While both mindfulness-based and traditional cognitive behavioral therapy (CBT) approaches benefit women with provoked vestibulodynia, some women might have more success with one type over the other.
Determining who is more likely to benefit from which therapy may help clinicians tailor treatment, the authors of a new Journal of Sexual Medicine study said.
Women with provoked vestibulodynia (PVD) feel pain when the area around the vaginal entrance (the vestibule) is touched. The situation can make intercourse painful, and many women start to avoid intimacy.
PVD is classified as primary (lifelong) or secondary (occurring after a period of normal sexual function).
The study involved 130 women who had had PVD for at least six months. The women participated in either a traditional CBT intervention (63 women) or mindfulness-based CBT (67 women).
In the traditional CBT group, women learned about the effects of PVD on sexual function as well as behavioral and communication skills and cognitive techniques for coping with PVD. Women in the mindfulness group learned about and practiced mindfulness exercises. Therapy sessions took place once a week for 8 weeks. Each session lasted 2.25 hours.
The women completed a series of questionnaires to assess their pain intensity, sexual function, and pain catastrophizing. Assessments took place before the therapy sequence, after its conclusion, and again at 6-month and 12-month follow-up points.
The researchers found that each type of therapy seemed best suited for certain women.
For example, mindfulness-based CBT was associated with greater pain reduction in women with higher treatment credibility (the belief that their treatment was a logical approach for treating PVD). Women who expressed lower treatment credibility had similar results regardless of the intervention type.
“Because the placebo response is widely accepted to account for some of the positive effects of (either pharmacologic or psychological) treatment, measuring patients’ expectations about treatment impact is important,” the authors wrote.
Women who had been in shorter-duration relationships had greater success with mindfulness-based CBT, while those in longer-duration relationships did better with traditional CBT. It’s possible that the behavioral aspects of CBT better-suited women in longer-term relationships, as it involves partners and renews patterns of intimacy in relationships that have been struggling for longer periods.
Also, women with primary PVD did better with CBT, while those with secondary PVD had more improvement with the mindfulness-based approach. The researchers suggested that women who had been coping with PVD all their lives might be better able to change their thoughts through CBT while women who could remember times of enjoyable sex might respond better to the mindfulness approach’s focus on acceptance.
International Society of Sexual Medicine
“What is provoked vestibulodynia (PVD)?”
The Journal of Sexual Medicine
Brotto, Lori A., PhD, et al.
“Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia”
(Full-text. Published: August 22, 2020)