Alice Hucker, Candidate, Doctor of Psychology (Clinical) Professor Marita McCabe, PhD

1. Incorporating mindfulness and online chat-groups into an internet-based intervention for female sexual dysfunctions Alice Hucker, Candidate, Doctor of Psychology (Clinical) Professor Marita McCabe, PhD

2. What will I cover today?? • Brief overview of the PursuingPleasure program – background, method and results • Mindfulness for female sexual dysfunctions (FSD) • Using online chat-groups for FSD treatment

3. Background: FSD treatments • Approx. 40-45% of women have at least one FSD over the course of their lives (Lewis et al., 2004) • Medical interventions – currently none approved by the Food & Drug Administration • Relationship and psychosocial factors play a large role in FSD genesis and maintenance • Therefore (!)… psychological approaches are seen as a key way of intervening

4. Psychological treatments • Masters & Johnson’s behavioural sex therapy (1970) • CBT approaches • Mindfulness – new addition to CBT approaches (Brotto et al., 2008) • Self-help methods: • Bibliotherapy and video therapy • Benefits: convenience, privacy and increased self-efficacy • Addresses certain barriers to treatment: e.g. embarrassment, geography SEX!

5. Internet-based interventions • Internet-based interventions - most recent innovation • Similar benefits to self-help methods • Also – can be therapist assisted, can draw together a community of women, more interactive • Jones and McCabe (2011) evaluated an online CBT program for FSDs – “Revive” • Communication, sensate focus, email contact • Some significant improvements were observed – but also some treatment resistance • Mainly a behavioural intervention due to difficulties engaging participants over email

6. Current study: The PursuingPleasure program • Aims: PursuingPleasure (PP) is an online CBT program for mixed FSDs that aims to address some of the limitations of Revive: • Incorporates mindfulness techniques • Addition of fortnightly online chat-groups • Provides more comprehensive psychoeducation and written CBT exercises • Increased partner participation – psychoed, assessments

7. Method • Participants: Females with mixed FSD, +18 yo, stable heterosexual relationship • 26 women completed the program; 31 women in control group • Materials: • Program content delivered online via the PP website. • Chat-groups conducted in a password-protected chat-room that allowed synchronous (real-time) text conversation

8. Method cont’d • Procedures: • 6 progressive online modules, each lasting approximately 2 weeks • Fortnightly chat-groups - contained 4-8 women • Chat-groups facilitated by online sex therapist

9. Method cont’d • Module content • Psychoed (sex beliefs & myths), communication exercises, mindfulness of breathe • Psychoed (female anatomy, four P’s), communication exercises, mindfulness (body awareness), non-sexual massages • Psychoed (female desire, benfits of sex), CBT exercises, communication exercises, mindfulness during solo touching, non-sexual massages • Psychoed (male anatomy, body image), CBT exercises, communication exercises, mindful genital touching • Psychoed (intercourse, kegels), CBT exercises, communication exercises, mindful intercourse • Psychoed (sex aids, medical interventions), communication exercises, mindful intercourse, relapse prevention planning

10. Results • MANOVA (group by time) - compared treatment and control group pre-test to post-test on sexual functioning • Significant group*time interaction at p<.05 • Univariate results showed: • Significant improvements in arousal, lubrication, orgasm, satisfaction, distress & performance anxiety at p<.05 • Significant improvements in desire at p<0.1 • Non-significant result for sexual pain

11. Results • Chi-square test for independence – treatment group showed a significant reduction in the amount of time that FSD was experienced, as compared to control • Paired samples t-tests for maintenance of treatment gains at 3-month follow-up • No significant differences at p<.05 – treatment gains maintained for desire, arousal, lubrication, orgasm, satisfaction, distress & performance anxiety • Attrition – similar to Revive and f2f studies

12. So…the program was successful! • Now for some more discussion about: • Incorporating mindfulness exercises into treatment • Using chat-groups for FSD treatment

13. Mindfulness during sex • Mindfulness can: • Increase awareness of the present moment – body sensations, smells, noises, textures • Decrease distraction • Decrease anxiety • Increase relaxation • Increase connection with partner and body

14. Mindlessness during sex

15. Mindfulness exercises in practice • Started with non-sexual mindfulness exercises and these became progressively more sexually oriented • Mindfulness of the breathe • Mindfulness of eating, music, walking • Body awareness in the shower • Mindful sensate focus: • Non-sexual touching • Solo body exploration • Genital touching with partner (outercourse) • Penetration (intercourse)

16. Mindfulness exercises • Women stated that the mindfulness exercises were one of the most helpful aspects of the program “I have found the treatment program really helpful, mostly in improving the way my partner and I communicate and also learning the mindfulness techniques which have helped me through a lot of stressful situations and have also helped me focus during sex.” (female participant in PP)

17. Chat groups • Aims: • Address challenges and barriers to behaviour change • Provide social support • Address misunderstandings, monitor changes, receive participant feedback

18. Chat group procedures • Loose structure focussing on experiences in the program, and discussion of challenges and barriers to change • Interventions used: • Psychoeducation, validation, normalisation – created safe environment & encouraged sharing, resulted in much relief • Exploring cognitive distortions and barriers to change – platform for cognitive therapy • Solution-focussed discussions – addressed environmental & behavioural barriers

19. Chat group procedures • Interventions used (cont’d): • Rapport building – allowed for email follow up • Reinforcing concepts and exercises from the program - misunderstandings clarified • Group techniques: • Group validation & normalisation – created environment of social support, sharing & encouragement • Brainstorming, problem solving - offered new perspectives and insights

20. Chat group outcomes • Feedback about groups: “I found the online chats a great way to discuss sexual issues with strangers. It overcomes the reservations of a group chat in person because of the level of anonymity of the chats. I was able to be more honest and open in my discussions and tackling the program.”

21. Summary • PursuingPleasure is the first internet-based intervention for FSDs to incorporate online chat-groups & mindfulness exercises • These techniques also have the potential for other applications: • Online chat-groups as an adjunct to individual f2f sex therapy • Mindfulness techniques in individual/couple sex therapy • Individual online chat sessions • Email therapy in between f2f sessions • Online psychoeducation databases for clients – not just Google!

22. Thanks!