Restoring Emotional, Sexual, and Physical Empowerment Through CBT & Trauma-sensitive Care: A Chronic Pelvic Pain Intervention
| Status: | Recruiting |
|---|---|
| Conditions: | Psychiatric, Women's Studies |
| Therapuetic Areas: | Psychiatry / Psychology, Reproductive |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | October 2015 |
| End Date: | September 2017 |
| Contact: | Vanessa Tirone, Ph.D. |
| Email: | vanessa_tirone@rush.edu |
This project will develop and preliminarily examine RESPECT, a trauma-sensitive
psychological and physical therapy intervention to treat chronic pelvic pain, posttraumatic
stress symptoms (PTS), and dysfunctional sexual behavior among women with sexual abuse
histories. Patients will be recruited after being referred to pelvic floor physical therapy
for treatment of chronic pelvic pain. Participants will complete seven sessions of
individual cognitive behavioral psychotherapy. Physical therapy will be provided by
clinicians who have been trained in trauma-sensitive treatment techniques. Treatment
acceptability and outcomes will be assessed at baseline, mid intervention, post-intervention
and follow-up via self-report measures. The RESPECT protocol is expected to be feasible to
implement among sexual abuse survivors and to be well liked by patients. RESPECT is expected
to reduce chronic pelvic pain, PTS, dysfunctional sexual behavior, treatment avoidance.
psychological and physical therapy intervention to treat chronic pelvic pain, posttraumatic
stress symptoms (PTS), and dysfunctional sexual behavior among women with sexual abuse
histories. Patients will be recruited after being referred to pelvic floor physical therapy
for treatment of chronic pelvic pain. Participants will complete seven sessions of
individual cognitive behavioral psychotherapy. Physical therapy will be provided by
clinicians who have been trained in trauma-sensitive treatment techniques. Treatment
acceptability and outcomes will be assessed at baseline, mid intervention, post-intervention
and follow-up via self-report measures. The RESPECT protocol is expected to be feasible to
implement among sexual abuse survivors and to be well liked by patients. RESPECT is expected
to reduce chronic pelvic pain, PTS, dysfunctional sexual behavior, treatment avoidance.
This project will develop and preliminarily examine RESPECT, a trauma-sensitive
psychological and physical therapy intervention to treat chronic pelvic pain, posttraumatic
stress symptoms (PTS), and dysfunctional sexual behavior among women with sexual abuse
histories. Chronic pelvic pain disorders are highly prevalent in the U.S., affecting between
10-21% of premenopausal women at some time in their lives. Chronic pelvic pain is associated
with dyspareunia, depression, anxiety, relationship distress, functional impairment and poor
quality of life. History of sexual abuse is associated with development of chronic pelvic
pain and with the severity of psychological distress and functional impairment among chronic
pain patients.
Unfortunately, frontline chronic pelvic pain treatments such as physical therapy and
pain-specific psychological interventions fail to address sexual trauma. Standard physical
therapy may actually trigger trauma related symptoms because it involves invasive techniques
including internal digital palpation of pelvic floor muscles and the use of vaginal
dilators. Neglecting trauma in chronic pelvic pain treatment could contribute to poor
treatment outcomes, low adherence, and drop out. RESPECT's trauma-sensitive psychological
intervention will teach women skills to cope with PTS, pain, sexual dysfunction, and
discomfort during physical therapy. RESPECT's trauma-sensitive physical therapy intervention
will more sensitively apply the invasive aspects of treatment and reinforce women's use of
trauma-related coping skills learned in the psychological intervention. RESPECT is predicted
to decrease chronic pelvic pain, PTS, dysfunctional sexual behavior, treatment avoidance.
Study Aims
1. Develop a multi-level trauma-sensitive (psychological and physical therapy) chronic
pelvic pain intervention for inner-city women with histories of sexual abuse and PTS
symptoms.
2. Examine the feasibility of RESPECT in treating this population.
3. Use a pilot open trial to examine the impact of RESPECT chronic pelvic pain, PTS,
dysfunctional sexual behavior, treatment avoidance.
RESPECT's trauma-sensitive psychological intervention will 1) educate the patient about the
relations between sexual abuse, PTS, and chronic pelvic pain 2) empower her by explaining
that sexual abuse, chronic pelvic pain, and PTS are not her fault but she has the power to
combat them 3) desensitize her to anxiety provoking components of the physical therapy
intervention, and 4) teach her relaxation tools that she can use during physical therapy
sessions, while practicing at-home physical therapy exercises, and to cope with pain more
generally.
RESPECT's trauma-sensitive physical therapy intervention will 1) teach the patient
techniques to address muscular tension that contributes to chronic pelvic pain 2) empower
her by increasing her control over each phase of treatment (e.g., starting, stopping,
expressing feelings and preferences) 3) comfort her by explaining that it is normal to
experience discomfort during physical therapy treatment and 4) encourage her to use the
trauma-related coping skills she learned in the psychotherapy component.
This initial project is intended to lead to a larger open trial that will examine not only
treatment outcomes, but also the mechanisms of change (e.g., women's feeling of empowerment,
decrease in PTS symptoms).
psychological and physical therapy intervention to treat chronic pelvic pain, posttraumatic
stress symptoms (PTS), and dysfunctional sexual behavior among women with sexual abuse
histories. Chronic pelvic pain disorders are highly prevalent in the U.S., affecting between
10-21% of premenopausal women at some time in their lives. Chronic pelvic pain is associated
with dyspareunia, depression, anxiety, relationship distress, functional impairment and poor
quality of life. History of sexual abuse is associated with development of chronic pelvic
pain and with the severity of psychological distress and functional impairment among chronic
pain patients.
Unfortunately, frontline chronic pelvic pain treatments such as physical therapy and
pain-specific psychological interventions fail to address sexual trauma. Standard physical
therapy may actually trigger trauma related symptoms because it involves invasive techniques
including internal digital palpation of pelvic floor muscles and the use of vaginal
dilators. Neglecting trauma in chronic pelvic pain treatment could contribute to poor
treatment outcomes, low adherence, and drop out. RESPECT's trauma-sensitive psychological
intervention will teach women skills to cope with PTS, pain, sexual dysfunction, and
discomfort during physical therapy. RESPECT's trauma-sensitive physical therapy intervention
will more sensitively apply the invasive aspects of treatment and reinforce women's use of
trauma-related coping skills learned in the psychological intervention. RESPECT is predicted
to decrease chronic pelvic pain, PTS, dysfunctional sexual behavior, treatment avoidance.
Study Aims
1. Develop a multi-level trauma-sensitive (psychological and physical therapy) chronic
pelvic pain intervention for inner-city women with histories of sexual abuse and PTS
symptoms.
2. Examine the feasibility of RESPECT in treating this population.
3. Use a pilot open trial to examine the impact of RESPECT chronic pelvic pain, PTS,
dysfunctional sexual behavior, treatment avoidance.
RESPECT's trauma-sensitive psychological intervention will 1) educate the patient about the
relations between sexual abuse, PTS, and chronic pelvic pain 2) empower her by explaining
that sexual abuse, chronic pelvic pain, and PTS are not her fault but she has the power to
combat them 3) desensitize her to anxiety provoking components of the physical therapy
intervention, and 4) teach her relaxation tools that she can use during physical therapy
sessions, while practicing at-home physical therapy exercises, and to cope with pain more
generally.
RESPECT's trauma-sensitive physical therapy intervention will 1) teach the patient
techniques to address muscular tension that contributes to chronic pelvic pain 2) empower
her by increasing her control over each phase of treatment (e.g., starting, stopping,
expressing feelings and preferences) 3) comfort her by explaining that it is normal to
experience discomfort during physical therapy treatment and 4) encourage her to use the
trauma-related coping skills she learned in the psychotherapy component.
This initial project is intended to lead to a larger open trial that will examine not only
treatment outcomes, but also the mechanisms of change (e.g., women's feeling of empowerment,
decrease in PTS symptoms).
Inclusion Criteria:
- Fluent in English
- History of sexual abuse
- Premenopausal
- Chronic pelvic pain defined as pelvic pain with a duration of six months of at least
a moderate severity
Exclusion Criteria:
- Not menstruating for reasons other than birth control
- Not currently receiving any current trauma-focused psychological treatment (i.e.,
prolonged exposure therapy, cognitive processing therapy, eye movement
desensitization reprocessing)
- No current psychotic symptoms or current use of anti-psychotic medications
- No current suicidal ideation in the past month
- Not currently pregnant
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