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Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia.

The journal of sexual medicine
November 1, 2020
Lori A Brotto et al. (5 authors)
Clinical TrialJournal ArticleResearch Support, Non-U.S. Gov'tHuman StudyClinical
Study Details

Study Goal

The researchers aimed to evaluate moderators of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) in improving dyspareunia, reducing pain catastrophizing, and enhancing sexual function in women with provoked vestibulodynia (PVD).

Results Summary

Both MBCT and CBT effectively reduced pain, sexual dysfunction, and pain catastrophizing in women with PVD. Treatment credibility, relationship length, and PVD subtype differentially moderated improvements, with MBCT benefiting those with higher credibility, shorter relationships, and secondary PVD, while CBT was more effective for primary PVD and longer relationships.

Population

Women with provoked vestibulodynia (PVD).

Effective Dosage

Not specified

Duration

Treatment outcomes were assessed before and after treatment, and at 6- and 12-month follow-ups.

Interactions

None mentioned

Extracted Claims (11)
InterventionDirectionEndpointPopulationDosageImpactClaim #
mindfulness-based cognitive therapy (MBCT)
decrease
self-reported pain
women with provoked vestibulodynia (PVD)
-
effectively reduced
#1
mindfulness-based cognitive therapy (MBCT)
decrease
sexual dysfunction
women with provoked vestibulodynia (PVD)
-
effectively reduced
#2
mindfulness-based cognitive therapy (MBCT)
decrease
pain catastrophizing
women with provoked vestibulodynia (PVD)
-
effectively reduced
#3
cognitive behavioral therapy (CBT)
decrease
self-reported pain
women with provoked vestibulodynia (PVD)
-
effectively reduced
#4
cognitive behavioral therapy (CBT)
decrease
sexual dysfunction
women with provoked vestibulodynia (PVD)
-
effectively reduced
#5
cognitive behavioral therapy (CBT)
decrease
pain catastrophizing
women with provoked vestibulodynia (PVD)
-
effectively reduced
#6
mindfulness-based cognitive therapy (MBCT)
decrease
pain intensity
women with higher treatment credibility ratings
-
improved more
#7
cognitive behavioral therapy (CBT)
decrease
pain catastrophizing
women with primary PVD
-
improved more
#8
mindfulness-based cognitive therapy (MBCT)
decrease
pain catastrophizing
women with secondary PVD
-
improved more
#9
mindfulness-based cognitive therapy (MBCT)
increase
sexual function
women in shorter relationships
-
improved more
#10
cognitive behavioral therapy (CBT)
increase
sexual function
women in longer relationships
-
improved more
#11
Abstract

BACKGROUND AND AIM: The goal was to evaluate the moderators of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) to improve dyspareunia, reduce pain catastrophizing, and improve overall sexual function in women with provoked vestibulodynia (PVD). Both treatments effectively reduced self-reported pain, sexual dysfunction, and pain catastrophizing in women with PVD. METHODS: A total of 130 women with PVD were assigned to CBT or MBCT. OUTCOMES: Potential moderators included (i) PVD subtype (primary or secondary), (ii) baseline pain intensity, (iii) trait mindfulness, (iv) treatment credibility, (v) relationship duration, and (vi) age. Outcomes were pain intensity, sexual function, and pain catastrophizing at 4 time points: before and after treatment and 6- and 12-month follow-up. Moderation was tested using multilevel models, nesting 4 time points within participants. The interaction of the moderator, time effect, and treatment group was evaluated for significance, and a simple slope analysis of significant interactions was performed. RESULTS: Pain reduction across 4 time points was the greatest in women who were younger, in relationships of shorter duration, and with greater baseline pain. Treatment credibility moderated pain intensity outcomes (B = 0.305, P < .01) where those with higher treatment credibility ratings (for that particular treatment) improved more in MBCT than CBT. PVD subtype moderated pain catastrophizing (B = 3.150, P < .05). Those with primary PVD improved more in the CBT condition, whereas women with secondary PVD improved more in the MBCT condition. Relationship length moderated sexual function (B = 0.195, P < .01). Women in shorter relationships improved more with MBCT, whereas women in longer relationships improved more on sexual function with CBT. No other tested variables moderated outcomes differentially across both treatment conditions. CLINICAL IMPLICATIONS: Women who present with high credibility about mindfulness, in shorter relationships, and with secondary PVD might respond better to MBCT whereas those with primary PVD and longer relationships might respond better to CBT. STRENGTHS & LIMITATIONS: Clinical sample. Half the women who were not sexually active were omitted from analyses of sexual function. CONCLUSION: Overall, treatment credibility, relationship length, and PVD subtype were found to moderate improvements differently in MBCT and CBT. These findings may assist clinicians in individualizing psychological treatment for women with PVD. CLINICAL TRIAL REGISTRATION: This clinical trial was registered with clinicaltrials.gov, NCT01704456. Brotto LA, Zdaniuk B, Rietchel L, et al. Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia. J Sex Med 2020;17:2247-2259.

Medical Subject Headings (MeSH)
CatastrophizationCognitive Behavioral TherapyFemaleHumansMindfulnessPainVulvodynia
Study Links
Quality Scores
SafetyNot Assessed
Efficacy85/10
Quality90/10
Citation Metrics
Total Citations14
Citations/Year2.8
Relative Citation Ratio1.71
NIH Percentile69.5%
Research Impact Scores
APT Score0.50
Weight Score2.55
Normalized Score0.72
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