Metacognition in Patients with Premature Ejaculation and Erectile Dysfunction
Bagcioglu, Erman, Altunoluk, Bulent, Bez, Yasin, Soylemez, Haluk, Asik, Ahmet, Emul, Murat, Journal of Evidence-Based Psychotherapies
Anxiety is the most common intrapsychic component in male sexual dysfunction. Metacognition is considered to be the way of thinking about "thinking" which could be associated with anxiety. The aim of the study was to investigate the metacognition level of patients with premature ejaculation. Forty patients with premature ejaculation and 40 with erectile dysfunction, and a matched number of healthy people participated. Participants were asked to fill out Meta-cognitions Questionnaire-30, Beck Depression and Beck Anxiety Inventories. The total metacognition score was significantly higher in patients with premature ejaculation (p < .05) and erectile dysfunction (p < .05) than healthy controls. Total metacognition score was not significantly differed between sexual disorder groups (p > .05). The positive beliefs, negative beliefs scores were significantly higher in patients with sexual disorders (p < .05). The cognitive self consciousness score was significantly higher in patients with premature ejaculation than erectile dysfunction group (p < .05) and healthy controls (p < .05). Patients with sexual disorders might endorse the metacognitive belief that worrying about worriable problems can have positive effects in solving problems and avoiding unpleasant situations, which may be associated with sexual disorder.
Keywords: metacognition, premature ejaculation, erectile dysfunction, anxiety, worry
In the last two decades, the majority of sexual problems including premature ejaculation (PE) and erectile dysfunction (ED) have been related to anxiety. PE is further believed to have psychological consequences (i.e., low selfesteem, shameful feelings, depression) in patients suffering from this condition (Corona et al., 2006). Anxiety was found to be the most common psychological component in PE (Corona et al., 2004). Thus, it has been classically associated with anxiety-induced excessive sympathetic outflow (Corona et al., 2004; Rowland, Strassberg, de Gouveia Brazao, & Slob, 2000). PE is reported to be an early symptom of ED because of high anxiety experiences and feeling of frustration due to soft erection (Waldinger, 2002). Thus, a bidirectional relationship has been proposed between dysfunctional sexual response and negative emotional states including depressive, anxiety or obsessive compulsive symptoms which may contribute to, or be the consequence (Corona et al., 2008).
Metacognition is defined as "stable knowledge or beliefs about one's own cognitive system and knowledge about factors that affect the functioning of cognitive the system" (Marcantonio et al., 2010). In a metacognitive model, worry is viewed as an inflexible means of coping (Wells & King, 2006) and becomes a problem when negative beliefs concerning the uncontrollability and the dangers of worrying develop and lead to unhelpful control strategies. Patients with PE or ED have been described as preoccupied with thoughts about controlling their orgasm along with the anxious anticipation of a possible failure and thoughts about keeping their erection. We hypothesized that patients with PE or ED might endorse metacognitive thoughts such as "Worrying will help me get sexual problems sorted out in my mind" or "Ruminating will help me solve this sexual problem" . Thus, for the first time in the literature, we aimed to investigate the metacognitive characteristics of patients with PE and ED and to compare them with healthy controls, using a recently adapted form of the metacognition questionnaire (Wells & Cartwright-Hatton, 2004).
Forty eligible patients with primary PE and forty patients with ED who met the criteria according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised Text (DSM-IV, TR) participated in the study at the clinical settings of the University Hospital of Kahramanmaras Sutcu Imam, and Ergani State Hospital. …