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- Attention, imagination and sexual functionPublication . Campos, Pedro Manuel Tomaz de Carvalho; Leal, Isabel PereiraSexual functioning is a complex phenomenon shaped by dynamic interactions between cognitive, attentional, emotional, and relational processes. Attentional mechanisms and erotic mental imagery play key roles in sustaining sexual engagement, but their combined and independent contributions remain insufficiently understood. This thesis aimed to examine: 1) how general inattention, intrusive worries during sexual activity (sexual worries), problematic smartphone use (a common cause of distraction), and the vividness of partner-focused imagery (an index of internally directed attention) independently shape sexual function, pleasure, distress; 2) whether an intervention to stimulate sexual fantasy enhances sexual desire, sexual pleasure, and partner-focused mental imagery vividness, and reduces sexual distress and sexual worries. A multi-phase, quantitative design was employed. Study 1, a cross-sectional survey with 559 heterosexual adults, explored associations between these attentional factors and sexual outcomes. Study 2, a longitudinal study with 134 women, assessed whether these predictors explained changes in sexual functioning, pleasure, and distress over one month. Study 3, a randomized controlled trial with 60 participants, evaluated the effects of a four-week sexual fantasy intervention against a positively valenced nonsexual imagery task. In Study 1, better sexual function was independently by more vivid partner-focused imagination in women and men, and by fewer sexual worries in women only; greater sexual distress was independently predicted by less vivid partner-focused imagination and more sexual worries in women and men, and by problematic smartphone use in women only; 3) greater sexual pleasure was independently predicted by fewer sexual worries in women and by less problematic smartphone use in men. In Study 2, better sexual function was longitudinally predicted by less problematic smartphone use; sexual distress was longitudinally predicted by less vivid partner-focused imagination; and sexual pleasure was longitudinally predicted by both less problematic smartphone use and more vivid partner-focused imagination. All these results in Studies 1 and 2 were obtained independently of age and dysphoric feelings (a composite measure of depression, anxiety, and stress). In Study 1 only, dysphoric feelings additionally predicted poorer sexual function in men and women, and greater sexual distress and lesser sexual pleasure in women. Although general inattention was correlated with poorer sexual function and greater sexual distress for men and women in Study 1, it was never a significant predictor in multiple regressions. Study 3, with its experimental design, showed that guided fantasy practice increased sexual desire and pleasure, reduced intrusive sexual worries, and improved partner focused imagery vividness over four weeks. These findings offer new insights for cognitive affective models of sexual response, highlighting attention and imagination as dynamic, modifiable processes central to sexual well-being. Practically, they highlight opportunities for integrating attentional training and guided imagination exercises into clinical and educational contexts, offering innovative, low-cost approaches to enhancing erotic connection, reducing sexual distress, and fostering sexual health.