A randomized clinical trial for women with vulvodynia: Cognitive-behavioral therapy vs. supportive psychotherapy

Abstract

Many treatments used for women with vulvodynia are based solely upon expert opinion. This randomized trial aimed to test the relative efficacy of cognitive-behavioral therapy (CBT) and supportive psychotherapy (SPT) in women with vulvodynia. Of the 50 participants, 42 (84%) completed 10-week treatments and 47 (94%) completed one-year follow-up assessments. Mixed effects modeling was used to make use of all available data. Participants had statistically significant decreases in pain severity (p’s<.001) with 42% of the overall sample achieving clinical improvement. CBT, relative to SPT, resulted in significantly greater improvement in pain severity during physician examination (p=.014), and greater improvement in sexual function (p=.034), from pre- to post-treatment. Treatment effects were well maintained at one-year follow-up in both groups. Participants in the CBT condition reported significantly greater treatment improvement, satisfaction and credibility than participants in the SPT condition (p’s<.05). Findings from the present study suggest that psychosocial treatments for vulvodynia are effective. CBT, a directed treatment approach that involves learning and practice of specific pain-relevant coping and self-management skills, yielded better outcomes and greater patient satisfaction than a less directive approach.

Psychosexual aspects of vulvovaginal pain

“…This may be due to the fact that the partners were not involved. Another randomized trial examining the efficacy of individual CBT for vulvar pain compared to a supportive psychotherapy demonstrated that CBT yielded significantly greater improvements in pain and sexual function from pre-to post-treatment, with gains maintained at one-year follow-up [52]. Results of this study suggest a potential benefit for greater treatment outcome and patient satisfaction with a more directed approach such as CBT [52].…”

“…Another randomized trial examining the efficacy of individual CBT for vulvar pain compared to a supportive psychotherapy demonstrated that CBT yielded significantly greater improvements in pain and sexual function from pre-to post-treatment, with gains maintained at one-year follow-up [52]. Results of this study suggest a potential benefit for greater treatment outcome and patient satisfaction with a more directed approach such as CBT [52].A systematic review of PVD treatment studies concluded that because behavioral treatments yield comparable success to several medical interventions but with no negative side effects, CBT represents an encouraging non-invasive option that can target pain as well as psychosexual consequences experienced by the woman and her partner [53].However, CBT has been investigated successfully in a group and in an individual format, but never in a couple format for PVD, which is the most common and recommended way that CBT for sexual dysfunction is delivered in clinical settings. …”

Provoked Vestibulodynia: Mediators of the Associations Between Partner Responses, Pain, and Sexual Satisfaction

“…Although positively correlated, sexual satisfaction may be distinguished, in part, from sexual functioning because it emphasizes the interpersonal aspect of sexual activities, whereas sexual functioning focuses on the intrapersonal aspects of the sexual response (Rosen et al, 2000). Although studies have shown significant improvements in sexual function across treatment groups for women with PVD, prior research has evidenced little success in terms of improving sexual functioning above clinical thresholds, regardless of the type of intervention (Bergeron, Binik, Khalifé, Pagidas, & Glazer, 2001;Bergeron, Khalifé, Glazer, & Binik, 2008;Masheb, Kerns, Lozano, Minkin, & Richman, 2009). Consequently, changes in the more subjective measures of sexual distress and satisfaction are emerging as important outcome variables and key targets for intervention.…”

Challenges in Designing Psychological Treatment Studies for Sexual Dysfunction

“…Though we agree that comparison to supportive psychotherapy would be interesting, it must be noted that this would not constitute a placebo control group, but rather an active control group because it elicits several of the factors that contribute to improvements that are not specific to the treatment itself. As an example, one published randomized trial of CBT (as the experimental arm) versus supportive group therapy (as the active control arm) for women with vulvodynia showed similar improvements in pain severity, depressive symptoms, and anxiety, with the CBT group showing significantly greater satisfaction with treatment, presumably due to the skills-based nature of that group (Masheb, Kerns, Lozano, Minkin, & Richman, 2009). One might conclude from this study that supportive psychotherapy did not only elicit therapy non-specific effects, but rather, was the supportive element, itself, was efficacious.…”