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Female sexual dysfunction (FSD) affects approximately one-third of women worldwide and is linked to negative physical, psychological, and interpersonal outcomes. Although both cognitive-behavioral therapy and mindfulness-based therapy are effective treatments for FSD, face-to-face treatments can be costly and are inaccessible to many people in remote areas. The goal of the current study is to pilot a randomized controlled trial to examine the effectiveness of and satisfaction with two online interventions for FSD. Women will be randomized to an online cognitive-behavioral program, an online mindfulness-based program, or a wait-list control group. Treatment will be administered entirely online and last 8-12 weeks. Women will meet weekly via Zoom with a navigator who will provide individualized support.
HYPOTHESES:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CBT-O | Experimental | Women randomized to this arm will receive access to the eight modules of Cognitive-Behavioural Therapy-Online (CBT-O). Participants will meet weekly via Zoom with treatment navigators during the 8-12 weeks that it takes to complete the program. |
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| MBT-O | Experimental | Women randomized to this arm will receive access to the eight modules of Mindfulness-Based Therapy-Online (MBT-O). Participants will meet weekly via Zoom with treatment navigators during the 8-12 weeks that it takes to complete the program. |
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| Wait-List Control | No Intervention | Participants who are randomized to the wait-list group will complete two baseline online questionnaire/assessment batteries before being randomized to one of the active treatment groups. Participants will be randomized into one of the active treatment groups after a 10 week waiting period. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Cognitive-Behavioural Therapy - Online (CBT-O) | Behavioral | Face-to-face CBT was adapted for web-based self-directed therapy. CBT-O was found to be feasible and usable (Stephenson et al., 2021; Zippan et al., 2020). Each of the eight modules has between-module activities to complete. The eight modules are: 1) Psychoeducation, introduction to CBT; 2) The cognitive model and thought records; 3) Unhelpful thinking patterns; 4) Cognitive restructuring; 5) Behavioral experiments; 6) Self-touch and sensate focus; 7) Sensate focus with your partner; and 8) Maintaining (and extending) your gains. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in sexual distress | Revised version of the Female Sexual Distress Scale-R (Derogatis et al., 2008). Scores on the scale range from 0-52, where higher scores represent higher levels of distress. | baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Change in sexual desire | The Sexual Interest and Desire Inventory (SIDI; Clayton et al. 2006) total score will be used to measure sexual desire. Possible total scores range from 0-51, with higher scores indicating higher levels of sexual functioning. | baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Change in sexual function | Female Sexual Function Index total score (FSFI; Rosen et al., 2000). Scores range from 2 - 36 where increase in sexual dysfunction is represented by lower scores. | baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Change in depression (mediator) | Patient Health Questionnaire (PHQ-9). Scores can range from 0-27, with higher scores indicating more depression symptoms. | baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
Inclusion Criteria:
Exclusion Criteria:
Women
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| Name | Affiliation | Role |
|---|---|---|
| Lori Brotto, PhD | The University of British Columbia | Principal Investigator |
| Kyle Stephenson, PhD | Xavier University of Louisiana. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UBC Sexual Health Research Lab; Gordon & Leslie Diamond Health Care Centre | Vancouver | British Columbia | V5Z 1M9 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40132194 | Derived | Brotto LA, Stephenson KR, Marshall N, Balvan M, Okara Y, Mahar EA. Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study. J Med Internet Res. 2025 Mar 25;27:e69828. doi: 10.2196/69828. |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Dec 23, 2021 | Jan 14, 2022 | Prot_SAP_001.pdf |
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| Mindfulness-Based Therapy - Online (MBT-O) | Behavioral | The content of MBT-O was adapted from an efficacious face-to-face mindfulness intervention for women with Sexual Interest/Arousal Disorder (Brotto et al., 2021; Paterson et al., 2017). MBT-O was found to be feasible and usable (Brotto et al., under review). Each of the eight modules has between-module activities to complete. The eight modules are: 1) Psychoeducation, introduction to mindfulness; 2) Increasing awareness of physical sensations in the body; 3) Exploring movement and body image; 4) Awareness of sexual thoughts and beliefs; 5) Working with aversion, self-touch; 6) Exploring sexual sensations, knowing limits; 7) Integrating the partner into mindful touching; and 8) Maintaining (and extending) your gains. |
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| Change in sexual satisfaction | Quality of Sex Inventory (QSI; Shaw & Rogge, 2016). For all items, responses are given values on a 0 to 5 point scale with 0 = Not at all TRUE and 5 = Completely TRUE. The items of the sexual satisfaction subscale are summed to create a total where higher scores indicate higher levels of sexual satisfaction (0-60). The items of the sexual dissatisfaction subscale are summed separately to create a total where higher scores reflect higher levels of sexual dissatisfaction (0-60). | baseline; post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Change in relational sexual concern | Relational concern subscale of the Sexual Satisfaction Scale-Women (SSS-W; Meston & Trapnell, 2005). Scores range from 6-30, with higher scores reflecting lower levels of sexual relational concern. | baseline; post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Change in relationship satisfaction | Couples satisfaction index (CSI-16; Funk & Rogge, 2007). CSI-16 scores can range from 0 to 81. Higher scores indicate higher levels of relationship satisfaction. | baseline; post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Treatment satisfaction for module 1 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 1. | An average of 1 week after starting the 8-module program |
| Treatment satisfaction for module 2 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 2. | An average of 2 weeks after starting the 8-module program |
| Treatment satisfaction for module 3 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 3. | An average of 3 weeks after starting the 8-module program |
| Treatment satisfaction for module 4 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 4. | An average of 5 weeks after starting the 8-module program |
| Treatment satisfaction for module 5 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 5. | An average of 6 weeks after starting the 8-module program |
| Treatment satisfaction for module 6 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 6. | An average of 7 weeks after starting the 8-module program |
| Treatment satisfaction for module 7 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 7. | An average of 9 weeks after starting the 8-module program |
| Treatment satisfaction for module 8 | Face-valid single item measures, asking participants to rate helpfulness of content covered each week, and ease of reading the content (0-10 scale). Research suggests a cut-off of 6.5/10 on these measures to indicate acceptable utility and clarity of content. Asked after completing module 8. | An average of 10 weeks after starting the 8-module program |
| Quantitative program treatment satisfaction as assessed by the adapted Erectile Dysfunction Inventory of Treatment Satisfaction | Adapted Erectile Dysfunction Inventory of Treatment Satisfaction (Althof et al., 1999; items 1-10). Scores range from 0-40, with higher scores reflecting higher treatment satisfaction. | post-treatment (within 2 weeks of completing the 8-module program) |
| Qualitative program treatment satisfaction | Qualitative feedback about eSense and between-module activities collected by treatment navigators. | through completion of the 8-module program, an average of 10 weeks |
| Change in satisfaction with life | Satisfaction with Life Scale (Diener et al., 1985). Scores range from 5-35, with higher scores reflecting higher levels of life satisfaction. | baseline; post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Change in sexual avoidance (mediator) |
The Golombok Rust Inventory of Sexual Satisfaction (GRISS) Questionnaire (female) - Sexual Avoidance Subscale. Scores can range from 0-16, with higher scores indicating higher levels of sexual avoidance. |
| baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Change in sexual consequences (mediator) | Measure of Sexual Consequences (Stephenson et al., 2018). Scores can range from 11-55, with higher scores indicating more frequent negative sexual consequences. | baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |
| Participants' baseline expectations about treatment efficacy assessed by two face-valid items (moderator) | measured using two items: "To what extent to you think the treatment you will receive is logical in terms of alleviating your sexual desire concerns?" and "To what extent do you expect improvement in your sexual desire as a result of this treatment?" | baseline |
| Treatment compliance: Single-item measure of between-module activity completion (moderator) | navigators will ask participants to rate between-module activity completion on a 1-7 Likert scale ranging from "did not attempt" to "successfully completed all assignments" weekly | through completion of the 8-module program, an average of 10 weeks |
| Treatment compliance: Between-module activity completion assessed by Homework Rating Scale-II (moderator) | participants complete the Homework Rating Scale-II (HRS-II) after each module. Scores can range from 0-48, with higher scores reflecting high levels of between-module activity completion. | through completion of the 8-module program, an average of 10 weeks |
| Treatment compliance: Navigator adherence to study guidelines (moderator) | measuring navigator adherence to study guidelines by recording a random 50% of Zoom sessions (participants will be informed of these recordings) and coding navigator sessions for adherence using an adherence measure developed by investigators that access adherence to study guidelines, with higher scores reflecting higher levels of adherence to study guidelines. | through completion of the 8-module program, an average of 10 weeks |
| Treatment compliance: Number of weeks in program (moderator) | Recording number of weeks participant took to complete the program. | post-treatment (within 2 weeks of completing the 8-module program) |
| Treatment compliance: Number of treatment sections of program completed (moderator) | Recording number of treatment sections participants complete. | post-treatment (within 2 weeks of completing the 8-module program) |
| Treatment compliance: Participant engagement with website as assessed by Google Analytics data (moderator) | eSense website engagement assessed by Google analytics data (e.g., total duration of time on website). This will provide a measure of participant engagement. | through completion of the 8-module program, an average of 10 weeks |
| Perceived navigator empathy (moderator) | Empathy subscale of the Barrett-Lennard Relationship Inventory (Barrett-Lennard, 2015). Scores range from -48 to 48, with higher scores reflecting that participants perceive higher levels of empathy in their navigator. | post-treatment (within 2 weeks of completing the 8-module program) |
| Perceived navigator alliance (moderator) | Perceived navigator alliance with the Working Alliance Inventory, Short Form (Hatcher & Gillaspy, 2006). Scores range from 12-84, with higher levels reflecting that participants perceive higher levels of working alliance with their navigator. | post-treatment (within 2 weeks of completing the 8-module program) |
| Partner Involvement (moderator) | Two face-valid questions asking how much their partners were involved with and supportive of their treatment. The items are: "How involved has your partner been with your participation over the course of your involvement with eSense (e.g., talking to you about your participation, viewing modules themselves, participating in activities)?" and "How supportive has your partner been of your participation in the eSense program?" | post-treatment (within 2 weeks of completing the 8-module program) |
| Big-Five personality traits (exploratory moderator) | Big Five Inventory-10 (BFI-10; Rammstedt & John, 2007) | baseline |
| Change in PTSD symptoms (exploratory outcome) | PTSD Checklist (PCL) - 5; 4-item version (Price et al., 2016). Scores can range from 0-16, with higher scores indicating more severe PTSD symptomatology. | baseline; mid-treatment (an average of 5 weeks after starting the 8-module program); post-treatment (within 2 weeks of completing the 8-module program); and 6-month follow-up |