Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples' Sexual Intimacy After Prostate Cancer: A Mixed Methods Approach - Beyond the Abstract

Sexual health and intimacy are consistently reported among the top unmet supportive care needs of prostate cancer (PC) survivors.1 With an aging population and advances in PC detection and treatment, the need for better PC sexual health interventions is acute. While multiple studies have assessed the effectiveness of psychosocial interventions to address the sexual health needs of PC survivors and their partners, the results of this body of research remain mixed. We believe that the inconsistent outcomes for psychosocial interventions can be attributed—at least in part—to a focus on regaining some form of erectile functioning so that couples can return to their pre-PC sexual scripts. Unfortunately, in many cases, a return to pre-treatment sexual function is not possible after PC treatments.2 Thus, even the most well-meaning of clinicians has the potential to contribute to a couple’s sense of hopelessness and failure around the inability to return to the sex life they once had.3


Our team has evaluated mindfulness-based interventions for women with sexual dysfunction over the past 15 years and found them to be effective for a range of populations. Based on these data, we designed a mindfulness-based sex therapy to address sexual health concerns in couples following PC treatments. Mindfulness was chosen as a treatment modality due to the growing body of research in the sex therapy world indicating that it is an effective intervention for a range of sexual health concerns.4-6 Further, the present-moment, non-judgemental focus of mindfulness-based sex therapy lends itself well to the approach of accepting one’s current level of sexual functioning, finding ways to enjoy sex after PC treatment, and even write a new sexual script with a focus on pleasure and connection, as opposed to a performance-based model.

While the sample size for the current study was small, results indicated improvements in sexual satisfaction, which were sustained 6 months after the treatment ended. Qualitative feedback from participants who took part in the treatment group indicated a wide range of important, and—at times—surprising feedback about the mindfulness-based approach that would be highly valuable for any clinician who works with PC survivors, including those clinicians involved in sexual rehabilitation treatment provision and development. While more research is surely needed to confirm the promising findings reported here, and to better understand the mechanisms of change, mindfulness appears to hold promise as an avenue of exploration for bettering the care of PC survivors and their partners.

Written by: Lori Brotto, Director, UBC Sexual Health Laboratory, Canada Research Chair in Women’s Sexual Health, Professor, Department of Obstetrics & Gynaecology, University of British Columbia, Executive Director, Women’s Health Research Institute, Vancouver, BC Canada

References:

  1. Ream E, Quennell A, Fincham L, et al. Supportive care needs of men living with prostate cancer in England: a survey. Br J Cancer 2008;98:1903-1909.
  2. Sivarajan G, Prabhu V, Taksler GB, et al. Ten-year outcomes of sexual function after radical prostatectomy: results of a pro- spective longitudinal study. Eur Urol 2014;65:58-65.
  3. Bossio, J. A., Miller, F., O’Loughlin, J. I., & Brotto, L. A. (2019). Sexual health recovery for prostate cancer survivors: The proposed role of acceptance and mindfulness-based interventions. Sexual medicine reviews, 7(4), 627-635.
  4. Bossio JA, Basson R, Driscoll M, et al. Mindfulness-based group therapy for men with situational erectile dysfunction: a mixed-methods feasibility analysis and pilot study. J Sex Med 2018;15:1478-1490.
  5. Brotto LA, Erskine Y, Carey M, et al. A brief mindfulness- based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gy- necologic cancer. Gynecol Oncol 2012;125:320-325.
  6. Brotto, Lori A., et al. Moderators of Improvement From Mindfulness-Based vs Traditional Cognitive Behavioral Therapy for the Treatment of Provoked Vestibulodynia." The Journal of Sexual Medicine 2020;17:2247-2259.

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