Dr. Anne Truong, sexual health specialist and host, explains performance anxiety in men as a psychological condition that commonly coexists with erectile dysfunction (ED) and perpetuates a cycle of fear, stress, reduced penile blood flow, and poor sexual performance. She recommends cognitive behavioral therapy (CBT) — typically 8–12 weekly sessions — often combined with breathing exercises (box breathing, nasal inhalation to boost nitric oxide) and optional low-dose daily tadalafil (5 mg) for a durable improvement. She directs listeners to certified therapists (AASECT) and her resources (Modern Man Club, GetWoodNow course, sexualhealthformenpodcast.com).
Questions this episode answers
Over 7,000 men.
About 8 to 12 weekly sessions (≈2–3 months).
5 milligrams daily.
Inhale 4s → hold 4s → exhale 4s (mouth) → hold 4s; inhale through the nose is emphasized.
150 hours sexual education, 60 hours sex-therapy-specific training, 300 hours supervised clinical experience, 50 hours direct supervision by an AASECT-certified supervisor.
This podcast is for you. The Modern Man I'm Dr. Anne Truong, your host. I'm an intimate health medical doctor and best selling author of the book Erectile Dysfunction Fix. I'll do a deep dive into sexual health and performance and how it affects men of all ages and backgrounds. So let's get started and be sure to visit my website@sexualhealthformenpodcast.com for more information and resources from the show. See you on the inside.
Foreign. Hello there modern men. I'm Dr. Aaron Trong. I'm a sexual health specialist treated over 7,000 men. Have you ever wondered what you need to do if you have performance anxiety that you feel like you're lost? Well, in today's episode we're going to talk about what you need to do to get a effective treatment for performance anxiety. So what is performance anxiety? Performance anxiety is a feeling of panic, feeling of worry, feeling of anxiety when you're about to get it on because maybe you had past experiences that didn't go well and you didn't perform or maybe someone has made a comment, negative comment that kind of lingers on here. It's almost like a little PTSD that you keep thinking about and reliving over and over again. And the reason why I'm talking about this, because I see this a lot in my patients in the office as well as in our coaching group, the modern man club, is that performance anxiety almost follow physical erectile dysfunction and then even if we treat the physical part of ed, the performance anxiety still somewhat linger. But because it's in here. And the reason why I stress that because the larger sexual organ for you to get erections really come from the brain. And even if we work together and I treat erection and then the erection has better flow but if the brain is not treated then no erection can happen. So I try want to focus on today's session on performance anxiety and what the research is showing and what I feel that you need to know so that way you can find resources to help you. And I feel that every man that has ED has some component of performance anxiety. Now there is a treatment is primarily recommended for men with ED with performance anxiety that that is called cbt like cat B, like in boy T, like in tom. CBT stands for cognitive behavioral therapy and it stands out as the most effective intervention because it directly addresses the psychological mechanism that maintain performance anxiety and affect erectile function. And researchers demonstrate that CBT specifically targets the cognitive and behavioral factors that create and perpetuate the anxiety performance cycle. Now Performance anxiety create a vicious cycle where fear of sexual failure lead to increased stress and anxiety. And then anxiety causes physiological changes including reduced blood flow to the penis. And then poor sexual performance reinforces the original fear, creating a self perpetuating cycle. And you need to know that because the further you think about your erection, the more stress you're going to get. And when stress is high, erection goes down. Because when stress is high, that's when you activate the sympathetic nervous system. And the sympathetic nervous system will move the blood from your penis and out to your arms and your legs. So stress decreased blood flow to your penis. CBT break this cycle that I just mentioned of the cycle of fear, failure, anxiety and poor performance. And it reframe CBT help men by reframing the negative thought patterns and then help you develop healthier coping mechanism to deal with performance anxiety. Studies have shown. In a landmark study, men receiving CBT alongside with low dose PDE5 inhibitors such as tadalafil show continued improvement in their ED months after CBT treatment has finished. While those receiving just medication alone without the CBT show no further improvement or even decline. Decline even if you stay just the medication alone. Now, CBT has shown to reduce not only ED symptoms, but also anxiety and depression that coexist as well. And I want to mention and stress at this point is that combining CBT with breathing that I talk about, check out the episode where I talk about breathing out of erection, where there are several mechanism of breathing that will help lower your heart rate. When your heart rate is lower, stress is lower, erection comes back, heart rate high, no erection. So the breathing technique that I talk about, the box breathing technique where you breathe in for four, you hold it for four and, and you breathe out to your mouth for four, and then you hold for four. But make sure you breathe into your nose, because if you go into your nose, it goes to the nasal sinuses up here, which then help you create more nitric oxide. Breathing through the nose help you create more nitric oxide, nitric oxide, bring in more blood flow. And also box breathing will also decrease your heart rate as well. So decrease heart rate, increase nitric oxide. Erection, all right, but high heart rate, stress, decreased erection. So the key CBT component addresses performance anxiety at this point. So keep that in mind that if you mix it with breathing that I talk about and then Maybe just low dose 5 milligrams of tadalafil or cialis daily will actually treat your ED and it may even last once you finish the therapy. Now, how long should you do CBT therapy between 8 to 12 weekly sessions for optimal result, about 2 to 3 months would be best. If you're with a partner doing a couple days. You're also going to be given homework and exercises. And CBT addresses the root cause of performance anxiety and it has longer lasting effect beyond just medication. And of course no side effects. And it's holistic. You can even do this on Zoom. You don't even need to come in and see a therapist in the office. So where can you find therapists that are certified? I really like therapists that are certified by the American association of Sexuality Educator, Counselor and Therapist. Now, the AA is a certified sex therapist and the very rigorous process. They spend 150 hours on sexual education, 60 hours sex therapy specific training and 300 hours of supervised clinical experience. And 50 hours of direct supervision by another AASE CT certified supervisor and also advanced clinical degree with psychotherapy training as well. Now check out this link right here or you can go directly to their website@ww.aasect.org or the link that I have on here. Check it out. Just you can find a certified therapist that are qualified to treat your performance anxiety with cbt. All right. So I hope that helped. And I can't stress to you how important it is to also treat the psychological component of ED and the physical part because they are intertwined and they probably 99% of the time coexist. And I see this a lot where my patients get better physically, but they're still unable to perform because they're still need to go get rid of the performance anxiety which they have lifted for years. And going through doing CBT is a mode to do that. And I know as men, you know, my husband's the same way. They're like, I'm not going to see a therapist. There's nothing wrong with going to see a therapist. It doesn't mean that you're weak. It doesn't mean that you're any different. It just means you need help. Going to see the therapist, no different than going to see physical therapy to do therapy on your back. And so there is no different. Now you're going to have a chance to do it on Zoom and on Virtual. You don't have to come in for an office evaluation and some insurance will cover for this as well. You have to kind of find out. And you can go on the website, type in your location and you can find out therapists that are certified that are near you or work with a therapist that you feel that you like to work with because now it's all virtual. So I just want to be a resource for you and give you a resource for performance anxiety because it's very very common and I don't want you to miss out. Okay? So I hope you find this useful. Let me know if you have any questions and it would mean the world to me if you get notified and subscribe and share this with somebody that you care about. A lot of our viewers are non subscribers so I hope you guys will subscribe to our channel. It will mean the world to me. And don't forget, do not suffer with ED in silence. Do not have to suffer alone. We have a resource for you that's called the Modern Man Club. It's a space where I will coach you and together with community of men that has ED where we work together and getting you out of ED breakthrough to Sexual Confidence and Sexual Clarity and performance anxiety as well. And so check it out noedman.com@ the link right here. So I'll see you in the next episode. Okay Modern Men. You are not alone and you don't have to suffer anymore. ED can feel isolated, frustrating and even defeating. The endless guessing, the quiet shame, the weight of not feeling like yourself. It's exhausting. But here's the truth. You are not broken. You are not alone. You don't have to figure this out alone anymore. The Get Wood now boost program is your step by step path to sexual confidence and restoration. No more suffering in silence. No more trial and error. Just real solution, real result and the confidence you deserve. It's time to take back your power on your term. Let's get this journey started together. Check out the course@getwoodnow.com I'll see you there.
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