Sexual intrusive thoughts in a non-clinical sample: the effects of content and direct experience on distress level.
Article Type: Report
Subject: Stress (Psychology) (Influence)
Stress (Psychology) (Management)
Sex (Research)
Authors: Smith, Angela H.
Wetterneck, Chad T.
Harpster, Renata
Pub Date: 12/22/2011
Publication: Name: The Canadian Journal of Human Sexuality Publisher: SIECCAN, The Sex Information and Education Council of Canada Audience: Academic Format: Magazine/Journal Subject: Psychology and mental health Copyright: COPYRIGHT 2011 SIECCAN, The Sex Information and Education Council of Canada ISSN: 1188-4517
Issue: Date: Winter, 2011 Source Volume: 20 Source Issue: 4
Topic: Event Code: 310 Science & research; 200 Management dynamics Canadian Subject Form: Sexual behaviour Computer Subject: Company business management
Geographic: Geographic Scope: Canada Geographic Code: 1CANA Canada
Accession Number: 286557619
Full Text: Abstract: Sexual intrusive thoughts (SITs) are common in both clinical and non-clinical populations and these experiences are distressing for many. The present study examined distress from SITs in relation to thought content and real-life sexual experiences in a non-clinical population. Participants (N = 209) reported their most distressing SIT and indicated whether or not the thought was related to a real-life event. SITs were categorized as aggressive or non-aggressive, and groups were compared in distress and endorsement of real-life sexual experiences. The thought of being a victim of sexual aggression was the most distressing SIT for over 40% of participants. Results indicated that there were no significant differences in distress between aggressive and non-aggressive SITs; however, thoughts related to real-life sexual experiences were associated with higher levels of distress than thoughts not related to real-life sexual experiences. Among aggressive SITs, reallife experiences did not differentiate levels of distress. Thus, distress from SITs may be related to real-life experiences for some, but for those who experience aggressive SITs, the experience may be equally distressing for those who have and have not had an experience similar to the thought.

Introduction

Intrusive thoughts and images are repetitive, spontaneously occurring, unwanted, and disruptive (Rachman, 1981). Intrusive thoughts that are sexual in content are commonly experienced in both clinical (Williams & Farris, 2011) and nonclinical populations (Byers, Purdon, & Clark, 1998; Wetterneck, Smith, Burgess, & Hart, 2011). For most people, intrusive thoughts are relatively short-lived and undisruptive; however, they are highly problematic and distressing for some (Freeston & Ladouceur, 1999) and are thought to be underreported even in clinical populations (Grant, Pinto, Gunnip, Mancebo, Eisen, & Rasmussen, 2006). The present study investigated distress from sexual intrusive thoughts (SITs) in relation to thought content and real-life sexual experience.

Research on sexual thoughts in non-clinical samples has helped to clarify the prevalence, content, and themes of sexual thought and also to differentiate sexual fantasies from SITs (e.g., Little & Byers, 2000; Renaud & Byers, 1999); however, much less is known about the relationship between real-life sexual experiences and distress from sexual thoughts. Renaud and Byers (2005; 2006) examined real-life experiences of childhood sexual abuse and coercive sexual behaviour in adulthood and the appraisal of aggressive sexual thoughts as positive or negative. Their findings indicate that coercive sexual behaviour was associated with positive interpretations of dominant sexual thoughts, but sexual abuse in childhood was not associated with negative interpretations of dominant sexual thoughts. Additionally, childhood sexual abuse and coercive sexual behaviour in adulthood were both associated with more positive interpretations of submissive sexual thoughts. However, there is no empirical data to suggest whether or not distress related to SITs differs based on the content of these thoughts (i.e., aggressive versus non-aggressive) and real-life sexual experiences.

To date, few studies have examined distress from SITs in either clinical or non-clinical populations. Sexual obsessions have begun to receive more attention in the literature on Obsessive Compulsive Disorder (OCD) (Grant et al., 2006; Williams, Crozier, & Powers, 2011; Williams & Farris, 2011); however, studying these thoughts in non-clinical populations remains useful. Individuals with sexual obsessions often consider these thoughts to be indicative of perversion, weakness, deviance, or immorality (Gordon, 2002); thus, shame and embarrassment may hinder treatment-seeking behaviour. Studying these thoughts in non-clinical populations provides a way of elucidating the variables that develop or maintain distress from such thoughts.

The present study examined SITs in a non-clinical sample to determine whether the content of the thought or real-life sexual experiences similar to the thought are associated with distress from the thought. Specifically, this study examined distress related to one's most bothersome sexual thought and compared groups based on the content of their thought (i.e., aggressive or non-aggressive) and on their real-life sexual experiences. The relationships studied here were one part of a larger investigation of SITs in a non-clinical population.

Methods

Participants and procedure

Graduate and undergraduate psychology students from a mid-size university in south-east Texas participated in the study in exchange for course credit, extra credit, or the opportunity to win a $50 cash prize. Due to the sensitive nature of the topic, additional participants were obtained via "snowball" emailing methods initiated by graduate student researchers. Kraut and colleagues (2003) concluded that online surveying is advantageous for conducting experiments comprised of highly sensitive questions related to socially sensitive information. Graduate researchers sent contacts in their email accounts a description of the study and a link to the online questionnaire. The email requested that recipients consider completing the survey themselves and to then forward the survey to their email contacts for them to complete it as well. Participants recruited through "snowball" emailing methods had the opportunity to provide their email address for a chance to win a $50 cash prize. The study was administered online (n = 247) and in paper format (n = 91).

Three hundred and thirty eight participants were recruited for the study; however only participants who endorsed a distressing SIT (n = 209) were included in the data analysis. Participants ranged in age from 18 to 59 (M = 28.79, SD = 8.36) and were primarily female (82.3%, n = 172). Most participants were heterosexual (89.5%, n = 187) and in a relationship (75.2%, n = 147). The sample included participants who were White/Caucasian (65.1%, n = 136), Hispanic (16.3%, n = 34), Black/ African American (6.7%, n = 14), Asian/Pacific Islander (4.3%, n = 9), other (4.3%, n = 9), and unreported (3.3%, n = 7). Participants were not asked about their history of psychiatric diagnoses or about their seeking or receiving treatment.

Measures

Prior to completing the measures used for the present analyses, participants completed the Sexual Cognitions Checklist (Renaud & Byers, 1999), which involved reading a description of 56 sexual thoughts and providing a frequency rating for experiencing the thoughts. Each of the 56 thoughts was rated twice; participants were asked, "How often have you had this thought when it was positive?" and "How often have you had this thought when it was negative?" Responses were rated on a seven-point scale ranging from 0 (I have never had this thought) to 6 (I have had this thought frequently during the day). This was intended to prime the participants to the range of different sexual thoughts that might apply when completing the subsequent questions.

Participants were then instructed to write out their most distressing SIT and indicate whether or not that thought was related to an event that they willingly or unwillingly (Yes or No) experienced. Participants also indicated the level of distress associated with the thought by answering the question, "On average, how much distress do you usually experience when you have an intrusion of this kind?" Responses were rated on a 6-point scale: 0 (none), 1 (minimal), 2 (a little), 3 (moderate), 4 (great), 5 (extreme).

Analyses

Participants' most distressing sexual thoughts were categorized into themes created and defined by a research team familiar with studying sexual intrusive thoughts and obsessions. First, two members of the research team used an inductive method of coding based on inspection of the data to define categories and categorize each thought. Then, a third member of the team coded each thought based on the created categories and definitions. Percent agreement was calculated by dividing the number of correct ratings for each category (based on the initial researchers' determinations) by the total number of items for each category.

Analyses were then run in four steps. First, univariate analyses were used to obtain frequencies and average levels of distress for each theme. Second, independent samples t-tests were used to compare distress between aggressive and non-aggressive groups. Next, individuals were grouped based on whether their most distressing SIT was or was not related to a real-life sexual experience (i.e., intrusive memory), and groups were compared on distress. Finally, groups were combined into aggressive-memory and aggressive-thought, and were compared on distress from their most distressing SIT.

Results

SIT themes, definitions and percent agreement in coding

Table 1 presents and defines the seven SIT themes and indicates the percent inter-rater agreement for each theme and overall. In brief, the themes reflecting participants' most disturbing SITs or images included: experiencing forced sexual acts causing pain or harm (aggressive-victim), sexually causing pain or harm to another (aggressive perpetrator), a sexual act with a non-partner, a partner engaged in such an act, or sex with an inappropriate partner (other partner), a sexual act contrary to participant's orientation (sexual orientation), sex with a religious figure or setting (religious), sexual act with a family member that was not already coded as aggressive-victim or perpetrator (family), and other sexual thoughts or images not covered above (other). Inter-rater agreement on these themes ranged from 73% 100% with an overall reliability of 91%.

Frequency of theme endorsement and associated distress scores

The most frequently cited thematic category was aggressive-victim (43.5%) and one of the least often cited was aggressive perpetrator (2.9%) both of which had almost identical average distress scores in the mid-range between moderate and great distress (3.50) (Table 2). Overall aggression accounted for 46.4% of participant SITs, the vast majority of which were aggressive-victim. Thoughts related to cheating on a partner or one's partner cheating (other partner, 19.6%) and to other thoughts (14.8%) were common and had distress scores close to the moderate level (3.0).

Non-aggressive sexual acts in a family context were less common (10.5%) but had the highest average distress score (3.77) among all SITs. Among all participants the mean distress score was 3.30 which is slightly above moderate distress. Within the total sample, distress scores ranged from 2.80 - 3.77 with 20.7% reporting distress scores for their SIT of 4 (great distress) or 5 (extreme distress). Overall, however, we found no significant difference in distress among the thematic groups (F(6,201) = 1.49, p =. 19). Furthermore, male and female participants did not differ in their endorsement of distress from SITs (t = -0.93, p = .35).

Group comparisons of distress including impact of real-life experiences

A comparison of mean distress scores for SITs described as aggressive (n = 97) and non-aggressive (n = 112) found no significant statistical difference although a trend in that direction may be possible (t = 1.79, p = .08) (Table 3).

In terms of the relationship of SIT distress scores to real life-experience, we compared distress scores of the 79 individuals (37.8%) who indicated that their most distressing SIT was related to a real-life experience ("memory") with scores for 116 who did not make that association ("non-memory"). Distress scores were significantly higher in the memory group (t = 2.99, p < .01) indicating that real-life experience had a significant effect of SIT distress scores (Table 3).

With specific reference to aggressive SITs, over half of the participants who presented an SIT categorized as aggressive-victim (n = 47) also indicated a similar real-life experience. In other words, 47 individuals in the sample had been victims of sexual aggression and their most upsetting SIT was related to this experience. However, distress scores in this "aggressive, memory" group did not differ significantly from those in the "aggressive, nonmemory" group (n = 43) who did not report a real life experience associated with their SIT of sexual victimization (t = 1.27, p =.21) (Table 3).

Discussion

The present study examined distress from SITs in relation to the content of the thought (i.e., aggressive or non-aggressive) and real-life experiences related to the thought. Our results are consistent with previous findings indicating that a variety of SITs are commonly experienced by non-clinical individuals (Renaud & Byers, 1999). We found that distress scores across all SITs averaged slightly above 3 (moderate) while about 21% of participants reported scores of 4 (great) or 5 (extreme). This suggests that low to moderate distress from SITs may be the norm in nonclinical populations but that a sizeable percentage of individuals can experience considerable distress. Clinicians could use this information about SITs to reassure their clients that others share experiences similar to their own.

Previous research has indicated a positive relationship between distress and intrusive thoughts that contradict valued aspects of one's self(Rowa & Purdon, 2003). This study adds to the limited body of research that has compared groups based on themes represented by their most distressing sexual intrusive thoughts. The results suggest that the specific sexual content of the thought does not differentiate the level of distress from the thought. Although mean distress scores varied between SITs, we found no significant difference between scores associated with such themes as aggressive sexual victimization, a partner cheating, sexual relations with a family member, or thoughts contrary to one's sexual orientation. This finding supports what is already known about such unwanted thoughts; namely, that the content of the thought alone does not contribute significantly differentiate level of distress.

It is of interest that we found no difference in mean distress scores for SITs based on aggressive-victim and aggressive-perpetrator. While one might assume that victimization would be more distressing, it is possible that thoughts of being the perpetrator of sexual aggression might be systematically more distressing because of their association with morality and exposing others to danger and harm. However, given that SITs about aggressive-perpetrator were much less likely than aggressive victim (6 versus 91), the imbalance in our sample precludes conclusions.

A key new finding of the present study is distress from SITs was significantly higher when the SIT was related to a real-life experience. This suggests that intrusive thoughts related to a real-life experience (intrusive memories) are more distressing than non-memory related intrusive thoughts, regardless of the content of the thought. One explanation for these findings is that aggressive and non-aggressive intrusive memories are each related to higher levels of distress for different reasons. Intrusive memories of sexual victimization are more likely to elicit fear (as well as myriad other feelings), and intrusive memories related to cheating, for example, may elicit feelings of immorality. It is also possible that intrusive memories are more salient and elicit greater distress responses due to their potential to be richer in detail. Clinicians working with clients presenting with SITs should keep this in mind. Treating all intrusive thoughts or obsessions the same way (i.e., paying little attention to the thought content in the service of the underlying belief constructs) may sometimes be a disservice to the client. If the obsession is related to a real-life experience, more time may be needed to disentangling the implications of the thought versus the implications of the memory.

When all SITs were included in our analyses, intrusive memories were more salient than intrusive thoughts that were unrelated to a memory. However, these results also indicate that among aggressive SITs, there was no significant difference in mean distress scores between the memory and non-memory groups. This finding was somewhat surprising, as it was expected that a memory of a rape would be more distressing than the thought of rape for someone who never experienced such a trauma. Dissociation is commonly experienced by individuals who have been sexually traumatized and may provide one explanation for the findings; it is not unlikely that individuals who dissociate as a way of regulating unwanted thoughts would report lower levels of distress. Additionally, for those who were not victims of sexual aggression, frequent thoughts of being sexually victimized may be misattributed to an overestimation of the threat in the environment. While the underlying reason remains unclear, these findings elucidate the threat-potential of aggressive SITs, even if they may not have been previously experienced.

Limitations

While our results provide evidence that past experiences may provide another link between intrusive sexual thoughts and distress, the limitations of the study should be noted. First, little is known about the participants' past experiences of trauma, either sexual or non-sexual. It is possible that there is a link between past trauma and distress from SITs but in the present study, real-life experiences were only reported if they were related to the intrusive thought the participant provided. In addition, this study did not ask about the presence of trauma or sexual violence in general; thus someone could endorse that their most distressing sexual thought was not related to a real-life event, and still have suffered from sexual abuse. Furthermore, the type and amount of previous sexual abuse was not considered. Future studies would benefit from including a more thorough assessment of past trauma experiences. Another limitation is that we did not assess other factors that may have been associated with distress, such as whether the thought was appraised as immoral or fear provoking because of physical danger. While some associations seem intuitive (i.e., thoughts of rape are dangerous and thoughts of cheating are immoral), further clarification of the cause of distress may be clinically relevant. Finally, using online recruitment as part of the data collection strategy created a risk of a self-selection bias which may limit the generalizability of the findings.

These limitations considered, the present findings do provide new and clear evidence of a link between real-life sexual experiences and distress from SITs. Hopefully, these results will stimulate further investigation to clarify this relationship and to expand knowledge on related issues.

References

Byers, E.S., Purdon, C., & Clark, D.A. (1998). Sexual intrusive thoughts of college students. The Journal of Sex Research, 35, 359-369.

Gordon, W.M. (2002). Sexual obsessions and OCD. Sexual and Relationship Therapy, 17, 343-354.

Grant, J.E., Pinto, A., Gunnip, M., Mancebo, M.C., Eisen, J.L., & Rasmussen, S.A. (2006). Sexual obsessions and clinical correlates in adults with obsessive-compulsive disorder. Comprehensive Psychiatry, 47, 325-329.

Little, C.A., & Byers, E.S. (2000). Differences between positive and negative sexual cognitions. The Canadian Journal of Human Sexuality, 9, 167-179.

Rachman, S. (1981). Part 1. Unwanted intrusive cognitions. Advances in Behaviour Research and Therapy, 3, 89-99.

Renaud, C.A., & Byers, E.S. (1999). Exploring the frequency, diversity, and content of university students' positive and negative sexual cognitions. The Canadian Journal of Human Sexuality, 8, 17-30.

Renaud, C.A., & Byers, E. (2005). Relationship between sexual violence and positive and negative cognitions of sexual dominance. Sex Roles, 53, 253-260.

Renaud, C.A., & Byers, S.E. (2006). Positive and negative cognitions of sexual submission: Relationship to sexual violence. Archives of Sexual Behavior, 35, 483-490.

Rowa, K., & Purdon. C. (2003). Why are certain intrusive thoughts more upsetting than others? Behavioural and Cognitive Psychotherapy, 31, 1-11.

Wetterneck, C.T., Smith, A.H., Burgess, A.J., & Hart, J.M. (2011). Distress from sexual thoughts: Do religiosity, emotions, and thought appraisal matter? Journal of Cognitive Psychotherapy. 25, 189-202.

Williams, M.T., Crozier, M., & Powers, M. (2011). Treatment of sexual-orientation obsessions in obsessive-compulsive disorder using exposure and ritual prevention. Clinical Case Studies, 10, 53-66.

Williams, M.T., & Farris, S.G. (2011). Sexual orientation obsessions in obsessive-compulsive disorder: Prevalence and correlates. Psychiatry Research, 187, 156-159.

Angela H. Smith (1), Chad T. Wetterneck (2) and Renata Harpster (2)

(1) University of Houston, Houston, TX

(2) University of Houston-Clear Lake, Houston, TX
Table 1 Definitions of SIT themes

                                                          Percent
Theme                  Definition                        Agreement

Aggressive-            a sexual act or image that           .96
victim                 causes physical pain or harm
                       (e.g., "rape", "molestation,"
                       and sexual acts that are
                       "forced" or "pressured",
                       incest as a minor)

Aggressive-            a sexual act or image in which       1.0
perpetrator            the person having the thought
                       explicitly states that they
                       are causing physical pain or
                       harm to another (e.g.,
                       thoughts or images of
                       children, raping someone,
                       etc.)

Other partner          a sexual act with or image of        .79
                       a person other than one's
                       partner OR thought or image of
                       one's partner engaged in a
                       sexual act with another OR
                       thought or image of a sexual
                       act with an "inappropriate
                       other" (e.g., subordinate or
                       authority figure, friends,
                       etc.)

Sexual orientation     a sexual act or image contrary       .87
                       to one's sexual orientation

Religious              a sexual act with or image of        1.0
                       a religious figure, including
                       God OR thought or image of a
                       sexual act in a religious
                       setting

Family                 a sexual act with or image of       0.95
                       a family member, not including
                       those that are aggressive in
                       nature (i.e., thoughts that
                       involve a sexual act with a
                       family member and which are
                       also aggressive are coded as
                       aggressive; incest thoughts
                       are coded in the family
                       category unless they also
                       mention that the person is a
                       child)

Other                  any sexual thought or image         0.73
                       that is not related to
                       aggression, unfaithfulness,
Overall inter-rater    sexual orientation, religion,       0.91
reliability            or family (e.g., thoughts of
                       masturbating in front of an
                       open window, unsatisfying
                       sexual experience with my
                       partner)

Table 2 SIT themes and associated distress

SIT Theme                 Endorsement    Distress
                             N (%)        M (SD)

Aggressive-Victim          91 (43.5)     3.49 (1.30)
Other partner              41 (19.6)     3.02 (1.49)
Other                      31 (14.8)     2.97 (1.43)
Family                     22 (10.5)     3.77 (1.66)
Sexual orientation         13 (6.2)      3.00 (1.16)
Aggressive-Perpetrator      6 (2.9)      3.50 (1.64)
Religious                   5 (2.4)      2.80 (0.84)
Total                     209 (100.0)    3.30 (1.40)

Distress was measured by the question, "On average, how
much distress do you usually experience when you have an
intrusion of this kind?" with response choices of 0 (none), 1
(minimal), 2 (little), 3 (moderate), 4 (great), and 5 (extreme).

Table 3 Group comparisons of distress and effects of
real-life experience
                               Distress
Thought type                   M (SD)

Aggressive (n = 97)            3.49 (1.31)
Non-aggressive (n = 112)       3.14 (1.46)
                               t = 1.79, p =.08

Memory ([dagger]) (n = 79)     3.67(1.37)
Non-memory ([dagger])          3.06(1.42)
 ([dagger]) (n = 116)
                               t=2.99, p <.O1 **

Aggressive, memory (n = 47)    3.66(1.34)
Aggressive, non-memory         3.30(1.32)
 (n = 43)
                               t= 1.27, p=.21

Note: The first 14 participants were not asked whether or
not the thought was related to a real-life sexual experience.

([dagger]) Memory refers to an intrusive thought related to a real-
life sexual experience.

([dagger]) ([dagger]) Non-memory refers to an intrusive thought
not related to a real-life sexual experience.
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