Sexual Modes Questionnaire

Abstract

The Sexual Modes Questionnaire (SMQ) is a self-report instrument developed by Pedro J. Nobre and José Pinto-Gouveia (2003) designed to assess the complex interaction among cognitions, emotions, and subjective sexual responses during sexual activity. The measure features distinct versions tailored for males (30 items) and females (33 items) and is suitable for use in both clinical samples (e.g., individuals with sexual dysfunction) and nonclinical populations. The SMQ is structured around three core, interdependent subscales: the Automatic Thought (AT) subscale, the Emotional Response (ER) subscale, and the Sexual Response (SR) subscale.

Keywords

Sexual Modes Questionnaire, SMQ, sexual cognition, automatic thoughts, sexual emotions, sexual response, sexual function, sexual dysfunction, self-report measure.

Authors

Pedro J. Nobre, José Pinto-Gouveia.

Purpose

The primary purpose of the Sexual Modes Questionnaire (SMQ) is to provide a structured and comprehensive assessment of the cognitive-emotional processing that mediates sexual responses. It is rooted in the cognitive-behavioral understanding that immediate, spontaneous thoughts and subsequent emotional reactions significantly influence an individual’s subjective sexual experience.

The measure allows clinicians and researchers to identify maladaptive cognitive patterns, such as performance anxiety or negative body image thoughts, that contribute to or maintain sexual difficulties. By quantifying the frequency of these thoughts, the associated emotional distress, and the resulting subjective arousal, the SMQ facilitates the development of targeted therapeutic interventions.

Construct

The SMQ is constructed to measure a tripartite psychological model focusing on the interaction between internal mental processes and physiological sexual outcomes. It specifically targets the interplay between cognitions, emotions, and subjective sexual arousal experienced during sexual engagement.

The scale captures three distinct, yet related, components:

• Automatic Thought (AT) Subscale: This component evaluates the frequency of spontaneous thoughts and images. The content of these thoughts is gender-specific; for men, items focus heavily on sexual performance (especially erectile response) and failure anticipation; for women, items cover failure, disengagement, sexual abuse history, low body image, and control thoughts.

• Emotional Response (ER) Subscale: This component measures the emotional consequences of the automatic thoughts. Respondents select from a list of ten common emotions (including worry, sadness, fear, guilt, pleasure, and satisfaction) that they typically experience when encountering a specific automatic thought.

• Sexual Response (SR) Subscale: This component assesses the intensity of subjective sexual response (arousal) that occurs in the context of the specific thought and emotional combination, thus linking the cognitive-emotional chain directly to the physiological outcome.

Validity

Convergent Validity

Convergent validity was established by examining the relationship between the SMQ and established, validated measures of sexual function. These included the International Index of Erectile Function (IIEF) for men and the Female Sexual Function Index (FSFI) for women. Statistically significant correlations were found across both genders, confirming that automatic thoughts and emotions during sexual activity are intrinsically linked to measured sexual response outcomes.

The female AT subscale demonstrated high negative correlations with the FSFI, particularly among factors such as Sexual Abuse Thoughts (F1), Failure and Disengagement Thoughts (F2), and Lack of Erotic Thoughts (F5). Similarly, the male AT subscale showed significant negative correlations with the IIEF, especially with Failure Anticipation Thoughts (F1), Erection Concern Thoughts (F2), and Lack of Erotic Thoughts (F5). The ER subscale correlations were also significant: the FSFI negatively correlated with sadness, guilt, and anger, and positively correlated with pleasure; the IIEF showed higher correlations with sadness, disillusionment, pleasure, and satisfaction.

Discriminant Validity

Discriminant validity analysis successfully demonstrated the SMQ’s capacity to distinguish between clinical and nonclinical populations. Significant differences were observed in automatic thoughts, emotions, and sexual responses between a clinical group (diagnosed with sexual dysfunction) and a matched control group. Women in the clinical group exhibited significantly higher scores on Failure and Disengagement Thoughts (F2), Lack of Erotic Thoughts (F5), and the total AT scale. Men in the clinical group presented significantly higher scores on Failure Anticipation (F1), Erection Concern (F2), and Lack of Erotic Thoughts (F5) compared to the control group.

Reliability

The reliability of the SMQ was assessed through internal consistency and test-retest measures, focusing primarily on the Automatic Thought (AT) subscale.

Internal consistency, measured using Cronbach’s alpha (α), indicated high general consistency for the total AT scale in both versions (Male: α = .88; Female: α = .87). The consistency of the specific dimensions within each factor was also strong, with α statistics ranging from .71 to .80 for the female version and from .69 to .83 for the male version (Nobre & Pinto-Gouveia, 2003).

Test-retest reliability was evaluated by computing the Pearson product-moment correlation between two administrations separated by a four-week interval. The female version demonstrated excellent stability across time, yielding a high correlation for the total scale (r = .95, p < .01). Correlations for specific female dimensions ranged from r = .52 (p < .05) to r = .90 (p < .01). The male version showed a more moderate total scale correlation (r = .65, p = .08), with specific dimension correlations ranging from r = .20 (p < .05) to r = .95 (p < .01).

Factor Analysis

The structure of the Automatic Thought (AT) subscale was determined through factor analysis (Principal Component Analysis with Varimax rotation) for both male and female versions (Nobre & Pinto-Gouveia, 2003).

The analysis of the female AT subscale (33 items) identified six distinct factors, collectively accounting for 53.1% of the total variance. These factors include:

1. Sexual Abuse Thoughts

2. Failure and Disengagement Thoughts

3. Partner’s Lack of Affection

4. Sexual Passivity and Control

5. Lack of Erotic Thoughts

6. Low Self Body-Image Thoughts

The male AT subscale (30 items) was found to comprise five factors, centered around performance anxiety and negative sexual self-concept:

1. Failure Anticipation Thoughts

2. Erection Concern Thoughts

3. Age and Body-Related Thoughts

4. Negative Thoughts Toward Sex

5. Lack of Erotic Thoughts

Scoring for the AT subscale allows for the calculation of an index of negative automatic thoughts by summing all item scores (with erotic cue-related thoughts being reverse-scored). The Emotional Response index is a proportion score (total number of a specific emotion endorsed divided by the total number of all emotions endorsed, ranging 0.0 to 1.0). The Sexual Response index is calculated by summing the sexual response scores for endorsed items and dividing by the total number of endorsed items (ranging 1 to 5).

Instrument

Test Type: Self-report questionnaire, multidimensional psychological scale.

Format: Paper-and-pencil or computer administration. Utilizes Likert-type scales (5-point) for measuring frequency of thoughts and intensity of sexual arousal, alongside a checklist format for emotional responses.

Language Available: Portuguese (Original), English.

Population Group: Adults (Men and Women).

Age Group: Adult population.

Population Details: Applicable for use in both clinical samples (e.g., individuals with diagnosed sexual dysfunction) and nonclinical samples (general population) for research or therapeutic assessment.

Test Methodology: The SMQ uses a sequential response method. Participants first rate the frequency of each automatic thought (1 = Never to 5 = Always). Next, they check all applicable emotions (from a list of 10) typically experienced with that thought. Finally, they rate the intensity of their subjective sexual arousal (1 = Very Low to 5 = Very High) linked to the specific thought and emotional state.

Keywords

Automatic thoughts, sexual arousal, cognitive-behavioral therapy, performance anxiety, sexual response, International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI).

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: Contact Pedro J. Nobre for further information and permissions.

Correspondence Address: Pedro J. Nobre, Universidade de Trás-os-Montes e Alto Douro, Portugal; José Pinto-Gouveia, Universidade de Coimbra, Portugal.

Permissions & Fee and Test Year

The Sexual Modes Questionnaire (SMQ) was initially published and validated in 2003 (Nobre & Pinto-Gouveia). For more information regarding the SMQ and permission for its use, please contact the primary author, Pedro J. Nobre.

Reference’s

• Nobre, P. J., & Pinto-Gouveia, J. (2003). Sexual Modes Questionnaire: Measure to assess the interaction between cognitions, emotions and sexual response. The Journal of Sex Research, 40, 368–382.

• Nobre, P. J., & Pinto-Gouveia, J. (2006). Emotions during sexual activity: Differences between sexually functional and dysfunctional men and women. Archives of Sexual Behavior, 35, 8–15.

• Nobre, P. J., & Pinto-Gouveia, J. (2008). Differences in automatic thoughts presented during sexual activity between sexually functional and dysfunctional males and females. Journal of Cognitive Therapy and Research, 32, 37–49.

• Rosen, R. C., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26, 191–208.

• Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology, 49, 822–830.

Items of the Sexual Modes Questionnaire

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The items presented below are a list of thoughts one can have during sexual activity. In the first column, please indicate the frequency with which you experience these thoughts by circling a number (1—Never to 5—Always). Next, indicate the types of emotions you typically experience when having these thoughts by marking an X in the columns for the appropriate emotions. Finally, in the last column, for each thought experienced indicate the intensity of your typical sexual response (arousal) while you are having that thought by circling a number (1—Very Low to 5—Very High).

NOTE: For thoughts that you indicate as never experiencing, you do not need to fill out the emotion or sexual response column.

Never Seldom Sometimes Often

Male version

Example: Imagine that the thought “Making love is wonderful” comes to your mind very often whenever you are engaged in a sexual activity, that this idea is accompanied by pleasurable emotions, and that your sexual arousal becomes very high. In this case your answer should be:

Female Version

The items presented below are a list of thoughts one can have during sexual activity. In the first column, please indicate the frequency with which you experience these thoughts by circling a number (1—Never to 5—Always). Next, indicate the types of emotions you typically experience when having these thoughts by marking an X in the columns for the appropriate emotions. Finally, in the last column, for each thought experienced indicate the intensity of your typical sexual response (arousal) while you are having that thought by circling a number (1—Very Low to 5—Very High).

NOTE: For thoughts that you indicate as never experiencing, you do not need to fill out the emotion or sexual response column.

Example: Imagine that the thought “Making love is wonderful” comes to your mind often whenever you are engaged in a sexual activity, that this idea is accompanied by pleasurable emotions, and that your sexual arousal becomes very high. In this case your answer should be: