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Incorporating mindfulness and online chat-groups into an internet-based intervention for female sexual dysfunctions

Alice Hucker, Candidate, Doctor of Psychology (Clinical)Professor Marita McCabe, PhD

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What will I cover today??

Brief overview of the PursuingPleasure program – background, method and results

Mindfulness for female sexual dysfunctions (FSD)

Using online chat-groups for FSD treatment

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Background: FSD treatments Approx. 40-45% of women have at least one FSD over the course of their lives (Lewis et al., 2004)

Medical interventions – currently none approved by the Food & Drug Administration

Relationship and psychosocial factors play a large role in FSD genesis and maintenance• Therefore (!)… psychological approaches are

seen as a key way of intervening

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Psychological treatments

Masters & Johnson’s behavioural sex therapy (1970)

CBT approaches Mindfulness – new addition to CBT

approaches (Brotto et al., 2008) Self-help methods:

• Bibliotherapy and video therapy• Benefits: convenience, privacy

and increased self-efficacy• Addresses certain barriers to treatment:

e.g. embarrassment, geography

SEX!

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Internet-based interventions Internet-based interventions - most recent

innovation• Similar benefits to self-help methods• Also – can be therapist assisted, can draw together

a community of women, more interactive

Jones and McCabe (2011) evaluated an online CBT program for FSDs – “Revive”• Communication, sensate focus, email contact• Some significant improvements were observed – but

also some treatment resistance• Mainly a behavioural intervention due to difficulties

engaging participants over email

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Current study: The PursuingPleasure program

Aims: PursuingPleasure (PP) is an online CBT program for mixed FSDs that aims to address some of the limitations of Revive:• Incorporates mindfulness techniques• Addition of fortnightly online chat-groups • Provides more comprehensive psychoeducation

and written CBT exercises• Increased partner participation

– psychoed, assessments

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Method

Participants: Females with mixed FSD, +18 yo, stable heterosexual relationship• 26 women completed the program; 31 women

in control group Materials:• Program content delivered online via the PP

website.• Chat-groups conducted in a password-protected

chat-room that allowed synchronous (real-time) text conversation

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Method cont’d

Procedures: • 6 progressive online modules, each lasting

approximately 2 weeks• Fortnightly chat-groups - contained 4-8 women • Chat-groups facilitated by online sex therapist

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Method cont’d Module content

1. Psychoed (sex beliefs & myths), communication exercises, mindfulness of breathe

2. Psychoed (female anatomy, four P’s), communication exercises, mindfulness (body awareness), non-sexual massages

3. Psychoed (female desire, benfits of sex), CBT exercises, communication exercises, mindfulness during solo touching, non-sexual massages

4. Psychoed (male anatomy, body image), CBT exercises, communication exercises, mindful genital touching

5. Psychoed (intercourse, kegels), CBT exercises, communication exercises, mindful intercourse

6. Psychoed (sex aids, medical interventions), communication exercises, mindful intercourse, relapse prevention planning

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Results MANOVA (group by time) - compared

treatment and control group pre-test to post-test on sexual functioning• Significant group*time interaction at p<.05• Univariate results showed:

• Significant improvements in arousal, lubrication, orgasm, satisfaction, distress & performance anxiety at p<.05

• Significant improvements in desire at p<0.1• Non-significant result for sexual pain

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Results

Chi-square test for independence – treatment group showed a significant reduction in the amount of time that FSD was experienced, as compared to control

Paired samples t-tests for maintenance of treatment gains at 3-month follow-up No significant differences at p<.05 – treatment

gains maintained for desire, arousal, lubrication, orgasm, satisfaction, distress & performance anxiety

Attrition – similar to Revive and f2f studies

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So…the program was successful!

Now for some more discussion about:

•Incorporating mindfulness exercises into treatment

•Using chat-groups for FSD treatment

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Mindfulness during sex

Mindfulness can:• Increase awareness of the present moment

– body sensations, smells, noises, textures• Decrease distraction • Decrease anxiety• Increase relaxation• Increase connection with partner and body

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Mindlessness during sex

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Mindfulness exercises in practice

Started with non-sexual mindfulness exercises and these became progressively more sexually oriented

1. Mindfulness of the breathe2. Mindfulness of eating, music, walking3. Body awareness in the shower4. Mindful sensate focus:

• Non-sexual touching• Solo body exploration• Genital touching with partner (outercourse)• Penetration (intercourse)

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Mindfulness exercises

Women stated that the mindfulness exercises were one of the most helpful aspects of the program

“I have found the treatment program really helpful, mostly in improving the way my partner and I communicate and also learning the mindfulness techniques which have helped me through a lot of stressful situations and have also helped me focus during sex.” (female participant in PP)

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Chat groups

Aims:• Address challenges

and barriers to behaviour change

• Provide social support• Address

misunderstandings, monitor changes, receive participant feedback

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Chat group procedures Loose structure focussing on experiences in

the program, and discussion of challenges and barriers to change

Interventions used:• Psychoeducation, validation, normalisation –

created safe environment & encouraged sharing, resulted in much relief• Exploring cognitive distortions and barriers

to change – platform for cognitive therapy• Solution-focussed discussions – addressed

environmental & behavioural barriers

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Chat group procedures Interventions used (cont’d):

• Rapport building – allowed for email follow up• Reinforcing concepts and exercises from the

program - misunderstandings clarified Group techniques:

• Group validation & normalisation – created environment of social support, sharing & encouragement

• Brainstorming, problem solving - offered new perspectives and insights

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Chat group outcomes

Feedback about groups:

“I found the online chats a great way to discuss sexual issues with strangers. It overcomes the reservations of a

group chat in person because of the level of anonymity of the chats. I was able to be more honest and open in my discussions and tackling the program.”

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Summary PursuingPleasure is the first internet-based

intervention for FSDs to incorporate online chat-groups & mindfulness exercises

These techniques also have the potential for other applications:• Online chat-groups as an adjunct to individual f2f

sex therapy• Mindfulness techniques in individual/couple sex

therapy• Individual online chat sessions• Email therapy in between f2f sessions• Online psychoeducation databases for clients – not

just Google!

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Thanks!