Internet-based Emotion Regulation Intervention for Sexual Health

• Emotion regulation skills training (Behavioral): The intervention will involve an online emotion-regulation skills training for individuals with sexual problems. It will last for 8 weeks, encompassing psycho-educational and emotion-regulation skills components. Every week participants will gain access to a different intervention module of the training, containing videos, presentation slides, written support material and a recommendation of activities to be completed until the following week of training. Participants are expected to dedicate 30 minutes to one hour per week to complete each module.

Primary outcomes

• Change in Female Sexual Function Index (FSFI) at 6 months [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: this is a 19-item questionnaire for the assessment of sexual functioning in women in domains of sexual functioning (e.g., sexual arousal, orgasm, satisfaction, pain). Answers are provided using a 5-point Likert scale.
• Change in International Index of Erectile Function (IIEF)at 6 months [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: The IIEF is 15-item, self-administered questionnaire for assessing sexual functioning in men. Answers are given on a 6-point Likert scale. The IIEF encompasses five different domains of sexual functioning: erectile function, orgasm function, sexual desire, intercourse satisfaction and overall satisfaction.
• Change in Sexual Quotient (QS) at 6 months [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: The QS is a brief and comprehensive tool composed of 10-questions, which are answered on a scale from 0 (never) to 5 (always). It addresses general sexual function, and stages of the sexual response cycle (desire, arousal, orgasm) and sexual satisfaction.

Secondary outcomes

• Sexual Modes Questionnaire (SMQ) - Automatic Thoughts subscale [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: This self-report scale consists of 30 items in the male version, and 33 items in the female version. Respondents are asked to rate the frequency (from 1 \[never\] to 5 \[always\]) with which they have experienced specific automatic thoughts during sexual activity.
• Sexual Self-Schema Scale (SSSS). [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: consists of 30 items assessing respondents' perception of themselves as a sexual person compared to others of the same gender and age. Answers are provided using a 5- point Likert scale ranging from 1 (not at all descriptive of me) to 5 (very much descriptive of me).
• Patient Health Questionnaire-9 (PHQ-9) [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: A 9-item self-report measure used to assess symptoms of depression.
• General Anxiety Disorder - 7 (GAD-7) [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: A 7-item self-report measure used to assess symptoms of anxiety.
• the Difficulties in Emotion Regulation Scale (DERS) [baseline, 2 months after baseline (end of intervention), 8 months after baseline (follow-up)]: The DERS assesses several facets of emotion regulation, including difficulties relevant to an individual's (a) acceptance of emotional responses, (b) ability to engage in goal-directed behaviour under distress, (c) ability to control impulsive behaviours when distressed, (d) access to emotion regulation strategies, and (e) emotional clarity. Participants rate their degree of agreement with each statement on a scale from 1 (almost never; 0 to 10 percent) to 5 (almost always; 91 to 100 percent).

Sex: All, ages: 18 Years to 65 Years, accepts healthy volunteers

Inclusion Criteria:

* between 18 and 65 years of age,
* fluent in Brazilian Portuguese,
* self-reported sexual problems, assessed in men by a score of < 21 on the International Index Erectile Function (IIEF) and in women by a score of < 26 on the Female Sexual Function Index (FSFI),
* in a stable relationship for at least the preceding 3 months.

Exclusion Criteria:

* medical conditions that can interfere with the outcomes of the intervention, e.g., diabetes, cancer, cardiovascular problems,
* ongoing psychotherapy.
* no sexual activity in the previous 4 weeks.

• Results publication: Jobim Fischer V, Rossato Holz M, Billieux J, Andersson G, Vogele C. Web-Based Emotion Regulation Training for Sexual Health: Randomized Controlled Trial. JMIR Form Res. 2024 Apr 3;8:e50850. doi: 10.2196/50850. PMID 38568720

• Claus Vögele, Prof. Dr, Principal investigator, Head of Department Department of Behavioural and Cognitive Sciences