Cognitive and Behavioral Outcomes of Sexual Behavior Scale

Abstract

The Cognitive and Behavioral Outcomes of Sexual Behavior Scale (CBOSBS) was developed by Kimberly R. McBride, Michael Reece, and Stephanie A. Sanders at Indiana University to quantify the negative consequences associated with sexual behaviors, particularly those related to the concept of sexual compulsivity (SC). The scale is structured around six domains of negative outcomes identified by the Society for the Advancement of Sexual Health (SASH): social, emotional/psychological, physical, legal, financial/occupational, and spiritual.

The CBOSBS is a multidimensional instrument comprising two main components: a 20-item cognitive outcomes scale, which measures worry or concern about potential negative consequences, and a 16-item behavioral outcomes scale, which measures the actual experience of negative outcomes. Validation research was primarily conducted using a nonclinical sample of young adults (N = 390). The scale is self-administered and typically takes about 10 minutes to complete.

Keywords

Sexual compulsivity, negative sexual outcomes, cognitive outcomes, behavioral outcomes, SASH, psychometric properties, Likert scale, young adults.

Authors

Kimberly R. McBride, Michael Reece, Stephanie A. Sanders

Purpose

The primary purpose of the CBOSBS is to provide a standardized measurement tool for assessing the extent to which an individual experiences negative outcomes resulting from their sexual behaviors. This assessment is framed within an outcomes-based understanding of sexual compulsivity (SC), suggesting that behaviors perceived as “out of control” lead to identifiable impairment across various life domains.

The scale was explicitly designed to measure the experience of negative outcomes across the six key domains articulated by the Society for the Advancement of Sexual Health (SASH). By measuring both cognitive distress (worry about outcomes) and actual behavioral consequences (experienced outcomes), the CBOSBS offers a comprehensive measure of impairment resultant from sexual activity.

Construct

The CBOSBS measures the construct of Negative Outcomes Associated with Sexual Behavior, which is theoretically linked to sexual compulsivity (SC). The scale’s items were generated based on theoretical understandings of SC, focusing on the measurable, adverse effects of sexual behavior rather than the frequency or intensity of the behavior itself.

The construct is operationalized across six dimensions of life impairment: Financial/Occupational, Legal, Physical, Psychological/Emotional, Spiritual, and Social. The scale captures two key facets of this impairment: the subjective experience of anxiety and concern regarding potential negative outcomes (cognitive component), and the objective reporting of having actually experienced those negative outcomes (behavioral component).

Validity

Construct validity for the 20 cognitive outcomes items was investigated using a statistical procedure. Specifically, a principal component analysis (PCA) with varimax rotation was performed, specifying six factors to align with the six predetermined outcome categories articulated by SASH.

The six-factor solution successfully explained 74.8% of the total variance, confirming the strong structure and the multidimensional nature of the cognitive scale. While the overall inter-item correlation matrix did not suggest a unidimensional scale, certain specific inter-item correlations were high—for instance, worry about financial problems and worry about wasting money—indicating potential redundancy among items that may warrant future refinement.

Reliability

Internal consistency reliability for the CBOSBS was assessed using Cronbach’s alpha. Separate analyses were conducted for the two scale components. The 20-item cognitive scale demonstrated high internal consistency (α = .89). The 16-item behavioral scale showed a slightly lower, yet acceptable, level of reliability (α = .75), which is typical given its dichotomous response format.

Reliability estimates were also calculated separately for each of the six underlying subscales, or factors. All subscales exhibited high Cronbach’s alpha levels, supporting the reliability of the factor structure in the study sample. Despite indications that some items might be redundant, the decision was made to use total scale scores for initial analyses due to the low occurrence of negative outcomes reported in the young, nonclinical sample, suggesting further testing in diverse populations is needed before item elimination.

Factor Analysis

Factor analysis was executed on the 20 cognitive outcome items utilizing a principal component analysis (PCA) approach. A varimax rotation was applied, forcing a six-factor solution to match the six domains (financial/occupational, legal, physical, psychological, spiritual, social) that guided the scale’s development based on SASH guidelines.

The analysis confirmed the scale’s intended multidimensional structure, with the six-factor solution accounting for nearly three-quarters of the total variance (74.8%). The resulting inter-item correlation matrix supported the conclusion that the CBOSBS is not a unidimensional scale, meaning it effectively measures distinct categories of negative outcomes rather than a single general construct of distress.

Instrument

Test Type: Self-report psychometric scale

Format: The scale is composed of two sections. The Cognitive Outcomes section (20 items) uses a 4-point Likert-type scale ranging from Never to Always. The Behavioral Outcomes section (16 items) uses a dichotomous format (Yes or No).

Language Available: English (Original)

Population Group: Nonclinical young adults

Age Group: Young adults

Population Details: Scale validation was performed on a nonclinical sample of young adults (N = 390). Pilot testing also utilized a similar nonclinical sample.

Test Methodology: The scale is self-administered and typically requires approximately 10 minutes to complete. Participants are asked to rate their worry (cognitive items) or report their actual experience (behavioral items) over the previous year.

Scoring

The Cognitive and Behavioral Outcomes of Sexual Behavior Scale yields a total score ranging from 0 to 76, calculated by summing the scores of the two components.

• Cognitive Items: Scored 0 (Never) to 3 (Always). Total cognitive score range is 0 to 60.
• Behavioral Items: Scored 0 (No) or 1 (Yes). Total behavioral score range is 0 to 16.

The threshold used to indicate sexual compulsivity (SC) is defined as meeting or exceeding the 80th percentile of the normative sample scores.

Keywords

Sexual health, psychometrics, negative consequences, sexual behavior, compulsive sexual behavior, SASH, scale validation, clinical assessment.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (Correspondence email for Kimberly R. McBride)

Correspondence Address: Kimberly R. McBride, Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405.

Permissions & Fee and Test Year

Test Year: The primary validation studies were published in 2007 and 2008.

Permissions and Fees: Specific information regarding permissions or fees is not detailed in the source material. The correspondence address and email for Kimberly R. McBride are provided for researchers seeking usage permissions.

Reference’s

• McBride, K. R., Reece, M., & Sanders, S. A. (2007). Predicting negative outcomes of sexuality using the Compulsive Sexual Behavior Inventory. International Journal of Sexual Health, 19(4), 51–62.
• McBride, K. R., Reece, M., & Sanders, S. A. (2008). Using the Sexual Compulsivity Scale to predict outcomes of sexual behavior in young adults. Journal of Sexual Addiction and Compulsivity, 15, 97–115.
• Perera, B., Reece, M., Monahan, P., Billingham, R., & Finn, P. (2009a). Childhood characteristics and personal dispositions to sexually compulsive behavior among young adults. Sexual Addiction and Compulsivity, 16(2), 131–145.
• Perera, B., Reece, M., Monahan, P., Billingham, R. & Finn, P. (2009b). Relations between substance use and personal dispositions towards out-of-control sexual behaviors among young adults, International Journal of Sexual Health, 21(2), 87–95.
• Reece, M., Dodge, B., & McBride, K. (2006). Sexual compulsivity: Issues and challenges. In R. McAnulty & M. Burnette (Eds.), Sex and sexuality (pp. 213–231). London: Praeger Press.

Items of the Cognitive and Behavioral Outcomes of Sexual Behavior Scale

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

Below is a list of things that some people worry about as a result of their sexual activities (including things people do alone and those they do with others). Please indicate the extent to which the following apply to you:

Never = A Sometimes = B Often = C Always = D I am worried that the things I have done sexually:

1. might have placed me or one of my sex partners at risk for pregnancy.

2. might have placed me or one of my sex partners at risk for a sexually transmitted infection (like herpes, gonorrhea, or crabs).

3. might have placed me or one of my sex partners at risk for HIV.

4. might have resulted in pain, injury, or other problems for one of my sex partners.

5. might have resulted in pain, injury, or other problems for myself.

6. might have presented the potential for serious physical injury or death.

7. might be leading to problems with my friends.

8. might be leading to problems with my family members.

9. might be leading to problems with my boyfriend/girlfriend/spouse.

10. might have placed me at risk of being arrested.

11. might have been against the law.

12. might have led to financial problems.

13. might have caused me to waste my money.

14. were interfering with my ability to complete tasks for work or school.

15. might have presented the potential for me to lose my job.

16. could lead to school-related problems, such as probation, expulsion, or other sanctions.

17. were inconsistent with my spiritual beliefs.

18. were inconsistent with my religious values.

19. were making me feel guilty.

20. were making me ashamed of myself.

    Instructions: Below is a list of things that sometimes happen to people as a result of their sexual activities (including those they do alone and those they do with others). Please indicate whether these things have happened to you during the last year as a result of your sexual activities.

    In the past year, as a result of the things you have done sexually, did the following happen to you:

21. I or my sexual partner(s) became pregnant.

    1. Yes

    2. No

22. I contracted a sexually transmitted infection. a

23. I contracted HIV.

24. I gave someone else a sexually transmitted infection.

25. I gave someone else HIV.

26. I caused pain, injury, or other physical problems for myself.

27. I caused pain, injury, or other physical problems for a sex partner.

28. My relationships with friends and/or family members were damaged.

29. My relationships with a spouse or other relationship partner were damaged.

30. I was arrested.

31. I experienced financial problems.

32. I experienced problems at school.

33. I experienced problems at work.

34. I experienced spiritual distress.

35. I was embarrassed or ashamed of myself.

36. I felt guilty.

The response scale directly above is repeated after each item.