Arousal Training

Description of the Strategy

Arousal training in adults may be used for a range of clinical disorders and may involve interventions to reduce or enhance levels of arousal. Patients need to be trained to detect their levels of arousal and then implement strategies to either increase or decrease these levels. Most particularly, arousal training may be effective for a range of anxiety disorders, where arousal levels need to be reduced, or for sexual dysfunction, where arousal levels may need to be increased. The two disorders that are considered in this entry are panic disorder and male erectile disorder. These two disorders have been chosen because (a) there is a clear association between levels of arousal and the disorder; (b) treatments have been developed to address the arousal symptoms; and (c) panic disorder illustrates high levels of arousal, whereas erectile disorder occurs as a result of low levels of arousal.

Panic Disorder

The symptoms of a panic attack include dizziness, sweating, a racing heart, trembling, shaking, and shortness of breath. People who are diagnosed with panic disorder experience recurrent, unexpected panic attacks. They experience high levels of anxiety about the consequences of their panic attacks, as well as concerns about future attacks.

Effective treatment programs for panic disorder help patients tune into their levels of arousal and then implement strategies to reduce their arousal levels before the onset of a panic attack. This may involve breathing retraining, which has a calming effect and serves to prevent the patient from hyperventilating. Cognitive restructuring, which involves a process of altering cognitions about panic attacks and also addressing the automatic thoughts that frequently accompany panic attacks, is also a useful strategy in the treatment of this disorder. Graded exposure to the situation that precipitates the panic attack is also a helpful strategy, particularly for patients who experience panic with agoraphobia. A hierarchy of events can be established, from least arousing to highest in arousal levels, and this hierarchy can be worked though using both controlled breathing and cognitiverestructuring techniques.

Male Erectile Disorder

Erectile disorder is a common problem among males, with estimates indicating that 40% of men over 40 years of age experience this problem. The disorder is likely to increase with increasing age. It is expressed as difficulty in a man experiencing sufficient levels of sexual arousal to obtain an erection. Erectile disorder may be either partial or complete, with some men experiencing a less robust erection and others experiencing a total loss of erectile capacity. There appear to be both physiological and psychological factors that contribute to the disorder.

Treatment for erectile disorder primarily focuses on variations of Masters and Johnson's sensate focus program. This program involves strategies to increase arousal through systematic desensitization. Essentially, the man is encouraged to focus on the enjoyment of the sexual interaction and not the extent of his erection. Stimulation commences in the general body areas, then moves progressively to the more sexual parts of the body. By taking the focus off performance and shifting the attention to sexual enjoyment, performance anxiety decreases and sexual arousal (and so the degree of the man's erection) increases.

...