Experiential avoidance as a mediator between anticipatory anxiety and the severity of erectile dysfunction

Abstract

ABSTRACT Introduction While anticipatory anxiety is a psychological factor of erectile dysfunction (ED), the problem of experiential avoidance, which is an attempt to avoid heightened anxiety and tension associated with anticipatory anxiety, has recently been highlighted (Stephenson, 2019). Experiential avoidance becomes a problem when one worsens his or her own anxiety and tension through it (Hayes et al., 2006). It can be deduced that experiential avoidance, rather than anticipatory anxiety itself, is the problem that exacerbates ED symptoms. Objective This study aimed to examine whether experiential avoidance mediates the relationship between anticipatory anxiety and the severity of ED using mediation analysis. Methods An online survey targeting the general adult male population (age: 20–50 years) was conducted by a private research company. Participants with organic diseases were excluded from this study through a screening survey process. Eventually, valid responses from 389 participants (mean age of the participants: 36.39 years, standard deviation: 7.39 years) were obtained. Of these 389 participants, 149 participants had no ED, 72 had mild ED, 99 had mild-to-moderate ED, and 69 had moderate-to-severe ED. 1) IIEF-5 (IIEF-5 Kimoto et al., 2009): This questionnaire measured erectile functioning. ED severity can be classified based on a cutoff point. Higher the score obtained in this questionnaire, more is the severity of ED. 2) Anticipatory anxiety about ED: This questionnaire measured anticipatory anxiety regarding ED. It consisted of four items based on descriptions in ED-related books (e.g., “Time feels longer than usual until the moment you plan to have intercourse.”). Higher the score obtained in this questionnaire, more is the anticipatory anxiety regarding ED. 3) Avoidance and Fusion Questionnaire-Erectile Dysfunction (AFQ-ED; Saito et al., 2021): This questionnaire measured experiential avoidance regarding ED (e.g., “I keep telling myself ‘I cannot fail this time’.”). Higher the score obtained in this questionnaire, more is the experiential avoidance regarding ED. Results A mediation analysis was conducted with anticipatory anxiety about ED as an independent variable, experiential avoidance regarding ED as a mediating variable, and ED severity as a dependent variable (Figure 1). The results of an indirect effect test carried out using the bootstrap method (10,000 re-samplings) showed that the association between anticipatory anxiety about ED and ED severity was significantly mediated by experiential avoidance regarding ED. Conclusions The results of this study showed that experiential avoidance regarding ED serves as a partial mediator. This suggests that the hypothesis that “experiential avoidance, rather than anticipatory anxiety itself, is the problem that exacerbates ED symptoms” is valid. The effectiveness of psychological interventions (mainly cognitive behavioral sex therapy) provided to patients with ED targeting experiential avoidance should be studied in future. Disclosure Work supported by industry: yes, by BioMimetics Sympathies, Inc.. A consultant, employee (part time or full time) or shareholder is among the authors (BioMimetics Sympathies, Inc.).