = 9.4286 Time 7 - Post Measure I vs C = 11.50 G vs C = 15.3571 Concept 4: Self-Exploration ' c Source dF SS MS F Prob. Treat 2 1225. .7 612. .83 1. .39 0. 2750 Error Within 18 7945. .3 441. ,40 1. ,00 0. 5000 Time 6 278. ,57 46. .429 1. .60 0. 1545 TRT*TM 12 855. .95 71. ,329 2. .46 0. 0072 Error 108 3137. ,2 29. ,048 Total 146 13443. ,0 Contrast F Prob. 1. Indiv vs Group 2. Indiv + Grp vs C n t r l 0.770 2.094 0.39167 0.16512 123 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 8.71 Individual: 4 2 1 3 5 6 7 4 10.87 2 1 3 5 6 7 Group: No s i g n i f i c a n c e Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 6.89 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 No signficarice Time 3 No s i g n i f i c a n c e Time 4 No s i g n i f i c a n c e Time 5 G vs C = 10.07 Time 6 G vs C = 11.214 Time 7 - Post Measure I vs C = 12.75 G vs C = 13.7143 Concept 5: V e r b a l i z i n g My Sexual Desires to My Partner Source dF Sj3 MS F Prob. Treat 2 3358.1 1679.1 3.73 0.0442 Error Within 18 8105.2 450.29 1.00 0.5000 Time 6 1047.0 174.50 4.28 0.0007 TRT*TM 12 700.64 58.387 1.43 0.1620 Error 108 4403.2 40.771 Tot a l 146 17614.0 Contrast F Prob. 1. Indiv vs Group 0.126 0.72701 2. Indiv + Grp vs C n t r l 7.391 0.01408 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = = 10.33 Individual: No Signi f i c a n c e Group: 1 2 3 4 5 6 7 1 12.8572 2 3 4 5 6 7 Control: • No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K1 = 3 = 8.18 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 Time 3 Time 4 Time 5 Time 6 No s i g n i f i c a n c e No s i g n i f i c a n c e No s i g n i f i c a n c e I vs C = 14.7917 G vs C = 15.381 I vs C = 11.875 G vs C = 15.9286 Time 7 - Post Measure I vs C = 14.750 G vs C = 18.7143 Concept 6: My Role i n Sexual A c t i v i t y Source dF SS MS Prob. Treat Error Within Time 2 5655.6 2827.8 6.41 0.0079 18 7940.2 441.12 1.00 0.5000 6 2873.2 445.54 8.65 0.0000 (Continued) 126 Source dF SS MS F Prob. TRT*TM 12 1988.6 165.72 3.22 0.0006 Error 108 5560.5 51.486 Tota l 146 23818.0 Contrast 1. Indiv vs Group 2. Indiv + Grp vs C n t r l F Prob. 0.705 0.41221 12.310 0.00251 . Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 7 = 11.61 Individual: 1 2 3 4 5 1 12.37 16.25 18.75 21.625 2 - 12.25 14.75 17.625 3 4 5 6 7 Group 2 14.98 1 14'. 14 3 4 11.7143 5 6 7 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 12.9 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 G vs C = 14.500 Time 5 I vs C = 20.0417 G vs C = 22.881 Time 6 I vs C = 17.875 G vs C = 18.2143 Time 7 - Post Measure I vs C = 22.9167 G vs C = 25.381 Concept 7: Orgasm Source dF J3S MS F Prob. Treat 2 4054.5 2027.2 4.05 0.0353 Error Within 18 9012.2 500.68 1.00 0.5000 Time 6 553.7 92.283 1.24 0.2911 (continued) Source dF SS MS F Prob. TRT*TM 12 1366.0 113.83 1.53 0.1236 Error 108 8029.7 74.350 Tota l 146 23016.0 Time 1 Time 2 Time 3 Time 4 Time 5 Time 6 Time 7 Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 11.00 • Pre Measure No s i g n i f i c a n c e G vs C = 11.8571 I vs C = 12.95 G v s C = 11.90 No s i g n i f i c a n c e I vs C = 18.83 G vs C = 22.69 I vs C = 13.25 G vs C = 15.5714 Post Measure I vs C = 12.7500 G vs C = 15.5000 APPENDIX XV Analysis of Variance for Rotter Sexual Attitude Scale Source dF SS MS F Prob. Treat 2 688.98 344.49 0.47 0.6314 Time 2 62.317 31.159 0.60 0.5516 TRT*TM 4 459.22 114.80 2.23 0.0852 Error 36 1854.5 51.513 Total 62 16208.0 Contrast F Prob. 1. Indiv vs Group 2. Indiv + Grp vs C n t r l 0.212 0.759 0.65049 0.39519 130 APPENDIX XVI Item Co r r e l a t i o n m+f Response Behavioral Index II III IV VI 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 .9459 .9347 .6841 .7473 .6951 .8731 . 1194 .5543 .7035 1.0000 .2813 .4385 1.0000 .9959 .6892 .8479 .9902 .9716 .7632 .'9827 .9141 .9289 .5419 .8528 .5323 .9110 .9086 .7948 .7839 .8900 .8364 .6892 .9729 .9771 .9887 .8693 .7787 .9706 .9725 .5782 .8639 .9863 .9618 .7947 .9786 .5915 .5528 .1160 1.0000 .7270 .8539 .9345 .9709 .9922 .8979 .9801 .9465 .8503 .9191 1.0000 1.0000 .9437 .4969 .9050 .0269 1.0000 .9452 .9521 .9339 .9750 .9859 .8762 .8517 .6294 .8379 .5226 .8750 .9441 .7173 .3452 .8855 .6134 .7204 .9738 .9720 .9605 .9888 .7315 .9171 .9289 .8459 .5864 .8631 1.0000 .4108 .4598 1.0000 .8158 1.0000 .5680 APPENDIX XVII Analyses of Variance of Categories on the Sexual Behavior Ind Category 1: V i s u a l Sexual Exposures Source dF SS MS F Prob. Treat 2 762.15 Time 5 105.21 TRT*TM 10 387.13 Error 90 1298.3 Tota l 125 5501.9 381.07 2.33 0.1263 21.042 1.46 0.2113 38.713 2.68 0.0065 14.426 Contrast F_ Prob. 1. Indiv vs Group 2.287 0.14880 2. Indiv + Grp vs C n t r l 1.989 0.17651 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K1 = 6 = 5.93 Individual:- No s i g n i f i c a n c e Group; No s i g n i f i c a n c e Control: 4 6 5 3 2 1 4 6 5 3 2 1 8.5 8.5 6.83 Time 1 Time 2 Time 3 Time 4 Time 5 Time 6 Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 4.85 - Pre Measure No s i g n i f i c a n c e G vs C = 5.098 G vs C = 6.14 - Post Measure I vs C = 5.545 G vs C = 10.21 - Post Measure I vs G = 4.94 G vs C = 7.57 - Post Measure I vs G = 7.88 G vs C = 10.21 Category 2: Non-Sexual Sensate Focus 133 Source dF SS MS Prob. Treat Time TRT*TM Error T o t a l 2 5 10 90 125 30.782 13.778 93.456 355.10 761.49 15.391 2.7556 9.3456 3.9455 1.03 0.3764 0.70 0.6260 2.37 0.0155 Contrast F Prob. 1. Indiv vs Group 1.246 0.27899 2. Indiv + Grp vs C n t r l 0.891 0.35769 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 6 = 3.09 Individual: No s i g n i f i c a n c e Group; 1 2 5 6 4 3 1 3.28 3.42 2 6 5 4 3 Control: 3.38 6 5 4 2 3 1 Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 2.87 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 - Post Measure G vs C = 2.89 Time 5 - Post Measure No s i g n i f i c a n c e Time 6 - Post Measure No s i g n i f i c a n c e Category 3: Sexual Sensate Focus Source dF SS MS F Prob. Treat 2 1300.5 650.25 6.18 0.0090 Time 5 159.09 31.817 1.73 0.1361 TRT*TM 10 412.f30 41.230 2.24 0.0220 (continued) Source dF j>S MS F Prob. Error T o t a l 90 1656.4 125 5422.0 "18.405 Contrast F Prob. 1. Indiv 2. Indiv vs Group + Grp vs C n t r l 0.002 12.334 0.96759 0.00249 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 6 = 6.69 Individual:- No s i g n i f i c a n c e Group: 1 2 4 3 6 5 _ 1 7.1428 2 4 3 6 5 Control; No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 5.47 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 I vs C = 7.83 Time 3 I vs C = 9.46 G vs C = 7.40 Time 4 - Post Measure I vs C = 11.17 G vs C = 8.74 Time 5 - Post Measure I vs C = 7.20 G vs C = 11.19 Time 6 - Post Measure I vs C = 5.75 G vs C = 9.57 Category 4: Ten Minute Foreplay Source dF MS SS F Prob. Treat 2 42.088 21.044 6.10 0.0095 Time 5 2.7063 0.54127 0.24 0.9420 TRT*TM 10 16.191 1.6191 0.73 0.6965 Error 90 199.94 2.2215 Tota l 125 322.99 137 Contrast F Prob. 1. Indiv vs Group 1.566 0.22674 2. Indiv + Grp vs C n t r l 10.918 0.00394 Post Hoc Analyses by Adminstration Tukey C r i t i c a l Value K' = 3 = .'602 Time 1 - Pre Measure G vs C = 1.833 Time 2 G vs C = 1.98 I vs' G = 1.39 Time 3 I vs C = 1.75 G vs C = 1.43 Time 4 - Post Measure I vs G = .732 I vs C = 1.708 G vs C = .9782 Time 5 - Post Measure I vs G = .839 G vs C = 1.55 Time 6 - Post Measure G vs C = .9762 138 Category 5: 20 Minute Foreplay Source dF SS MS F Prob. Treat 2 9.7312 4.8656 6.07 0.0097 Time 5 1.4683 0.29365 0.41 0.8394 TRT*TM 10 7.1915 0.71915 1.01 0.4429 Error 90 64.174 0.71304 Tota l 125 96.992 Contrast F Prob. 1. Indiv vs Group 0.804 0, .38166 2. Indiv + Grp vs C n t r l 11.108 0, .00370 Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 1.07 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 No s i g n i f i c a n c e Time 3 No s i g n i f i c a n c e Time 4 - Post Measure No s i g n i f i c a n c e Time 5 Post Measure G vs C = 1.28 Time 6 - Post Measure I vs C = 1.50 Category 6: Foreplay 30 Minutes Source dF SS MS F Prob. Treat 2 1.4127 0,70635 1.39 0.2738 Time 5 0.89683 0.17937 0.87 0.5015 TRT*TM 10 2.1468 0.21468 1.05 0.4118 Error 90 18.456 0.20507 Tota l 125 32.040 Contrast F Prob. 1. Indiv vs Group 2.029 0. 17148 2. Indiv + Grp vs C n t r l 0.671 0. 42350 Category 7: Intercourse Source dF SS^  MS F_ Prob. 2.83 0.0856 0.65 0.6659 1.39 0^\^M Treat 2 55.005 27.502 Time 5 3.4921 0.69841 TRT*TM 10 15.072 1.5072 Error 90 97.436 1.0826 Tota l 125 346.16 Contrast F Prob. 1. Indiv vs Group 0.555 0.46585 2. Indiv + Grp vs C n t r l 4.972 0.03874 Post Hoc Analyses by Administration Tukey C r i t i c a l Values K' = 3 = 1.32 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 I vs C = 2.125 Time 3 I vs C = 1.71 Time 4 - Post Measure I vs C = 2.42 G vs C = 1.81 Time 5 - Post Measure" I vs C = 1.375 G vs C = 1.78 Time 6 - Post Measure I vs C = 1.625 G vs C = 1.5 Category 8: Orgasm Source dF SS MS I. Prob. Treat 2 4.3373 2.1687 1.42 0.2675 Time 5 0.53968 0.10794 0.65 0.6609 (continued) Source dF SS MS I Prob. TRT*TM 10 1.5556 0.15556 0.94 0.5022 Error 90 14.905 0.16561 Tota l 125 48.825 Contrast F Prob. 1. Indiv vs Group 0.437 0.51691 2. Indiv + Grp vs C n t r l 2.328 0.14448 Category 9: Number of Female I n i t i a t e d Sexual A c t i v i t i e s Source dF SS MS F Prob. Treat 2 33.032 16.516 1.23 0.3159 Time 5 16.063 3.2127 2.38 0.0448 TRT*TM 10 26.052 2.6052 1.93 0.05 Error 90 121.55 1.3506 Tota l 125 438.54 Contrast F Prob. 1. Indiv 2. Indiv vs Group + Grp vs C n t r l 0.000 2.453 0.98790 0.13468 Post Hoc Analyses by Condition Tukey C r i t i c a l Value K' = 6 = 1.81 Ind i v i d u a l : No s i g n i f i c a n c e Group: 1 3 6 5 4 2_ 1 1.93 2.0 3 6 5 4 2 1 Control: No s i g n i f i c a n c e Post Hoc Analyses by Administration Tukey C r i t i c a l Value K' = 3 = 1.484 Time 1 - Pre Measure No s i g n i f i c a n c e Time 2 G vs C = 1.9047 Time 3 I vs C = 1.959 Time 4 - Post Measure I vs C = 1.625 Time 5 - Post Measure I vs C = 1.625 G'.vs C = 1.785 Time 6 - Post Measure G vs C = 1.6429 143 APPENDIX XVIII DESCRIPTION OF VIDEO-TAPED VIGNETTES LIVING ROOM. F seated on chair looking at catalogue, M enters and s i t s on couch and picks up paper. Hold f o r 10-15 seconds. F speaks to M about something i n catalogue. Together they l e a f through catalogue, discussing various items, e.g., p i c t u r e s , f u r n i t u r e , F in d i c a t i n g where i t might go i n room. LIVING ROOM. F s i t t i n g on chair reading. M on couch reading. F turns on T,V. and s i t s next to M — exchange a few words. F leans back and M puts arm around shoulders and hold hands with other hand. (Zoom on hand holding, finger play and hand on shoulder. Fade out.) LIVING ROOM. M s i t t i n g on couch reading newspaper. F enters wearing coat. Speaks to M, b r i e f k i s s , and then takes o f f coat. S i t s beside M. They put arms around each other and k i s s — t h i s continues with increasing enthusiasm — Hps, neck, tongue, etc. (Close up and fade out.) LIVING ROOM. Same as Scene 3 but with M the aggressor. BEDROOM. F l y i n g on bed, clothed, watching T.V. M enters and s i t s on bed, leans over and kisses her. Talks for a few seconds, and then M leaves room. Zoom on happy female face. M returns, takes o f f shoes and l i e s beside F. They put arms around each other and k i s s 5-6 seconds. Intermingled t a l k and k i s s f or 30-40 seconds and fade out. BEDROOM. M on bed reading, f u l l y clothed. F enters, s i t s on edge of bed and ta l k s to M. Leans over and kisses M, 3-5 sees. F gets up takes o f f coat and leaves room. Returns i n 15-20 seconds. Lies down 144 and puts arms around M, Kisses him, They l i e together t a l k i n g and . b r i e f l y k i s s 4-5 times -— only s l i g h t l y sexual, 7. BEDROOM. F alone begins to get undressed, as i f for bed. Takes o f f shoes, pantyhose, blouse, s k i r t , s l i p , bra, and panties and puts on nightgown and l i e s on top of bed. This should l a s t as long as p r a c t i -c a l (3 mins). 8. BEDROOM, M alone begins to get undressed as f o r bed. Takes o f f shoes, socks, s h i r t , pants, shorts. Puts on pajamas and l i e s on top of bed reading. 9. LIVING ROOM, F on couch reading, M enters, s i t s along side her. T e l l s her he has sore back. She o f f e r s to rub his back. She unbuttons and removes h i s s h i r t . He l i e s on couch on stomach. F s i t s on knees on f l o o r and rubs back. They t a l k while t h i s i s going on. This i s not sexual. 10. BEDROOM. M and F standing by bed next to each other facing each other. M embraces F and kisses her on cheek, then l i p s . M and F move to bed and l i e next to each other embracing — camera zooms closer — couple k i s s n a t u r a l l y , pause — couple tongue k i s s i n g — zoom closer to mouth. 11. BEDROOM. M standing by bureau i n bedroom putting away socks or some items into bureau. F s i t t i n g on bed brushing h a i r (distant shot). Camera on F, F gets up and approaches M. M turns toward F — couple look at each other for about 5 sees, and then embrace. Camera zooms i n and around couple and up and down couple. During embrace couple whisper into each other's ear and smile and continue to embrace. 12. BEDROOM. M l y i n g on bed, clothed, watching T.V. F enters. S i t s on bed and kisses M, 5-10 seconds. L i e s beside M. They begin to k i s s — 145 l i p s , neck, ear, tongue. Zoom i n on t h i s . F runs hand up and down M Ts back. Zoom. M does the same. Two minute of passionate k i s s i n g and fade out. F should appear the aggressor. BEDROOM. F enters, turns on T.V. and l i e s on bed. M enters 10 sees, l a t e r . Speaks and l i e s on bed with F. They hold hands and watch T.V. 10-15 sees, F kisses M and he responds. They hold each other and ki s s passionately. F strokes M g e n i t a l i a over clothes. M fondles F breasts over clothes. M fondles F breasts over clothes and then undoes buttons on F dress and fondles breasts over brassiere. Close up of action and fade out. LIVING ROOM. M s i t t i n g on cha i r watching T.V. F enters, s i t s on couch and speaks to M, she wants him to s i t on couch. M moves to couch. F kisses M, t h i s continues with M running hands up F's back. She responds, continue k i s s i n g . M fondles F breasts over clothes (Close up and fade out.) LIVING ROOM. Same as Scene 5 but with M the aggressor: BEDROOM. M l y i n g on bed and reading. F enters, wearing s k i r t , sweater. Lies down with M and kisses him. They k i s s with increasing passion f o r about a minute. F puts M's hands on her breast, outside clothes, while continuing to k i s s and fade out. BEDROOM. M l y i n g on bed watching T.V. F enters, wearing s k i r t , sweater. S i t s on bed and kisses M. Lie s down with M. They k i s s with increasing passion; running hands up and down each other's back. M puts hand i n s i d e F's sweater and fondles breasts. F c l e a r l y enjoys t h i s . Zoom i n . They continue to k i s s and fade out. BEDROOM. Male s i t s alone nude, without erection: (close up of whole 146 body, concentration on g e n i t a l area), LIVING ROOM. Same as Scene 2 except roles reversed. M unbuttons and removes F blouse and bra. She l i e s on couch and he rubs back. This i s not sexual. BEDROOM. Male/female sensate - focus - nude. Nonsexual exploration of each others' body. BEDROOM. F i n bra and panties; M i n shorts. M and F l y i n g on bed conversing and looking at each other - distant shot. F embraces M and couple k i s s e s . M caresses F while k i s s i n g and moves hand from back to breast (over bra). Zoom to hand manipulation. Camera then moves s l i g h t l y back and F moves hand over M back and chest; M continues breast (over bra) fondling — camera zooms i n . BEDROOM. F i n bra and panties; M i n shorts. M and F l y i n g next to each other on bed (distant shot). M on stomach, F on back. Couple kisses and embraces. M caresses F stomach and fondles breasts. M moves hand over F's panties and caresses — zoom i n to male hand. BEDROOM. Same as Scene 9 except M caresses under panties as well as on top of panties. BEDROOM. F i n bra and panties; M i n shorts. M and F l y i n g next to each other on bed, M on stomach, F on back reading. Distant shot. M looks at F and places hand on stomach, caressing. Zoom i n . F puts down book and turns toward M — couple kisses. M moves hand to breast over bra fondling breast. M moves hand under bra fondling — zoom closer to breast. BEDROOM. M and F l y i n g next to each other, F on back, M on stomach. M places hand on F's stomach and kisses F (10 sees, distant shot). 14x7 Couple embrace warmly and k i s s again (camera zooms c l o s e r ) . Tongue k i s s i n g and camera zooms to mouth .'(10 sees). Couple part and then tongue kisses warmly again. LIVING ROOM. M l y i n g on couch watching T.V. F enters, shuts o f f T.V. and s i t s on couch and kisses M and then l i e s beside him. Continue k i s s i n g with increasing enthusiasm. M fondles F breasts over clothes and g e n i t a l i a . (Close up of k i s s i n g and touching and fade out). LIVING ROOM. Same as Scene 7 but M takes o f f F blouse and brassiere and fondles breasts. BEDROOM. M at bureau picki n g out pajamas, wife on bed combing h a i r (distant shot). F gets up and places comb on her bureau and ta l k s to M. Couple look at each other and then embrace. (Camera zooms i n concentrating mainly on arms but also up and down showing body contact) Couple moves apart s l i g h t l y s t i l l holding on to each others' arms then embrace again a f t e r looking at each other for about 5 to 10 seconds. LIVING ROOM. M reading on chair. F enters, speaks, and then takes M by hand and leads him to couch. They both l i e down and k i s s . F stroke M g e n i t a l i a over clothes. M strokes F over clothes and then puts hand under s k i r t and does same but not remove panties. Close up of faces, hands and fade out. LIVING ROOM. M s i t t i n g on chair reading. F s i t t i n g on couch. F moves and takes book from M and s i t s on lap. Kisses him. He responds and they continue k i s s i n g , neck, l i p s , tongue. M undoes buttons on F dress (blouse) and fondles breasts over brassiere. (Continues t h i s , close up and fade out.) BEDROOM. M undressing F. This should be done i n one continuous scene 148 within 3 to 4 minutes. K i s s i n g . BEDROOM. F undressing M. This should be done i n one continuous sequence with 3 to 4 minutes. Only removal of clothes. BEDROOM. F l y i n g on bed reading. M enters, s i t s on bed for a few seconds and then l i e s down and puts arm around F. She response and they k i s s with increasing passion, running hand over each other's back and upper legs over clothes and F strokes M g e n i t a l i a over clothes. (key st i m u l i not seen more than 5 sec.) Continue t h i s with k i s s i n g . Close up and fade out. LIVING ROOM. M alone b r i e f l y . Same as scenes 7 & 8 but a f t e r k i s s i n g for a while, F stands up and slowly takes o f f blouse and bra and then s i t s on M's lap and continue k i s s i n g and fondling. BEDROOM. M and F.enter bedroom. M s i t s on bed and removes shoes and socks. F touches up h a i r i n front and M puts arms around waist. F turns and they k i s s . M then slowly begins to unbutton F's blouse and takes i t o f f . Close up of t h i s and fade out. LIVING ROOM. M s i t t i n g on couch watching T.V. (30 sees). F enters dressed i n nightgown. Asks M about coming to bed. S i t s down with him and puts arm around him and kisses him. This with increasing enthusiasm. M fondles F breasts and s l i p s n i g h t i e from shoulder. Fondles and kisses breast and then F stands and leads M from room. The general notion here i s that F seduces M. LIVING ROOM. Same as Scene 13 of Tape 1 but roles reversed. M enters i n pajamas, s i t s next to F and begins to seduce her. M fondles F breasts. F puts hand i n M pajamas and fondles penis. M stands and leads F from room. 149 38. LIVING ROOM. M s i t t i n g on chair watching T.V. dressed i n pajamas. F enters i n nightgown. S i t s on couch watches T.V, 15^ -20 seconds. Gets up and shuts o f f T.V. T e l l s M to j o i n her on couch. M moves to couch. They s i t together and k i s s and t h i s increases, F unbuttons M pajamas top and removes i t . She then removes nightgown. M removes pajamas top and removes i t . She then removes nightgown. M removes pajama pants and they l i e on couch k i s s i n g and fondling each other. 39. BEDROOM. M and F on bed, M on back, F on stomach. Couple embracing and k i s s i n g . F moves apart s l i g h t l y revealing breasts. Camera zooms s l i g h t l y showing breasts. M moves hand from back to breasts and caresses. Couple turn so that M i s on stomach and F on back. M kisses F and moves hand to stomach and then to F's breasts. Zoom c l o s e r to breasts. 40. BEDROOM. Female caresses male geni t a l s over c l o t h i n g . 41. BEDROOM. M and F naked on top of bed. M l y i n g on back with F on top guiding penis into vagina. 42. BEDROOM. Male manipulation of female g e n i t a l s . (Caressing stomach, thighs, rubbing mons, i n s e r t i o n of finger.) 43. BEDROOM. M and F i n bed; M on stomach, F on back. Couple embracing and ki s s i n g . M moves hand to F's thigh and g e n i t a l area (zoom i n ) . Couple turncon side and both caress g e n i t a l area of partner. 44. BEDROOM. Female guiding male hands i n progressive exploration of body. 45. BEDROOM. M and F naked on top of bed. M l y i n g on back with F on top guiding penis into vagina. 

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