Development of cognitive-behavioral therapy intervention for patients with Dhat syndrome
The second patient was a 23-year-old single male, matriculate, hotel waiter from lower socioeconomic status. He presented with complaints of night emissions, bodily weakness, and lack of concentration, erectile dysfunction and pain at the back, head and around the penis. His problems started with night emissions at the age of 16 years. He then started feeling that his body was becoming weak due to the loss of Dhat (‘semen’) during night emissions. On the day after night emission, he would have pain at the back and his pelvic region. He used to apply analgesic ointment (‘balm’) for this or occasionally take painkillers for the same. He had stopped going to work when presented. The module after modification was applied and the results after intervention [] showed clinically significant changes on sexual knowledge, somatic symptoms and parameter of WHOQOL – physical health.\nIt was observed that a mere intellectual understanding of the harmlessness of loss of semen alone would not help. It was important to bring in a behavioral change. Thus, masturbation was added as a behavioral homework assignment. Principles of single male sex therapy[] were used in this regard. Another important understanding was the importance of understanding the role of performance anxiety in these patients. This was not just in the presence of a partner but also even during masturbation. This patient could not engage in masturbation for ‘fear of failure’. This fear obviously led to inability to maintain erections. Principles of sensate focus were included in this context where the patient had to focus on the sensation of erection. This helped him to de-focus him from the performance aspect of it, which reduced his anxiety.