Assignment 2 (Example 3)

PTSD & SEXUAL INTIMACY 1
Treatment of Post-Traumatic Stress Disorder in Patients in Relation to Sexual Intimacy
Department of Psychology, New York University
PSYCH-GA — 2126: Research Methods & Experience
Jasmina Sose Selimotic, Ph.D.
April 20, 2020

Method
This study was designed to use data from a neural correlate study in post-traumatic stress
disorder (PTSD) and find a therapeutic application for it. In the study, participants signed up to
undergo an MRI for a study on the neural correlates of threat in people with post-traumatic stress
disorder. They played a virtual reality game inside of the MRI while experiencing mild shocks
when they approach a beehive. The shocks are administered in a pattern. Research by Suarez-
Jimenez et al. (2018) shows that participants with PTSD exhibit overgeneralized anxiety and
cannot distinguish the pattern. This study seeks to discover a correlation between types of
therapy and effectiveness at reducing the anxiety in order to apply it to people living with PTSD
in respect to their sexual intimacy and romantic relationships.
Participants
An a priori power analysis was conducted using the G*Power software v. 3.1.9.6 (Faul et
al., 2009) to determine the sample size for the study. Considering a power of 0.80 (α = 0.05) and
a medium effect size, and a one-tailed t-test for correlation were used, the minimum sample size
necessary for the study is 64. Participants were recruited through an online sign-up portal from
the New York metropolitan area and were required to be between the ages of 18 and 55 at time
of treatment. In addition, participants were required to be diagnosed with post-traumatic stress
disorder by a licensed psychologist using the Clinically Administered PTSD Scale for DSM 5
(CAPS-V), with the Criterion A event as direct sexual assault/abuse.
Procedure
Participants that exhibited overgeneralized anxiety in the MRI who also have experienced sexual
assault or abuse that led them to develop post-traumatic stress disorder were given the option to
have weekly therapy sessions for 12 weeks. They were divided into two groups based on therapy
type. One was cognitive behavioral therapy (CBT) and the other was interpersonal therapy (IPT).
Both groups used the PLISSIT model (Annon, 1976) as a guide to sexual treatment. At the
beginning of the 12 weeks, participants were given a demographic questionnaire, a questionnaire
on trauma, and two other questionnaires on sexuality. Halfway through the therapy at 6 weeks,
participants were given the sexuality surveys again, and then they filled out the questionnaires
one final time at the end of the therapy sessions. The change in scores from the first session to
the last reflected the effectiveness of the therapy. During the last session, they were reevaluated
one more time with the CAPS-V monthly version. Each questionnaire is explained below in
detail if it is protected under copyright laws, but otherwise scoring and questionnaires are located
in the appendix.
Measures
Trauma in Childhood
Participants completed the Childhood Trauma Questionnaire, a 28 item questionnaire
measuring perceived trauma. This scale measures the various types of sexual abuse people
experienced in childhood and the frequency with which those abuses occurred, and it contains
four dimensions (i.e., physical and emotional abuse, emotional neglect. sexual abuse, and
physical neglect). For this study, we focus on the sexual abuse dimension which has six items.
(e.g., Someone tried to make me do sexual things or watch sexual things; Bernstein et al., 1994).
Each item is rated on a Likert scale from 0 (never true) to 4 (very often true).
Sexual Functioning
The Female Sexual Function Index (FSFI; Rosen et al., 2000) was administered to female
participants. It is composed of 19 questions regarding sexual satisfaction, discomfort, and

frequency of sexual encounters during the last four weeks (e.g., Over the past four weeks, how
would you rate your level of sexual arousal (‘turn on’) during sexual activity or intercourse?).
Answers were are rated on a Likert scale from 1 (the least) to 5 (the highest) with an option for 0
for no sexual activity.
The International Index of Erectile Function (IIEF; Rosen et al., 1997) was administered
to males who could not take the FSFI. This scale contains 15 questions (e.g., How often were you
able to get an erection during sexual activity?) and ratings are similar to the FSFI, as they are
also on a scale from 1 (low) to 5 (high). The questions addressed sexual functioning, enjoyment,
and desire levels.
Sexual Quality of Life
The Sexual Quality of Life scale is divided into SQoL-F for women (Symonds et al.,
2005) and SQoL-M for men (Abraham et al., 2008). Both are protected under copyright laws, but
have been validated. These tests focus on the quality of life of people who already have
physiological sexual dysfunctions, such as vulvodynia in women and erectile dysfunction in
men. Specifically, the questions examine feelings about sex as a result of the preexisting sexual
dysfunction in respect to the last four weeks of the person’s experiences. The SQoL-M has 11
questions and is rated on a six-point Likert scale ranging from completely agree to completely
disagree (e.g., When I think about my sexual life, I feel anxious; Abraham et al. 2008). The
SQoL-F asks the same questions, but it has an additional seven questions (e.g., When I think
about my sex life, I feel like less of a woman).
Post-Traumatic Stress Scale
The participants are given the Clinician-Administered PTSD Scale for DSM-5 (CAPS-V)
Monthly version again at the end of the therapy to determine their progression in their post-
traumatic stress. The CAPS-V is administered only by a clinician,. Sample questions such as “In
the past month, have you had any unwanted memories of (EVENT) while you were awake, so
not counting dreams?” (Weathers, et al., 2013) where the event is the predetermined event that is
recognized to have led to the development of PTSD. The patient is then asked follow-up
questions and the clinician rates the severity on a scale from 0 (Absent) to 4 (Extreme).
References
Abraham, L., Symonds, T., & Morris, M. F. (2008). Psychometric validation of a sexual quality
of life questionnaire for use in men with premature ejaculation or erectile dysfunction. The
Journal of Sexual Medicine, 5(3), 595–601. doi: 10.1111/j.1743-6109.2007.00749.
Annon, J. S. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral
treatment of sexual problems, Journal of Sex Education and Therapy, 115(2).
doi: 0.1080/01614576.1976.11074483.
Faul, F., Erdfelder, E., Buchner, A., & Lang, A.-G. (2009). Statistical power analyses using
G*Power 3.1: Tests for correlation and regression analyses. Behavior Research
Methods, 41, 1149-1160.
Rosen, R., Brown, C., Heiman, J., Leib, S. (2000). The female sexual function index (FSFI): A
multidimensional self-report instrument for the assessment of female sexual function.
Journal of Sex & Marital Therapy, 26(2), 191–208. doi: 10.1080/009262300278597.
Rosen, R., Riley, A., & Wagner, G. (1997). The international index of erectile function (IIEF): A
multidimensional scale for assessment of erectile dysfunction. Urology, 49: 822-830. doi:
10.1016/s0090-4295(97)00238-0.
Suarez-Jimenez, B., Bisby, J. A., Horner, A. J., King, J. A., Pine, D. S., & Burgess, N. (2018).
Linked networks for learning and expressing location-specific threat. Proceedings of the
National Academy of Sciences, 115(5). doi: 10.1073/pnas.1714691115.
Symonds T, Boolell M, Quirk F. (2005). Development of a questionnaire on sexual quality of
life in women. The Journal of Sex and Marital Therapy. 31(5):385-97. doi:
10.1080/00926230591006502.
Weathers, F.W., Blake, D.D., Schnurr, P.P., Kaloupek, D.G., Marx, B.P., & Keane, T.M.
(2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). [Assessment]
Dimension Description Comments Score

Participants (25%) Number of participants Number of 10
and their main participants and their
characteristics are main characteristics
presented were presented
Procedures (25%) Description of data You need more 8
collection procedures details about your
and manipulations are procedures,
explained particularly
regarding the
treatments.
Measures (25%) Measures or materials Measures or 10
are described materials were
described
APA style (25%) APA style is properly APA style is 10
used. properly used.
Total See comments regarding the style in text 95%
Appendix A
The Female Sexual Function Index Questionnaire
Female Sexual Function Index (FSFI)
Subject Identifier ________________________ Date ________________
INSTRUCTIONS: These questions ask about your sexual feelings and responses during the past
4 weeks. Please answer the following questions as honestly and clearly as possible. Your
responses will be kept completely confidential. In answering these questions the following
definitions apply:
Sexual activity can include caressing, foreplay, masturbation and vaginal intercourse. Sexual
intercourse is defined as penile penetration (entry) of the vagina.
Sexual stimulation includes situations like foreplay with a partner, self-stimulation

(masturbation), or sexual fantasy.
CHECK ONLY ONE BOX PER QUESTION.
Sexual desire or interest is a feeling that includes wanting to have a sexual experience, feeling
receptive to a partner's sexual initiation, and thinking or fantasizing about having sex.
1. Over the past 4 weeks, how often did you feel sexual desire or interest?
o Almost always or always

o Most times (more than half the time)
o Sometimes (about half the time)
o A few times (less than half the time)
o Almost never or never
2. Over the past 4 weeks, how would you rate your level(degree) of sexual desire or
interest?
o Very high
o High
o Moderate
o Low
o Very low or none at all
Sexual arousal is a feeling that includes both physical and mental aspects of sexual excitement. It
may include feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle
contractions.
3. Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during
sexual activity or intercourse?
o No sexual activity
4. Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on")
during sexual activity or intercourse?
o Very high
o High
o Moderate
o Low
5. Over the past 4 weeks, how confident were you about becoming sexually aroused during
o Very high confidence
o High confidence
o Moderate confidence
o Low confidence
o Very low or no confidence
6. Over the past 4 weeks, how often have you been satisfied with your arousal (excitement)
7. Over the past 4 weeks, how often did you become lubricated ("wet") during sexual
activity or intercourse?

8. Over the past 4 weeks, how difficult was it to become lubricated ("wet") during sexual
o Extremely difficult or impossible
o Very difficult
o Difficult
o Slightly difficult
o Not difficult
9. Over the past 4 weeks, how often did you maintain your lubrication ("wetness") until
completion of sexual activity or intercourse?
10. Over the past 4 weeks, how difficult was it to maintain your lubrication ("wetness")
until completion of sexual activity or intercourse?
o Very difficult
o Difficult
o Not difficult
11. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did
you reach orgasm (climax)?
12. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult
was it for you to reach orgasm (climax)?
o Very difficult
o Difficult
o Not difficult
13. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm
(climax) during sexual activity or intercourse?
o Very satisfied
o Moderately satisfied
o About equally satisfied and dissatisfied
o Moderately dissatisfied
o Very dissatisfied
14. Over the past 4 weeks, how satisfied have you been with the amount of emotional
closeness during sexual activity between you and your partner?
o Very satisfied
o Very dissatisfied
15. Over the past 4 weeks, how satisfied have you been with your sexual relationship with
your partner?
o Very satisfied
o Very dissatisfied
16. Over the past 4 weeks, how satisfied have you been with your overall sexual life?
o Very satisfied
o Very dissatisfied
17. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal
penetration?
o Did not attempt intercourse

18. Over the past 4 weeks, how often did you experience discomfort or pain following
vaginal penetration?

19. Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain
during or following vaginal penetration?

o Very high
o High
o Moderate
o Low
Thank you for completing this questionnaire
Appendix B
Scoring for Female Sexual Function Index
FSFI SCORING APPENDIX

Question Response Options
1. Over the past 4 weeks, how often did you feel sexual desire or interest?
5 = Almost always or always

4 = Most times (more than half the time)
3 = Sometimes (about half the time)
2 = A few times (less than half the time)
1 = Almost never or never
2. Over the past 4 weeks, how would you rate your level (degree) of sexual desire or
interest?
5 = Very high
4 = High
3 = Moderate
2 = Low
1 = Very low or none at all
3. Over the past 4 weeks, how often did you feel sexually aroused ("turned on") during
0 = No sexual activity
4. Over the past 4 weeks, how would you rate your level of sexual arousal ("turn on")
5 = Very high
4 = High
3 = Moderate
2 = Low
5. Over the past 4 weeks, how confident were you about becoming sexually aroused during
5 = Very high confidence
4 = High confidence
3 = Moderate confidence
2 = Low confidence
1 = Very low or no confidence
6. Over the past 4 weeks, how often have you been satisfied with your arousal (excitement)

7. Over the past 4 weeks, how often did you become lubricated ("wet") during sexual
8. Over the past 4 weeks, how difficult was it to become lubricated ("wet") during sexual
1 = Extremely difficult or impossible
2 = Very difficult
3 = Difficult
4 = Slightly difficult
5 = Not difficult
9. Over the past 4 weeks, how often did you maintain your lubrication ("wetness") until
completion of sexual activity or intercourse?
10. Over the past 4 weeks, how difficult was it to maintain your lubrication ("wetness")
until completion of sexual activity or intercourse?
2 = Very difficult
3 = Difficult
5 = Not difficult
11. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did
you reach orgasm (climax)?
12. Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult
was it for you to reach orgasm (climax)?
2 = Very difficult
3 = Difficult
5 = Not difficult
13. Over the past 4 weeks, how satisfied were you with your ability to reach orgasm
(climax) during sexual activity or intercourse?
5 = Very satisfied
4 = Moderately satisfied
3 = About equally satisfied and dissatisfied
2 = Moderately dissatisfied
1 = Very dissatisfied
14. Over the past 4 weeks, how satisfied have you been with the amount of emotional
closeness during sexual activity between you and your partner?
5 = Very satisfied
15. Over the past 4 weeks, how satisfied have you been with your sexual relationship with
your partner?
5 = Very satisfied
16. Over the past 4 weeks, how satisfied have you been with your overall sexual life?
5 = Very satisfied
17. Over the past 4 weeks, how often did you experience discomfort or pain during vaginal
penetration?
0 = Did not attempt intercourse

18. Over the past 4 weeks, how often did you experience discomfort or pain following
vaginal penetration?

19. Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain
during or following vaginal penetration?

1 = Very high
2 = High
3 = Moderate
4 = Low
FSFI DOMAIN SCORES AND FULL SCALE SCORE

The individual domain scores and full scale (overall) score of the FSFI can be derived from the
computational formula outlined in the table below. For individual domain scores, add the scores
of the individual items that comprise the domain and multiply the sum by the domain factor (see
below). Add the six domain scores to obtain the full scale score. It should be noted that within
the individual domains, a domain score of zero indicates that the subject reported having no
sexual activity during the past month. Subject scores can be entered in the right-hand column.
Domain Questions Score Factor Minimum Maximum Score

Range Score Score
Desire 1, 2 1- 5 0.6 1.2 6.0
Arousal 3, 4, 5, 6 0-5 0.3 0 6.0
Lubrication 7, 8, 9, 10 0-5 0.3 0 6.0
Orgasm 11, 12, 13 0-5 0.4 0 6.0
Satisfaction 14, 15, 16 0 (or 1) – 5 0.4 0.8 6.0
Pain 17, 18, 19 0-5 0.4 0 6.0
Full Scale Score Range 2.0 36.0
Appendix C
International Index of Erectile Function Patient Questionnaire
Patient Questionnaire
These questions ask about the effects that your erection problems have had on your sex
life over the last four weeks. Please try to answer the questions as honestly and as
clearly as you are able. Your answers will help your doctor to choose the most effective
treatment suited to your condition. In answering the questions, the following definitions
apply:
- sexual activity includes intercourse, caressing, foreplay & masturbation

- sexual intercourse is defined as sexual penetration of your partner
- sexual stimulation includes situation such as foreplay, erotic pictures etc.
- ejaculation is the ejection of semen from the penis (or the feeling of this)
- orgasm is the fulfilment or climax following sexual stimulation or intercourse
1. How often were you able to get an erection during sexual activity?
0 – No sexual activity
1 – Almost never or never
2 – A few times (less than half the time)
3 – Sometimes (about half the time)
4 – Most times (more than half the time)
5 – Almost always or always
2. When you had erections with sexual stimulation, how often were your erections
hard enough for penetration?
0 – No sexual activity
3. When you attempted intercourse, how often were you able to penetrate (enter) your
partner?
0 – Did not attempt intercourse

4. During sexual intercourse, how often were you able to maintain your erection after
you had penetrated (entered) your partner?

5. During sexual intercourse, how difficult was it to maintain your erection to

completion of intercourse?

1 – Extremely difficult
2 – Very difficult
3 – Difficult
4 – Slightly difficult
5 – Not difficult
6. How many times have you attempted sexual intercourse?
0 – No attempts
1 – One or two attempts
2 – Three to four attempts
3 – Five to six attempts

4 – Seven to ten attempts
5 – Eleven or more attempts
7. When you attempted sexual intercourse, how often was it satisfactory for you?

8. How much have you enjoyed sexual intercourse?
0 – No intercourse
1 – No enjoyment at all
2 – Not very enjoyable
3 – Fairly enjoyable
4 – Highly enjoyable
5 – Very highly enjoyable
9. When you had sexual stimulation or intercourse, how often did you ejaculate?
0 – No sexual stimulation or intercourse

10. When you had sexual stimulation or intercourse, how often did you have the feeling
of orgasm or climax?

11. How often have you felt sexual desire?

12. How would you rate your level of sexual desire?
1 – Very low or none at all

2 – Low
3 – Moderate
4 – High
5 – Very high
13. How satisfied have you been with your overall sex life?
1 – Very dissatisfied
2 – Moderately dissatisfied
3 – Equally satisfied and dissatisfied
4 – Moderately satisfied
5 – Very satisfied
14. How satisfied have you been with your sexual relationship with your partner?
1 – Very dissatisfied
2 – Moderately dissatisfied
3 – Equally satisfied and dissatisfied
4 – Moderately satisfied
5 – Very satisfied
15. How do you rate your confidence that you could get and keep an erection?
1 – Very low
2 – Low
3 – Moderate
4 – High
5 – Very high
Appendix D
IIEF Scoring Sheet Guidelines
Guidelines on Clinical Application of IIEF Patient Questionnaire
Background
The 15-question International Index of Erectile Function (IIEF) Questionnaire is a validated,

multidimensional, self-administered investigation that has been found useful in the clinical
assessment of erectile dysfunction and treatment outcomes in clinical trials. A score of 0-5 is
awarded to each of the 15 questions that examine the 4 main domains of male sexual
function: erectile function, orgasmic function, sexual desire and intercourse satisfaction.
In a recent study(1),the IIEF Questionnaire was tested in a series of 111 men with sexual
dysfunction and 109 age-matched, normal volunteers. The following mean scores were
recorded:
FUNCTION DOMAIN MAX CONTR PATIEN

SCORE OLS TS
A. Erectile Function (Q1,2,3,4,5,15) 30 25.8 10.7

B. Orgasmic Function (Q9,10) 10 9.8 5.3
C. Sexual Desire (Q11,12) 10 7.0 6.3
D. Intercourse Satisfaction (Q6,7,8) 15 10.6 5.5
E. Overall Satisfaction (Q13,14) 10 8.6 4.4
Clinical Application
IIEF assessment is limited by the superficial assessment of psychosexual background and

the very limited assessment of partner relationship, both important factors in the
presentation of male sexual dysfunction. Analysis of the questionnaire should, therefore, be
viewed as an adjunct to, rather than a substitute for, a detailed sexual history and
examination. The following guide-lines may be applied:
1. Patients with low IEEF scores (<14 out of 30) in Domain A (Erectile Function) may be
considered for a trial course of therapy with Sildenafil unless contraindicated.
Specialist referral is indicated if this is unsuccessful.
2. Patients demonstrating primary orgasmic or ejaculatory dysfunction (Domain B) should

be referred for specialist investigation.
3. Patients with reduced sexual desire (Domain C) require testing of blood levels of androgen
and prolactin.
4. Psychosexual counselling should be considered if low scores are recorded in Domains D

and E but there is only a moderately lowered score (14 to 25) in Domain A.

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PTSD & SEXUAL INTIMACY 1

Treatment of Post-Traumatic Stress Disorder in Patients in Relation to Sexual Intimacy

Department of Psychology, New York University

PSYCH-GA — 2126: Research Methods & Experience

Jasmina Sose Selimotic, Ph.D.

April 20, 2020

in respect to their sexual intimacy and romantic relationships.

of treatment. In addition, participants were required to be diagnosed with post-traumatic stress

(CAPS-V), with the Criterion A event as direct sexual assault/abuse.

beginning of the 12 weeks, participants were given a demographic questionnaire, a questionnaire

Participants completed the Childhood Trauma Questionnaire, a 28 item questionnaire

participants. It is composed of 19 questions regarding sexual satisfaction, discomfort, and

for no sexual activity.

and desire levels.

Sexual Quality of Life

physiological sexual dysfunctions, such as vulvodynia in women and erectile dysfunction in

about my sex life, I feel like less of a woman).

Post-Traumatic Stress Scale

Journal of Sexual Medicine, 5(3), 595–601. doi: 10.1111/j.1743-6109.2007.00749.

treatment of sexual problems, Journal of Sex Education and Therapy, 115(2).

Methods, 41, 1149-1160.

multidimensional self-report instrument for the assessment of female sexual function.

Journal of Sex & Marital Therapy, 26(2), 191–208. doi: 10.1080/009262300278597.

National Academy of Sciences, 115(5). doi: 10.1073/pnas.1714691115.

Symonds T, Boolell M, Quirk F. (2005). Development of a questionnaire on sexual quality of

(2013). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). [Assessment]

Dimension Description Comments Score

The Female Sexual Function Index Questionnaire

Female Sexual Function Index (FSFI)

Subject Identifier ________________________ Date ________________

Sexual stimulation includes situations like foreplay with a partner, self-stimulation

CHECK ONLY ONE BOX PER QUESTION.

o Almost always or always

o Sometimes (about half the time)

o Did not attempt intercourse

o Did not attempt intercourse

o Did not attempt intercourse

Thank you for completing this questionnaire

Scoring for Female Sexual Function Index

FSFI SCORING APPENDIX

5 = Almost always or always

1 = Almost never or never

4 = Most times (more than half the time)

0 = Did not attempt intercourse

0 = Did not attempt intercourse

0 = Did not attempt intercourse

FSFI DOMAIN SCORES AND FULL SCALE SCORE

Domain Questions Score Factor Minimum Maximum Score

Full Scale Score Range 2.0 36.0

International Index of Erectile Function Patient Questionnaire

- sexual activity includes intercourse, caressing, foreplay & masturbation

0 – Did not attempt intercourse

0 – Did not attempt intercourse

5. During sexual intercourse, how difficult was it to maintain your erection to

0 – Did not attempt intercourse

6. How many times have you attempted sexual intercourse?

3 – Five to six attempts

0 – Did not attempt intercourse

Subject Identifier ________ Date