Anxiety could feasibly impair orgasmic function in women via several cognitive processes. Anxiety can serve as a distraction that disrupts the processing of erotic cues by causing the woman to focus instead on performance related concerns, embarrassment, and/or guilt. It can lead the woman to engage in self-monitoring during sexual activity, an experience Masters and Johnson referred to as "spectatoring". Physiologically, for many years it was assumed that the increased sympathetic activation that accompanies an anxiety state may impair sexual arousal necessary for orgasm via inhibition of parasympathetic nervous system activity. Meston and Gorzalka, however, have noted that activation of the sympathetic nervous system, induced via means such as 20 min of intense stationary cycling or running on a treadmill actually facilitates genital engorgement under conditions of erotic stimulation.

The most notable anxiety reduction techniques for treating female orgasmic disorder are systematic desensitization and sensate focus. Systematic desensitization for treating sexual anxiety was first described by Wolpe. The process involves training the woman to relax the muscles of her body through a sequence of exercises. Next, a hierarchy of anxiety-evoking stimuli or situations is composed and the woman is trained to imagine the situations while remaining relaxed. Once the woman is able to imagine all the items in the hierarchy without experiencing anxiety, she is instructed to engage in the activities in real life.

Sensate focus was originally conceived by Masters and Johnson. It involves a step-by-step sequence of body touching exercises, moving from nonsexual to increasingly sexual touching of one another’s body. Components specific for treating anorgasmic women often include nondemand genital touching by the partner, female guidance of genital manual, and penile stimulation and coital positions designed to maximize pleasurable stimulation. Sensate focus is primarily a couple’s skills learning approach designed to increase communication and awareness of sexually sensitive areas between partners. Conceptually, however, the removal of goal-focused orgasm, which can cause performance concerns, the hierarchical nature of the touching exercises, and the instruction not to advance to the next phase before feeling relaxed about the current one, suggest sensate focus is also largely an anxiety reduction technique and could be considered a modified form of in vivo desensitization.

The success of using anxiety reduction techniques for treating female orgasmic disorder is difficult to assess because most studies have used some combination of anxiety reduction, sexual techniques training, sex education, communication training, bibliotherapy, and Kegel exercises, and have not systematically evaluated the independent contributions to treatment outcome. Moreover, even within specific treatment modalities, considerable variation between studies exists. For example, systematic desensitization has been conducted both in vivo and imaginal, has used mainly progressive muscle relaxation but also drugs and hypnotic techniques to induce relaxation, and has varied somewhat in the hierarchical construction of events. Furthermore, the relative contribution of factors such as individual vs. group treatment, patient demographics (age, marital status, education, religion), precise diagnosis and severity of presenting sexual concerns, therapist characteristics (sex, theoretical orientation and training), treatment settings (private, hospital, university clinics), and length of treatment sessions and duration are often reported but systematic evaluation of many of these factors is missing from the literature. Finally, of the controlled studies that have included anxiety reduction techniques, few have differentiated between treatment outcomes for primary and secondary anorgasmic women. Across studies, women have reported decreases in sexual anxiety and, occasionally, increases in frequency of sexual intercourse and sexual satisfaction with systematic desensitization, but substantial improvements in orgasmic ability have not been noted. Similarly, of the few controlled studies that have included sensate focus as a treatment component, none have reported notable increases in orgasmic ability. These findings suggest that, in most cases, anxiety does not appear to play a causal role in female orgasmic disorder and anxiety reduction techniques are best suited for anorgasmic women only when sexual anxiety is coexistant.