A theoretical model for sexual performance anxiety (SPA) and a clinical approach for its remediation (SPA-R)

Anxiety, and more specifically performance anxiety, is commonly associated with sexual problems both by health professionals and clients alike. Yet, despite its strong association with sexual dysfunctions, the conceptualization and understanding of performance anxiety are seldom provided in a comprehensive and detailed manner that imparts utility for its remediation.

Here, we offer a theoretical model for sexual performance anxiety that directly informs a clinical approach for its remediation, with the goal of better preparing clinicians who routinely work with, counsel, and treat men and women experiencing a sexual problem.

We first lay a groundwork that explains the general characteristics of anxiety as a psychological construct and emotion and briefly summarize 2 overarching models that relate anxiety to performance. Then we present a theoretical model that provides a heuristic for understanding sexual performance anxiety (SPA) and review factors purported to moderate and mediate anxiety in sexual performance situations. Finally, we present a clinical approach for its remediation (SPA-R) that is directly tied to the theoretical model (SPA), specifically demonstrating how consideration of various targets in the flow chart can serve as a roadmap for addressing performance anxiety within a psychotherapeutic context.

We highlight and explain each aspect of the model and delineate the connection between the model and its application, summarizing a number of key principles inherent to the therapeutic process.

We offer both this theoretical model and remedial clinical application not necessarily as the only or even best solution for dealing with clients suffering from sexual performance anxiety but as a challenge to stimulate both critique and further discussion, elaboration, and research on this critically important, though somewhat neglected, topic.