Love yourself as a therapist, doubt yourself as an institution? Therapist and institution effects on outcome, treatment length, and dropout.

OBJECTIVE: Research suggests that some therapists achieve better outcomes than others. However, an overlooked area of study is how institution differences impact patient outcomes independent of therapist variance. This study aimed to examine the role of institution and therapist differences in adult outpatient psychotherapy. METHOD: The study included 1428 patients who were treated by 196 therapists at 10 clinics. Two- and three-level hierarchical linear regression models were employed to investigate the effects of therapists and institutions on three dependent patient variables: (1) symptom change, (2) treatment duration, and (3) dropout. Level three explanatory variables were tested. RESULTS: The results showed that therapist effects (TE) were significant for all three types of treatment outcome (7.8%-18.2%). When a third level (institution) was added to the model, the differences between therapists decreased, and significant institution effects (IE) were found: 6.3% for symptom change, 10.6% for treatment duration, and 6.5% for dropout. The exploratory analyses found no predictors able to explain the systematic variation at the institution level. DISCUSSION: TE on psychotherapy outcomes remain a relevant factor but may have been overestimated in previous studies due to not properly distinguishing them from differences at the institution level.

Psychometric Properties of the Diagnostic Interview for Sexual Dysfunctions in Women in a Symptom-Reporting Sample.

While structured clinical interviews are considered the gold standard for diagnosing mental disorders, respective instruments are still lacking in the field of sexual dysfunctions. The study evaluates the psychometric properties of the new Diagnostic Interview for Sexual Dysfunctions in Women (DISEX-F), which is based on the eleventh edition of the International Statistical Classification of Diseases (ICD-11) and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), in a sample of 100 women with self-reported sexual problems. Participants were interviewed twice by trained diagnosticians with the DISEX-F. A third diagnostician evaluated the audio records of the initial interview. Participants also completed self-report measures of sexual functioning/distress and interview acceptance. The DISEX-F demonstrates excellent inter-rater reliability, good test-retest reliability, and strong convergent and discriminant evidence of validity. Furthermore, it achieves high acceptance among participants. Discordant diagnostic outcomes were especially linked to false differential diagnostic decisions and information variance in participants reporting. The results strongly support using the DISEX-F for women presenting with self-reported sexual problems in practice and research.

Exploring barriers and facilitators to women's intention and behavior to seek treatment for distressing sexual problems.

Many women experience distressing problems with sexual functioning, most commonly in the form of low sexual desire or arousal, difficulties reaching orgasm, or genito-pelvic pain with sexual activity. Although effective treatments are available, more than half of the women who experience distressing sexual problems do not seek professional help. Understanding help-seeking patterns, experiences with treatment providers, and barriers to treatment is crucial to address this underutilization. Examining the role of personal characteristics, sexual problem symptoms, and cognitive factors in explaining the intention to seek treatment can help identify individuals who are most reluctant to seek help. Psychological online interventions are a promising resource to increase the availability of effective treatments. Knowledge about the predictors of women's intention to use internet-delivered treatments, as well as information about personal preferences regarding their scope, can help tailor them to women's needs. To address these research questions, cross-sectional data of 800 women (Mage = 30.49, range = 18-73) were analyzed. While many women considered clinical psychologists to be the most qualified treatment providers, gynecologists were cited as the most likely first point of contact. Among women not utilizing any treatments, many reported a preference for dealing with a sexual problem on their own as a reason not to seek help. Higher help-seeking intention was related to living in a larger city, experiencing higher sexual distress, experiencing pain or difficulties with vaginal penetration, higher self-stigma. and lower sexual assertiveness. Women who were convinced of the effectiveness of psychological online interventions and who appreciated the benefits of anonymity indicated that they were more likely to use them. Understanding what factors influence women's decisions about whether or not to seek professional help for distressing sexual problems is key to reducing the underutilization of available resources and developing treatments that meet their needs and preferences.

Subjective effects and perceived mechanisms of change of cognitive behavioral and mindfulness-based online interventions for low sexual desire in women.

Cognitive-behavioral (CBT) and mindfulness-based therapy (MBT) are effective treatments for Hypoactive Sexual Desire Dysfunction (HSDD) in women. To date, evidence regarding the mechanisms of these treatments for improving low sexual desire is still lacking. To gain comprehensive information on the subjective effects and perceived mechanisms of change of CBT and MBT for HSDD, semi-structured qualitative interviews were conducted with 51 cis-women who participated in a trial investigating internet-based CBT and MBT for HSDD. Data were analyzed with deductive and inductive content analysis. Subjective treatment effects included increased desire, improved communication, and greater self-acceptance. Different mechanisms of change for CBT and MBT were endorsed by participants. This study provides tangible evidence of the different pathways through which CBT and MBT can improve women's sexual desire.

Internet- and mobile-based psychological interventions for sexual dysfunctions: a systematic review and meta-analysis.

Sexual dysfunctions are highly prevalent and undertreated. Internet- and mobile-based psychological interventions (IMIs) could be a promising addition to close this treatment gap, given their accessibility, anonymity, and scalability. This systematic review and meta-analysis investigated the efficacy of IMIs for sexual dysfunctions. A comprehensive literature search was conducted in August 2021 on randomized controlled trials investigating the effects of IMIs on sexual functioning and satisfaction compared to a control condition. Twelve RCTs with 14 comparisons were reviewed with six IMIs targeting female and six IMIs targeting male sexual dysfunctions and n = 952 participants were evaluated in the meta-analysis. IMIs were significantly more effective than control conditions (k = 11 waitlist control group, k = 3 online discussion board) at post-treatment for female sexual functioning (g = 0.59, CI: 0.28-0.90, I2 = 0%) and satisfaction (g = 0.90, CI: 0.02-1.79, I2 = 82%), and male sexual functioning (g = 0.18, CI: 0.02-0.34, I2 = 0%). No significant effect was found for male sexual satisfaction (g = 0.69, CI: -0.13-1.51, I2 = 88%) with substantial heterogeneity in studies. Most studies showed high dropout, with ten studies indicating some concern of risk of bias, and two studies showing high risk of bias. The results suggest that IMIs can be an effective treatment for sexual dysfunctions, although additional high-quality research is needed. Given the limited availability of specialized treatment for sexual dysfunctions and individual preferences for discrete treatment options, IMIs seem to be a valuable addition to routine care, empowering individuals to promote their sexual health on a guided self-help basis.

A Qualitative Study of Women's Experiences with Cognitive-Behavioral and Mindfulness-Based Online Interventions for Low Sexual Desire.

Cognitive-behavioral (CBT) and mindfulness-based therapy (MBT) are among the most researched types of psychological interventions for low sexual desire in women. While both have been found effective in improving women's sexual desire, little is known about how women personally experience these treatments. To closely examine both approaches from a participant's perspective, semi-structured telephone-based interviews were conducted with 51 cis-women (Mage = 39, SD = 11, range = 22 to 69) who participated in a randomized controlled study comparing internet-based CBT and MBT for low sexual desire with a waitlist. Interview data were analyzed using thematic and content analysis. Most women (n = 44, 86.3%) evaluated their respective treatment (i.e., CBT or MBT) as helpful in improving their sexual desire. CBT-techniques, such as cognitive restructuring, were mentioned as being helpful for challenging maladaptive thinking patterns, while formal mindfulness-exercises allowed women to disengage from negative sexuality-related thoughts. Elements of sex therapy, including self-stimulation exercises and sensate focus, were perceived as crucial for getting women in touch with their sexual desires and preferences. Strengths of the online format included anonymity, flexibility, and convenient access. Overall, women's personal accounts supported feasibility, acceptability, and clinical usefulness of CBT- and MBT-based internet interventions targeting low sexual desire.

Positive Mental Health Scale: Validation and measurement invariance across eight countries, genders, and age groups.

Positive mental health (PMH), defined as the presence of general emotional, psychological, and social well-being is an important factor of general mental health. To allow for valid comparisons of PMH across different groups of interest, measurement invariant instruments are needed. The present study tested the measurement invariance of the nine-item Positive Mental Health Scale (PMH-Scale) across eight countries (i.e., France, Germany, Poland, Russia, Spain, Sweden, the United Kingdom, and the United States) as well as across genders, and age groups. Population-based online-panel surveys were conducted (N per country > 1,000). The PMH-Scale showed good to excellent internal consistency as well as unidimensionality in all subsamples. Convergent validity was supported by positive correlations with the Perceived Social Support Questionnaire (F-SozU K-6), discriminant validity was shown be negative correlations with the subscales of the Depression Anxiety Stress Scales 21 (DASS-21). The PMH-Scale showed scalar measurement invariance across countries, genders, and age groups. Comparisons of latent means showed small to medium group differences, with highest levels of PMH found in the French and US-American samples as well in participants between 45 and 54 years of age. Lowest levels of PMH were found in Russian participants. Gender differences in PMH were negligible. The PMH-Scale can be used to meaningfully compare the levels of PMH across the eight investigated countries, women, and men, as well as younger and older individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric properties of the S-Scale: Assessing a psychological mindset that mediates the relationship between socioeconomic status and depression.

Individuals with low socioeconomic status (SES) are disproportionally affected by depressive disorders which are among the main causes for loss in healthy life years in adults worldwide. The main objective of the research presented here was to identify a psychological mindset of individuals with low SES and to investigate whether this mindset mediates the relationship between low SES and symptoms of depression. Towards these goals, a series of four studies was conducted: Study 1 identified a set of ten statements reflecting a psychological mindset associated with low SES using a population-based sample from Germany (N = 1,969). Study 2 cross-validated a psychometric scale (S-Scale) that was created based on these statements in a population-based sample from Germany (N = 3,907). Study 3 introduced a longitudinal perspective and showed that the S-Scale mediated the relationship between low SES and symptoms of depression assessed one year later in a German student sample (N = 1,275). Study 4 supported unidimensionality and construct validity of a unified version of the S-Scale and confirmed the mediation effect of the S-Scale for SES and depression while controlling for confounding variables (e.g., socially desirable responding) in a U.S. American convenience sample (N = 1,000). Evidence from four studies supported the reliability and validity of the S-Scale. Controlling for a psychological mindset as measured with this scale, low SES was no longer a predictor of depressive symptoms. The S-Scale can be used in clinical and research settings to assess a psychological mindset that puts individuals at risk for depression. Overall strengths of this series of studies include the use of population-based and longitudinal datasets and the application of findings to different operationalizations of SES. Future studies should investigate whether this mindset can be modified by psychological interventions and whether changes in this mindset predict improvements in depressive symptoms.

Visual attention and sexual arousal in women with and without sexual dysfunction.

Attention to sexual stimuli is a prerequisite to process such stimuli as sexually-meaningful and is an important means to facilitate sexual arousal. Attending to sexual cues is crucial for healthy sexual functioning. Studies suggest that sexual dysfunction is associated with less attention towards sexual stimuli. The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women with sexual dysfunction visually attend to the genital area in dynamic sexual stimuli (i.e., erotic videos) differently than women with subclinical sexual function or those with typical sexual functioning. A total of 69 women (Mage = 27.77, SD = 8.00) with clinical (n = 30), subclinical (n = 23), and typical (n = 16) levels of sexual functioning watched four 1-min video clips depicting heterosexual couples engaging in vaginal intercourse or cunnilingus while the total fixation duration on the genital area as well as their subjective and genital sexual arousal were recorded. As hypothesized, the clinical group fixated on the genital area less than women with typical sexual functioning. A longer total fixation duration on the genital area was followed by increases in subjective arousal and genital arousal. The relationship between attention and arousal was not moderated by sexual functioning group. This study provides first evidence of the role of sustained visual attention for facilitating sexual arousal in women with and without sexual dysfunction.

Psychometric Properties of a Self-Report Version of the Sexual Interest and Desire Inventory-Female (SIDI-F-SR).

BACKGROUND: The Sexual Interest and Desire Inventory-Female (SIDI-F) is a clinician-administered scale that allows for a comprehensive assessment of symptoms related to Hypoactive Sexual Desire Dysfunction (HSDD). As self-report questionnaires may facilitate less socially desirable responding and as time and resources are scarce in many clinical and research settings, a self-report version was developed (Sexual Interest and Desire Inventory- Female Self-Report; SIDI-F-SR). AIM: To assess the psychometric properties of the SIDI-F-SR and to investigate the agreement between the SIDI-F and SIDI-F-SR. METHODS: A total of 170 women (Mage = 37, SD = 11, range = 20-69) with HSDD answered the SIDI-F, administered by a clinical psychologist via telephone, first, followed by the SIDI-F-SR, delivered as an Internet-based questionnaire. A subset of 19 women answered the SIDI-F-SR twice over a period of 14 weeks. OUTCOMES: Convergent validity of the SIDI-F-SR was assessed via correlations with the desire subscale of the Female Sexual Function Index and the Female Sexual Distress Scale Revised. Internal consistency and test-retest reliability as well as intraclass correlation and predictors of absolute agreement between SIDI-F and SIDI-F-SR were examined. RESULTS: Test-retest-reliability was good (r = 0.74). Convergent validity was low but comparable between SIDI-F and SIDI-F-SR. Internal consistency of the SIDI-F-SR was acceptable (α = 0.76) and comparable to the SIDI-F (α = 0.74). When corrections for the restriction of range were applied, internal consistency of the SIDI-F-SR increased to 0.91. There was high agreement between SIDI-F and SIDI-F-SR (ICC = 0.86). On average, women scored about one point higher (indicated more desire) in the self-report vs the clinician-administered scale. CLINICAL IMPLICATIONS: The SIDI-F-SR can be used in settings where time and resources are limited. Whether the clinical cutoff point for the SIDI-F is adequate for the SIDI-F-SR has yet to be determined. STRENGTHS AND LIMITATIONS: Large sample of diverse women with HSDD. Lack of control groups (ie, healthy controls, women with other sexual dysfunctions). CONCLUSION: The SIDI-F-SR showed promising psychometric properties in a sample of women with HSDD. Velten J, Hirschfeld G, Meyers M, et al. Psychometric Properties of a Self-Report Version of the Sexual Interest and Desire Inventory-Female (SIDI-F-SR). J Sex Med 2021;18:990-995.

Using Three Indirect Measures to Assess the Role of Sexuality-Related Associations and Interpretations for Women's Sexual Desire: An Internet-Based Experimental Study.

Theoretical models emphasize the role of both automatic appraisals (i.e., associations) and conscious appraisals (i.e., interpretations) for sexual desire. Studies on sexuality-related appraisals have not combined self-report measures and experimental paradigms in order to compare the relevance of associations or interpretations. The aim of this study was to assess the relative contribution of both associations and interpretations to the explanation of low sexual desire in women. Toward this goal, indirect measures assessing associations (via a Single Target Implicit Association Test [STIAT]) and interpretations (via a Scrambled Sentences Test [SST] and a scenario task) were administered in a sample of 263 women (Mage = 27.90, SD 8.27) with varying levels of sexual desire and different sexual orientations (exclusively heterosexual women: 54.6%). Negative sexuality-related interpretations as assessed with two variants of the SST as well as the scenario task added to the explanation of lower sexual desire in women. Negative associations as measured with the STIAT were predictive of lower sexual desire only in women who did not indicate an exclusively heterosexual orientation. In this study, sexuality-related interpretations were more relevant to women's sexual desire than automatic associations. Future studies should assess the causal mechanism underlying sexuality-related interpretations (e.g., by evaluating whether these can be changed via cognitive bias modification techniques or psychological treatments).

The Cooperative Revolution Reaches Clinical Psychology and Psychotherapy: An Example From Germany.

Background: Psychology is at the beginning of a cooperative revolution. Traditionally, psychological research has been conducted by individual labs, limiting its scope in clinical samples and promoting replication problems. Large-scale collaborations create new opportunities for highly powered studies in this resource-intensive research area. To present the current state of a Germany-wide platform for coordinating research across university outpatient clinics for psychotherapy. Method: Since 1999, over 50 such clinics were created in Germany. They represent a unique infrastructure for research, training, and clinical care. In 2013, a steering committee initiated a nationwide research platform for systematic coordination of research in these clinics (German abbreviation "KODAP"). Its main goal is to aggregate and analyze longitudinal treatment data - including patient, therapist, and treatment characteristics - across all participating clinics. Results: An initial survey (100% response rate) yielded recommendations for improved integration of data collection. Pilot data from 4,504 adult (16 clinics) and 568 child and adolescent patients (7 clinics) proved feasibility of data transfer and aggregation despite different data formats. Affective, neurotic, stress, and somatoform (adults) and anxiety and behavioral (children and adolescents) disorders were most frequent; comorbidity was high. Overcoming legal, methodological, and technical challenges, a common core assessment battery was developed, and data collection started in 2018. To date, 42 clinics have joined. Conclusions: KODAP shows that research collaboration across university outpatient clinics is feasible. Fulfilling the need for stronger cumulative and cooperative research in Clinical Psychology will contribute to better knowledge about mental health, a core challenge to modern societies.

Visual Attention to Sexual Stimuli in Women With Clinical, Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study.

BACKGROUND: Visual attention to sexual stimuli is an important means to facilitate sexual arousal and is thereby relevant for healthy sexual functioning. Experimental studies suggest that sexual dysfunction is associated with less attention toward sexual stimuli. AIM: The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women in the clinical range of sexual function attend to a genital area in visual sexual stimuli differently than women with subclinical sexual function or those with normal sexual functioning. METHODS: Toward this goal, 69 women (Mage = 27.77, SD = 8.00, range = 19-54) with clinical (n = 30), subclinical (n = 23), and normal (n = 16) levels of sexual functioning watched a series of 10 pictures depicting heterosexual couples during vaginal intercourse while their eye movements were recorded. Each picture was presented twice-once with a distracting object (eg, a to-do list or household appliance) present in the picture and once without-for 8 seconds, each. OUTCOMES: 5 eye-tracking measures indicative of different aspects of initial and sustained attention were analyzed. RESULTS: As hypothesized, 3 out of 5 eye-tracking measures (ie, first fixation duration, number of first fixations, and total fixation duration) indicated that women in the clinical group attended less to the genital area in the pictures than women with normal sexual functioning. For 2 indices (ie, first fixation duration and total fixation duration), women with subclinical (vs normal) sexual functioning also attended less to the genital area. In contrast to our hypothesis, the presence of a distracting object did not influence attention to the genital area in either of the sexual function groups. CLINICAL IMPLICATIONS: This study provides further evidence of the role of attentional biases in sexual dysfunction in women. STRENGTHS AND LIMITATIONS: Eye-tracking methodology allows for a continuous measurement of visual attention; this is one of the first studies using this methodology to assess differences in visual attention in women with and without sexual dysfunction. However, the cross-sectional nature of this study prevents causal interpretation of findings. CONCLUSION: Future studies should use experimental paradigms to determine the causal role of visual attention for the development or maintenance of sexual dysfunction. Velten J, Milani S, Margraf J, et al. Visual Attention to Sexual Stimuli in Women With Clinical, Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study. J Sex Med 2021;18:144-155.

Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments.

BACKGROUND: Psychological therapies are effective treatments for hypoactive sexual desire dysfunction (HSDD; formerly hypoactive sexual desire disorder), a common sexual dysfunction among women. Access to evidence-based treatments, however, remains difficult. Internet-based interventions are effective for a variety of psychological disorders and may be a promising means to close the treatment gap for HSDD. OBJECTIVE: This article describes the treatment protocol and study design of a randomized controlled trial, aiming to study the efficacy of cognitive behavioral and mindfulness-based interventions delivered via the internet for women with HSDD to a waitlist control group. Outcomes are sexual desire (primary) and sexual distress (secondary). Additional variables (eg, depression, mindfulness, rumination) will be assessed as potential moderators or mediators of treatment success. METHODS: A cognitive behavioral and a mindfulness-based self-help intervention for HSDD will be provided online. Overall, 266 women with HSDD will be recruited and assigned either to one of the intervention groups, or to a waitlist control group (2:2:1). Outcome data will be assessed at baseline, at 12 weeks, and at 6 and 12 months after randomization. Intention-to-treat and completer analyses will be conducted. RESULTS: We expect improvements in sexual desire and sexuality-related distress in both intervention groups compared to the waitlist control. Recruitment has begun in January 2019 and is expected to be completed in August 2021. Results will be published in 2022. CONCLUSIONS: This study aims to contribute to the improvement and dissemination of psychological treatments for women with HSDD and to clarify whether cognitive behavioral and/or mindfulness-based treatments for HSDD are feasible and effective when delivered via the internet. TRIAL REGISTRATION: ClinicalTrials.gov NCT03780751; https://clinicaltrials.gov/ct2/show/NCT03780751. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/20326.

The brief daily stressors screening tool: An introduction and evaluation.

The present study introduces a short screening instrument for the measurement of experienced general daily stressors across different life domains that can be used in large-scale studies. The brief daily stressors screening tool (BDSST) assesses the experience of general daily stressors in eight distinct life domains. General daily stressors are indicated for the past 12-months on a five-point Likert scale. The present study evaluates the BDSST in two successive studies. The first study was conducted in a representative German sample (n = 7,849). The second study was conducted to assess one-month-retest-stability in another representative German sample (n = 1,294). The BDSST shows promising psychometric properties. It has a skewed positive distribution, internal consistency and stability are acceptable and its one-factor structure was confirmed in a bifactor confirmatory factor analysis. The BDSST is a reliable and valid short instrument for the assessment of experienced general daily stressors in large-scale studies and routine clinical practise. For in-depth clinical assessment, it can be used to identify relevant life domains for further investigation.

Development and Validation of a Measure of Responsive Sexual Desire.

According to the incentive motivation model, sexual desire does not occur spontaneously but can be triggered by sexual stimuli and stems from one's experience of sexual arousal. Until now, research into responsive sexual desire has been challenged by the lack of measures capturing desire that emerges following sexual arousal. The aim of this study was to validate the 18-item Report of Behavior and Feelings-Desire (RBF-D) scale in a sample of 291 women (Mage = 22.41, SD = 5.82) with varying degrees of sexual desire. Items on the RBF-D were selected to reflect 5 aspects of responsive sexual desire: sexual activity with a primary partner, sexual desire for a primary partner, sexual activity with other persons, sexual desire for other persons, and autoerotic activities. A 5-factor solution was confirmed via exploratory structural equation modeling. Internal consistency of 4 out of 5 factors was good. Convergent validity was established via small to medium associations of the RBF-D factors with other measures of sexual desire. Low and nonsignificant correlations with depression and sexual inhibition supported the discriminant validity. The RBF-D is a valid and reliable measure that can be useful in clinical and research settings where assessment of responsive sexual desire and behavior is needed.

Relationship Between Daily Stress, Depression Symptoms, and Facebook Addiction Disorder in Germany and in the United States.

This study investigated the link between experience of daily stress, depression symptoms, and the Facebook Addiction Disorder (FAD) in Germany and in the United States. In samples from both countries (German sample: N = 531; U.S. sample: N = 909), daily stress was positively associated with FAD. Depression symptoms significantly positively moderated this positive relationship. Thus, current findings demonstrate that depressed individuals who often tend to intensively use Facebook to escape from daily stress and to find relief and social support are at enhanced risk to develop FAD, which reinforces their negative symptoms. Therefore, interventions for depressed individuals should include alternative strategies to cope with daily stressors.

Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care: A 5- to 20-Year Follow-Up Study.

OBJECTIVE: Long-term follow-ups several years after receiving cognitive behavioral therapy (CBT) are scarce and most of the existing literature describes follow-up data of randomized-controlled trials. Thus, very little is known about the long-term effects of CBT in routine care. METHODS: We investigated psychological functioning in a sample of 263 former outpatients who had received CBT for a variety of mental disorders such as depression, anxiety-, eating- or somatoform disorders 8.06 (SD 5.08) years after treatment termination. All participants completed a diagnostic interview as well as the Brief-Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Effect sizes and response rates according to Jacobson and Truax [J Consult Clin Psychol 1991;59:12-9] were calculated from pre- to posttreatment and from pretreatment to follow-up assessment. RESULTS: Pre- to posttreatment effect sizes ranged between 0.75 (BDI) and 0.63 (BSI) and pretreatment to follow-up effect sizes were 0.92 (BDI) and 0.75 (BSI). Of all patients, 29% (BDI) and 17% (BSI) experienced clinically significant change at posttreatment and 42% (BDI) and 24% (BSI) at follow-up. CONCLUSION: The results point to the long-term effectiveness of CBT under routine conditions for a wide array of problems, especially when compared to the long-term effects of medical treatment. It is noteworthy that the results at follow-up were even better than at posttreatment, indicating further improvement. However, about a quarter of the patients did not respond sufficiently to therapy, neither concerning short-term nor long-term effects.

Correction to: Temporal Stability of Sexual Excitation and Sexual Inhibition in Women.

The authors would like to issue a correction for a statement made in the conclusion section of the paper entitled "Temporal stability of sexual excitation and sexual inhibition in women". As one might expect and as rightly stated throughout the paper, our study suggests that improvements in sexual function might increase sexual excitation and decrease sexual inhibition in women, not the other way around.