Assessment of distraction from erotic stimuli by nonerotic interference.

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Assessment of Distraction From Erotic Stimuli by Nonerotic Interference a

Alex B. Anderson & Lisa Dawn Hamilton

a

a

Psychology Department , Mount Allison University Published online: 10 Mar 2014.

To cite this article: Alex B. Anderson & Lisa Dawn Hamilton (2014): Assessment of Distraction From Erotic Stimuli by Nonerotic Interference, The Journal of Sex Research, DOI: 10.1080/00224499.2013.876608 To link to this article: http://dx.doi.org/10.1080/00224499.2013.876608

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JOURNAL OF SEX RESEARCH, 0(0), 1–10, 2014 Copyright # The Society for the Scientific Study of Sexuality ISSN: 0022-4499 print=1559-8519 online DOI: 10.1080/00224499.2013.876608

Assessment of Distraction From Erotic Stimuli by Nonerotic Interference Alex B. Anderson and Lisa Dawn Hamilton

Downloaded by [INASP - Pakistan (PERI)] at 23:16 20 November 2014

Psychology Department, Mount Allison University Distraction from erotic cues during sexual encounters is a major contributor to sexual difficulties in men and women. Being able to assess distraction in studies of sexual arousal will help clarify underlying contributions to sexual problems. The current study aimed to identify the most accurate assessment of distraction from erotic cues in healthy men (n ¼ 29) and women (n ¼ 38). Participants were assigned to a no distraction, low distraction, or high distraction condition. Distraction was induced using an auditory distraction task presented during the viewing of an erotic video. Attention to erotic cues was assessed using three methods: a written quiz, a visual quiz, and a self-reported distraction measure. Genital and psychological sexual responses were also measured. Self-reported distraction and written quiz scores most accurately represented the level of distraction present, while self-reported distraction also corresponded with a decrease in genital arousal. Findings support the usefulness of self-report measures in conjunction with a brief quiz on the erotic material as the most accurate and sensitive ways to simply measure experimentally-induced distraction. Insight into distraction assessment techniques will enable evaluation of naturally occurring distraction in patients suffering from sexual problems.

The ability to focus and attend to environmental cues plays a vital role in our individual perceptual experiences and resulting behavior. Attentional processes are considered multidimensional: They can be modulated by the emotional relevance of the cue and interrupted by increased cognitive load and task demands (e.g., complex mathematical problem solving; Compton, 2003). Attentional processes play a key role in sexual functioning, and attention to erotic cues is essential to adequate sexual response. As outlined by Masters and Johnson (1970) and Barlow (1986), nonerotic distractions during a sexual situation disrupt attention toward relevant erotic cues and can contribute to difficulty with sexual arousal, desire, and orgasm in men and women. In a survey of nonerotic thoughts during sexual activity, 92% of participants reported at least one nonerotic thought in their recent sexual experiences (Purdon & Holdaway, 2006). Nonerotic thoughts that interfere with attention to appropriate erotic cues and=or induce anxiety have been associated with low levels of sexual response (Nobre & Pinto-Gouveia, 2008). Research has also linked nonerotic distracting thoughts about

Hannah Burroughs, Patrick Joyce, Amanda Julian, Shawn Seeley, and Lindsay Sherwood assisted in the recruitment of participants and the collection and entering of data for this research. Pilot data for the distraction task were collected by Dexter Van Dam and Samantha Binns. Correspondence should be addressed to Lisa Dawn Hamilton, Psychology Department, Mount Allison University, Sackville, New Brunswick E4L 1C7, Canada. E-mail: [email protected]

performance and bodily appearance anxiety to reports of negative body image and sexual dissatisfaction (Meana & Nunnink, 2006), as well as low self-esteem and inconsistent orgasm (Dove & Wiederman, 2000). In a laboratory setting, Koukounas and McCabe (1997) examined the sexual, attentional, and emotional processes that contribute to sexual stimulation. Participants rated their levels of absorption, emotional response, and their degree of arousal to an erotic film. Results indicated that both men and women reported greater sexual arousal to the sexual stimuli when they became absorbed in the activities portrayed in the film than when they were distracted. The effects of attention on arousal have been demonstrated in experimental laboratory studies of voluntary attention, where participants have been able to manipulate their level of arousal by changing their cognitive strategy. For example, fantasizing and positive thoughts are used to increase arousal, while concentrating on distracting, nonsexual, and negative thoughts (e.g., pain) are used to suppress genital and psychological sexual responding in men and women (Beck & Baldwin, 1994; Cerny, 1978; Laan, Everaerd, van Aanhold, & Rebel, 1993; Laws & Rubin, 1969). A number of experimental paradigms have also manipulated participants’ level of attention through simulated distractors to draw attention from sexually relevant stimuli and directly test the link between distraction and arousal. These distractors include sexually relevant, anxiety-provoking tasks, such as estimating


ANDERSON AND HAMILTON

the percentage of erection (Abrahamson, Barlow, & Abrahamson, 1989), as well as neutral, nonsexual distraction, such as simple addition tasks completed during the simultaneous viewing of erotic stimuli (Adams, Haynes, & Brayer, 1985). Studies of neutral distraction have generally demonstrated that cognitive interference inhibits genital arousal. For men, genital arousal has been found to decrease during the simultaneous viewing of erotic stimuli and the completion of both visual (Koukounas & Over, 1999) and auditory nonerotic distraction tasks across increasing task complexity (Geer & Fuhr, 1976; van Lankveld & van den Hout, 2004). In a study conducted by Abrahamson and colleagues (1989), a neutral distraction task required participants to estimate the length and width of a straight line. Findings were inconsistent with other studies of neutral distraction, such that the task did not affect genital arousal. The authors attributed these findings to the simplicity of the distractor task, highlighting the importance of cognitive load in the inhibition of sexual arousal. Similar to studies involving men, neutral cognitive distraction has been found to affect genital arousal in women when presented to the visual and auditory modalities. Prause and Heiman (2010) found that both reported and genital arousal decreased during a film with visual distortions as compared to the same stimulus without added distraction. Elliott and O’Donohue (1997) measured genital arousal in women while participants listened to an erotic audiotape in conjunction with no, low, and high auditory distraction. They found that genital arousal was significantly lower in the high-distraction condition compared to the no-distraction condition, while genital arousal for the low-distraction condition fell between the two but was not significantly different from either. Similarly, Salemink and van Lankveld (2006) implemented five levels of distraction during the presentation of auditory erotic stimuli and found that only the highest level of distraction significantly impaired arousal compared to a control condition. The results for psychological sexual arousal have been less clear. In studies using visual erotic films where psychological arousal was measured continuously in real time (Abrahamson et al., 1989; van Lankveld & ven den Hout, 2004), increases in distraction have not affected men’s psychological arousal response. Of the studies that measured subjective arousal retrospectively, Koukounas and Over (1999) found a negative relationship between reaction time to a distracting probe and psychological arousal during the presentation of an erotic film. Przybyla and Byrne (1984) measured psychological arousal retrospectively after exposing male and female participants to auditory distraction during separate conditions of auditory and visual erotic stimuli. Both men and women reported less subjective arousal with increasing task complexity while listening to an erotic audiotape. For the erotic film, however, a sex difference emerged, whereby increased auditory distraction inhibited psychological 2

arousal in women but not in men. These findings were attributed to reported sex differences where men are found to be more responsive than women to visual cues. The simultaneous presentation of a neutral distractor and erotic audiotape has been found to decrease psychological sexual arousal in women when measured retrospectively (Elliott & O’Donohue, 1997) and continuously (Adams et al., 1985; Przybyla & Byrne, 1984). These deleterious effects have also been documented during the viewing of erotic films where psychological arousal was measured continuously (Prause & Heiman, 2010; Przybyla & Byrne, 1984). Salemink and van Lankveld (2006) measured psychological arousal in women both continuously and by retrospective report. Results supported the inhibitory effects of distraction on retrospective measures of sexual response using a visual analogue scale; however, these findings did not extend to the continuous measure of psychological arousal using a rotating button. As reviewed, past research efforts have established the negative relationship between sexual functioning and cognitive distraction; however, few studies have attempted to assess participants’ level of attention to erotic stimuli during cognitive interference tasks. Given the negative effects of distraction on sexual functioning, it is important to identify ways to assess naturally occurring distraction in patients experiencing sexual difficulties. To date, studies have assessed participants’ level of distraction through self-report measures (Adams et al., 1985), as well as tests of attention to video stimuli using a quiz on the subject matter after the presentation of erotic stimuli (Elliott & O’Donahue, 1997; Hamilton & Meston, 2013; Seal & Meston, 2007). In their study, Elliott and O’Donohue (1997) assessed distraction by having participants complete both a written quiz about material presented in an erotic audiotape and also report on the level of distraction they experienced during the cognitive task on a 10-point Likert scale. The authors reported that the number of correct responses on the written quiz varied as a function of no-, low-, and high-distraction levels (although they did not report means or post hoc test results), with higher scores corresponding to lower levels of distraction and vice versa. Self-reports of distraction also showed a significant increase as distraction level increased. The direct correlation between these distraction manipulation checks and genital or psychological sexual arousal was not analyzed. More recently, Hamilton and Meston (2013) found that scores on a written, multiple-choice quiz correlated with genital arousal in women. These findings support the use of post-stimulus quizzes and direct self-report measures in studies of cognitive distraction and auditory erotic stimuli. Previous research has used both self-report and written tests to assess the level of attention to erotic elements during the presentation of erotic stimuli. Self-reported measures of distraction rely heavily on participant introspection and awareness of their level of attention; therefore, using a more implicit test, such

ASSESSMENT OF DISTRACTION FROM EROTIC STIMULI


as a quiz, to assess attentional focus could be more accurate. With erotic films, however, there is usually very little verbal material, so the usefulness of a written test to assess attention to visual erotic cues is unclear. In addition to testing the effectiveness of a written test, the present study also included a visual test, which may be more appropriate for assessing attention to visual erotic stimuli. The primary aim of the present study was to identify the most accurate assessment of distraction during the presentation of sexual stimuli by comparing three different methods: a written quiz, a visual quiz, and a Likert scale self-report, while exposed to different levels of an auditory distractor. We expected to replicate past research showing the deleterious effects of nonerotic distraction on arousal responses in men and women without sexual difficulties. The present study addressed three research questions: RQ1: Which method of assessing attention most accurately represents the level of distraction present during the viewing of erotic film clips? RQ2: Which method of assessing attention best corresponds with both genital and psychological sexual arousal? RQ3: Are there gender differences in attention to erotic stimuli in conjunction with cognitive distraction?

Method Participants Participants were 29 men and 38 women ranging in age from 18 to 36, with a mean age of 20.3 years (SD ¼ 3.11), recruited from an undergraduate psychology course and from the community. A student researcher visited introductory psychology courses to advertise the study and provide contact information for participation, and the study was advertised on the psychology department participant recruitment website. In addition, flyers advertising the study were posted in the community to recruit nonstudent volunteers. Students received course credit for their participation, and nonstudent volunteers were compensated with $20 for their time. Participants were excluded if they met any of the following criteria: (a) under the age of 18; (b) exclusively attracted to same-sex people; (c) no previous sexual activity; (d) currently pregnant; (e) currently taking medications known to affect vascular or sexual functioning; (f) difficulty with mental or physical sexual arousal; (g) past sexual abuse resulting in distress; (h) any neurological impairment; (i) diagnosed with sexually transmitted disease; (j) not fluent in English; (k) and left-handed. All participants reported having been sexually active with a partner; 18 men (78%) and 19 women (66%) reported sexual activity with a partner within the past month. Table 1 summarizes the demographic characteristics for both male and female participants.

Table 1. Demographic Characteristics for Male and Female Participants Characteristic Ethnicity Aboriginal Asian European=White=Caucasian Latino=a Did not report Sexual orientation Heterosexual Bisexual Unlabeled Relationship status Single Casual dating In a relationship Has children

Male (n ¼ 29)

Female (n ¼ 38)

2 1 27 1

31 1 4

29

31 6 1

10 4 15

17 7 14 1

Materials Film. Film stimuli included two 12-minute videos, each consisting of a one-minute display of the word relax, three minutes of a neutral nature video clip, followed by eight minutes of an erotic film clip. Each erotic film clip consisted of a heterosexual couple engaging in consensual petting, oral sex, and vaginal intercourse. All participants saw both videos, and the order of presentation was counterbalanced across participants. Auditory distraction. An auditory distraction task was presented to participants through headphones while they viewed the erotic portion of the video. This distractor was modeled after the neutral distraction task in Elliott and O’Donohue (1997). Auditory distracting stimuli were presented to participants’ right ear only to account for functional specializations for language in the left hemisphere. Due to atypical language lateralization in left-handed and ambidextrous individuals, participants were required to identify as right-handed (Szaflarski et al., 2002). In the no-distraction control condition, audio for the erotic video was presented to the left ear only, with no added distraction. In the experimental low- and high-distraction conditions, audio for the erotic video was presented to the left ear only, and a list of distracting sentences was presented to the right ear only (see Table 2 for the list of sentences). In the lowdistraction condition, instructions appeared on the screen directing participants to repeat each sentence out loud into a microphone attached to the headphones. In the high-distraction condition, instructions were given on the screen to repeat the sentence out loud and then say it a second time, backward (Elliott & O’Donohue, 1997). A new sentence was presented every 12 seconds for the duration of the eight-minute erotic film clip, for a total of 40 sentences per video. A 12-second delay between each sentence was found to be adequate time 3



Table 2.

List of Auditory Distraction Sentences

Sentence Series 1

Sentence Series 2

It is my aunt’s birthday. She is turning 50. We are having a party. People will arrive soon. I am baking a cake. Chocolate is her favorite. The band will play music. There is a stage outside. The decorations are up. There are lots of balloons. They are yellow and red. My neighbor is a chef. He will serve the food. Everyone will like the menu. The dessert is my cake. The party is a secret. There will be a crowd. The whole family is coming. Her friends will be too. My aunt will be surprised. I’m going to the store. I need eggs and flour. It will not take long. I put on my shoes. No need for a jacket. Outside the sun is bright. The kids are playing ball. They ask me to join. It is my favorite game. I can’t stay too long. I will miss the party. I help score two goals. The goalie is very fast. The big dog is barking. He is very friendly. I continue on my way. The market is very busy. I will buy her a present. She will like the flowers.

I am with my friend. We are at the game. This is the best season. I love to watch baseball. I wave to my brother. He is on the team. We sit on the bleachers. They are selling food. I pay for my hot dog. There are lots of people. The teachers are watching. Friends and family are too. I can see my old coach. His son plays baseball. He is a fast runner. I am wearing my jersey. My friend wears his too. The sky is cloudy and dark. I hope it doesn’t rain. The game is almost over. It is our turn to bat. It is a close game. All the fans are cheering. We hope they will win. The pitcher throws the ball. The batter takes a swing. He misses once again. ‘‘Strike two,’’ yells the umpire. This is not his day. He will bat once more. The bat hits the ball. It is high in the air. It lands in the outfield. The batter runs to first. Loud cheers are heard. Will he make it home? He slides to home base. ‘‘Safe,’’ shouts the umpire. They have won the game.

Note. Sentences were counterbalanced across the two videos and across the order of presentation.

for participants in the high-distraction condition to repeat the sentence both forward and backward. There were two sequences of sentences and each told a different story. The sentence sequences were counterbalanced across the videos. To enhance their focus on the distraction stimuli, participants were advised that they might be tested on the narrative material. Distracting sentences were designed to be five words in length and to be of the same difficulty and relevance. The narratives were simplistic, neutral, and nonsexual in nature, and provided sufficient details that could be reported in a hypothetical recall task. Table 2 provides a list of the two different sequences of distraction sentences. Genital arousal. For women, genital response was measured using a vaginal photoplethysmograph, measuring vaginal pulse amplitude. Vaginal pulse amplitude was 4

continuously measured in millivolts (mV) throughout the video sequences and calculated using the amplitude of the pulse signal, or the difference between the peak and the trough of each pulse wave. For men, the penile plethysmograph was used to measure circumference change in millimeters (mm). Vaginal pulse amplitude and penile plethysmograph measures were sampled at 500 samples per second using a Biopac MP36 data acquisition system (Santa Barbara, CA). Data were recorded and analyzed using Acknowledge 4.1 software (Santa Barbara, CA). To compare men’s and women’s genital arousal, data were z-transformed across videos for each participant. Z-scores were then averaged across the neutral video and erotic video. A z-transformed difference score was then calculated for each participant for both videos (Mean Erotic Z-Score – Mean Neutral Z-Score). Psychological arousal. Both retrospective and continuous reports were used to measure psychological arousal. An ‘‘arousometer’’ was used to measure psychological arousal. The arousometer is a variable assessment transducer from Biopac, and was run with the Biopac MP36 data acquisition system. The device consists of a finger-sized lever mounted onto a plastic track marked by nine equal intervals. Participants were told that each interval represented increasingly higher levels of feeling sexually aroused, such that ‘‘0’’ indicated no feelings of sexual arousal and ‘‘9’’ indicated intense feelings of sexual arousal. No participants moved the lever during the neutral condition. Analysis was conducted by averaging psychological arousal during the erotic phase of the study. Similar to Salemink and van Lankveld (2006), we also used a one-item retrospective measure of psychological arousal in the post-video questionnaire. Following each video, participants ranked their response to the following questions on a scale from 1 (Not at all) to 10 (Extremely): (1) How aroused were you by the erotic video? (2) How enjoyable was the erotic video? Questionnaires Screening interview. An initial telephone interview was conducted to examine participation eligibility. Participants were required to meet the specified inclusion criteria, and those who qualified were asked to come to the lab to participate in the study. Demographics. The demographics questionnaire consisted of 20 items collecting information such as gender, age, ethnicity, sexuality, relationship status, and past experience with erotic material. Women were also asked about their menstrual cycles. Sexual functioning. The Female Sexual Function Index (FSFI) was used to examine current levels of sexual function in women (Rosen et al., 2000). The FSFI is a 19-item questionnaire based on a 5-point Likert



scale. The scale is scored on the six domains of desire, arousal, lubrication, orgasm, satisfaction, and pain, which are all scored out of six. For the purpose of this study, the domains of arousal and lubrication were assessed. Scores below the cutoff of three were comparable to clinical reports of psychological and physical sexual arousal difficulty (Wiegel, Meston, & Rosen, 2005). The International Index of Erectile Function (IIEF) was used to assess current levels of sexual function in men (Rosen et al., 1997). The IIEF consists of 15 items, including the following subscales: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. For the purpose of this study, the arousal domain of erectile function was assessed, in which men scoring below the cutoff of 20 were considered to experience moderate or severe erectile dysfunction (Rosen, 2004). All participants scored above cutoffs for sexual functioning on these measures. Attention. To measure participants’ attentional focus, an Adult ADHD Self-Report Scale version 1.1 (ASRS) was administered. The scale consisted of the 18 Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for adult attention deficit hyperactivity disorder (ADHD; Kessler et al., 2005). Responses to each item were based on a 5-point scale ranging from Never to Often. Following Kessler and colleagues’ (2005) guidelines, an ‘‘inattentive’’ score and a ‘‘hyperactivity’’ score were computed and categorized as follows: highly likely to have ADHD (24–36); likely to have ADHD (17–23); and unlikely to have ADHD (0–16). For the purpose of the current study, only inattentive scores above 24 were considered predictive of attention difficulty. Given that 60% of the general population reportedly displays some symptoms of inattentiveness and hyperactivity (Arcos-Burgos & Acosta, 2007), it was important to exclude only participants from the current study who were likely to be severely functionally impaired by their inattention difficulties. All participants scored below the cutoff, and no data were excluded from final analyses. Assessing distraction. The primary outcome measure for the study was the assessment of distraction. Three different methods were used to assess distraction. The first method was a visual images quiz (visual quiz), which consisted of 20 still images presented on the television screen for two seconds each; 10 images were taken from the erotic video participants had just watched, and 10 were taken from other portions of the video that participants did not see (scenes that were edited out). Participants were asked to indicate for each image whether it was in the video they had just seen. The second method was a multiple-choice quiz (written quiz), which consisted of 13 questions pertaining to the erotic video. Questions were designed to assess attention to details shown in the video. Both the written quiz and visual quiz

were scored by calculating the number of correctly answered questions and reporting the percent correct. Participants completed the visual quiz following one video and the written quiz after the other video. The order of quiz completion was counterbalanced across participants and conditions. The third method was a self-report of distraction (self-reported distraction) in the post-video questionnaire. After each video, participants ranked the following items on a scale from 1 (Not at all) to 10 (Extremely): (1) How distracted were you during the erotic video? (2) How hard was it to pay attention to the erotic video? The self-report items were reverse coded so that they would be in the same direction as the quiz scores—higher scores indicated less distraction. Procedure All procedures were approved by the Mount Allison University Research Ethics Board. Participants were first screened over the phone before being scheduled for an individual appointment. Upon arrival at the laboratory, the researcher explained the details of the study verbally and in writing, and the participant provided written informed consent. Once alone in the internally locked testing room, the participant was instructed to either insert the vaginal photoplethysmograph into the vagina (women) or place the penile plethysmograph on the flaccid penis (men). During a 10-minute habituation period, the participant sat quietly in a recliner and filled out the demographics questionnaire. The participant was then instructed to put headphones on. Each participant was randomly assigned to a no-, low-, or high-distraction condition based on a preestablished ordering system. The visual showing the word relax and the neutral portions of the video were promptly followed by instructions for the auditory distraction task, which was presented immediately before the erotic portion of the video. During the relax, neutral, and erotic video phases, continuous measures of genital and psychological arousal were recorded using the vaginal photoplethysmograph=penile plethysmograph and the arousometer. The participant was then instructed to complete the post-video questionnaire, and then either the written quiz or the visual quiz. Following completion of the post-video assessments, the participant completed the FSFI or IIEF, the ASRS, and a series of filler questionnaires before viewing the second video to ensure arousal returned to baseline.

Results The current study examined the effects of distraction on genital and psychological sexual arousal to determine the best way to assess distraction in a laboratory setting. Due to equipment malfunction, genital data were not included for 11 female participants and 1 male 5



participant. Due to participants forgetting to use the arousometer, data were omitted for nine female participants and no male participants. Specifically, one woman forgot to use the arousometer during Video 1 only, two women during Video 2 only, and six women during both videos. We also assessed scores on the ADHD inattentiveness scale. There were no significant differences across the no-distraction (M ¼ 13.4, SEM ¼ 1.03), low-distraction (M ¼ 15.1, SEM ¼ 1.0), and high-distraction (M ¼ 12.5, SEM ¼ 1.19) conditions, F (2, 61) ¼ 1.5, p ¼ .22; therefore we did not control for inattentiveness scores in our analyses. However, there was a gender difference on inattentiveness t(63) ¼ 2.65, p ¼ .01, such that women (M ¼ 15.22, SEM ¼ .80) scored higher than men (M ¼ 12.07, SEM ¼ .88). To assess the effect of the distraction task on genital arousal, z-transformed difference scores were entered into a repeated measures analysis of variance (ANOVA) (first video, second video) with gender and distraction condition as independent variables. There was a main effect of condition, F (2, 47) ¼ 7.14, p ¼ .002, indicating that the distraction task significantly impaired genital arousal (Figure 1). Post hoc tests indicated that the significant difference was between the no-distraction and high-distraction conditions, p ¼ .004. There was also a main effect of gender F (1, 46) ¼ 9.9, p < .001, such that men (M ¼ 1.38, SEM ¼ .07) showed significantly higher increases in genital arousal compared to women (M ¼ .82, SEM ¼ .09), but there was no interaction between gender and distraction F (2, 47) ¼ .55, p ¼ .58. There was no main effect of time, F (1, 47) ¼ .04, p ¼ .91, indicating that participants had similar levels of genital arousal to both of the videos, regardless of order. A repeated-measures ANOVA assessed the effect of the distraction task on continuous psychological arousal (arousometer). There was no main effect of condition, F (2, 51) ¼ .87, p ¼ .42, but there was a main effect of gender, F (1, 51) ¼ 9.4, p ¼ .003, and an interaction between gender and condition, F (2, 51) ¼ 3.22, p ¼ .05). Men reported significantly higher levels of arousal

than women in response to the erotic videos in the no-distraction and low-distraction conditions but not in the high-distraction condition (Figure 2). In addition, there was a main effect of time, such that participants reported higher levels of arousal for the second video they watched (M ¼ 3.76, SEM ¼ .21) compared to the first (M ¼ 3.46, SEM ¼ .19), F (1, 51) ¼ 4.4, p ¼ .03). For the one-item retrospective measure of sexual arousal, a repeated-measures ANOVA found a main effect of distraction, F (2, 61) ¼ 3.28, p ¼ .04, but no main effect of gender, F (1, 61) ¼ 1.60. p ¼ .21, or interaction between gender and distraction condition, F (2, 61) ¼ 2.28, p ¼ .11. Post hoc tests of distraction condition showed a significant difference between the no-distraction (M ¼ 5.4, SEM ¼ .40) and high-distraction (M ¼ 4.1, SEM ¼ .46) conditions, p ¼ .05, but not between no- and low-distraction (M ¼ 4.4, SEM ¼ .41) or low- and high-distraction conditions. There was also a significant effect of time such that participants reported significantly higher levels of arousal across all conditions for the second video they watched (M ¼ 4.94, SEM ¼ .27) compared to the first (M ¼ 4.43, SEM ¼ .26), F (1, 61) ¼ 5.9, p ¼ .02. Our primary aim was to determine which method of assessing distraction (written quiz, visual quiz, selfreport) was most effective. First, to determine whether the methods of assessment differentiated between distraction conditions, we entered the results of attention assessment method (visual quiz, written quiz, self-report) as the dependent variable in a multivariate ANOVA with distraction condition and gender as the independent variables. There was a main effect of distraction for the overall MANOVA, F (6, 110) ¼ 8.28. p < .001. There was no main effect of gender, F (3, 54) ¼ 2.11, p ¼ .11, nor was there an interaction between gender and distraction condition, F (6, 110) ¼ 1.34, p ¼ .25. The ANOVAs for each distraction assessment type showed

Figure 1. Effect of distraction on genital arousal in men and women (Mean z-score increase SEM).

Figure 2. Interaction effect of distraction on psychological arousal in men and women (mean arousometer score SEM).

6



Figure 3. Method of assessment scores by distraction condition. Self-reported distraction was reverse coded so that lower scores would indicate higher distraction, similar to the visual and written quiz scores. All scores are mean percent of the maximum (SEM).

that there was a significant main effect of distraction for the written quiz, F (2, 56) ¼ 17.56, p < .001, the visual quiz, F(2, 56) ¼ 3.46, p ¼ .04, and self-reported distraction (reverse scored to be in the same direction as the quizzes), F(2, 56) ¼ 12.28, p < .001 (Figure 3). Post hoc tests indicated that on the written quiz participants scored significantly lower in the high-distraction condition compared to the no-distraction (p < .001) and low-distraction (p < .001) conditions. There was no significant difference on scores for the written quiz between no- and low-distraction conditions (p ¼ .58). Self-reported distraction showed the same pattern of results, with distraction scores being much higher in the high-distraction condition compared to the lowdistraction condition (p < .001) and no-distraction condition (p ¼ .001), but no difference between lowand no-distraction conditions, (p ¼ .40). Post hoc tests for the visual quiz showed that there were no significant differences among distraction conditions. To determine which method of assessment was the best predictor of level of distraction, the methods of assessment were entered into stepwise discriminant function analyses with distraction condition as the outcome variable. The best predictor of distraction condition was the written quiz (Wilks’ K ¼ .62) with self-reported distraction doing almost as well (Wilks’ K ¼ .71). The model for the written quiz alone was significant, indicating a good fit, p < .001. The combined model with written quiz and self-reported distraction also Table 3.

significantly predicted distraction condition (Wilks’ K ¼ .50), p < .001. Alone, the written quiz grouped 54.5% of cases correctly, and when combined, the scores from both the written quiz and self-reported distraction predicted 59.4% of cases correctly. The visual quiz was the worst predictor of distraction condition (Wilks’ K ¼ .93), likely due to the low variability in the responses, and it did not reach the cutoff to be included in the discriminant analysis models. To test which method of assessing attention best corresponded with genital arousal, bivariate Pearson correlations were computed between scores on distraction assessment measures and the genital arousal response. For self-reported distraction, correlations were calculated for distraction and genital arousal z-scores for each video. These correlations were then averaged, and the p value was calculated based on the average calculations. For both men and women, genital arousal z-scores were negatively correlated with self-reported distraction. For men only, the written quiz was positively correlated with genital arousal scores. For psychological arousal, written quiz scores were positively correlated with arousometer scores for men but negatively correlated for women. There was no relationship between psychological sexual arousal and any of the other methods of distraction assessment. There was also no relationship between retrospective self-reported arousal and any measures of distraction. All correlations are shown in Table 3.

Discussion The main objective of this study was to identify the best predictor of distraction condition among three assessment methods, including a written quiz, a visual quiz, and self-reported distraction. We also sought to determine which of these methods, if any, was associated with genital and psychological arousal response and to identify gender differences or similarities in distraction and its assessment. This study adds to the literature by validating simple methods of assessing distraction in laboratory studies of sexual arousal. The best predictor of distraction condition was the written quiz, followed closely by participants’ selfreported distraction. These findings are consistent

Correlations Between Arousal Measures and Distraction Measures for Men and Women Women

Distraction Measure Written quiz score Visual quiz score Self-reported distraction (Reversed & combined)

Men

Genital

Arousometer

Retrospective

Genital

Arousometer

Retrospective

.10 .14 .45

.41 .11 .10

.11 .06 .11

.41 .04 .40

.63 .01 .16

.34 .08 .36

Indicates a significant correlation at p < .01.

7



with the results obtained by Elliott and O’Donohue (1997). In the current study, both the written quiz and the self-reported arousal scores differentiated between the no- and high-distraction conditions, but neither method could discriminate between no- and low-distraction conditions. The current study also included a novel type of assessment, the visual quiz, which may have been a more appropriate assessment method for visual stimuli. Contrary to our expectation, the visual quiz was not predictive of distraction condition during the viewing of visual erotic stimuli. There was a ceiling effect for the visual quiz, with most participants scoring between 80% and 100%. The limited variability in scores may be attributed to the simplicity of the task. It seems as though the written quiz assesses the finer, contextual details of the video sequence, allowing this method to discriminate between distraction levels, while the visual quiz did not. Results indicated no gender differences in distraction condition using any of the three assessment methods, suggesting that both self-report measures and written tests may be valuable in the assessment of men’s and women’s attention to erotic stimuli. For both men and women, self-reported distraction was not only predictive of distraction level but also corresponded with genital arousal measures. That is, individuals reporting higher levels of distraction exhibited lower levels of genital arousal, and lower levels of self-reported distraction were accompanied by higher genital responding. However, self-reported distraction was not correlated with psychological arousal. This finding is not unexpected, given that self-reported distraction changed across conditions while psychological arousal did not. Retrospective reports of sexual arousal were not correlated with any of the distraction measures. Although this one-item measure was significantly different across distraction conditions, the effect was not related to the methods of assessing distraction. Men’s performance on the written quiz was positively correlated with both continuous psychological and genital arousal, but this pattern of results did not extend to women. For women, there was no relationship between written quiz scores and genital arousal, and there was a negative correlation between the written quiz and psychological arousal. It is unclear why men and women would have different relationships between the genital arousal and written quiz measures. The frequent malfunction of vaginal photoplethysmography equipment in the current study reduced female genital data in the final analyses and thus may have limited the detection of the relationship between these variables. To account for the negative relationship between women’s written quiz scores and psychological arousal, one explanation could be related to the higher scores of female participants on inattentiveness. Female participants scoring high on inattentiveness may have temporarily forgotten the motor task of reporting arousal in order to attend to the erotic video at levels that were 8

comparable to men. As such, women may have achieved high scores on the written quiz under no distraction and used the arousometer only intermittently rather than continuously, providing an inaccurate reflection of their psychological arousal. Gender differences in psychological arousal were not observed in the retrospective reports, further supporting the notion that the continuous arousal measure may have been more problematic for women than men. While the use of a movable lever during the simultaneous viewing of erotic stimuli has been found to interfere with genital arousal (Geer & Fuhr, 1976), results of the current study suggest that it may misrepresent continuous reports of psychological arousal in people who are moderately inattentive. Of the nine female participants who failed to use the arousometer and were omitted from analyses, five individuals obtained scores in the ‘‘likely to have ADHD’’ category for inattention. Female participants may have forgotten to use the arousometer due to high levels of inattentiveness. As a result, women may have allocated attention toward the erotic cues and the cognitive distractor tasks, while forgoing the motor task of reporting arousal. Alternatively, female participants may have been influenced by awareness that the researcher was monitoring their continuous self-report measures of arousal. Due to social desirability factors, women may have failed to report continuous psychological arousal. The current study supports past research by replicating the deleterious effects of auditory distraction on genital arousal in men and women. Overall, genital measures of sexual arousal were greatest in the absence of distraction and most impaired under high levels of distraction. Men were more genitally and psychologically aroused by the erotic film than women were, a finding that has been previously documented by research assessing gender differences in erotic film preference (Janssen, Carpenter, & Graham, 2003). While there were gender differences in level of arousal, there were no interactions between gender and distraction condition for genital arousal. There was, however, an interaction for psychological arousal, such that high levels of distraction equally affected men and women. It should be noted that while our high-distraction condition was significantly different from the nodistraction condition for the written quiz, self-reported distraction, genital arousal, and retrospective psychological arousal, there was no difference between the low-distraction and no-distraction conditions in any of these assessments. The genital arousal results of this study mirror those of Elliott and O’Donohue (1997) and Salemink and van Lankveld (2006), such that the highest level of distraction significantly impaired arousal compared to the control condition; however, the intermediate distractors, although following the expected pattern of response, were not significantly different from the control conditions. These findings



demonstrate that a high level of cognitive distraction is required to interfere with genital arousal in a laboratory setting. In real-life sexual interactions, it is likely that distractors would be more personally relevant (e.g., work, children, sexual anxieties) and would be more powerful than our low-distraction manipulation. The results of a manipulation check indicated that the auditory distractor task had no effect on the continuously reported psychological arousal of men and women. Results are consistent with past research on male sexual responding in which such correlations have been calculated (Przybyla & Byrne, 1984; van Lankveld & van den Hout, 2004). These findings have been attributed to the overestimation of erectile response resulting from a resistance to accept dysfunctional performance. Overreports may be motivated by an increased tendency to approach sexual situations in sexually functional men. Previous research on female sexual responding supports the inhibitory effects of distraction on psychological arousal (Adams et al., 1985; Prause & Heiman, 2010; Przybyla & Byrne, 1984; Salemink & van Lankveld, 2006). As previously mentioned, women may have underreported their level of psychological arousal due to social desirability factors. Alternatively, women may not have enjoyed the erotic videos, resulting in overall low levels of arousal response. The women’s average score on the ‘‘enjoyment’’ question was 4.15=10, indicating a low level of enjoyment of the videos; however, men scored similarly with an average enjoyment of 5.12=10. Similar to Salemink and van Lankveld (2006), we found that while continuous psychological arousal assessment was not affected by distraction condition, retrospective reports were. As noted previously, the distracting nature of the arousometer may account for the lack of change in continuous psychological arousal across distraction conditions. As such, continuous measures may not serve as an accurate assessment of arousal in studies where participants are being actively distracted. Limitations of the current study include the use of a low demand reminder strategy to report psychological arousal using the arousometer. Some previous studies assessing continuous psychological arousal have incorporated more salient reminder techniques, such as verbally reminding participants at given time intervals during erotic video presentation (e.g., Kukkonen, Binik, Amsel, & Carrier, 2010). A more intrusive reminder technique in the current study may have potentially introduced an additional distractor, interfering with attention to the erotic stimuli. Another limitation to the current study relates to the inclusion of participants with moderately elevated ADHD-inattentive scores. Although we felt it was acceptable to include people with a possibility of ADHD symptoms for reasons noted, future studies may incorporate a more conservative score on inattention, particularly when using continuous measures of arousal. An additional limitation relates to

the generalization of the findings outside of the lab setting. While the study results demonstrate the deleterious effects of distraction on arousal, our manipulation of distraction is not an ecologically valid representation of naturally occurring distraction. In the current study, participants were informed of the distractor task and were aware of the manipulation. In studies examining naturally occurring distraction, self-report measures may not be an accurate representation of cognitive activity. To ensure the results of this study generalize to participants who are not being actively distracted, it is recommended that a more implicit measure, the written quiz, be used in conjunction with a self-report measure of distraction. The results of this study illustrate the detrimental effects of distraction on genital sexual responding and highlight the importance of assessing distraction in studies of arousal. Insight into distraction assessing distraction will enable an accurate evaluation of naturally occurring distraction in patients suffering from sexual problems. Funding This project was supported by the Marjorie Young Bell Faculty Fellowship and by a Marjorie Young Bell Faculty Fund award from Mount Allison University to the second author. References Abrahamson, D. J., Barlow, D. H., & Abrahamson, L. S. (1989). Differential effects of performance demand and distraction on sexually functional and dysfunctional males. Journal of Abnormal Psychology, 98, 241–247. doi:10.1037=0021-843X.98.3.241 Adams, A. E., Haynes, S. N., & Brayer, M. A. (1985). Cognitive distraction in female sexual arousal. Psychophysiology, 22, 689–696. doi:10.1111=j.1469-8986.1985.tb01669 Arcos-Burgos, M., & Acosta, M. T. (2007). Tuning major gene variants conditioning human behavior: The anachronism of ADHD. Current Opinion in Genetics and Development, 17, 234–238. doi:10.1016=j.gde.2007.04.011 Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54(2), 140–148. doi:10.1037=0022-006X. 54.2.140 Beck, J. G., & Baldwin, L. E. (1994). Instructional control of female sexual responding. Archives of Sexual Behavior, 23(6), 665–684. doi:10.1007=BF01541818 Cerny, J. A. (1978). Biofeedback and the voluntary control of sexual arousal in women. Behavior Therapy, 9(5), 847–855. doi:10.1016= S0005-7894(78)80016-1 Compton, R. J. (2003). The interface between emotion and attention: A review of evidence from psychology and neuroscience. Behavioral and Cognitive Neuroscience Reviews, 2, 115–129. doi:10.1177=1534582303255278 Dove, N. L., & Wiederman, M. W. (2000). Cognitive distraction and women’s sexual functioning. Journal of Sex and Marital Therapy, 26, 67–78. doi:10.1080=009262300278650 Elliott, A. N., & O’Donohue, W. T. (1997). The effects of anxiety and distraction on sexual arousal in a nonclinical sample of

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