Videoconferencing Psychotherapy in an App Environment for Trauma-Related Psychopathology

The theoretical background of the life-span sequelae of exposure to interpersonal psychological trauma (emotional or physical neglect or abuse or sexual abuse) in childhood, particularly when a primary caretaker is involved, and its assessment and treatment possibilities in a 100% online environment are outlined. These sequelae may be understood as a complex variant of PTSD (CPTSD) or a complicated array of overlapping mental and personality disorders or as trans-diagnostic symptoms. However, disorders of extreme stress not otherwise specified (DESNOS) constitute a distinct syndrome of potential clinical utility. In childhood, adolescence, and young adulthood (YA), these symptoms seem encompassed by developmental trauma disorder (DTD). Affect dysregulation, identity alterations, and relational impairment are central features of DESNOS/DTD/CPTSD and can also be understood as trans-diagnostic symptom clusters. More and more people use smartphone apps in daily life. Therefore we started our 100% online treatments in patients’ environments and at their convenience (need driven). Our digitally enriched outpatient clinics (DOCs) using smartphone apps for videoconferencing psychotherapy (VCP) and personal data monitoring aim to augment established evidence-based treatment protocols. Also, they facilitate continuously gathering real-time sensor- and self-reported data that improve ecological validity of self-reports and monitoring for course of treatment and relapse prevention

Herziening Besluit Psychotherapeut: kans voor sprong voorwaarts.

Het Besluit Psychotherapeut (bp) 1998 regelt de toegang tot het beroep van psychotherapeut in het big-register. Er klinken geluiden om de definitie van het beroep psychotherapeut opnieuw onder de loep te nemen via een herziening van het bp. Een herziening van dit besluit binnen afzienbare tijd is nuttig en noodzakelijk. De bijdrage van psychotherapieonderzoekers aan de herziening is essentieel, omdat de kwaliteitseisen moeten stoelen op onderzoeksgegevens over de werkzaamheid en kosten)effectiviteit van therapieën in plaats van op theoretische stromingen. Van herziening van het besluit valt een belangrijk effect op de praktijk van de psychotherapeutische hulpverlening te verwachten

Understanding sexual pain: A cognitive-motivational account

Article in press: Dewitte M et al. Understanding sexual pain: A cognitive-motivational account. PAIN (2010), doi:10.1016/j.pain.2010.10.051Sexual pain or dyspareunia is a prevalent and disabling health problem in women. It is generally defined as a recurrent or persistent pain during sexual activities, involving vaginal penetration or tactile stimulation of the vulva and vestibule. In many patients, the pain is also elicited by nonsexual activities and is comparable to other pain syndromes in terms of severity, sensory characteristics, and neurological processes. As yet, little is known about the etiology of sexual pain because current research is complicated by a number of factors. First, dyspareunia encompasses multiple pain conditions with varying etiologies, causing nosological confusion. Second, evidence on causal factors is inconclusive because there are no controlled experimental studies that allow discerning cause and effect. Third, research has put more emphasis on physical markers – including neurogenic pelvic inflammation, neurochemical influences, central and peripheral sensitization, and increased vulva–vaginal innervations – rather than considering psychosocial variables that may exacerbate and maintain sexual pain problems. Pain is, however, a multidimensional experience that needs to be addressed in all its dimensions, including biomedical as well as psychosocial aspects. Because much less is known about the psychological and relational determinants of sexual pain, this review focuses specifically on the role of cognitive-motivational factors in relation to pain. Such cognitive-motivational perspective is likely to inform both research and clinical practice

Sexual distress in relation to pelvic floor dysfunction-related distress

Background: Sexual distress is seen as an essential component of female sexual dysfunction. Sexual distress originates from problems with sexual desire, sexual arousal, lubrication, orgasm, or painful intercourse, for which women could and do seek help, for example, in a pelvic physical therapy (PPT) practice. In PPT practice, sexual dysfunction is often presented as a main reason to seek help, besides commonly treated complaints, such as urinary and fecal incontinence, micturition and defecation problems, pelvic organ prolapses, and pelvic pain. However, it is not clear if sexual dysfunction and distress is the main reason to seek help. In this study, women’s help-seeking behavior in PPT practice was investigated, focusing on sexual distress in relation to pelvic floor complaints. Method: Pelvic floor dysfunction-related distress was assessed with the Pelvic Floor Distress Inventory, pelvic pain-related distress with a question from the Four-Dimensional Symptom Questionnaire, and painful intercourse with a question from the Female Sexual Functioning Index. Sexual distress was assessed with the Female Sexual Distress Scale. Women with PPT experience were compared to women without PPT experience. Results: Women with PPT experience scored higher on the Female Sexual Distress Scale in comparison to women without PPT experience. However, when corrected for the distress scores, this effect disappeared. Pelvic floor dysfunction-related distress completely mediated the relationship between help-seeking and sexual distress. Reversed mediation analysis did not show such an effect. That is, no effect of sexual distress was found on the relationship between help-seeking and pelvic floor dysfunction-related distress. Conclusion: In the current study, pelvic floor dysfunction-related distress was the main reason for seeking help in a PPT practice, not sexual distress

Sexual distress in relation to pelvic floor dysfunction-related distress

Background: Sexual distress is seen as an essential component of female sexual dysfunction. Sexual distress originates from problems with sexual desire, sexual arousal, lubrication, orgasm, or painful intercourse, for which women could and do seek help, for example, in a pelvic physical therapy (PPT) practice. In PPT practice, sexual dysfunction is often presented as a main reason to seek help, besides commonly treated complaints, such as urinary and fecal incontinence, micturition and defecation problems, pelvic organ prolapses, and pelvic pain. However, it is not clear if sexual dysfunction and distress is the main reason to seek help. In this study, women’s help-seeking behavior in PPT practice was investigated, focusing on sexual distress in relation to pelvic floor complaints. Method: Pelvic floor dysfunction-related distress was assessed with the Pelvic Floor Distress Inventory, pelvic pain-related distress with a question from the Four-Dimensional Symptom Questionnaire, and painful intercourse with a question from the Female Sexual Functioning Index. Sexual distress was assessed with the Female Sexual Distress Scale. Women with PPT experience were compared to women without PPT experience. Results: Women with PPT experience scored higher on the Female Sexual Distress Scale in comparison to women without PPT experience. However, when corrected for the distress scores, this effect disappeared. Pelvic floor dysfunction-related distress completely mediated the relationship between help-seeking and sexual distress. Reversed mediation analysis did not show such an effect. That is, no effect of sexual distress was found on the relationship between help-seeking and pelvic floor dysfunction-related distress. Conclusion: In the current study, pelvic floor dysfunction-related distress was the main reason for seeking help in a PPT practice, not sexual distress

A psychosocial approach to erectile dysfunction: position statements from the European Society of Sexual Medicine

INTRODUCTION: Although erectile dysfunction (ED) involves an interaction between physiological and psychological pathways, the psychosocial aspects of ED have received considerably less attention so far. AIM: To review the available evidence on the psychosocial aspects of ED in order to develop a position statement and clinical practice recommendations on behalf of the European Society of Sexual Medicine (ESSM). METHOD: A comprehensive, narrative review of the literature was performed. MAIN OUTCOME MEASURES: Specific statements and recommendations according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence criteria were provided. RESULTS: A multidisciplinary treatment, in which medical treatment is combined with a psychological approach, is preferred over unimodal treatment. There is increasing evidence that psychological treatments of ED can improve medical treatments, the patient's adherence to treatment, and the quality of the sexual relationship. The main components of psychological treatment of ED involve cognitive and behavioral techniques aimed at reducing anxiety, challenging dysfunctional beliefs, increasing sexual stimulation, disrupting sexual avoidance, and increasing intimacy and communication skills in a relational context. When applicable and possible, it is strongly recommended to include the partner in the assessment and treatment of ED and to actively work on interpartner agreement and shared decision-making regarding possible treatment options. To ensure a better integration of the biopsychosocial model into clinical practice, developing concrete treatment protocols and training programs are desirable. CONCLUSION: Because the psychosocial approach to ED has been underexposed so far, this position statement provides valuable information for clinicians treating ED. Psychological interventions on ED are based on existing theoretical models that are grounded in empirical evidence. However, the quality of available studies is low, which calls for further research. The sexual medicine field would benefit from pursuing more diversity, inclusivity, and integration when setting up treatments and evaluating their effect. Dewitte M, Bettocchi C, Carvalho J, et al. A Psychosocial Approach to Erectile Dysfunction: Position Statements from the European Society of Sexual Medicine (ESSM). Sex Med 2021;9:100434