For all disorders, the CBT therapist starts by educating clients about their diagnosis, helps them set goals, and socializes them to CBT by teaching them essential thinking and behavioral skills.
CBT for both premature ejaculation and erectile problems focuses on removing the pressure to perform. Anxiety about performance causes men to focus away from their own sensations, develop thoughts of failure, and tense their bodies when sexually aroused. CBT therapists teach these clients relaxation and refocusing tools to heighten awareness of their sensations, to focus on pleasure, to reduce anxiety and the demand to perform. Sensate focus, a form of intimate touch without intercourse, is one tool used to reduce pressure, and is of particular use for erectile dysfunction. A variety of tools (stop, start or squeeze methods) can be used to delay ejaculation.
Treatment of painful intercourse centers on the role anxiety has in triggering or exacerbating pain. Clients learn muscle relaxation, coping statements, communication skills, guided imagery, and mindful awareness to reduce the muscle tension and negative self-focus associated with pain. Similar interventions may be used with orgasmic difficulties, with a special emphasis on overall stress reduction, as well as examining beliefs that lead to feelings of shame, embarrassment or guilt.
In all cases, couples therapy may also be used to explore issues in communication, to offer practice in listening and self-expression skills, and to examine beliefs the partners have about themselves and their relationship.