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Introduction Despite the importance of using penile injections as part of a penile rehabilitation program, men have difficulty complying with these programs. Aim To test a novel psychological intervention based on Acceptance and Commitment Therapy for erectile dysfunction (ACT-ED) to help men utilize penile injections. Methods This pilot randomized controlled trial (RCT) recruited men who were beginning a standard care (SC) structured penile rehabilitation program following radical prostatectomy. The SC program instructed patients to use penile injections 2 to 3 times per week. Participants were randomized to SC+ACT-ED or SC+enhanced monitoring (EM). Over 4 months, patients in the SC+ACT-ED group received SC plus 4 ACT sessions and 3 ACT phone calls; those in the EM group received SC plus 7 phone calls from an experienced sexual medicine nurse practitioner. Participants were assessed at study entry and at 4 and 8 months. For this pilot study, the goal was to determine initial efficacy (ie, effect sizes, where d = 0.2 is small, d = 0.5 is medium, and d = 0.8 is large). Main Outcome Measure Primary outcomes were feasibility and use of penile injections. Secondary outcomes were ED treatment satisfaction (ie, Erectile Dysfunction Inventory of Treatment Satisfaction, or EDITS), sexual Self-Esteem and Relationship (SEAR) quality, sexual bother (SB), and prostate cancer treatment regret. Results The 53 participants were randomized (ACT, n = 26; EM, n = 27). The study acceptance rate was 61%. At 4 months, the ACT-ED group utilized more penile injections per week (1.7) compared to the EM group (0.9) (d = 1.25; P = .001) and was more adherent to penile rehabilitation compared to the EM group (ACT, 44%; EM, 10%; relative risk [RR], 4.4; P = .02). These gains were maintained at 8 months for injections per week (ACT, 1.2; EM, 0.7; d = 1.08; P = .03) and approached significance for adherence (ACT, 18%; EM, 0%; P = .10). At 4 months, ACT-ED, compared to EM, reported moderate effects for greater satisfaction with ED treatment (d = 0.41; P = .22), greater sexual self-esteem (d = 0.54; P = .07) and sexual confidence (d = 0.48; P = .07), lower sexual bother (d = 0.43; P = .17), and lower prostate cancer treatment regret (d = 0.74; P = .02). At 8 months, moderate effects in favor of ACT-ED were maintained for greater sexual self-esteem (d = 0.40; P = .19) and less treatment regret (d = 0.47; P = .16). Clinical Implications ACT concepts may help men utilize penile injections and cope with the effects of ED. Strengths and Limitations Strengths include use of an innovative intervention utilizing ACT concepts and pilot RCT. Limitations include the pilot nature of the study (eg, small samples size, lack of statistical power). Conclusion ACT-ED is feasible and significantly increases the use of penile injections. ACT-ED also shows promise (moderate effects) for increasing satisfaction with penile injections and sexual self-esteem while decreasing sexual bother and prostate cancer treatment regret.

The authors alone are responsible for the views expressed in this letter and they do not necessarily represent the decisions, policy or views of the World Health Organization. The letter is based in part upon work from Action CA16207 "European Network for Problematic Usage of Internet", supported by the European Cooperation in Science and Technology (COST).

The loss of a child is the most painful, intense, and devastating type of bereavement, and parents who lose a child to cancer, specifically, face unique challenges in making meaning of their loss. Despite their increased risk, however, there is an absence of empirically supported interventions for this highly vulnerable population. Meaning-centered grief therapy (MCGT), a one-on-one intervention adapted from meaning-centered psychotherapy, was designed to address this need and to assist grieving individuals with higher levels of prolonged grief symptoms with enhancing their sense of meaning, purpose, and identity. This chapter summarizes the theoretical basis for MCGT, the adaptation process, and describes the content of the intervention, including a case example.