Mindfulness-Based Interventions in The Treatment of Female Sexual Dysfunction: A Systematic Review

Abstract

Female sexual health has become a growing field of research and focus of clinical practice in the last 10-15 years. Mindfulness-based interventions, which emphasize the focus of attention on here and now experiences without being judgmental but with an accepting attitude, have emerged as a promising treatment option for women with sexual dysfunction. In this context, the purpose of this review is to evaluate the usability and effectiveness of mindfulness-based psychological interventions in women having difficulty at various stages of sexual functioning. In line with this purpose, several databases were searched with the keywords of “sexual dysfunction AND mindfulness”, “sexual desire AND mindfulness”, “sexual arousal AND mindfulness”, “sexual pain AND mindfulness”, and “orgasm disorder AND mindfulness”. Based on PRISMA decision criteria, 13 research article published between 2000 and 2017 have been identified. The findings indicated that both individual and group-oriented mindfulness-based therapies significantly improved sexual dysfunctions in various aspects of the sexual response cycle and these improvements were maintained in the long term. Besides the primary outcomes related to sexual functioning, it appears to cause positive changes in many areas such as depression, anxiety, couple harmony, and communication as well. 

Keywords

• Mindfulness,female sexual dysfunction,treatment,systematic review

Kadında Cinsel İşlev Bozukluğunun Tedavisinde Bilinçli Farkındalık Temelli Müdahaleler: Sistematik Bir Derleme

Öz

Kadın cinsel sağlığı son 10-15 yılda giderek gelişen bir araştırma alanı ve klinik uygulamaların odağı haline gelmiştir. Yargılayıcı olmadan ve kabullenici bir tutumla dikkatin anlık deneyimlere odaklanmasını vurgulayan bilinçli farkındalık temelli müdahaleler, cinsel işlev bozukluğu yaşayan kadınlar için umut verici bir tedavi seçeneği olarak ortaya çıkmaktadır. Bu bağlamda bu derleme çalışmasının amacı, cinsel işlevselliğin çeşitli aşamalarında sorun yaşayan kadınlarda bilinçli farkındalık temelli psikolojik müdahalelerin kullanılabilirlik ve etkililiğini değerlendirmektir. Bu amaç doğrultusunda, çeşitli veri tabanları “sexual dysfunction AND mindfulness”(“cinsel işlev bozukluğu” ve “bilinçli farkındalık”), “sexual desire AND mindfulness” (“cinsel istek” ve “bilinçli farkındalık”), “sexual arousal AND mindfulness” (“cinsel uyarılma” ve “ bilinçli farkındalık”),, “sexual pain AND mindfulness” (“cinsel ağrı” ve “ bilinçli farkındalık”), ve “orgasm disorder AND mindfulness” (“orgazm bozukluğu” ve “bilinçli farkındalık”) anahtar kelimeleri ile taranmıştır. PRISMA karar kriterlerine bağlı kalınarak yapılan tarama 2000 ve 2017 yılları arasında yayınlanmış 13 araştırma makalesi tespit edilmiştir. Bulgular, hem bireysel hem de grup odaklı bilinçli farkındalık temelli terapilerin cinsel tepki döngüsünün çeşitli boyutlarında yaşanan cinsel işlev bozukluklarında anlamlı düzeyde iyileşme sağladığını ve bu iyileşmelerin uzun dönemde korunduğunu göstermiştir. Cinsel işlevsellikle ilgili birincil sonuçların yanında, depresyon ve kaygı, çift uyumu, iletişim gibi pek çok alanda da olumlu değişime yol açtığı görülmektedir.

Anahtar Kelimeler

• Farkındalık,kadında cinsel işlev bozukluğu,tedavi,sistematik derleme

References

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American Psychiatric Pub.
2. Barnhofer T, Crane C, Hargus E, Amarasinghe M, Winder R, Williams JM. (2009) Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study. Behaviour Research and Therapy, 47(5):366-373.
3. Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J, Segal ZV, Abbey S, Speca M, Velting D, Devins G. (2004) Mindfulness: A proposed operational definition. Clinical psychology: Science and Practice, 11(3):230-241.
4. Bober SL, Recklitis CJ, Bakan J, Garber JE, Patenaude AF. (2015) Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: effects of a brief, psychosexual intervention. The Journal of Sexual Medicine, 12(1):189-197.
5. Brotto LA, Basson R. (2014) Group mindfulness-based therapy significantly improves sexual desire in women. Behaviour Research and Therapy, 57:43-54.
6. Brotto LA, Basson R, Luria M. (2008) A mindfulness-based group psychoeducational intervention targeting sexual arousal disorder in women. The Journal of Sexual Medicine, 5(7):1646-1659.
7. Brotto LA, Basson R, Smith KB, Driscoll M, Sadownik L. (2015) Mindfulness-based group therapy for women with provoked vestibulodynia. Mindfulness, 6(3):417-432.
8. Brotto LA, Chivers ML, Millman RD, Albert A.(2016) Mindfulness-based sex therapy improves genital-subjective arousal concordance in women with sexual desire/arousal difficulties. Archives of Sexual Behavior, 45(8):1907-1921.

9. Brotto LA, Dunkley CR, Breckon E, Carter J, Brown C, Daniluk J, Miller D.(2017) Integrating quantitative and qualitative methods to evaluate an online psychoeducational program for sexual difficulties in colorectal and gynecologic cancer survivors. Journal of Sex & Marital Therapy, 43(7):645-662.
10. Brotto LA, Erskine Y, Carey M, Ehlen T, Finlayson S, Heywood M, Kwon J, McAlpine J, Stuart G, Thomson S, Miller D. (2012b) A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecologic Oncology, 125(2):320-325.
11. Brotto LA, Heiman JR, Goff B, Greer B, Lentz GM, Swisher E, Tamimi H, Van Blaricom A. (2008) A psychoeducational intervention for sexual dysfunction in women with gynecologic cancer. Archives of Sexual Behavior,37(2):317-329.
12. Brotto LA, Seal BN, Rellini A. (2012a) Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse. Journal of Sex & Marital Therapy, 38(1):1-27.
13. Catak PD, Ögel K. (2010) Bir Terapi Yöntemi Olarak Farkindalik/Mindfulness as a Therapy Method. Noro-Psikyatri Arsivi,47(1):69-73.Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. (2013) Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Archives of Sexual Behavior, 42(6):915-33.
14. Hayes SC, Strosahl KD, Wilson KG. (1999) Acceptance and Commitment Therapy, New York: Guilford Press.
15. Hocaloski S, Elliott S, Brotto LA, Breckon E, McBride K. (2016) A mindfulness psychoeducational group intervention targeting sexual adjustment for women with multiple sclerosis and spinal cord injury: a pilot study. Sexuality and Disability,34(2):183-198.
16. Hucker A, McCabe MP. (2014) An online, mindfulness-based, cognitive-behavioral therapy for female sexual difficulties: impact on relationship functioning. Journal of Sex & Marital Therapy, 40(6):561-576.
17. Hucker A, McCabe MP. (2015) Incorporating mindfulness and chat groups into an online cognitive behavioral therapy for mixed female sexual problems. The Journal of Sex Research, 52(6):627-639.
18. Kabat-Zinn J. (1982) An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results. General Hospital Psychiatry, 4(1):33-47.
19. Kabat-Zinn J. (2005) Full Catastrophe Living: Using The Wisdom of Your Body and Mind to Face Stress, Pain, and Illness, 15th ed. New York, NY: Delta-Bantam.
20. Lamont J, Bajzak K, Bouchard C, Burnett M, Byers S, Cohen T, Fisher W, Holzapfel S, Senikas V. (2012) Female sexual health consensus clinical guidelines. Journal Of Obstetrics and Gynaecology Canada, 34(8):769-775.
21. Laumann EO, Paik A, Rosen RC. (1999). Sexual dysfunction in the United States: prevalence and predictors. Jama, 281(6):537-544.Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira Jr ED, Rellini AH, Segraves T. (2010) Definitions/epidemiology/risk factors for sexual dysfunction. The Journal of Sexual Medicine, 7(4pt2):1598-1607.
22. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine, 6(7):e1000100.
23. Matchim Y, Armer JM, Stewart BR. (2011) Effects of mindfulness-based stress reduction (MBSR) on health among breast cancer survivors. Western Journal of Nursing Research, 33(8):996-1016.
24. Paterson LQ, Handy AB, Brotto LA.(2017) A pilot study of eight-session mindfulness-based cognitive therapy adapted for women’s sexual interest/arousal disorder. The Journal of Sex Research, 54(7):850-861.
25. Piet J, Hougaard E, Hecksher MS, Rosenberg NK. (2010) A randomized pilot study of mindfulness-based cognitive therapy and group cognitive-behavioral therapy for young adults with social phobia. Scandinavian Journal of Psychology, 51(5):403-410.
26. Pyke RE, Clayton AH. (2015) Psychological treatment trials for hypoactive sexual desire disorder: a sexual medicine critique and perspective. The Journal of Sexual Medicine, (12):2451-2458.
27. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P): elaboration and explanation. Bmj, 349:g7647.
28. Simons JS, Carey MP. (2001) Prevalence of sexual dysfunctions: results from a decade of research. Archives of Sexual Behavior, 30(2):177-219.
29. ter Kuile MM, Both S, van Lankveld JJ. (2010). Cognitive behavioral therapy for sexual dysfunctions in women. Psychiatric Clinics, 33(3):595-610.
30. Tiefer L. (2006) Sex therapy as a humanistic enterprise. Sexual and Relationship Therapy, 21(3):359-375.
31. Weiner L, Avery-Clark C. (2014) Sensate focus: Clarifying the Masters and Johnson's model. Sexual and Relationship Therapy, 29(3):307-319.