Susanna B. Hummel, Hester S.A. Oldenburg, Daniela E.E. Hahn, Jacobien M. Kieffer, Miranda A. Gerritsma, Marianne A. Kuenen, and Neil K. Aaronson, The Netherlands Cancer Institute; Nina Bijker, Academic Medical Center; Paul J. Borgstein, Onze Lieve Vrouwe Gasthuis East; Eric J. van Dulken, Medical Center Slotervaart; Bart C. Vrouenraets, Onze Lieve Vrouwe Gasthuis West, Amsterdam; Jacques J.D.M. van Lankveld, Open University, Heerlen; Gijsbert Heuff, Spaarne Gasthuis Hoofddorp, Hoofddorp; Alexander M.F. Lopes Cardozo, Noordwest Hospital Group Alkmaar, Alkmaar; Peter W. Plaisier, Albert Schweitzer Hospital, Dordrecht; Herman Rijna, Spaarne Gasthuis Haarlem, Haarlem; Suzan van der Meij, Flevo Hospital, Almere; and Eva Broomans, Virenze Institute of Mental Health Care, Utrecht, the Netherlands.
J Clin Oncol. 2017 Apr 20;35(12):1328-1340. doi: 10.1200/JCO.2016.69.6021. Epub 2017 Feb 27.
Purpose We evaluated the effect of Internet-based cognitive behavioral therapy (CBT) on sexual functioning and relationship intimacy (primary outcomes) and body image, menopausal symptoms, marital functioning, psychological distress, and health-related quality of life (secondary outcomes) in breast cancer survivors (BCSs) with a DSM-IV diagnosis of a sexual dysfunction. Patients and Methods We randomly assigned 169 BCSs to either Internet-based CBT or a waiting-list control group. The CBT consisted of weekly therapist-guided sessions, with a maximum duration of 24 weeks. Self-report questionnaires were completed by the intervention group at baseline (T0), midtherapy (T1), and post-therapy (T2) and at equivalent times by the control group. We used a mixed-effect modeling approach to compare the groups over time. Results Compared with the control group, the intervention group showed a significant improvement over time in overall sexual functioning (effect size for T2 [ES] = .43; P = .031), which was reflected in an increase in sexual desire (ES = .48 and ES = .72; P < .001), sexual arousal (ES = .50; P = .008), and vaginal lubrication (ES = .46; P = .013). The intervention group reported more improvement over time in sexual pleasure (ES = .32 and ES = .62; P = .001), less discomfort during sex (ES = .49 and ES = .66; P = .001), and less sexual distress (ES = .59; P = .002) compared with the control group. The intervention group reported greater improvement in body image (ES = .45; P = .009) and fewer menopausal symptoms (ES = .39; P = .007) than the control group. No significant effects were observed for orgasmic function, sexual satisfaction, intercourse frequency, relationship intimacy, marital functioning, psychological distress, or health-related quality of life. Conclusion Internet-based CBT has salutary effects on sexual functioning, body image, and menopausal symptoms in BCSs with a sexual dysfunction.
我们评估了基于互联网的认知行为疗法（CBT）对性功能和关系亲密程度（主要结果）以及身体形象、更年期症状、婚姻功能、心理困扰和健康相关生活质量（次要结果）的影响，这些影响是针对患有 DSM-IV 性功能障碍诊断的乳腺癌幸存者（BCS）。
我们随机将 169 名 BCS 分配到基于互联网的 CBT 或等待名单对照组。CBT 包括每周由治疗师指导的课程，最长持续 24 周。干预组在基线（T0）、中程治疗（T1）和治疗后（T2）以及对照组在等效时间完成自我报告问卷。我们使用混合效应建模方法来比较组间随时间的变化。
与对照组相比，干预组在总体性功能方面随着时间的推移显示出显著的改善（T2 时的效应大小[ES]为.43；P =.031），这反映在性欲（ES =.48 和 ES =.72；P <.001）、性唤起（ES =.50；P =.008）和阴道润滑（ES =.46；P =.013）的增加。与对照组相比，干预组在性愉悦感（ES =.32 和 ES =.62；P =.001）、性过程中的不适（ES =.49 和 ES =.66；P =.001）和性困扰（ES =.59；P =.002）方面的改善更大。与对照组相比，干预组的身体形象（ES =.45；P =.009）和更年期症状（ES =.39；P =.007）改善更为明显。在 orgasmic 功能、性满意度、性交频率、关系亲密程度、婚姻功能、心理困扰或健康相关生活质量方面，未观察到显著影响。
基于互联网的 CBT 对患有性功能障碍的 BCS 的性功能、身体形象和更年期症状具有有益的影响。
