[The alignment of efficiency studies with clinical guidelines. Where are the opportunities for improvement?].

Objective: To provide insight as well as challenges and opportunities to more effectively align Dutch efficiency research with clinical guidelines.

Design: Evaluation research METHOD: The alignment with existing clinical guidelines regarding medical specialist care was analyzed for 111 efficiency studies funded by the Dutch national health care research programme, and completed between 2018-2023.

Results: Ninety percent of the studies could be linked to a clinical guideline.

Evidence for Persistence of Sexual Evaluative Learning Effects.

Introduction: Several studies demonstrated that genital arousal and enhanced positive affect toward neutral stimuli due to sexual conditioning did not extinguish during a brief extinction phase, but other studies showed contrasting results. Possible resistance to extinction of conditioned human sexual response has, however, not been studied using extensive extinction trials.

Aim: To study resistance to extinction of conditioned sexual response in men and women.

The effect of a dopamine antagonist on conditioning of sexual arousal in women.

Rationale: Dopamine (DA) plays a key role in reward-seeking behaviours. Accumulating evidence from animal and human studies suggests that human sexual reward learning may also depend on DA transmission. However, research on the role of DA in human sexual reward learning is completely lacking.

The Influence of Emotion Upregulation on the Expectation of Sexual Reward.

Introduction: Emotion regulation research has shown successful altering of unwanted aversive emotional reactions. Cognitive strategies can also downregulate expectations of reward arising from conditioned stimuli, including sexual stimuli. However, little is known about whether such strategies can also efficiently upregulate expectations of sexual reward arising from conditioned stimuli, and possible gender differences therein.

d-Cycloserine reduces context specificity of sexual extinction learning.

Background: d-Cycloserine (DCS) enhances extinction processes in animals. Although classical conditioning is hypothesized to play a pivotal role in the aetiology of appetitive motivation problems, no research has been conducted on the effect of DCS on the reduction of context specificity of extinction in human appetitive learning, while facilitation hereof is relevant in the context of treatment of problematic reward-seeking behaviors.

Methods: Female participants were presented with two conditioned stimuli (CSs) that either predicted (CS+) or did not predict (CS-) a potential sexual reward (unconditioned stimulus (US); genital vibrostimulation).

The influence of emotion down-regulation on the expectation of sexual reward.

Emotion regulation research has shown successful altering of unwanted aversive emotional reactions. Cognitive strategies can also regulate expectations of reward arising from conditioned stimuli. However, less is known about the efficacy of such strategies with expectations elicited by conditioned appetitive sexual stimuli, and possible sex differences therein.

Extinction of aversive classically conditioned human sexual response.

Introduction: Research has shown that acquired subjective likes and dislikes are quite resistant to extinction. Moreover, studies on female sexual response demonstrated that diminished genital arousal and positive affect toward erotic stimuli due to aversive classical conditioning did not extinguish during an extinction phase. Possible resistance to extinction of aversive conditioned sexual responses may have important clinical implications.

Extinction and renewal of conditioned sexual responses.

Introduction: Extinction involves an inhibitory form of new learning that is highly dependent on the context for expression. This is supported by phenomena such as renewal and spontaneous recovery, which may help explain the persistence of appetitive behavior, and related problems such as addictions. Research on these phenomena in the sexual domain is lacking, where it may help to explain the persistence of learned sexual responses.

The role of conditioning, learning and dopamine in sexual behavior: a narrative review of animal and human studies.

Many theories of human sexual behavior assume that sexual stimuli obtain arousing properties through associative learning processes. It is widely accepted that classical conditioning contributes to the etiology of both normal and maladaptive human behaviors. Despite the hypothesized importance of basic learning processes in sexual behavior, research on classical conditioning of the sexual response in humans is scarce.