Effects of Group Mindfulness-Based Cognitive Therapy versus Supportive Sex Education on Sexual Concordance and Sexual Response Among Women with Sexual Interest/Arousal Disorder.

Low interest in sexual activity and impaired sexual response are among women's most frequent sexual concerns. Mindfulness-based treatments improve low sexual desire and arousal and associated distress. One theorized mechanism of change is the cultivation of increased mind-body awareness via greater concordance between psychological and physiological components of sexual response. We examined sexual psychophysiology data from 148 cisgender women randomized to receive mindfulness-based cognitive therapy (MCBT: n = 70) or supportive sex education (STEP: n = 78) over eight weekly group sessions. Women completed in-lab assessments of subjective, affective, and genital sexual responses to an erotic film pre- and post-treatment, and at 6- and 12-month follow-ups. Both groups showed positive changes in sexual and affective responses, but these were generally more pronounced for MBCT. MCBT increased sexual concordance to a greater degree, and gains in sexual concordance predicted improvements in sexual distress throughout treatment.

Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome.

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.

A randomized trial comparing group mindfulness-based cognitive therapy with group supportive sex education and therapy for the treatment of female sexual interest/arousal disorder.

Objective: Sexual interest/arousal disorder (SIAD) is the most prevalent sexual dysfunction in women. Our goal was to compare (a) group mindfulness-based cognitive therapy (MBCT) plus sex education with (b) group supportive sex education and therapy (STEP) for women with SIAD. Method: Eight-session treatments were delivered weekly and participants completed the measures of sexual desire and arousal, sexual distress, relationship satisfaction, rumination, and global impressions of change, at baseline, immediately posttreatment, and at 6- and 12-month posttreatment. Of 148 women who consented, 70 were randomized to MBCT (mean age 39.3 ± 13.2 years) and 78 were randomized to STEP (mean age 37.9 ± 12.2 years). Results: Sexual desire and arousal significantly improved at each time point relative to baseline, with large effect sizes (d = -1.29 to -1.60), and similarly for MBCT and STEP. Sexual distress also improved at each time point with large effect sizes (d = 0.83-1.17), and more so for MBCT relative to STEP. Relationship satisfaction significantly improved (d = -0.17 to -0.20), and rumination about sex improved significantly in both arms, with medium effect sizes (d = 0.42-0.69), with both outcomes responding more to MBCT. About half the participants across both treatments reported moderate or great improvements in global indicators of desire and overall sexuality. Conclusions: Results support the efficacy of both group MBCT and group supportive sex education for improving symptoms of SIAD with 12-month retention of improvements. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of a Mindfulness Task on Women's Sexual Response.

Mindfulness-based interventions are effective at improving symptoms of sexual dysfunction in women. The mechanisms by which mindfulness improves sexual function are less clear. The main objective of our study was to investigate the impact of a mindfulness task on sexual response in women. Forty-one women (mean age = 27.2, SD = 5.6) participated in two laboratory sessions that each included two erotic films and one attention task that were presented in counterbalanced order. Both attention tasks consisted of a six-minute audio recording of either a modified body scan, focusing on genital arousal sensations (mindfulness condition), or a visualization exercise. Subjective and genital sexual arousal were measured continuously during stimulus presentation. The mindfulness task led to greater subjective and lower genital arousal. The agreement of subjective and genital sexual arousal (i.e., concordance) was greater in the mindfulness condition. Trait mindfulness was related to lower sexual arousal but also greater sexual concordance in women. Mindfulness-based interventions that encourage women to focus on physical arousal sensations in the here and now may be associated with women's improved sexual function by enhancing feelings of sexual arousal during sexual activity and by increasing concordance between subjective and genital sexual arousal.

Mindfulness-Based Sex Therapy Improves Genital-Subjective Arousal Concordance in Women With Sexual Desire/Arousal Difficulties.

There is emerging evidence for the efficacy of mindfulness-based interventions for improving women's sexual functioning. To date, this literature has been limited to self-reports of sexual response and distress. Sexual arousal concordance-the degree of agreement between self-reported sexual arousal and psychophysiological sexual response-has been of interest due to the speculation that it may be a key component to healthy sexual functioning in women. We examined the effects of mindfulness-based sex therapy on sexual arousal concordance in a sample of women with sexual desire/arousal difficulties (n = 79, M age 40.8 years) who participated in an in-laboratory assessment of sexual arousal using a vaginal photoplethysmograph before and after four sessions of group mindfulness-based sex therapy. Genital-subjective sexual arousal concordance significantly increased from pre-treatment levels, with changes in subjective sexual arousal predicting contemporaneous genital sexual arousal (but not the reverse). These findings have implications for our understanding of the mechanisms by which mindfulness-based sex therapy improves sexual functioning in women, and suggest that such treatment may lead to an integration of physical and subjective arousal processes. Moreover, our findings suggest that future research might consider the adoption of sexual arousal concordance as a relevant endpoint in treatment outcome research of women with sexual desire/arousal concerns.