Letters to the Editor
Visually Enhanced Psychosexual Therapy (VEST) in a Multicultural Community
Dear Editor:
There appears to be an increasing demand for sexual dysfunction treatments. Apart from, or instead of, medications (none of which so far help desire problems that are commonest among couples seeking sex therapy), psychosexual therapy has much to offer. Visually Enhanced Psycho- sexual Therapy (VEST) can significantly improve such treatment, especially in a multicultural setting where lack of language skills handicaps therapeutic progress. Using films and videos as an educational tool has an established history (1–6). In the field of sexology, recent work by several investigators has focused primarily on the erectile or libidinal response to audiovisual sexual stimulation (7–9). Delizonna’s study in particular needs to be heeded, especially in this pharmacologic era, because it demonstrates that achievement of mechanically induced erection or penile tumescence “was not accompanied by a subjective state of physical or mental sexual arousal” (10).
The VEST approach begins by presenting the neuroanatomical and psycho- physiological facts of sexual functioning. This factual base enables patients to grasp and concretely visualize the universal biological structure and function of the human autonomic nervous system, its parasympathetic and sympathetic components, and their specific and critical role in arousal and orgasmic release.
In addition to the audiovisual component, this 8- to 10-session, brief, directive psychosexual therapy program uses several treatment elements, including bibliotherapy, relaxation, emotional communication skill training, and sensate focus exercises. Emphasis is placed on teaching the core time-related concepts of being present-centred and process- absorbed, along with how to reach this state.
Visual aids, carefully used, can efficiently explain concepts cognitively and can promote emotional learning. Personal introduction to each program used and prompt postexposure debriefing after patient viewing in privacy are critical elements to increase efficacy and patient comfort with VEST.
More than 25 years of treating people with sexual problems reveals that selection of the most appropriate visual aid requires careful clinical judgement, as the potential to do harm exists. Here one can draw a parallel with the use of medication. Moreover, the therapist must be intimately familiar and comfortable with the material chosen for presentation and confident of its potential to enhance, not impede, the therapeutic flow and rhythm with a particular patient or couple.
Access to a comfortable space with the assurance of viewing privacy, preceded by an active relaxation exercise, enables patients to be more attentive and fully focused on the often emotionally challenging material presented.
In VEST, audiovisual programs are integral to the total therapeutic approach and keep careful pace with patient progress. Thus, various assignments, such as specific readings or sensory, communicative, or relaxation exercises at home between sessions need seamless integration. Their impact benefits from reenforcement within the safe context of the cumulative therapeutic process.
Extensive clinical experience indicates a high success rate (80% to 85%) with VEST, as indicated by sustained reversal of the presenting sexual dysfunction. The World Association for Sexology (WAS) guidelines for ethical use of videos or multimedia in sex education, counselling and therapy, provide useful guidance in the application of these quasi-medications (11).
Note
A version of this paper was presented at the American Psychiatric Association Annual Meeting; May 21, 2002; Philadelphia (PA). A version of this paper was also presented at the Ontario Psychiatric Association
Annual Meeting; January 17, 2002;
Toronto (ON).
References
1. Gagliano ME. A literature review on the efficacy of video in patient education. J Med Educ 1988;63:785–92.
2. Meade CD, McKinney WP, Barnas GP. Educating patients with limited literacy skills: the effectiveness of printed and videotaped material about colon cancer. Am J Public Health 1994;84:119–21.
3. Cohen D. The effectiveness of videotape in patient education on depression. J Biocommun 1983;10(1):19–23.
4. Holm M.B. Video as a medium in occupational therapy. Am J Occup Ther 1983;37:531–4.
5. Nielsen E, Sheppard MA. Television as a patient education tool: a review of its effectiveness. Patient Educ Couns 1988;11(1):3–16.
6. Herrmann KS, Kreuzer H. Is patient education using audiovisual methods helpful? Z Kardiol 1990;79:354–8.
7. Kim SC, Bang JH, Hyun JS, Seo KK. Changes in erectile response to repeated audiovisual sexual stimulation. Eur Urol 1998;33:290–2.
8. Pescatori ES, Silingardi V, Galeazzi GM, Rigatelli M, Ranzi A, Artibani W. Audiovisual sexual stimulation by virtual glasses is effective in inducing complete cavernosal smooth muscle relaxation: a pharmacocavernosometric study. Int J Impot Res 2000;12(2):83–8.
9. Bartlik B, Kocsis J, Legere R, Villaluz J, Kossoy A, Gelenberg AS. Sexual dysfunction secondary to depressive disorder. Journal of Gender-Specific Medicine 1999;2(2):52–60.
10. Delizonna LL, Wincze JP, Litz BT, Brown TA, Barlow DH. A comparison of subjective and physiological measures of mechanically produced and erotically produced erections (or, is an erection an erection?) J Sex Marital Ther 2001;27(1):21–31.
11. Sommers FG. Multicultural sex therapy. Proceedings of the 14th World Congress of Sexology; Aug 23–17, 1999; Hong Kong, SAR (China).
Frank G Sommers, MD, FRCPC
Toronto, Ontario
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