Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T09:33:36.811Z Has data issue: false hasContentIssue false

Sex therapy outcome research: a reappraisal of methodology

Published online by Cambridge University Press:  09 July 2009

J. Bancroft*
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
M. Dickerson
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
C. G. Fairburn
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
J. Gray
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
J. Greenwood
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
N. Stevenson
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
P. Warner
Affiliation:
MRC Reproductive Biology Unit, Edinburgh
*
1Address for correspondence: Dr J. Bancroft, MRC Reproductive Biology Unit, 37 Chalmers Street, Edinburgh EH3 9EW.

Synopsis

In the first section a controlled treatment study of male sexual dysfunction is described. ‘Unlucky’ randomization of subjects yielded treatment groups which differed with respect to variables of possible prognostic significance. Hence the results are largely uninterpretable.

In the second section the predominantly negative or inconsistent findings in sex therapy outcome research are reviewed and methodological problems, such as those described in the first part, are considered as possible reasons for these negative findings. The interrelationships are explored between (i) small treatment groups, (ii) prognostic variability, (iii) bias, (iv) power, and (v) small expected treatment effects. A strategy for future research is proposed, with particular emphasis on the recognition and use of relevant prognostic indices.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1986

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aleong, J. & Bartlett, D. E. (1979). Improved graphs for calculating sample sizes when comparing two independent binomial distributions. Biometrics 35, 875881.CrossRefGoogle Scholar
Altman, D. G. (1980). Statistics and ethics in medical research III. How large a sample? British Medical Journal 281, 13361338.CrossRefGoogle ScholarPubMed
Altman, D. G. (1984). A fair trial? British Medical Journal 289, 336337.CrossRefGoogle ScholarPubMed
Arentewicz, G. & Schmidt, G. (1983). The Treatment of Sexual Disorders. Basic Books: New York.Google Scholar
Bancroft, J. (1983). Human Sexuality and its Problems, pp. 257263. Churchill Livingstone: Edinburgh.Google Scholar
Bancroft, J., Tyrer, G. & Warner, P. (1982). The classification of sexual problems in women. British Journal of Sexual Medicine 9 (81), 3037.Google Scholar
Carney, A., Bancroft, J. & Mathews, A. (1978). Combination of hormonal and psychological treatment for female sexual unresponsiveness: a comparative study. British Journal of Psychiatry 132, 339346.CrossRefGoogle Scholar
Cochrane, W. G. (1957). Analysis of covariance: its nature and uses. Biometrics 13, 261281.CrossRefGoogle Scholar
Cooper, A. J. (1969). Disorders of sexual potency in the male: a clinical and statistical study of some factors related to short-term prognosis. British Journal of Psychiatry 115, 709719.CrossRefGoogle Scholar
Crowe, M. J. (1978). Conjoint marital therapy: a controlled outcome study. Psychological Medicine 8, 623636.CrossRefGoogle ScholarPubMed
Crowe, M. J., Gillan, P. & Golombok, S. (1981). Form and content in the conjoint treatment of sexual dysfunction: a controlled study. Behaviour Research and Therapy 19, 4754.CrossRefGoogle ScholarPubMed
Dow, M. G. T. (1983). A controlled comparative evaluation of conjoint counselling and self-help behavioural treatment for sexual dysfunction. Unpublished Ph.D Thesis: University of Glasgow.Google Scholar
Everaerd, W. (1977). Comparative studies of short-term treatment methods for sexual inadequacies. In Progress in Sexology (ed. Gemine, R. and Wheeler, C. C.), pp. 153166. Plenum: New York.CrossRefGoogle Scholar
Everaerd, W. & Dekker, J. (1982). Treatment of secondary orgasmic dysfunction. A comparison of symptomatic desensitisation and sex therapy. Behaviour Research and Therapy 20, 269274.CrossRefGoogle Scholar
Eysenck, H. J. & Eysenck, S. B. J.. (1966). Manual of the Eysenck Personality Inventory. Hodder & Stoughton: London.Google Scholar
Glover, J. (1983). Factors affecting the outcome of treatment of sexual problems. British Journal of Sexual Medicine 10 (102), 2831.Google Scholar
Gore, S. M. (1981). Assessing clinical trials – trial size. British Medical Journal 282, 16871689.CrossRefGoogle ScholarPubMed
Hawton, K. & Catalan, J. (1986). Prognostic factors in sex therapy. Behaviour Research and Therapy (in the press).CrossRefGoogle Scholar
Heiman, J. R. & LoPiccolo, J. (1983). Clinical outcome of sex therapy. Archives of General Psychiatry 40, 443449.CrossRefGoogle ScholarPubMed
Jehu, D. (1979). Sexual Dysfunction. A Behavioural Approach to Causation, Assessment and Treatment. Wiley: Chichester.Google Scholar
Lansky, M. R. & Davenport, A. E. (1975). Difficulties in brief conjoint treatment of sexual dysfunction. American Journal of Psychiatry 132, 171175Google ScholarPubMed
Lashoff, J. D. (1969). Analysis of covariance: a delicate instrument. American Educational Research Journal 6, 383407.CrossRefGoogle Scholar
Leiblum, S., Rosen, R. & Pierce, D. (1976). Group treatment format: mixed sexual dysfunction. Archives of Sexual Behavior 5, 313322.CrossRefGoogle Scholar
Locke, H. J. & Wallace, K. M. (1959). Short marital adjustment and prediction tests: their reliability and validity. Marriage and Family Living 21, 251255.CrossRefGoogle Scholar
Lord, F. M. (1958). Further problems in the measurement of growth. Educational and Psychological Measurement 18, 437451.CrossRefGoogle Scholar
Lord, F. M. (1967). A paradox in the interpretation of group comparisons. Psychological Bulletin 68, 304305.CrossRefGoogle ScholarPubMed
Marks, I. M. (1981). Review of behavioural psychotherapy II. Sexual disorders. American Journal of Psychiatry 138, 750756.Google ScholarPubMed
Mathews, A., Bancroft, J., Whitehead, A., Hackman, A., Julier, D., Bancroft, J., Gath, D. & Shaw, P. (1976). The behavioural treatment of sexual inadequacy: a comparative study. Behaviour Research and Therapy 14, 18611881.CrossRefGoogle ScholarPubMed
Mathews, A., Whitehead, A. & Kellett, J. (1983). Psychological and hormonal factors in the treatment of female sexual dysfunction. Psychological Medicine 13, 8392.CrossRefGoogle ScholarPubMed
Michal, V. (1982). Arterial disease as a cause of impotence. Clinics in Endocrinology and Metabolism 11 (3), 725748.CrossRefGoogle ScholarPubMed
Munjack, D., Cristol, A., Goldstein, A., Phillips, D., Goldberg, A., Whipple, K., Staples, F. & Kanno, P. (1976). Behavioural treatment of orgasmic function: a controlled study. British Journal of Psychiatry 129, 497502.CrossRefGoogle Scholar
Nelder, J. A. (1974). Log linear models for contingency tables: a generalisation of classical least squares. Applied Statistics 23, 323329.CrossRefGoogle Scholar
Nieschlag, E., Mauss, J., Coert, A. & Kicovic, P. (1975). Plasma androgen levels in men after oral administration of testosterone or testosterone undecanoate. Acta Endocrinologica 79, 361374.Google ScholarPubMed
O'Carroll, R. & Bancroft, J. (1984). Testosterone therapy for low sexual interest and erectile dysfunction in men: a controlled study. British Journal of Psychiatry 145, 146151.CrossRefGoogle Scholar
Obler, M. (1973). Systematic desensitisation in sexual disorders. Journal of Behaviour Therapy and Experimental Psychiatry 4, 93101.CrossRefGoogle Scholar
Orlinsky, D. E. & Howard, K. I. (1978). The relation of process to outcome in psychotherapy. In Handbook in Psychotherapy and Behavior Change (ed. Garfield, S. L. and Bergin, A. E.). Wiley: New York.Google Scholar
Riley, A. J. & Riley, E. J. (1978). A controlled study to evaluate directed masturbation in the management of primary orgasmic failure in women. British Journal of Psychiatry 133, 404409.CrossRefGoogle ScholarPubMed
Skakkebaek, N. E., Bancroft, J., Davidson, D. W. & Warner, P. (1981). Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study. Clinical Endocrinology 14, 4961.CrossRefGoogle Scholar
Sloane, R. B., Staples, F. R., Cristol, A. H., Yorkston, N. J. & Whipple, K. (1975). Behaviour Therapy versus Psychotherapy. Commonwealth Books: London.CrossRefGoogle ScholarPubMed
Snyder, D. K. & Berg, P. (1983). Predicting couples' response to brief directive sex therapy. Journal of Sex and Marital Therapy 9, 114120.CrossRefGoogle ScholarPubMed
Wagner, G. & Green, R. (1981). Impotence: Physiological, Psychological, Surgical Diagnosis and Treatment. Plenum: New York.CrossRefGoogle Scholar
Whitehead, A. & Mathews, A. (1977). Attitude change during behavioural treatment for sexual inadequacy. British Journal of Social and Clinical Psychology 16, 275281.CrossRefGoogle ScholarPubMed
Winer, B. J. (1962). Statistical Principles in Experimental Design, pp. 672673.McGraw-Hill: New York.CrossRefGoogle Scholar