Cognitive-behavioral therapy for women with lifelong vaginismus: process and prognostic factors.

Cognitive-behavioral therapy (CBT) seems an effective treatment of lifelong vaginismus, but mechanisms of action have not yet been established. The present study explored whether the effect of CBT for lifelong vaginismus is mediated by changes in fear of penetration and avoidance behavior, which CBT explicitly aims to alter. A second aim of this study was to predict treatment outcome on the basis of pre-treatment variables. Participants with lifelong vaginismus were allocated at random to a 3-months CBT (n=81) or a waiting-list control condition (n=36). Full vaginal penetration with the penis of the partner constituted the primary outcome measure. Change scores in successful 'non-coital penetrative-behavior' and 'fear of coitus' were used to measure the mediating variables. Treatment resulted in an increase of intercourse (outcome), a decrease in fear of coitus, and an enhancement of successful non-coital penetration behavior, compared with no treatment. Outcome (intercourse) was partly mediated by changes in fear of coitus and changes in avoidance behavior. No treatment predictors could be detected in this study sample. It is concluded that techniques such as gradual exposure, aimed at decreasing avoidance behavior and penetration fear, constitute an important avenue of change in the treatment of lifelong vaginismus.

Cognitive-behavioral therapy for women with lifelong vaginismus: a randomized waiting-list controlled trial of efficacy.

Women with lifelong vaginismus (N=117) were randomly assigned to cognitive-behavioral group therapy, cognitive-behavioral bibliotherapy, or a waiting list. Manualized treatment comprised sexual education, relaxation exercises, gradual exposure, cognitive therapy, and sensate focus therapy. Group therapy consisted of ten 2-hr sessions with 6 to 9 participants per group. Assistance with minimal-contact bibliotherapy consisted of 6 biweekly, 15-min telephone contacts. Twenty-one percent of the participants left the study before posttreatment assessment. Intent-to-treat analysis revealed that successful intercourse at posttreatment was reported by 14% of the treated participants compared with none of the participants in the control condition. At the 12-month follow-up 21% of the group therapy participants and 15% of the bibliotherapy participants, respectively, reported successful intercourse. Cognitive-behavioral treatment of lifelong vaginismus was thus found to be efficacious, but the small effect size of the treatment warrants future efforts to improve the treatment.

Boundary distortions for neutral and emotional pictures.

In two experiments, we examined Safer, Christianson, Autry, and Osterlund's (1998) claim that when emotional material is remembered, tunnel memory (i.e., the tendency to remember less of a scene than was actually shown) occurs. In Experiment 1, 81 undergraduate students drew photographs from memory after having briefly seen either four neutral or four emotional photographs. Both neutral and emotional drawings revealed boundary extension (i.e., the tendency to remember more of a scene than was actually shown). Experiment 2 relied on the camera distance paradigm (Intraub, Bender, & Mangels, 1992). In a recognition test, 60 undergraduate students judged the camera distance of previously seen neutral or emotional photographs. The majority of them demonstrated accurate judgments and neither extended nor restricted picture boundaries. Those participants who made an error more often displayed a boundary extension than a tunnel memory error. Taken together, our results suggest that boundary extension for neutral and emotional photographs is a more robust phenomenon than its counterpart, tunnel memory.