Abstract
Objective: The aim of this case study is to change the cognitive-behavioral and sex-therapy mechanisms to reduce sexual distress, relieve anxiety and shift the focus to solving the problem of premature ejaculation of a 35-year-old patient, reaching the stage of changing the sexual focus with the sensory one, by diversifying the excitatory stimuli so that his pleasure and satisfaction help him maintain a normal functioning of his sexual and mental life.
Methods: In the therapeutic intervention we applied CBT intervention techniques in cognitive behavioral therapy thus analyzing cognitions, behaviors, and emotions. 1. Standard testing, 2. Sexual testing, 3. Treatment plan. The standard clinical psychological testing used anamnesis and clinical observation, structured, semi-structured and unstructured clinical interviews (Delcea C. 2021) as well as clinical evaluation scales The Generalized Anxiety Disorder 7 (GAD 7), The Patient Health Questionnaire (PHQ- 9) Depression Scale, Beck's Depression Inventory (BDI II), Trauma Symptom Checklist (TSC-40), Symptom Checklist 90-R, Attachment Style Identification Questionnaire (Diana Poole Heller). For sexual testing we used the PESI-Premature Ejaculation Severity Index questionnaire, sexual interviews (Delcea C., 2021).
Methodology used in sex therapy intervention: 1. To understand the stimuli of excitement, pleasure, and relaxation, we used the Genogram of excitatory stimuli (Delcea C., 2019) to focus other stimuli on the favorite erogenous zone of the present model of arousal. 2. We used the CBE model (Cognition, Behavior, Emotion) in the cognitive restructuring of dysfunctional cognitions as well as the relational model for identifying and establishing the couple relationship and relational cooperation as well as intimacy and communication. 3. We decreased sexual distress involving decreased performance anxiety as well as relaxation techniques, anticipatory steps technique, distributive thinking technique, management technique, sexual anxiety (fear of performance), disturbance management, relationship management (Standardized intervention model SON, Delcea C ., 2019) as well as progressive desensitization, awareness of critical points and self-help by taking responsibility for the problem, gaining control over ejaculation and understanding the situation of premature ejaculation, improving communication, overcoming the barrier of privacy, accepting one's feelings about dysfunction, growth in one's own sexual performance as well as resolving interpersonal conflicts that maintain dysfunction. 4. Methods of Psychoeducation: The human sexual response, the anatomy and physiology of the male and female body as well as the analysis of the genitals, the change of the cognitive system regarding everything in a positive and playful note of the situation.
Results: In the PHQ-9 test score = 10, the subject has no clinical depression. In the GAD-7 test, the score = 8 shows that the subject has a slight anxiety, which correlates with the interview data regarding his performance anxiety. In the TSC 40 test score = 10, the subject does not present clinical symptoms of trauma. In the BDI test - 2 score = 12, it shows the presence of a slight mood disorder without symptoms of clinical depression. The SC 90-R test does not show any mental disorders present on Axis I - II. From the test we notice that Marian has a slight anxiety related to his sexual problem of premature ejaculation, thus finding out that the anxiety causes him a slight fear of sexual performance. He had unrealistic expectations of him as a man considering that a normal sexual act lasts 30 minutes, having no control over his ejaculation, his sexual scenarios and fantasies being unimaginative, he is seeing sexuality as a performance not as an exchange of emotions and feelings in the making of moments of affection.
Conclusions: Following the applied methodology, the subject presented a positive evolution, acquiring information about his dysfunction and the human sexual response.
Publisher
The Sexology Institute of Romania