The basis of conditioned-reflex therapy, as this type of treatment is also called, is the extinction of the pathological and the formation of adequate conditioned reflexes. It eliminates learned forms of behavior at the expense of the principle that you can get rid of any inadequate syndrome by following the same path.
This method is used in cases where rapid ejaculation was formed as a result of the man’s fear of being caught off guard at the first experience of mating or practicing masturbation, and maybe even when accelerated ejaculation occurs due to a sudden cessation of intercourse due to hostility towards sex or illness of the wife partners).
The destruction of the undesired syndrome of accelerated ejaculation and the formation of a normal behavioral program for increasing the time of sexual intercourse adapted to the specific situation is the goal of behavioral therapy.
Various techniques of foreign authors, as a rule, are individual, focused on a specific patient. Nevertheless, a positive effect in treatment was observed in many specialists who used such methods as reciprocal inhibition, systematic desensitization, weaning (aversive therapy), etc.
The essence of this method is quite clearly described in the psychotherapeutic encyclopedia. Half a century ago, in 1950, J. Volpe formulated the position that the state of anxiety is a behavioral stereotype, determined by entrenched reactions to situations that cause anxiety. In cases where premature ejaculation is caused by a reaction to anxiety and fear of the inevitability of early ejaculation, the connection between anxiogenic stimulus and reflex anxiety can be weakened if at the same time an inhibiting factor acts, such as muscle relaxation, such as relaxation buttocks, back muscles, etc.
This principle of anti-conditioning, as J. Volpe called it, formed the basis of the method of systematic desensitization proposed by him (desensitization). In the course of therapy, a man is introduced into a number of individually typical anxiogenic situations represented by him, ranked by the increase in their anxiety. At the same time, with the help of tranquilizers, hypnosis, or autogenic training, muscle relaxation is caused, which reduces an anxiety reaction. A man moves to more difficult situations as the absence of habitual anxiety becomes fixed in the preceding ones.
As a result of this treatment, he masters the skill of self-control over premature ejaculation in real life with the help of the muscle relaxation technique he has mastered.
This is one of the first methods of behavioral psychotherapy. Just as in the previous case, it can be used in the treatment of premature ejaculation only of a neurotic nature, largely determined by anxiety and the need to reduce its level. This form of behavioral psychotherapy serves to reduce emotional susceptibility to premature ejaculation.
Psychiatrists know that actions performed in the imagination can be equated to actions performed by a person in reality. The imagination in a state of relaxation is no exception to this rule. Fear, anxiety about premature ejaculation can be suppressed, if you combine in time the incentives that cause fear, and incentives that are antagonistic to fear. Counterconditioning will occur — a non-fear stimulus will quench the former reflex.
The logic of the rationale for this method is that in humans one of the effective incentives, the opposite of fear, is relaxation. Therefore, if you train a man of deep relaxation and in this state to induce him to conjure up incentives that cause an increasing degree of anxiety, the patient will be desensitized to real incentives or situations causing fear.
The method itself is relatively simple: in a man who is in a state of deep relaxation, ideas about sexual intercourse with accelerated ejaculation are caused, which leads to the emergence of fear. Then, by deepening the relaxation, the resulting anxiety is removed. In the imagination, there are various situations from the easiest to the most difficult, causing the greatest fear. The procedure ends when the strongest stimulus stops causing the patient fear. In the procedure of systematic desensitization itself there are three stages: mastering the method of muscle relaxation; creating a hierarchy of situations that cause fear; desensitization itself (a combination of ideas about situations that cause fear, with relaxation).
Training muscle relaxation according to the method of progressive muscle relaxation of S. Jacobson is carried out at an accelerated pace and takes about 8-9 sessions.
The hierarchy of fear situations and their ranking according to the degree of fear experienced should be drawn up together with the psychotherapist. An indispensable condition for compiling this list is the patient’s real experience of fear in such a situation, that is, it should not be imaginary.
Actually desensitization. A feedback technique is discussed – informing a psychotherapist of a man about the presence or absence of his fear at the moment of presenting the future termination of sexual intercourse. For example, he informs about the absence of anxiety by raising the index finger of his right hand, and on the presence of it by raising the finger of his left hand.
A man imagines a situation of 5-7 seconds, then, by heightening relaxation, eliminates the alarm that has arisen. And this period lasts about 20 s. The presentation of the situation is repeated several times, and if anxiety does not arise in a man, they proceed to the next, more difficult situation, for example, restraining ejaculation during the plateau phase. In the case of the emergence of severe anxiety that does not fade when the situation is repeated, they return to the previous situation.
Such sessions can be from 4-5 to 12 and more. This method is less effective when anxiety is caused by a somatic disease or is reinforced by promiscuous sex life. In this case, the method of systematic desensitization will be effective only if it is combined with personality-oriented types of psychotherapy, aimed, in particular, at understanding patients’ motives for their behavior, and treating the primary disease. This technique is effective only if there is a good contact of the psychotherapist with the patient. They compile and rank the list according to the degree of fear of situations, which include weakening of erection, sharp ejaculation, detachment of the partner, obstruction of comrades, inability to have a full sexual intercourse, difficulty in conceiving a child, etc.
This method has the greatest effect when the man and the doctor determined the situation quite accurately (the partner’s identity, the time of intercourse, the state of the man at that moment, the degree of physical or mental stress, or anything else) in which the fear for premature ejaculation took place.
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