One of the most common issues I see in my practice is the negative effect of anxiety on sexual performance and satisfaction. I’ve written about performance anxiety before, particularly in the context of social anxiety, but in this particular post I want to focus more on a different kind of anxiety– generalized anxiety.  The first thing to understand about anxiety is that it comes in many different forms and flavors. Social anxiety, panic disorders, hypochondria, and obsessive-compulsive disorder (OCD) are all classified as different types of anxieties. The most common anxiety, as it relates to sexual functioning is generalized anxiety.

Now, based on the name alone, most people probably don’t place enough importance to an anxiety that is considered to be generalized in nature. After all, everyone has experienced some sort of “generalized anxiety” before, right? I mean, the commute to work, the looming deadlines, the financial obligations can all make someone feel very, very anxious. So, it’s not really a big psychological problem, right? Not true at all.

At the core, folks with generalized anxiety experience a prevailing, sometimes even debilitating worry that something really bad is going to go wrong, that things are about to fall apart any moment. Often they feel that the anxiety alone is what keeps things glued together. If they stopped worrying, all hell would break loose. Often times this worrying is focused on things that, if they did fall apart, then all hell would indeed literally break loose. These things include pivotal life arenas such as finances, health, and relationships.

The main reason that sexuality often becomes the focus of generalized anxiety is that it serves a pivotal function in the maintenance of positive, healthy and successful relationships. In other words, if something went wrong with the sex, then the person’s partner would become dissatisfied, then leave, then divorce or separation, then the finances take a hit, and finally the person ends up old, sick, alone, and hungry. Or something like that. That’s the inevitable ending spot for the fear. And that’s how generalized anxiety works.

One of the first things I want to do to help my clients is to help them identify their thinking patterns. Specifically I want them to be able to distinguish between what I call “outcome-oriented” thinking vs “process oriented” thinking. Outcome oriented thinking is literally what it sounds like… when we get ahead of ourselves and focus exclusively on the outcome.  This is the default for folks with generalized anxiety and it’s never a positive outcome that’s in mind. And it only makes the anxiety worse. This kind of outcome oriented approach is what results in performance anxiety.

Think about a time when you got anxious about having to make a speech or presentation or perhaps a sports experience where the outcome of the game depended on your next move. If you were to take an outcome-oriented approach in that situation, what might you do? You might, for example, think about how embarrassing it would be if you messed up; how the crowd or audience would laugh at you or judge you internally for your failings. They might not say so but they won’t think very highly of you once you are done. Sound familiar? This kind of outcome oriented thinking always leads to a spike of anxiety that we continue to reinforce by dwelling on the outcome.

Process oriented thinking, on the other hand, focuses more on the minute-to-minute process of completing the task, rather than jumping the shark and going right to the outcome. Rather than focusing on what the audience thinks, an individual with a process-oriented approach would be thinking about the material more closely instead. The individual, for example, might think about what kind of audience will be listening, what are their learning needs, and what kind of a message the individual wants to broadcast. The focus would be on learning the material and considering how it could be conveyed in a way that would be most readily digested by the audience. These are all examples of process-oriented thinking. This kind of approach serves to lessen, rather than intensify, feelings of anxiety because it bypasses the usual catastrophic thinking and instead immerses the individual into his or her present moment experience.

Moving this into the sexual arena, an individual with an outcome oriented approach would be thinking about the end game only– things like erections, orgasms and the like– and usually imagining worst-case outcomes. Instead I help my clients to take on a process-oriented approach by focusing more on pleasure than erections, connection over orgasms. If an individual is enjoying the process, the erections and orgasms will come on their own, without the need for prompting. Often times it may be helpful for the individual to tell his partner that he doesn’t want to focus on intercourse, but simply on enjoying each other’s touch and sensuality. In this way, adopting a more process-oriented approach often does wonders in alleviating performance anxiety issues.

This is usually one of the first steps I take with my clients and often times, this may be enough to reset sexual expectations and get the person back on track. Usually though this is just a first step, which I then build from by providing my clients with additional tools and skills that they can then incorporate not only into their sexuality but also utilize to manage their anxiety in other areas of life as well.