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Relationship Satisfaction as a Predictor of Treatment Response During Cognitive Behavioral Sex Therapy

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Abstract

Although recent research suggests that individual cognitive behavioral therapy (CBT) may be an effective treatment for female sexual dysfunctions, we have little information regarding predictors of treatment response. The goal of the current study was to assess the degree to which pre-treatment relationship satisfaction predicted treatment response to cognitive behavioral sex therapy. Women with sexual dysfunction (n = 31, M age = 28 years, 77.4 % Caucasian) receiving cognitive-behavioral sex therapy with or without ginkgo biloba, as part of a wider randomized clinical trial, were assessed pre- and post-treatment using validated self-report measures of sexual satisfaction, sexual distress, sexual functioning, and relationship satisfaction. Pre-treatment relationship satisfaction predicted changes in sexual satisfaction and distress, but not sexual functioning. Women with higher relationship satisfaction at intake experienced larger gains in sexual satisfaction and distress over the course of treatment. Pre-treatment relationship satisfaction also moderated the association between changes in sexual functioning and changes in sexual distress, such that improved functioning was associated with decreased distress only for women entering therapy with high relationship satisfaction. These findings suggest that, for women with low relationship satisfaction before entering treatment, improvement in sexual functioning may not be enough to alleviate their sexual distress.

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Notes

  1. Gingko biloba extract was included in this initial study because of its hypothesized beneficial effects on peripheral circulation, which may facilitate genital engorgement during sexual activities. Analyses of the effects of Ginkgo biloba extract on vaginal engorgement in this initial study did not provide evidence that this herbal extract positively affected sexual responses (Meston et al., 2008). As such, we did not examine the effect of Ginkgo biloba in the current analyses.

  2. This criterion may have created a bias in the selection of participants since women who were affected by their sexual dysfunction to the point of not wanting to engage in sexual activities may have decided not to participate in the study. However, in order to gather an accurate assessment of difficulties becoming sexually aroused, it is essential for the participant to have at least attempted sexual activities and thus this criterion is essential for the accurate assessment of efficacy, although, undoubtedly, it introduces a limitation to studies in this area.

  3. Eta square values of .4 and higher indicate a large effect size.

  4. For example, in our most complex model (wherein interaction term FSFI-Function-Change X DAS-Pre was a significant predictor of SSS-Distress-Post while controlling for SSS-Distress-Pre), we conducted four regressions, adding one predictor for each new model and assessing the AIC of the model. Specifically, we computed a model with SSS-Distress-Post regressed on SSS-Distress-Pre only (AIC = 75.76), then added FSFI-Function-Change as an additional predictor (AIC = 54.35), then added DAS-Pre (AIC = 44.89), before finally adding the FSFI-Function-Change X DAS-Pre interaction (AIC = 37.49). In each case, the additional predictor added explanatory power to the model, even after penalizing for the increased number of coefficients in the model.

References

  • Bancroft, J., Loftus, J., & Long, S. J. (2003). Distress about sex: A national survey of women in heterosexual relationships. Archives of Sexual Behavior, 32, 193–208.

    Article  PubMed  Google Scholar 

  • Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54, 140–148.

    Article  PubMed  Google Scholar 

  • Binik, Y. M., Meana, M., Berkley, K. J., & Khalife, S. (1999). Dyspareunia: Is the pain sexual or the sex painful? Annual Review of Sex Research, 36, 210–235.

    Google Scholar 

  • Brotto, L. A., Bitzer, J., Laan, E., Leiblum, S., & Luria, M. (2010). Women’s sexual desire and arousal disorders. Journal of Sexual Medicine, 7, 586–614.

    Article  PubMed  Google Scholar 

  • Brotto, L. A., Seal, B. N., & Rellini, A. H. (2012). Pilot study of a brief cognitive behavioral versus mindfulness-based intervention for women with sexual distress and a history of childhood sexual abuse. Journal of Sex & Marital Therapy, 38, 1–27.

    Article  Google Scholar 

  • Byers, E. S. (2005). Relationship satisfaction and sexual satisfaction: A longitudinal study of individuals in long-term relationships. Journal of Sex Research, 42, 113–118.

    Article  PubMed  Google Scholar 

  • DeRogatis, L. R., Clayton, A. H., Rosen, R. C., Sand, M., & Pyke, R. E. (2011). Should sexual desire and arousal disorders in women be merged? [Letter to the Editor]. Archives of Sexual Behavior, 40, 217–219.

    Article  PubMed  Google Scholar 

  • Eddy, J. M., Heyman, R. E., & Weiss, R. L. (1991). A emperical evaluation of the Dyadic Adjustment Scale: Exploring differences between marital ‘satisfaction’ and marital ‘adjustment’. Behavioral Assessment, 13, 199–220.

    Article  Google Scholar 

  • Ferenidou, F., Kapoteli, V., Moisidis, K., Koutsogiannis, I., Giakoumelous, A., & Hatzichristou, D. (2008). Presence of a sexual problem may not affect women’s satisfaction from their sexual function. Journal of Sexual Medicine, 5, 631–639.

    Article  PubMed  Google Scholar 

  • Fincham, F. D., Garnier, P. C., Gano-Philips, S., & Osborne, L. N. (1985). Preinteraction expectations, marital satisfaction, and accessibility: A new look at sentiment override. Journal of Family Psychology, 9, 3–14.

    Article  Google Scholar 

  • Gottman, J. M. (1993). A theory of relationship dissolution and stability. Journal of Family Psychology, 7, 57–75.

    Article  Google Scholar 

  • Harvey, J. H., Wenzel, A., & Sprecher, S. (2004). (Eds.). The handbook of sexuality in close relationships. Hillsdale, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Hawton, K., & Catalan, J. (1986). Prognostic factors in sex therapy. Behaviour Research and Therapy, 24, 377–385.

    Article  PubMed  Google Scholar 

  • Hawton, K., Catalan, J., & Fagg, J. (1991). Low sexual desire: Sex therapy results and prognostic factors. Behaviour Research and Therapy, 29, 217–224.

    Article  PubMed  Google Scholar 

  • Hayes, R. D., Dennerstein, L., Bennet, C. M., & Fairley, C. K. (2008a). What is the ‘true’ prevalence of female sexual dysfunctions and does the way we assess these conditions have an impact? Journal of Sexual Medicine, 5, 777–787.

    Article  PubMed  Google Scholar 

  • Hayes, R. D., Dennerstein, L., Bennet, C. M., Sidat, M., Gurrin, L. C., & Fairley, C. K. (2008b). Risk factors for female sexual dysfunction in the general population: Exploring factors associated with low sexual function and sexual distress. Journal of Sexual Medicine, 5, 1681–1693.

    Article  PubMed  Google Scholar 

  • Heiman, J. R. (2002). Sexual dysfunction: Overview of prevalence, etiological factors, and treatments. Journal of Sex Research, 39, 73–78.

    Article  PubMed  Google Scholar 

  • Heiman, J. R., & LoPiccolo, J. (1983). Clinical outcome of sex therapy. Archives of General Psychiatry, 40, 443–449.

    Article  PubMed  Google Scholar 

  • Hurlbert, D. F. (1993). A comparative study using orgasm consistency training in the treatment of women reporting hypoactive sexual desire. Journal of Sex and Marital Therapy, 19, 41–55.

    Article  PubMed  Google Scholar 

  • Jones, L. M., & McCabe, M. P. (2011). The effectiveness of an Internet-based psychological treatment program for female sexual dysfunction. Journal of Sexual Medicine, 8, 2781–2792.

    Article  PubMed  Google Scholar 

  • Laumann, E. O., Palik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537–544.

    Article  PubMed  Google Scholar 

  • Lawrance, K., & Byers, E. S. (1992). Development of the interpersonal exchange model of sexual satisfaction in long term relationships. Canadian Journal of Human Sexuality, 1, 123–128.

    Google Scholar 

  • Leiblum, S. R. (Ed.). (2007). Principles and practice of sex therapy (4th ed.). New York: Guilford Press.

    Google Scholar 

  • Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Boston, MA: Little Brown.

    Google Scholar 

  • McCabe, M. P. (2001). Evaluation of a cognitive behavior therapy program for people with sexual dysfunction. Journal of Sex and Marital Therapy, 27, 259–271.

    Article  PubMed  Google Scholar 

  • McMullen, S., & Rosen, R. C. (1979). Self-administered masturbation training in the treatment of primary orgasmic dysfunction. Journal of Consulting and Clinical Psychology, 47, 912–918.

    Article  PubMed  Google Scholar 

  • Meston, C. M., Rellini, A. H., & Telch, M. J. (2008). Short- and long-term effects of gingko biloba extract on sexual dysfunction in women. Archives of Sexual Behavior, 37, 530–547.

    Article  PubMed  Google Scholar 

  • Meston, C. M., & Trapnell, P. D. (2005). Development and validation of a five-factor sexual satisfaction and distress scale for women: The Sexual Satisfaction Scale for Women (SSS-W). Journal of Sexual Medicine, 2, 66–81.

    Article  PubMed  Google Scholar 

  • Oberg, K., & Fugl-Meyer, K. S. (2005). On Swedish women’s distressing sexual dysfunctions: Some concomitant conditions and life satisfaction. Journal of Sexual Medicine, 2, 169–180.

    Article  PubMed  Google Scholar 

  • Riley, A. J., & Riley, E. J. (1978). A controlled study to evaluate directed masturbation in the management of primary orgasmic failure in women. British Journal of Psychiatry, 133, 404–409.

    Article  PubMed  Google Scholar 

  • Rosen, R. C., Brown, C., Heiman, J. R., Leiblum, S., Meston, C. M., Shabsigh, R., et al. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex and Marital Therapy, 26, 191–208.

    Article  PubMed  Google Scholar 

  • Rosen, R. C., Shifren, J. L., Monz, B. U., Odom, D. M., Russo, P. A., & Johanes, C. B. (2009). Correlates of sexually related personal distress in women with low sexual desire. Journal of Sexual Medicine, 6, 1549–1560.

    Article  PubMed  Google Scholar 

  • Rosenbaum, T. Y. (2005). Physiotherapy treatment of sexual pain disorders. Journal of Sex and Marital Therapy, 31, 329–340.

    Article  PubMed  Google Scholar 

  • Snyder, D. K., & Berg, P. (1983). Determinants of sexual dissatisfaction in sexually distressed couples. Archives of Sexual Behavior, 12, 237–245.

    Article  PubMed  Google Scholar 

  • Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage & the Family, 38, 15–28.

    Article  Google Scholar 

  • Stephenson, K. R., Hughan, C. P., & Meston, C. M. (2012). Childhood sexual abuse moderates the association between sexual functioning and sexual distress in women. Child Abuse & Neglect, 36, 180–189.

    Article  Google Scholar 

  • Stephenson, K. R., & Meston, C. M. (2010a). Differentiating components of sexual well-being in women: Are sexual satisfaction and sexual distress independent constructs? Journal of Sexual Medicine, 7, 2458–2468.

    Article  PubMed  Google Scholar 

  • Stephenson, K. R., & Meston, C. M. (2010b). When are sexual difficulties distressing for women? The selective protective value of intimate relationships. Journal of Sexual Medicine, 7, 3683–3694.

    Article  PubMed  Google Scholar 

  • Stinson, R. D. (2009). The behavioral and cognitive-behavioral treatment of female sexual dysfunction: How far we have come and the path left to go. Sexual and Relationship Therapy, 24, 271–285.

    Article  Google Scholar 

  • ter Kuile, M. M., van Lankveld, J. M., Groot, R. M., Neffs, J., & Zandbergen, M. (2007). Cognitive-behavioral therapy for women with lifelong vaginismus: Process and prognostic factors. Behaviour Research and Therapy, 45, 359–373.

    Article  PubMed  Google Scholar 

  • Trudel, G., Marchand, A., Ravart, M., Aubin, S., Turgeon, L., & Fortier, P. (2001). The effect of a cognitive-behavioral group treatment program on hypoactive sexual desire in women. Sexual and Relationship Therapy, 16, 145–164.

    Article  Google Scholar 

  • van Lankveld, J. M., Everaerd, W., & Grotjohann, Y. (2001). Cognitive-behavioral bibliotherapy for sexual dysfunctions in heterosexual couples: A randomized waiting-list controlled clinical trial in the Netherlands. Journal of Sex Research, 38, 51–67.

    Article  Google Scholar 

  • van Lankveld, J. M., ter Kuile, M. M., Groot, E. H., Melles, R., Neffs, J., & Zandbergen, M. (2006). Cognitive-behavioral therapy for women with lifelong vaginismus: A randomized waiting-list controlled trial of efficacy. Journal of Consulting and Clinical Psychology, 74, 168–178.

    Article  PubMed  Google Scholar 

  • Ward, P. J., Lundberg, N. R., Zabriskie, R. B., & Berrett, K. (2009). Measuring marital satisfaction: A comparison of the revised dyadic adjustment scale and satisfaction with married life scale. Marriage and Family Review, 45, 412–429.

    Article  Google Scholar 

  • Weiss, R. L. (1980). Strategic behavioral relationship therapy: Toward a model for assessment and intervention. In J. Vincent (Ed.), Advances in family intervention, assessment and theory (pp. 229–271). Greenwich, CT: JAI Press.

    Google Scholar 

  • Wiegel, M., Meston, C. M., & Rosen, R. C. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex and Marital Therapy, 31, 1–20.

    Article  PubMed  Google Scholar 

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Acknowledgments

This publication was supported, in part, by Grant Number 5 RO1 AT00224 from the National Center for Complementary and Alternative Medicine to Cindy M. Meston and, in part, by Grant Number R01 HD51676 from the National Institute for Child Health and Human Development to Cindy M. Meston. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institute for Child Health and Human Development.

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Authors and Affiliations

  1. Department of Psychology, University of Texas at Austin, 108 E. Dean Keeton, Austin, TX, 78751, USA

    Kyle R. Stephenson & Cindy M. Meston

  2. Department of Psychology, University of Vermont, Burlington, VT, USA

    Alessandra H. Rellini

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  1. Kyle R. Stephenson
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  2. Alessandra H. Rellini
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  3. Cindy M. Meston
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Correspondence to Kyle R. Stephenson.

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Stephenson, K.R., Rellini, A.H. & Meston, C.M. Relationship Satisfaction as a Predictor of Treatment Response During Cognitive Behavioral Sex Therapy. Arch Sex Behav 42, 143–152 (2013). https://doi.org/10.1007/s10508-012-9961-3

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  • DOI: https://doi.org/10.1007/s10508-012-9961-3

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