Sexual Performance Anxiety: Thought Reframe
A CBT worksheet for sexual performance anxiety linking situations, anxious thoughts and effects on arousal to more helpful thoughts, with helpful shifts.
1-page fillable PDF · US Letter (prints on A4) · CBT for sexual concerns
- Approach / concern
- Sex Therapy
- Technique
- CBT for sexual concerns
- Format
- Fillable PDF, 1 page (US Letter / A4)
- Access
- Advanced plan
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the Sexual Performance Anxiety: Thought Reframe?
Performance anxiety and spectatoring (monitoring oneself during sex) contribute to arousal and orgasm difficulties. CBT and mindfulness reduce anxiety and shift focus to pleasure.
Why it works
The Good-Enough Sex model emphasizes realistic, flexible expectations over performance (Metz & McCarthy, 2007). Mindfulness reduces spectatoring and supports arousal (Brotto, 2018).
When to use it
- Erectile concerns with anxiety
- Orgasm difficulties
- New relationships
- After a sexual ‘failure’
How to use it in session
- Identify situations.
- Catch anxious thoughts.
- Notice body effects.
- Write helpful thoughts.
- Practise with sensate focus.
Clinician tips
- Normalize variability in arousal.
- Involve partners where possible.
- Sexual concerns can have medical causes; consider a medical check-up alongside therapy.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
Why does worrying affect arousal?
Anxiety triggers the stress response, which works against the relaxed state arousal needs.
Should I see a doctor?
Yes, especially for persistent erectile difficulties, to rule out medical causes.
References
Metz, M. E., & McCarthy, B. W. (2007). The “Good-Enough Sex” model for couple sexual satisfaction. Sexual and Relationship Therapy, 22(3), 351-362.
Brotto, L. A. (2018). Better sex through mindfulness: How women can cultivate desire. Greystone Books.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
