Brief Emotion Regulation Training Facilitates Arousal Control During Sexual Stimuli

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Disgust, a negative emotion which evokes strong behavioral avoidance tendencies, has been associated with sexual dysfunction. Recently, it was postulated that healthy sexual functioning requires a balance between excitatory (increased sexual arousal)
  This article was downloaded by: []On: 02 October 2014, At: 01:34Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,37-41 Mortimer Street, London W1T 3JH, UK The Journal of Sex Research Publication details, including instructions for authors and subscription information: Brief Emotion Regulation Training Facilitates ArousalControl During Sexual Stimuli Mark van Overveld a  & Charmaine Borg ba  Rotterdam School of Management, Erasmus University Rotterdam b  Department of Clinical Psychology and Experimental Psychopathology , University of GroningenPublished online: 25 Sep 2014. To cite this article:  Mark van Overveld & Charmaine Borg (2014): Brief Emotion Regulation Training Facilitates Arousal ControlDuring Sexual Stimuli, The Journal of Sex Research, DOI: 10.1080/00224499.2014.948111 To link to this article: PLEASE SCROLL DOWN FOR ARTICLETaylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of theContent. Any opinions and views expressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon andshould be independently verified with primary sources of information. Taylor and Francis shall not be liable forany losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content.This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at  Brief Emotion Regulation Training Facilitates Arousal ControlDuring Sexual Stimuli Mark van Overveld Rotterdam School of Management, Erasmus University Rotterdam Charmaine Borg Department of Clinical Psychology and Experimental Psychopathology,University of GroningenDisgust, a negative emotion which evokes strong behavioral avoidance tendencies, hasbeen associated with sexual dysfunction. Recently, it was postulated that healthy sexual  functioning requires a balance between excitatory (increased sexual arousal) and inhibitory processes (lowered disgust levels). This suggests that amplification of excitatory processes(like sexual arousal) could be a valuable addition to treatments for affect-based sexual dys- functions. The major aim of the present study was to establish whether up-regulation could effectively enhance arousal levels during sexual stimuli, and whether such a training would simultaneously reduce disgust. Students ( N ¼ 163, mean age ¼  20.73 years,  SD ¼  2.35) weretrained in up-regulation of affect using either a sexual arousal film (i.e., female-friendlyerotic movie) or a threat arousal film clip (i.e., horror movie), while control groups viewed the films without training instructions. Following this, participants viewed and rated stateemotions during a series of pictures (sexual, disgusting, or neutral). Up-regulation of mood successfully enhanced general arousal in both groups, yet these arousal levels were not paralleled by reductions in disgust. Overall, the findings indicate that emotion regulationtraining by maximizing positive affect and general arousal could be an effective instrumentto facilitate affect-related disturbances in sexual dysfunctions. According to research on the human sexual responsecycle, healthy sexual functioning depends both on theactivation of several crucial components (Masters &Johnson, 1966) and the interaction among them, whichmay facilitate or hinder proper sexual functioning(Basson, 2001). One key factor in the sexual responsecycle for successful sexual behavior is the ability to gener-ate sufficient sexual arousal. Excitatory processes such assexual arousal may, however, in itself not be sufficient forhealthy sexual functioning. For example, many womenengage in sexual intercourse even when not yet sexuallyaroused (Brotto, Bitzer, Laan, Leiblum, & Luria, 2010).Hence, pleasurable sexual behavior could, in additionto bodily stimulation and elicitation of sexual arousal,depend on the effective reduction of inhibitory processeson sexual arousal (Janssen & Bancroft, 2007). Indeed,research has indicated that compared to men, womenfocus more on inhibitory processes while men focuson excitatory processes (Bancroft, Graham, Janssen, &Sanders, 2009). The dual control model posits that sexualbehavior reflects a balance between sexual excitatory andinhibitory processes (Bancroft et al., 2009).Emotions are likely candidates that could exert excit-atory or inhibitory influences on human sexual arousal,depending on emotional valence. In this regard, positiveas well as negative emotions are not merely outcomes of sexual arousal levels. Both positive and negative emo-tions impact sexual behavior directly by strengtheningor reducing levels of key factors within the sexualresponse cycle (e.g., levels of sexual arousal or sexualdesire;Graham,2010).Indeed,highlevelsofsexualdesireare associated with strong feelings of positive emotions,suchas high satisfaction andaffectionwith currentsexualrelationships (Carvalho & Nobre, 2011). Yet negativeemotions like fear related to self-perceived performanceand self-esteem may block the initiation of sexual arousaland = or sexual desire (Janssen, 2011). Further underliningthe importance of emotions on sexual behavior, individ-ual difficulty with regulating emotions predicted risky The authors wish to extend their gratitude to Sara Almeida for herefforts in the process of data acquisition.Correspondence should be addressed to Mark van Overveld,Department of Marketing Management, Rotterdam School of Management, Erasmus University Rotterdam, P.O. Box 1738, 3000DR Rotterdam, the Netherlands. E-mail: MOverveld@RSM.nlJOURNAL OF SEX RESEARCH,  0 (0), 1–10, 2014Copyright # The Society for the Scientific Study of SexualityISSN: 0022-4499 print = 1559-8519 onlineDOI: 10.1080/00224499.2014.948111    D  o  w  n   l  o  a   d  e   d   b  y   [   8   4 .   2   6 .   1   6   2 .   2   3   ]  a   t   0   1  :   3   4   0   2   O  c   t  o   b  e  r   2   0   1   4  sexual behavior in women (Messman-Moore, Walsh, &DiLillo, 2010).Of the potential emotions involved in sexualfunctioning, disgust may not appear an obviouscandidate to be involved in sexual behavior. Yet disgustis one of the basic emotions and functions as a defensemechanism to shield individuals against contaminationwith hazardous pathogens (Rozin, Nemeroff, Horowitz,Gordon, & Voet, 1995). Thus, disgust is evoked wherethe human body and external environment intersect.Indeed, individuals generally display heightened sensi-tivity toward contamination related to body partsand orifices, particularly the mouth and the genitalia(Rozin et al., 1995). In addition, humans are universallydisgusted by stimuli that involve the human body andits orifices, such as sweat, saliva, or sexual by-products(Rozin & Fallon, 1987). Increasing research attentionhas therefore focused on the role of disgust in sexualbehaviors (e.g., Borg & de Jong, 2012; de Jong, vanOverveld, & Borg, 2013). Disgust is an emotion typifiedby avoidance and could act as a powerful motivatorfor sexual withdrawal tendencies. A heightened disgusttoward genitalia and sexual by-products would renderpleasurable sexual behavior practically impossible.Indeed, previous work has shown that disgust appearsassociated with the occurrence of sexual complaints(e.g., women with lifelong vaginismus; van Overveldet al., 2012). Further, in the absence of sexual arousal,women generally respond to penetration stimuli withdisgust (Borg et al., 2014).In a recent review (de Jong et al., 2013), a model wasproposed whereby sexual arousal and disgust act asopposing forces during sexual functioning. Hence,encountering sexual stimuli could elicit both sexualarousal but also negative emotions such as disgust.Yet de Jong and colleagues (2013) posited that sexualarousal levels may counteract the effects of disgust andvice versa. Thus, in view of this model, the balancebetween the respective elicited responses determineswhether the outcome of the confrontation will result inarousal-induced sexual approach behavior or disgust-induced sexual avoidance behavior. Preliminaryevidence for this model presenting sexual arousal anddisgust as counteracting mechanisms has been obtained.In lab experiments, Borg and de Jong (2012) confirmedthat participants who were erotically stimulated were lessdisgusted and demonstrated lower disgust-inducedavoidance during aseries of disgusting (sex- and non-sex-related) behavioral experiments. Further, in men, sexualarousal was associated with a reduction in self-reportedlevels of disgust toward the prospect of, for instance,having sex with an extremely obese woman (Ariely &Loewenstein, 2006) and a perception of the disgustproperties of (previously considered disgusting) sexelicitors as less strong (Stevenson, Case, & Oaten, 2011).Following on from these findings, treatments of various sexual dysfunctions could be refined by focusingon amplifying key components of the sexual responsecycle (e.g., excitatory processes like sexual arousal)through emotion regulation training. Training parti-cipants in regulating emotions has alreadybeen examinedextensivelyandisassociatedwithawiderangeofbenefits,for example, in relationship satisfaction (Murray, 2005),trading performance (Sokol-Hessner et al., 2008), anxietyand arousal (Hofmann, 2009), as well as in stress (Jamie-son, Mendes, & Nock, 2013). With respect to enhancingor reducing the strength of experienced emotions, severalspecific techniques exist that are widely established (forseveral specific strategies, see also Richards & Gross,2000; Gross,2007; Gross & John, 2003; Koole, 2009), suchas training participants in down-regulation (i.e., weaken-ing emotional experiences) and up-regulation (i.e., maxi-mizing emotional experiences). Research has confirmedthat these strategies have differential effects on well-being(Livingstone & Srivastava, 2012) and are associated withdistinct patterns of neural activity (Ochsner et al., 2004).Further, up-regulation of positive emotions enhancedthe experience of positive emotions in patients withmood disorders, while down-regulation was associatedwith increases in negative emotions and relatedphysiological activity (i.e., heart rate increase; Gilbert,Nolen-Hoeksema, & Gruber, 2013). Consequently, ithas been suggested that amplifying positive emotionscould present a useful transdiagnostic tool in variousdisorders in which disturbances in affectual balanceare involved (Gilbert et al., 2013). Yet despite indica-tions that emotion regulation techniques may be helpfulto emotional control during sexual behavior (e.g.,Gillespie, Mitchell, Fisher, & Beech, 2012; Tull, Weiss,Adams, & Gratz, 2012), particularly the use of amplifi-cation (or up-regulation; Gross, 2007), such regulationhas rarely been applied to sex research to examinewhether sexual arousal could be effectively enhanced.Therefore, the major aim of the present study was toinvestigate whether a brief up-regulation training couldeffectively enhance arousal levels (and specificallywhether up-regulation of arousal during sexual stimulispecifically enhances arousal toward sexual stimuli).We limited our study to excitatory processes (i.e., ampli-fying threat or sexual arousal) because prior work hasalready shown that the emotion of disgust is difficultto extinguish (e.g., Smits, Telch, & Randall, 2002),indicating that standard down-regulation exercises maynot be sufficient to reduce disgust.Following the proposed relationship of sexualarousal with disgust (de Jong et al., 2013), proceduresto maximize arousal levels could be helpful in treatmentsof disorders that are characterized by disgust-inducedavoidance tendencies. Previous research has shown thatdisgust levels appear enhanced in women with (primary)lifelong vaginismus (van Overveld et al., 2012), andthese women also respond with greater disgust-specificphysiological reactivity to erotica instead of withsexual arousal (i.e., activity in facial electromyography VAN OVERVELD AND BORG 2    D  o  w  n   l  o  a   d  e   d   b  y   [   8   4 .   2   6 .   1   6   2 .   2   3   ]  a   t   0   1  :   3   4   0   2   O  c   t  o   b  e  r   2   0   1   4  [EMG] of levator labii; Borg & de Jong, 2012). Disgustappraisals for sexual intercourse, and = or for sexualstimuli in general, could hinder the generation of sexualdesire and = or sexual arousal in these patients andmotivate sexual avoidance behavior. If indeed sexualarousal and disgust levels are opposing forces, thentraining participants to manipulate individual arousallevels by enhancing excitatory processes (i.e., sexualarousal) may automatically be paralleled by a changein inhibitory factors (i.e., experiencing lower disgustduring sexual stimuli).In addition, different types of arousal exist and maydemonstrate separate associations with disgust. Forexample, while general arousal (i.e., excitement) couldbe difficult to disentangle from sexual arousal, and bothof these types could be associated with enhanced sexualapproach behavior, the reverse may be observed forthreat arousal. Threat arousal is triggered as part of the fight-or-flight response and will be more stronglyassociated with survival instincts and avoidance beha-vior. Interestingly, prior research has observed thatthreat stimuli in fact enhanced sexual arousal in parti-cipants (e.g., Beck, Barlow, Sackheim, & Abrahamson,1987). Yet this was attributed to the role of automaticand = or controlled cognitive processes. Instead of focus-ing on inhibiting influences during generation of sexualarousal (e.g., threat), cognitive processes helpedparticipants stay focused on sexual arousal. Further,neuroimaging research showed that areas in the brainassociated with arousal (i.e., amygdala; Tettamantiet al., 2012) are involved in all basic emotions. Emotion-al valence would then provide direction with respect tothe interpretation of general arousal levels. Therefore,an alternative explanation could be that when indivi-duals are aroused (i.e., general arousal), cognitiveprocesses facilitate the shift toward arousal stateswith distinct valence dimensions (i.e., threat or sexualarousal) and related behavioral consequences.Threat arousal and sexual arousal (and = or generalarousal) could exert opposing effects on sexual behavior.Indeed, prior research indicated that sexual arousal couldbe distinguished from other forms of arousal in neuralactivity (Walter et al., 2008). In addition, women whoviewed threat-related films demonstrated enhancedpelvic floor muscle activity (van der Velde & Everaerd,2001; van der Velde, Laan, & Everaerd, 2001), whichlikely reflects a protective mechanism in women ratherthan sexual excitation. In the same study, a discordancewas also observed where physiological reactivity wasnot paralleled with higher subjective sexual arousallevels,strengthening the claim that a defensive reaction could beinvolved during threat arousal. Thus, up-regulation of sexual arousal could be associated with decreased statedisgust for sexual stimuli, while up-regulation of threatarousal may not decrease disgust for sexual stimuli at all.Hence, to test the specificity of the proposed sexualarousal and disgust model, the second aim of our studywas to examine whether up-regulation would onlydecrease disgust levels after enhancing arousal in asexual context (sexual film clip). Therefore, we selectedthreat arousal as a control condition because weexpected that only enhanced sexual arousal would beassociated with a reduction in disgust levels. MethodParticipants All participants were business administrationstudents at the Rotterdam School of Management atErasmus University Rotterdam ( N  ¼ 163; 97 men and66 women). The participants had a mean age of 20.73years ( SD ¼ 2.35). Nearly half of the participants werenot in a relationship during the testing phase (49.1%; n ¼ 80); the rest were in a stable relationship with inti-mate sexual contact (36.2%;  n ¼ 59), in an open relation-ship with intimate sexual contact (11%;  n ¼ 18), or neverhad an intimate sexual relationship (3.7%;  n ¼ 6). Of themen, 96.9% ( n ¼ 94) indicated they were mainly attractedto women, 2.1% ( n ¼ 2) to men, and 1% ( n ¼ 1) to both.Of the women, 92.4% ( n ¼ 61) were mainly attracted tomen, 4.5% ( n ¼ 3) to women, and 3% ( n ¼ 2) to both. 1 Participants were randomly assigned to one of fourgroups: a sexual arousal up-regulation group (SAU; n ¼ 42; 19 women), a threat arousal up-regulation group(TAU;  n ¼ 40;15women),asexualarousalnonregulationgroup (SANR;  n ¼ 40; 18 women), and a threat arousalnonregulation group (TANR;  n ¼ 41; 14 women). Measures Disgust Propensity and Sensitivity Scale–Revised (DPSS-R; van Overveld, de Jong, Peters, Cavanagh, &Davey, 2006).  The DPSS-R measures dispositionaltendency to respond with disgust to any given situation(propensity) as well as the tendency to evaluate theexperience of disgust negatively (sensitivity). Participantsrate 12 items on a scale from 1 ( Never ) to 5 ( Always )on how often they experience disgust (propensity) andits emotional impact (sensitivity). The DPSS-R was psy-chometrically investigated in various studies (Fergus &Valentiner, 2009; van Overveld et al., 2006; van Overveld,de Jong, & Peters, 2010) and is a valid and reliableindex for measuring disgust propensity ( a ¼ .76 in presentstudy) and disgust sensitivity ( a ¼ .73 in present study). Sexual Disgust Questionnaire (SDQ; de Jong, vanOverveld, Weijmar Schultz, Peters, & Buwalda, 2009). The SDQ indexes a participant’s willingness to handleitems after contamination with sexual contaminants. 1 Because some of the picture stimuli presented heterosexualactivities, we additionally performed all analyses after excludinghomosexual individuals from the analyses. The results of the analysesdid not differ.BRIEF EMOTION REGULATION TRAINING 3    D  o  w  n   l  o  a   d  e   d   b  y   [   8   4 .   2   6 .   1   6   2 .   2   3   ]  a   t   0   1  :   3   4   0   2   O  c   t  o   b  e  r   2   0   1   4  The SDQ measures both the individual willingness totouch contaminated items (SDQ-Willingness) as wellas the level of disgust participants would experience if they were to touch these items (SDQ-Disgustingness).Participants rate six items for willingness (and the samesix for disgustingness) on a scale from 0 ( Certainly notwilling = disgusting ) to 8 ( Certainly willing = disgusting ).The items in both the SDQ-W and SDQ-D are con-taminated by two potential sources (familiar persons,unknown persons). Prior research showed that theSDQ is a valid index for measuring disgust towardsexual stimuli (van Overveld et al., 2012;  a s in range.63 to .83 in present study). Need for Arousal (NFA; Figner, Mackinlay, Wilkening,& Weber, 2009).  The NFA measures individual tend-ency to require a certain level of general (nonspecific)arousal in daily functioning. On 8 items, participantsrate from 1 ( Does not apply at all  ) to 8 ( Strongly applies )whether a series of descriptions describe their daily rou-tine appropriately and whether they experience or seekgeneral arousal during their daily routine. It is a validscale for indexing individual desire to experience generalarousal ( a ¼ .68 in present study). Film stimuli.  To induce arousal, four film clips wereused. Two films were used for inducing threat arousaland two for sexual arousal. For threat arousal, we selec-ted two film clips from  Halloween  (a women enteringa dark and silent house looking for her friend) and The Silence of the Lambs  (a detective chasing a mur-derer through his house). These film clips were editedin accordance with suggestions by Hewig and colleagues(2005) and lasted approximately 3.5 minutes. For sexualarousal, we used 7 minutes from a female-friendly eroticfilm ( De Gast ; a man and a woman undress and beginhaving sexual intercourse), which were split into two3.5-minute films. Previous research found these filmclips to be effective in inducing threat arousal orsexual arousal (Hewig et al., 2005; Borg & de Jong,2012). Pictures.  For the picture-viewing task, we used 18pictures that we proposed would induce either disgust(six pictures), (sexual) arousal (six pictures), or nothingat all (six pictures). The neutral pictures were all takenfrom the International Affect Pictorial System (IAPS;Lang, Bradley, & Cuthbert, 2008). 2 For the sexualstimuli, we used pictures that we used in prior research(penetration pictures from Borg et al., 2014 combinedwith IAPS pictures). However, to cover a wider varietyof sexual behaviors (e.g., oral sex, tongue kissing)and because some IAPS pictures appear slightlydated, additional pictures were obtained using theInternet. For disgust, all pictures were obtainedthrough the Internet (e.g., garbage, a jar of maggots,moldy bread, a woman licking a toilet bowl, salivadripping from a tongue, a person sleeping in a puddleof vomit). 3 Last, to index state emotions following the films andeach picture, visual analog scales (VASs) were usedwhere participants rated how strongly they felt a seriesof emotions (‘‘To what extent did you experience the fol-lowing emotions during the film: disgust = fear = plea-sure?’’). Participants then rated how strongly they feltdisgust, fear, and pleasure on a 10mm line, representinga scale from 0 ( Not at all  ) to 100 ( Always ). As parti-cipants may not perceive arousal as an emotion per se,a separate question was used for arousal with identicalscaling (‘‘How arousing was this film = picture?’’). Procedure Participants were recruited through the university’sdigital board where advertisements can be placed forstudy recruitment purposes for lab studies. An onlineadvertisement was placed for a study on emotions dur-ing sexual stimuli. This was done to prepare participantsfor the explicit nature of some of our study stimuli.Upon arrival at the lab, students were briefed on thestudy and provided informed consent. Next, each par-ticipant was seated in an isolated cubicle. Dependingon group membership, participants received either anonsexual threat arousal film (i.e., a five-minute filmfrom the movie  The Silence of the Lambs ) or a sexualarousal film (i.e., a five minute excerpt from the female-friendly erotic film  De Gast ). Next, VASs were com-pleted on state emotions during the film. Participantswere then instructed to view the next movie (nonregula-tion groups) or to watch the movie while trying toamplify their emotions (up-regulation groups). Theexact instructions are provided in the Appendix. Priorstudies using similar instructions have been found effec-tive to amplify emotions (e.g., Giuliani, McRae, &Gross, 2008; Ochsner et al., 2004). Again, participantswould view a threat arousal film or a sexual arousal filmin a sequential order. This allowed us to investigatewhether up-regulation effectively enhanced arousalwithin individuals. Afterward, participants completedthe VASs.Next, participants rated a series of 18 pictures (sixneutral, six core disgust, six sex) that were presented ina fixed (randomized) order. Participants rated howmuch general arousal, disgust, and pleasure they feltduring the 6-second presentation of the pictures. Finally,participants completed a short survey with all the trait 2 For neutral stimuli, the corresponding IAPS numbers are: basket(7010), mug (7009), stool (7025), book (7090), lamp (7175), and anabstract art wall decoration (7185). For sexual stimuli, we used thefollowing IAPS pictures: oral sex (4658, 4659) and a man lying ontop of a woman (4669).  3 All pictures are available from the corresponding author.VAN OVERVELD AND BORG 4    D  o  w  n   l  o  a   d  e   d   b  y   [   8   4 .   2   6 .   1   6   2 .   2   3   ]  a   t   0   1  :   3   4   0   2   O  c   t  o   b  e  r   2   0   1   4
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