Self-Help Therapies for Sexual Dysfunction
van Lankveld, Jacques, The Journal of Sex Research
Not everybody with a sexual problem goes to visit a professional. Some individuals, for various reasons, cannot; other individuals do not want to. Moreover, the capacity of the sexual health care service in many countries and regions is insufficient to accommodate the potential demand for help. As a result, in the last 4 decades various forms of "minimal interventions" in the treatment of sexual dysfunctions have been developed. In these interventions, contact with a professional who delivers treatment is limited or absent. Among these minimal interventions are self-help groups, bibliotherapy (i.e., self-help with assistance of a therapy manual, leaflet, or book), video therapy (with assistance of audiovisual material), telephone-based therapy, Internet-based therapy, and computer-based treatment algorithms. Some forms, like bibliotherapy, have proliferated and occupy a stable position in the field of treatment, as they are used by large numbers of individuals and couples that seek help. To accommodate these numbers, hundreds of new self-help titles are published every year. To illustrate, a search on March 25, 2008, of the amazon.com Web site, using self-help and sexual as search terms, resulted in 2,106 hits. Other interventions, such as Internet-based treatments, have only recently been put forward. Still others (like telephone-assisted therapist-administered treatments) are used mainly in specific, natural circumstances, for example, when people live large distances from mental health service centers or because they live abroad or in isolated geographical places rendering direct contact with a therapist difficult or impossible.
Beyond sexual problems, minimal intervention strategies, often termed self-help therapies, exist for a broad range of mental and physical health problems (for a handbook of self-help therapies, see Watkins & Clum, 2008). In this review, the term self-help is used to represent both the constructs of self-help and the minimal interventions that are implemented. Self-help methods can be classified into self-help groups and media-based self-help (Watkins & Clum, 2008, p. 1), the latter including bibliotherapy, video therapy, therapy through telephone contact, Internet-based therapy, and computer-assisted therapy. This review is restricted to media-based self-help.
Self-help methods can further be classified into (a) general, (b) problem-focused, and (c) technique-focused (Pantalon, 1998). General self-help approaches do not address specific disorders or self-help techniques, but focus on general aspects of mental health such as coping skills or the role of health attitudes. This approach contrasts with problem-focused methods, which provide tools for assessment and treatment for specific types of problems, for example, sexual arousal disorder. Technique-focused methods typically offer a method to reach a behavioral goal or emotional change that can be applied across different types of problems. Examples in the field of sexual problems are manuals that aim to teach the user to self-apply the principles of classic and operant conditioning (e.g., Kass & Strauss, 1975) or cognitive restructuring (van Lankveld, 1993, 2004). The majority of empirical outcome studies have been limited to the investigation of problem-focused self-help approaches, rather than general or technique-focused approaches.
The questions addressed in this review are (a) What is the position of media-based self-help approaches among the remedies for sexual problems?, and (b) What is their empirical status with regard to efficacy?
The Position of Self-Help Approaches Among the Remedies for Sexual Problems
Sexual dysfunctions are fairly prevalent among men and women. For example, a recent survey in The Netherlands among more than 4,000 adults between 18 and 70 years of age showed that lifetime prevalence of unspecified sexual dysfunction, meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed. …