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Internet-based treatment for vulvodynia (EMBLA) - Study protocol for a randomised controlled study.

Andrea Hess Hess Engström1,2, Merit Kullinger1,2, Izabella Jawad2

  • 1Centre for Clinical Research, Västmanland County Hospital, Västerås, Sweden.

Internet Interventions
|May 17, 2021
PubMed
Summary

This study investigated a guided internet-based Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) intervention for vulvodynia. The treatment effectively reduced provoked vulvar pain and improved quality of life during the waiting period for clinical care.

Keywords:
ACT, Acceptance and commitment therapyAcceptance and commitment therapyBAI, Beck Anxiety InventoryCBT, Cognitive Behavioural therapyCPAQ, Chronic Pain Acceptance questionnaireEQ5-D, EuroQol-5-dimension questionnaireESSI, ENRICHD Social Support InstrumentFSDS-R, Female Sexual Distress Scale – RevisedFSFI, Female Sexual Function IndexInternet-basedLOCF, last observation carried forwardMADRS-S, Montgomery-Åsberg Depression Rating ScaleRandomised controlled trialSWLS, Satisfaction with Life ScaleVulvodyniarDAS, Revised Dyadic Adjustment Scale

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Area of Science:

  • Psychiatry and Psychology
  • Gynecology
  • Digital Health

Background:

  • Vulvodynia is characterized by persistent vulvar pain without a clear cause.
  • There is a lack of research on internet-based interventions combining Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for vulvodynia.
  • This study addresses the need for accessible treatments during the often lengthy waiting periods for clinical care.

Purpose of the Study:

  • To examine the effects of a guided internet-based intervention incorporating CBT and ACT components on provoked vulvar pain in women with vulvodynia.
  • To assess the intervention's impact on secondary outcomes including depression, anxiety, sexual function, and quality of life.
  • To evaluate the intervention's efficacy during the waiting period before standard clinical treatment.

Main Methods:

  • A randomized controlled trial involving 52 patients with vulvodynia.
  • Participants were assigned to either a guided internet-based CBT/ACT intervention or a no-intervention control group.
  • Online assessments were conducted at baseline, post-treatment, and 9-month follow-up, with primary outcome as provoked vulvar pain.

Main Results:

  • The guided internet-based intervention demonstrated a significant reduction in provoked vulvar pain.
  • Improvements were observed in pain acceptance, depression, anxiety, sexual function, and quality of life.
  • Statistical analyses included linear-mixed effect models, general linear models, Mann Whitney's test, Fischer's exact test, and multivariate logistic regression.

Conclusions:

  • The EMBLA study provides evidence for the effectiveness of an internet-based CBT/ACT intervention as a complementary treatment for vulvodynia.
  • The findings suggest that this digital approach can improve pain, psychological well-being, and quality of life for women with vulvodynia.
  • Results are valuable for planning clinical care and highlight the potential of internet-based treatments in managing chronic pain conditions.