Moniek M. ter Kuile

The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): Psychometric Properties within a Dutch Population

The aim of the present study was to investigate the psychometric properties of the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the Female Sexual Distress Scale (FSDS; Derogatis, Rosen, Leiblum, Burnett, & Heiman, 2002) within a Dutch population of approximately 350 women with and without sexual complaints. The main conclusions of this study are that the multidimensional structure of the FSFI and the unidimensional structure of the FSDS are fairly well replicated in a Dutch sample. The amount of variance explained by confirmatory and exploratory factor analyses was good. Internal consistency and stability of the FSFI and its subscales and the FSDS are satisfactory to good, and the subscales are reasonably stable across demographic variables. The discriminant validity and the ability of the scales to predict the presence or absence of sexual complaints was excellent. The convergent and divergent construct validity of the FSFI and the FSDS was good. These results support the reliability and psychometric validity of the FSFI and the FSDS in the assessment of dimensions of female sexual functioning and sexual distress in clinical and nonclinical samples.

Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.

The aim of the present study was to examine (a) whether a cognitive‐behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant‐behavioral treatment plus cognitive coping skills training (N=59) or group discussion (N=58) or allocated to a waiting list control condition (N=31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12‐month follow‐up. Treatment also resulted in a short‐ and long‐term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.

Pain coping strategies in a Dutch population of chronic low back pain patients

&NA; The use of strategies for coping with chronic pain was assessed by means of the Coping Strategy Questionnaire (CSQ) in a Dutch sample of 108 chronic low back pain (LBP) patients referred for behavioral treatment. The 3 factors of the CSQ were related to measurements of behavioral and emotional adjustment to LBP above and beyond the effects of demographic and medical status variables. Especially patients high on the factor Helplessness reported higher levels of pain, functional impairment, anxiety, depression and psychoneuroticism, while patients high on the factor Perceived Control reported lower levels of pain, functional impairment and also manifested a higher level of uptime. The causal role of coping strategies in adjustment to pain, the selectivity of focusing on LBP patients selected through referral and implications for pain management are discussed.

Therapist-aided exposure for women with lifelong vaginismus: a replicated single-case design.

Vaginismus is commonly described as a persistent difficulty in allowing vaginal entry of a penis or other object. Lifelong vaginismus occurs when a woman has never been able to have intercourse. A replicated single-case A-B-phase design was used to investigate the effectiveness of therapist-aided exposure for lifelong vaginismus. A baseline period (Phase A) was contrasted with exposure + follow-up (Phase B), using random switching between phases. The main outcome measure (intercourse ability) was assessed daily for 24 weeks. Ten women participated. The exposure consisted of a maximum of three 2-hr sessions during 1 week at a university hospital. The participant performed vaginal penetration exercises on herself, in the presence of a female therapist. Two follow-up sessions were scheduled over a 5-week period. Nine of the 10 participants reported having intercourse after treatment, and in 5 of the 9, intercourse was possible within the 1st week of treatment. The results remained at 1-year follow-up. Furthermore, exposure was successful in decreasing fear and negative penetration beliefs posttreatment and at 3-month and 1-year follow-ups. Therapist-aided exposure appears to be an effective treatment for lifelong vaginismus.

The effect of pain-related fear on sexual arousal in women with superficial dyspareunia.

The role of pain‐related fear in the etiology and/or maintenance of superficial dyspareunia is still unclear. The objective of this experiment was to investigate the effects of pain‐related fear on sexual arousal in women with superficial dyspareunia (n=48) and women without sexual complaints (n=48). To induce pain‐related fear, participants were told that they had a 60% chance of receiving painful stimuli while being exposed to one of two erotic film clips. Genital arousal was assessed using vaginal photoplethysmography. Self‐reported ratings of genital sensations and affect were collected after both erotic stimulus presentations. Elevated levels of skin conductance and higher ratings of experienced threat during the pain threat condition indicated that fear was successfully elicited. Pain‐related fear impeded genital arousal in all women. Women of both groups reported significantly less positive affect and more negative affect when threatened. Although women with dyspareunia did not differ in their genital responsiveness from women without sexual complaints, they experienced overall significantly more negative affect than the control group. The present results indicate that pain‐related fear reduces genital and subjective sexual responding in women with and without sexual problems. We conclude that emotional appraisal of the sexual situation determines genital responsiveness in both sexually dysfunctional and functional women.

Cognitive Behavioral Therapy for Sexual Dysfunctions in Women

Sexual dysfunctions in women are classified into disorders of desire, arousal, orgasm, and pain (including dyspareunia and vaginismus). As the cognitive behavioral treatment (CBT) procedures differ among these sexual disorders, the treatments for each disorder are reviewed separately. The efficacy of CBT differs depending on the specific sexual dysfunction to be treated. It is concluded that only a few CBT treatments for womens sexual dysfunction have yet been empirically investigated in a methodologically sound way and little is known about which of the treatment components are most effective.

A cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS): factors associated with treatment success.

The results of this prospective open clinical trial (N = 76) indicate that a cognitive-behavioral group program for women with vulvar vestibulitis syndrome (VVS) affects sexuality, pain control, vaginal muscle control, and vestibular pain and that these changes may mediate changes in pain during intercourse. Improvements in sexual functioning and vestibular pain during treatment seem to be particularly important factors in determining short and longer term treatment outcome. These findings are consistent with a cognitive-behavioral conceptualization of VVS.

Autogenic training and cognitive self-hypnosis for the treatment of recurrent headaches in three different subject groups

&NA; The aims of this study were to(a) investigate the efficacy of autogenic training (AT) and cognitive self‐hypnosis training (CSH) for the treatment of chronic headaches in comparison with a waiting‐list control (WLC) condition,(b) investigate the influence of subject recruitment on treatment outcome(c) explore whether the level of hypnotizability is related to therapy outcome. Three different subjects groups (group 1, patients (n = 58) who were referred by a neurological outpatient clinic; group 2, members (n = 48) of the community who responded to an advertisement in a newspaper; and group 3, students (n = 40) who responded to an advertisement in a university newspaper) were allocated at random to a therapy or WLC condition. During treatment, there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls. At post‐treatment and follow‐up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index, psychological distress (SCL‐90) scores and medication use. Follow‐up measurements indicated that therapeutic improvement was maintained. In both treatment conditions, the high‐hypnotizable subjects achieved a greater reduction in headache pain at post‐treatment and follow‐up than did the low‐hypnotizable subjects. It is concluded that a relatively simple and highly structured relaxation technique for the treatment of chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures, irrespective of the source of recruitment. The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH.

The golombok rust inventory of sexual satisfaction (GRISS): Psychometric properties within a dutch population

The aim of this study was to investigate the psychometric properties of the Golombok Rust Inventory of Sexual Satisfaction (GRISS) in a Dutch population. The participants in this study were 373 heterosexual couples: 305 couples with a sexual problem and 68 student couples (test-retest). Evidence for a 12-factor solution corresponding to the original 12 subscales of GRISS was found, although some of the subscales were rather highly correlated. The homogeneity of the 12 GRISS subscales, as determined by mean interitem correlations, item-rest correlations, and Cronbachs coefficient alpha, was satisfactory to good. The test-retest reliability of the GRISS scales was sufficient. The GRISS subscales were reasonably stable with respect to age, duration of the relationship, and level of education. Furthermore, a higher order factor analysis on the 12 subscales suggested a male and a female sexual dissatisfaction factor.

Cognitive-affective correlates and predictors of superficial dyspareunia

This study investigated the role of cognitive-affective variables related to sexuality, chronic pain, individual and relational well-being in superficial dyspareunia. Although symptomatic women (n = 80) differed from complaint-free controls (n = 62) on all variables, sexuality related measures had the most important contribution into the prediction of group membership. Dyspareunia subgroups based on the presence/absence of a concomitant diagnosis of provoked vestibulodynia were only distinguishable on pain intensity but not on variables related to sexuality and psychological well-being. The present findings underscore the relevance of psychosexual factors in women with superficial dyspareunia.