Causes Of Frustration in Patients With Erectile Dysfunetion Based On Ego DepletionTheory:a Qualitative Study
Nov 26, 2024
Abstract:
Objective To analyze the causes of frustration in patients with erectile dysfunction, and to provide a reference for developing personalized psychological intervention programs. Methods Guided by the Theory of Ego Depletion, an interview routine was developed. descriptive qualitative research method was used to conduct semistructured in-depth interviews among 20 patients with significant frustration due to erectile dysfunction, then the interview data were reined and analyzed using content analysis. Results A total of three themes and eleven sub-themes were identified: excessive depletion of psychological resources (distress from disease symptoms, negative life events, weak sense of benefit from disease treatment, lack of reproductive health knowledge), insufficient compensation of psychological resources (lack of emotional support, irregular sexual life, interference from incorrect external information, economic pressure) and weakened regulation of psychological resources (self cognitive bias, thought suppression, lack of security)
Conclusion Multiple factors lead to the depletion of psychological resources in patients with erectile dysfunction. Hen psychological resource depletion is excessive or regulation and compensation are insufficient, the patients may appear negative thinking. Lt is necessary to take targeted intervention according to patients' psychological resources depletion, to reduce frustration in patients with erectile dysfunction. Psychological resources:
Keywords： erectile dysfunction: sexual dysfunction: frustration: ago depletion the negative psychology: mental health: qualitatresearchrche
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Erectile dysfunction (ED) is one of the most common sexual dysfunctions in men, which can have a serious impact on the mental health of patients and their partners [1]. Studies have shown that patients with erectile dysfunction are often accompanied by negative psychological factors such as anxiety and depression, as well as negative psychological factors such as decreased self-confidence and self-esteem. If not treated in time, the condition will be further aggravated, resulting in a vicious cycle [2]. Frustration refers to the psychological state of an individual who experiences failure at a critical moment in life [3]. Frustration is a negative emotional experience that usually occurs when an individual encounters failure, faces difficulties or fails to meet his or her expectations. This feeling often makes people feel incompetent, helpless, and self-blaming while reducing self-esteem and self-confidence. It can also lead to negative emotions such as anxiety and depression in individuals.
Frustration is obvious in patients with erectile dysfunction. At present, there are few studies on the psychological conditions of patients with erectile dysfunction in China, and no qualitative research has been conducted to explore their true psychological conditions. Qualitative research can further understand the psychological and emotional state of patients, help reveal the patients' real experience of the disease, their distress, and their expectations for disease treatment, to formulate a more comprehensive treatment plan, and improve the effectiveness of treatment and patient compliance [4]. Some researchers believe that ego depletion is a state after psychological resources are damaged, and frustration is considered to be a manifestation of negative thinking after psychological resources are damaged [5]. Previous studies have shown that the ego depletion theory can better explain the generation of negative thinking [6], providing a suitable theoretical framework for exploring the causes of frustration in patients with erectile dysfunction. This study is based on the framework of self-depletion theory and adopts descriptive qualitative research methods to explore the causes of frustration in patients with erectile dysfunction, to provide a basis for formulating targeted psychological intervention programs for patients with erectile dysfunction.
1 Subjects and methods
1.1 Subjects
From November 2022 to August 2023, purposive sampling and maximum differential sampling were used to select patients with erectile dysfunction who visited the male outpatient clinic and were hospitalized in the Reproductive Medicine Center of Shiyan People's Hospital as the research subjects. Inclusion criteria: ① Meet the diagnostic criteria in the "Guidelines for the Diagnosis and Treatment of Erectile Dysfunction of the Penis" [7]; ② Frustration Scale [8] assessment score ≥ 48 points; ③ Voluntarily join this study and sign the informed consent document; ④ Age > 18 years old. Exclusion criteria: ① Presence of psychological disorders or other major health problems; ② Presence of language communication barriers.
The sample size was based on data saturation. This study finally included 20 patients with erectile dysfunction for interviews, aged 26 to 43 (35.30±4.61) years old. Educational level: 2 cases of junior high school, 6 cases of high school, 3 cases of junior college, 9 cases of undergraduate. Marital status: 1 case of single, 1 case of divorce, 1 case of widowed, 17 cases of married. Monthly family income: 3000～＜5000 yuan in 3 cases, 5000～＜10000 yuan in 10 cases, 10000～24000 yuan in 7 cases. 11 cases had fertility needs, and 9 cases had no fertility needs. Erectile dysfunction: 1 case of mild, 15 cases of moderate, 4 cases of severe. Frustration score 48～62 (50.9±4.97) points.
1.2 Methods
1.2.1 Data collection method
A descriptive qualitative research method was used to conduct semi-structured interviews with patients. Guided by the theory of ego depletion, based on the characteristics of patients with erectile dysfunction, combined with the opinions of 3 medical experts with the title of deputy chief physician or above in the men's department, 1 national second-level psychological counselor, and 1 professional therapist with clinical work experience in men's department, after reviewing the literature and selecting 3 patients for pre-interview, the interview outline was determined. The outline is as follows: ① What aspects do you think caused you to feel frustrated? ② After you got sick, what attempts have you made to alleviate your frustration? ③ Based on your situation, talk about the physical, psychological, and environmental reasons that made you feel frustrated. ④ Can you describe the specific situation when you feel frustrated? Before the interview, we fullyunderstoodd the patient's relevant situation,explainedn the purpose and process of this study to him, andobtainedn the patient's informed consent before conducting in-depth communication according to the interview outline. The interview location is selected according to the interviewee's wishes and research needs. This study was carried out in the male reproductive health assessment room. During the interview, we strive to arouse the interviewee's desire to express himself, especially when discussing meaningful topics, and encourage him to provide more detailed explanations. When the interviewee's expression deviates from the topic, it is necessary to cleverly guide the discussion back on track. At the same time, observe and record the interviewee's non-verbal expression, and record the whole process. To protect the privacy of the interviewee, P1~P20 are used as representatives.
1.2.2 Data Analysis Method
Within 24 hours after the interview, the researchers transcribed the audio recordings into text and sorted out the non-verbal data. Two researchers independently analyzed the collected text data using content analysis, using the ego depletion theory as the theme framework [9] to refine, summarize and conclude the results of the data analysis, while inserting their own opinions. When there was a disagreement among the researchers, the third researcher checked the original data, and the three researchers discussed together until a consensus was reached, ultimately forming the theme and sub-themes of this study.
2 Results
2.1 Excessive consumption of psychological resources
2.1.1 Distress from disease symptoms
Disease symptoms make the body out of control and the coping strategies ineffective, which is the key factor for patients to feel frustrated. P1: "I am still young. At first, I always thought that my condition was not good enough. I felt that I would be able to do it next time, but every time I tried, I was worried that it would be like the last time, so I got worse and worse. Now I have less and less confidence and feel like a failure." P2: "After I got sick, I also tried hard to overcome psychological pressure, but when others made some sex-related jokes, I still felt that they were laughing at me. Now, I not only don't want to go to work, but I don't even want to go to friends' parties. I feel like a failure."
2.1.2 Negative life events
Negative life events other than diseases also consume patients' psychological resources. P3: "Not only am I a failure in my sex life, but my work is also not going well. I have no sense of accomplishment at home or outside." P5: "I have experienced too many things in the past few years. My company went bankrupt, my wife and children broke up, and my parents passed away. The pressure was already very high. Now that I am sick, I feel like a useless person with nothing."
2.1.3 Weak sense of benefit from disease treatment
The uncertainty of the treatment results of erectile dysfunction makes patients lose confidence in disease treatment, which leads to a strong sense of frustration. P6: "This situation has been going on for a long time. I didn't hold out hope. I just wanted to check to confirm whether there was a problem with my function. But I knew that I would not be cured."
P7: "Before coming here, I went to many hospitals, had injections, taken medicine, done various physical therapies, and had surgery, but there was no effect at all. At first, I still felt very hopeful, but now I am gradually losing confidence. Can I still be cured?"
2.1.4 Lack of reproductive Health Knowledgee
Lack of reproductive health knowledge causes patients to have cognitive biases about the disease, increases fear of the disease, and further increases the loss of patients' psychological resources. P8: "I think my condition is bad because of kidney deficiency. I take a lot of tonics and drink a lot of expensive medicinal wine every day, but there is still no improvement. As a man, it is useless to take all these tonics. It is embarrassing." P10: "I have always believed that only old people get this disease, but I am still young. After I got sick, I felt very ashamed and dared not see a doctor for fear of being laughed at. If my parents had not urged me to have a second child, I really would not dare to come to the hospital."
2.2 Insufficient compensation of psychological resources
2.2.1 Lack of emotional support
Family support can compensate for the psychological resources consumed by patients due to other reasons to a certain extent. Patients are often prone to negative emotions such as psychological fatigue in the process of coping with the disease, and low levels of family support cannot effectively compensate for the loss of patients' psychological resources. P11: "My wife and I often quarrel, our relationship has become very cold, and we rarely communicate. Now that I have this problem, she deliberately ridicules me. It makes me feel like a person who has accomplished nothing." P12: "After my mother-in-law learned that I had this situation, she always brought it up on different occasions. I feel that she is not helping me at all, but making me feel ashamed and losing the dignity that a man should have, which puts me in a more difficult situation." P13: "I am a seaman. Due to work reasons, my wife and I have been separated for a long time, and I have little communication with my wife. Now this situation has occurred again during sex, and I don't know what to do. Although my wife didn't say anything during sex, I feel very uncomfortable when I see her disgusted eyes. Is there something wrong with me?"
2.2.2 Irregular sex life
Irregular sex life can easily lead to erectile dysfunction and make patients feel frustrated. P14: "I was engaged in construction work in other places. The work was very tiring. I went to bed when I got back to the dormitory. I didn't have time to think about my married life every day. Now that I'm home, I always feel weak in the middle, which makes me lose all my confidence. " P15: "My wife and I got married not long ago. Due to work reasons, we can only meet on weekends. Sometimes we hold it back until the weekend if we want to. But I don't know if I hold it in for a long time, so we don't behave well when we meet. Several times I'm even afraid of meeting them anymore."
2.2.3 Interference from external misinformation
Because patients with erectile dysfunction are affected by misinformation on the Internet, they have difficulty identifying correct information and lose confidence in themselves, which in turn leads to increased frustration. P8: "I saw it on the Internet
I found that taking this medicine could improve my health, so I tried to buy it, but I ended up spending tens of thousands of yuan, and it was of no use at all. The disease has not been cured even now. I am so disappointed with myself! "
P10: "The information on the Internet all says that erectile function is a manifestation of masculinity. I have always thought so since I was a child. Now that there is a problem in this area, how can I not despair."
2.2.4 Economic pressure
Erectile dysfunction treatment is not covered by medical insurance, so financial pressure is also an important factor in ppatient'spsychological burden. P16: "I am the only worker in the family, and my wife's health has always been poor.
No, her illness has improved a lot in the past two years. We are planning to have a child, but I am in this situation again, and my family really can't afford it. P6: "My family is from a rural area and I don't have much money at my disposal." The first child is a daughter. At the urging of her parents, she now wants to have a second child. But there is something wrong with the function again, and I don't know how much time I should spend on it.
How much does it cost and is there any hope of a cure? "
2.3 Weakening of psychological resource regulation
2.3.1 Self-perception bias
When facing difficulties, an individual's correct assessment of his or her abilities is of great significance to the preservation of patients' psychological resources. When individuals have a negative evaluation of their control ability, their expectations for the future are likely to fall into pessimism. When one ignores one's true situation and overestimates one's control ability, it is easy to lose psychological resources by failing to meet one's expectations. P17: "I failed to have sex for the first time on my wedding night. After that, I not only felt that I had failed my wife's expectations but also had deep doubts about my abilities, thinking that I had a physical defect, which made me feel that I was not a complete person. Male. "P1: "I always thought that the problem with erectile function was just because I didn't get enough rest. I thought my wife was making a fuss and insisted on asking me to come for a check-up. I didn't expect that there was something wrong. I must have failed as a man."
2.3.2 Thought suppression
Individuals will also consume their psychological resources when they are caught up in some thoughts or ideas that do not meet certain standards and when they try to change. P11: "One time my wife and I failed to have sex, and she humiliated me at that time. Every time I have sex after that, I will think of what she said at that time. Although I know that this emotion has a great impact on me, I don't think about it at all. I didn't think about it, and my performance became worse and worse, and I became less and less confident." P18: "My wife got very out of shape after giving birth. I knew in my heart that it was hard for her, but I still couldn't control it. My inner resistance to her has become too much for me. I am now very disappointed in my character and abilities."
P10: "I'm a man, I can do anything, but I can't be embarrassed in this matter. If I can't even have sex, then how can I be considered a man?"
2.3.3 Lack of sense of security
After getting sick, the individual lacks a sense of security due to the lack of role and the ineffective diagnosis and treatment of the disease. The lack of sense of security usually puts the individual in a state of tension and fear, thus affecting their mental health and causing various psychological diseases. This may also Further wweakenconfidence in current diagnostic and treatment methods. P8: "I used to be honest at home, but after I got sick, I felt that I couldn't hold my head high in front of my family and friends. If I couldn't be cured, I would always be inferior to others." P19: "My wife has always wanted a child. But I'm really worried about getting such a disease. My wife divorced me because of this disease." P20: "I am the only boy in our family. Now that I am sick, my family will be cut off."
