Explaining the perceived barriers of sexual intimacy and its improvement in reproductive age couples with cognitive-behavioral couple therapy approach: A Sequential Exploratory Mixed Methods Study

Abstract

Objective: Marital sexual intimacy, as one of the dimensions of intimacy, may decrease during the couple's life, which can be a major concern for families and psychologists. Therefore, the present study was conducted with the aim of explaining the perceived barriers to sexual intimacy and its improvement in reproductive-age couples with a cognitive-behavioral couple therapy approach in Tabriz city using a sequential exploratory mixed methods study. Methods: This study was a sequential exploratory mixed methods study with two qualitative and quantitative phases. In the qualitative phase, semi-structured in-depth interviews were conducted with 26 reproductive-age couples using a purposeful approach. Data were analyzed using qualitative content analysis with the conventional approach and the main concepts were extracted. In the quantitative phase, an intervention program was implemented in Tabriz City in 2022. 42 couples were randomly assigned to the intervention and control (receiving routine care) groups. Educational-counseling program with a cognitive-behavioral couple therapy (CBCT) approach was provided to the intervention group by an independent therapist for 8 sessions. Marital intimacy, sexual function, and sexual motivation questionnaires were completed for couples before and after the intervention. The Statistical Package for the Social Sciences (SPSS) was used for the purpose of data analysis such as independent samples t-test; adjusted analysis of covariance; repeated measure ANOVA. Results: In the qualitative phase, 113 codes, 27 subcategories, and 7 categories were extracted from 26 interviews. The findings showed that couples described their barriers to sexual intimacy in seven areas: Lack of perceived emotional intimacy, sexual dissatisfaction, incompatibility with the sexual partner, Couples' lack of mutual recognition of sexual needs, sexual nostalgia, restrictive gender stereotypes, and stressors. The results of the quantitative phase showed that there was no significant difference between the control and intervention groups in intimacy, motivation, and sexual function scores before the intervention. However, twelve weeks after the intervention in the intervention group compared to the control group were observed a significant increase MD (95%CI) in marital intimacy, sexual function, and sexual motivation respectively in women, 18.28 (6.03 to 30.52), 19.04 (10.46 to 27.62), and 7.32 (3.40 to 11.23) and in men 19.69 (12.32 to 27.06), 12.31 (9.51 to 15.10), and 10.62 (7.67 to 13.57). Conclusion: CBCT had a significant effect on couples' intimacy, motivation, and sexual function by removing barriers to sexual intimacy. This approach is one of the most common methods of treating sexual disorders due to its short time and high efficiency. Considering that this improvement affects the relationships and quality of married life and family stability, therefore, it is recommended to use this method in designing strategies, planning, and adopting interventions to improve the quality of sexual life of couples. Keywords: barriers to sexual intimacy, sexual motivation, sexual function, couples, mixed study