Lori A. Brotto
PhD, R Psych
Dr. Lori Brotto is Director of the University of British Columbia (UBC) Sexual Health Laboratory, Canada Research Chair in Women’s Sexual Health, Professor in the Department of Obstetrics & Gynaecology at UBC, and Executive Director at the Women’s Health Research Institute. She completed her PhD in Clinical Psychology at UBC with a primary focus on psychophysiological aspects of sexual arousal in women diagnosed with sexual dysfunctions. Currently, Dr. Brotto’s research program focuses on women’s sexual health, specifically, development and testing of mindfulness-based psychological treatments for women. She also has a strong research interest in sexual difficulties related to gynaecologic and colorectal cancers and differentiating asexuality from sexual dysfunction.
Sexual difficulties are common in women, and significantly interfere with quality of life and relationship satisfaction. However, most women do not access treatments for their sexual concerns, leaving them to persist unaddressed for years. Our team have demonstrated the effectiveness of face to face group mindfulness interventions for a host of sexual concerns in different populations of women. The goal of this multi-phase project is to develop and demonstrate the feasibility and efficacy of an adapted online version of our cognitive behavioural and mindfulness-based treatments for sexual concerns.
Research plan: This is a pilot RCT to determine the efficacy of eSense, a recently-created web-based program aimed at improving female sexual dysfunction. eSense includes separate 8-module packages of online CBT (CBT-O) and MBT (MBT-O). In response to our initial submission (Spring 2018), we have demonstrated the feasibility and acceptability of the CBT arm of eSense across 3 studies.
The specific aims of this 3-year project are to:
1) Determine the efficacy of treatment (CBT-O and MBT-O) against a wait-list control group for sex-related distress and sexual function.
2) Compare CBT-O with MBT-O measuring pre- to post-treatment change, up to 6-month follow-up.
3) Evaluate treatment satisfaction, perceived relationship with navigator, and homework compliance with eSense.
We will recruit a total of 107 cis- and trans women who meet cut-off scores for sexual dysfunction and sex-related distress and have a final sample of n = 75. We will randomize in a 2:2:1 fashion to CBT-O (n = 30), MBT-O (n = 30), and wait-list control group (n = 15). Wait-list participants will complete two pre-treatment assessments and then randomized to a treatment arms. Treatment consists of 8 modules spanning 8-12 weeks (based on their self-determined pacing). Participants will have a weekly webcam enabled check-in with a navigator whose role is to provide encouragement and answer practical questions.
Zippan, N., Stephenson, K.R., & Brotto, L.A. (online ahead of print). Feasibility of a Brief Online Psychoeducational Intervention for Women with Sexual Desire/Arousal Disorder. Journal of Sexual Medicine.
The majority of women will develop persisting sexual concerns and vulvo-vaginal pain after treatment for breast cancer. Hormonal and off-label pharmaceutical approaches are either lacking in evidence or potentially unsafe for this population. Given evidence we have accrued showing the benefits of a mindfulness-based treatment for similar sexual concerns in gynaecologic cancer survivors, the goal of this project is to evaluate these treatments for survivors of breast cancer.
The current proposal details a 3-year, randomized, unblinded, two-site, controlled trial of 8 weekly sessions of group MBCT-S vs. 8 weekly sessions of a sex education control. The primary aims of the study are as follows:
1) To test the effects of MBCT-S versus a sex education control group on: (a) sexual desire, (b) sexually-related distress, and (c) sexual pain;
2) To test maintenance of effects at 3 and 6 months following treatment;
3) To examine four potential mediators of change following MBCT-S: (a) mindfulness skills, (b) pain acceptance, (c) pain catastrophizing, and (d) depression in the primary endpoints of sexual desire, sexual distress, and sexual pain.
4) To explore the relationship between the following patient characteristics and treatment outcomes to determine variables that predict the greatest benefits: demographic characteristics (e.g., age, disease characteristics), sexual health characteristics (e.g., menopausal status, severity of sexual symptoms), and mood (depressive symptoms).
Sexual Interest/Arousal Disorder (SIAD) is the most prevalent sexual concern experienced by women, yet treatment options are scarce. Previous research has heavily focused on pharmaceuticals, which have left women’s relational and contextual factors that negatively impact their sexual well-being unaddressed. The proposed study seeks to fill these gaps through mentorship training of a future clinician-scientist who will specialize in psychological treatments for women’s sexual dysfunction, as well as test the treatment utility of a sexual motivation manipulation paradigm that addresses contextual factors of sexual motivation. .
We plan to apply the Approach-Avoidance Motivation Model to women with sexual interest/arousal disorder by experimentally manipulating their approach and avoidance goals and testing outcomes for sexual wellbeing and behaviour, and attention to sexual cues.
We predict that inducing higher approach goals will result in significantly more approach goals, more attention, and higher markers of sexual wellbeing (behaviour, desire, satisfaction) and relationship satisfaction 72 hours after the manipulation. We predict that attention will mediate these outcomes given the pivotal role of attention in models of sexual response.