Twenty-four obese women were randomly assigned to 1 of 2 group treatments: behavioral choice treatment (BCT) or traditional behavioral treatment (TBT). BCT uses decision theory to promote moderate behavior change that can be comfortably, and therefore permanently, maintained. Groups completed a moderate-intensity walking program and obtained feedback from computerized eating dairies. The TBT group evidenced greater weight loss at posttreatment. However, the TBT group also evidenced a trend to regain weight, whereas the BCT group continued a slow weight loss during follow-up. Exercise followed a similar pattern. Both groups decreased in restraint and increased in self-esteem.

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According to a recent model of psychogenic erectile dysfunction (Sbrocco & Barlow, 1996), dysfunctional performance results from focusing on negative outcome expectancy and low confidence following a discrepancy between expected and actual performance. The purpose of the current study was to manipulate the experience of sexually functional and dysfunctional males to produce a discrepancy between expected and actual performance. Fifty-six sexually functional and 57 sexually dysfunctional men were assigned to one of four groups (negative feedback, neutral feedback. inflated feedback, or no feedback). Penile tumescence was recorded while viewing two 5-minute erotic videotapes. All participants viewed film 1 without feedback. Next. the feedback subjects were told the average score for an erection and were asked to predict the score they would receive during film 2 and how confident they were. While viewing film 2, the negative feedback group received feedback that their scores were below their prediction, the neutral feedback group received feedback that their scores were what they predicted. and the inflated feedback group was shown their scores were higher than predicted. After film 2, they were again asked to predict their scores on a subsequent (bogus) film and rate their confidence.Contrary to the Sbrocco and Barlow model, positive feedback decreased tumescence for both the dysfunctionals and functionals. This occurred. despite an increase in expectancy, confidence, and self-reported arousal. Also in contrast with the Sbrocco and Barlow model, ii negative feedback resulted in decreased outcome expectancy but did not induce a change in tumescence for the dysfunctionals. Finally, negative feedback unexpectedly resulted in decreased tumescence for the functionals.The only variable that predicted changes in tumescence was the self-reported level of surprise concerning the feedback. For both the dysfunctionals and functionals, the feedback groups that experienced a decrease in tumescence were more surprised by the feedback than the groups that experienced no change in tumescence.In conclusion, the present study found that positive expectations for and confidence in functional sexual performance may be necessary but not sufficient factors for successful tumescence. Positive outcome expectancies and confidence may only be useful if the man is not surprised by his performance. LIST OF FIGURESCross section of male pelvic region and cross section of penis Barlow's (1986Barlow's ( , 1988 model of sexual dysfunction Barlow, Sakheim, and Beck's (1983) shock threat paradigm Abrahamson, Barlow, Sakheim, Beck, and Athanasiou's (1985) What we do know is that a sexual situation involves the integration of information from various sensory modalities and sources. Information is internally and externally generated and cognitively processed in order to produce a sexual response. Obtaining and maintaining an erection is a complex process that requires not only normal physiological responding, but also functional cognitive a...

A false feedback paradigm was used to produce a discrepancy between expected and "actual" tumescence among 57 sexually dysfunctional and 58 sexually functional men randomly assigned to one of four false tumescence feedback conditions: negative (NEG), neutral (NEU), positive (POS), or no (NO) feedback. Participants predicted an erection score before viewing an erotic film and then received false tumescence feedback based on this score. Tumescence and cognitive ratings were obtained before and after the feedback. It was predicted that discrepancies would differ between dysfunctional and functional participants such that functional participants would have the ability to overcome discrepancies, whereas dysfunctional participants would not. As expected, POS decreased tumescence for dysfunctional participants and NO did not influence tumescence for either group. Unexpectedly, NEU decreased tumescence for dysfunctional participants and NEG decreased tumescence for functional participants. Despite tumescence changes, cognitive ratings generally followed the feedback that was given. These results only partially support current models of sexual dysfunction and behavioral regulation. Anxiety, self-focused attention, cognitive interference, and unexpectedness of the feedback could not account for the partial support. However, most feedback that was outside of the realm of the status quo for both functional and dysfunctional participants did decrease tumescence, despite outcome expectancies. These results suggest that both functional and dysfunctional men may be at risk for erectile failure should feedback about their performance be discrepant from what they expect. Prevention and treatment should focus on preparing men for occasional erectile failure and on helping them overcome discrepant feedback.