针对性兴趣/性唤起障碍的正念和性教育：治疗结果的中介因素和调节因素

Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome

——原载《性研究杂志》2023年第60卷第4期——

<The Journal of Sex Research>, 2023, 60 (4)

【摘要】性兴趣/性唤起障碍（SIAD）是女性常见的性功能障碍。基于正念的认知疗法 (MBCT) 加上心理教育和性治疗、教育和支持（STEP；其中包含与MBCT组相同的教育信息，但还整合了支持表达疗法），都是有效的。我们测试了改进的中介者和调节者。每个治疗臂每周进行八次疗程，参与者在治疗前、治疗后立即以及治疗后6个月和12个月时在线完成测量。抑郁、自我报告的内感受意识、自我慈悲、自我批评和正念被视为中介因素，而对改进的期望则被视为调节因素。在148名同意的顺性别女性中，70 名被随机分配到MBCT加心理教育组（平均年龄39.3±13.2岁），78名被随机分配到STEP组（平均年龄37.9±12.2岁）。仅在MBCT加心理教育组中，抑郁的减少介导了性痛苦的减少。内感受意识的改善介导了性欲和性唤起以及性困扰的变化，并且在MBCT加心理教育后达到更大程度。仅在MBCT加心理教育组中，自我慈悲的变化介导了性欲和性唤起的变化，并且在两组中介导了性困扰的变化。MBCT加心理教育后，自我批评的减少在更大程度上改善了性困扰。仅在MBCT加心理教育组中，正念的变化可以预测欲望、唤醒和痛苦的变化。对改善的期望并没有缓和任何结果。这些发现对于理解MBCT加上心理教育和支持性性教育改善SIAD症状的常见和可能不同的途径具有重要意义。

[Abstract] Sexual Interest / Arousal Disorder (SIAD) is a common sexual dysfunction in women. Both mindfulness-based cognitive therapy (MBCT) plus psychoeducation and sex therapy, education, and support (STEP; which contains the same educational information as in the MBCT arm but also integrates supportive-expressive therapy), are effective. We tested mediators and moderators of improvements. Each treatment arm consisted of eight sessions delivered weekly, and participants completed measures online pre-treatment, immediately post-treatment, and at 6- and 12-month post-treatment. Depression, self-reported interoceptive awareness, self-compassion, self-criticism, and mindfulness were examined as mediators, and expectations for improvement as a moderator. Of 148 cisgender women who consented, 70 were randomized to the MBCT plus psychoeducation group (mean age 39.3 ± 13.2 yrs) and 78 to the STEP group (mean age 37.9 ± 12.2 yrs). Decreases in depression mediated decreases in sexual distress in the MBCT plus psychoeducation group only. Improvements in interoceptive awareness mediated changes in both sexual desire and arousal, and sexual distress, and to a greater degree after MBCT plus psychoeducation. Changes in self-compassion mediated changes in sexual desire and arousal only for the MBCT plus psychoeducation group and mediated changes in sexual distress in both groups. Reductions in self-criticism mediated improvements in sexual distress to a greater extent after MBCT plus psychoeducation. Changes in mindfulness predicted changes in desire and arousal, and distress only in the MBCT plus psychoeducation group. Expectations for improvement did not moderate any outcomes. The findings have implications for understanding common and potentially distinct pathways by which MBCT plus psychoeducation and supportive sex education improve symptoms of SIAD.

论文原文：Lori A. Brotto, Bozena Zdaniuk, Meredith L. Chivers, Faith Jabs, Andrea D. Grabovac & Martin L. Lalumière (2023). Mindfulness and Sex Education for Sexual Interest/Arousal Disorder: Mediators and Moderators of Treatment Outcome. The Journal of Sex Research, 60 (4): 508-521.

https://doi.org/10.1080/00224499.2022.2126815

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