Cognitive Schema Factors in Opioid Substance Abuser Men with Sexual Dysfunction

Abstract

Background: Cognitive schemas are conceptualized as the nuclear construction of the cognitive system. Schemas are responsible for the meaning assigned to a specific event and for directing behavioural and emotional reactions to external or internal stimuli.Aims: This study was aimed at cognitive schema factors in men receiving methadone maintenance treatment (MMT) with sexual dysfunction. These cognitive factors have been consistently associated with male sexual dysfunction. Methods:We recruited 150 Iranian male patients from several centers of Methadone Maintenance Therapy (MMT) in Tehran, city of Iran. Patients underwent structured interviews that consisted of a semi-structured interview was administrated which included questions on socio-demographics, drug use details, and sexual behaviour. Besides our Questionnaire of Cognitive Schema Activation in Sexual Context(QCSASC), we also used The Sexual Self-Efficacy Scale-Erectile Functioning (SSES-E).Results: As expected, the Cognitive Schema Activation in Sexual Context was positively correlated with Sexual Self-Efficacy-Erectile Functioning (SSES-E),(r = .772, p < .001); therefore people who have a greater negative schema activation described themselves as having lesser confidence in the erectile competence. Also most of the subscales on the QCSASC were positively associated with the Sexual Self-Efficacy-Erectile Functioning measured by this instrument. The results indicated that people with low scores in Sexual Self-Efficacy-Erectile Functioning (SSES-E) indicate lesser confidence in the man's erectile competence and they reported higher scores on the measures of QCSASC, that reflecting greater negative schema activation. Conclusion:Consistent cognitive pattern in persons experiencing sexual difficulties, characterized by core beliefs associated to a person's lack of qualification, autonomy, and low self-esteem may constitute a momentous vulnerability element for the development of sexual difficulties. Therefore nuclear cognitive structures may play a main role in predisposing persons to sexual difficulties. These results have important therapeutic implications for couple therapy and sex therapy. maladaptive schemas. Depression is characterized by negative views about one's self. In anxiety, the self is seen as inadequate and in anger and paranoid disorders as mistreated or abused by others. 12-14Beck 15 theorized that there are two broad categories of negative schemas generally related to psychopathological situations. Helpless schemas are mainly related to the idea that oneself is personally helpless (powerless, weak, or vulnerable) or incompetent (a failure, inferior, or a loser), and unlovable schemas are specially related to the idea of not being loved by others (undesirable or unworthy). 15 This conceptualization was also used by Beck, 16 who developed taxonomy of 28 core beliefs (14 helpless and 14 unlovable beliefs). 16 We think that this proposed list could represent the main ''pathological'' self-schemas and be an alternative to other validate...