Department of Obstetrics and Gynecology, University of British Columbia.
Department of Psychology, Queen's University.
J Sex Res. 2023 May;60(4):508-521. doi: 10.1080/00224499.2022.2126815. Epub 2022 Sep 30.
Sexual Interest/Arousal Disorder (SIAD) is a common sexual dysfunction in women. Both mindfulness-based cognitive therapy (MBCT) plus psychoeducation and sex therapy, education, and support (STEP; which contains the same educational information as in the MBCT arm but also integrates supportive-expressive therapy), are effective. We tested mediators and moderators of improvements. Each treatment arm consisted of eight sessions delivered weekly, and participants completed measures online pre-treatment, immediately post-treatment, and at 6- and 12-month post-treatment. Depression, self-reported interoceptive awareness, self-compassion, self-criticism, and mindfulness were examined as mediators, and expectations for improvement as a moderator. Of 148 cisgender women who consented, 70 were randomized to the MBCT plus psychoeducation group (mean age 39.3 ± 13.2 yrs) and 78 to the STEP group (mean age 37.9 ± 12.2 yrs). Decreases in depression mediated decreases in sexual distress in the MBCT plus psychoeducation group only. Improvements in interoceptive awareness mediated changes in both sexual desire and arousal, and sexual distress, and to a greater degree after MBCT plus psychoeducation. Changes in self-compassion mediated changes in sexual desire and arousal only for the MBCT plus psychoeducation group and mediated changes in sexual distress in both groups. Reductions in self-criticism mediated improvements in sexual distress to a greater extent after MBCT plus psychoeducation. Changes in mindfulness predicted changes in desire and arousal, and distress only in the MBCT plus psychoeducation group. Expectations for improvement did not moderate any outcomes. The findings have implications for understanding common and potentially distinct pathways by which MBCT plus psychoeducation and supportive sex education improve symptoms of SIAD.
性兴趣/唤起障碍（SIAD）是女性常见的性功能障碍。正念认知疗法（MBCT）加心理教育和性治疗、教育和支持（STEP；包含与 MBCT 臂相同的教育信息，但也整合了支持表达治疗）都有效。我们测试了改善的中介和调节因素。每个治疗臂每周进行八次治疗，参与者在治疗前、治疗后即刻以及 6 个月和 12 个月后在网上完成测量。抑郁、自我报告的内感受意识、自我同情、自我批评和正念被视为中介因素，而对改善的期望则作为调节因素。在同意的 148 名顺性别女性中，70 名被随机分配到 MBCT 加心理教育组（平均年龄 39.3±13.2 岁），78 名被随机分配到 STEP 组（平均年龄 37.9±12.2 岁）。只有在 MBCT 加心理教育组中，抑郁的降低介导了性困扰的降低。内感受意识的改善介导了性欲和唤起以及性困扰的变化，并且在 MBCT 加心理教育后更为显著。自我同情的改善仅介导了 MBCT 加心理教育组的性欲和唤起变化，并介导了两组的性困扰变化。自我批评的减少在 MBCT 加心理教育后更能介导性困扰的改善。正念的变化仅预测了 MBCT 加心理教育组的欲望和唤起以及困扰的变化。对改善的期望并没有调节任何结果。这些发现对理解 MBCT 加心理教育和支持性性教育改善 SIAD 症状的常见和潜在独特途径具有重要意义。
