A tremendously exciting paper is being published in June’s Behaviour Research and Therapy journal. One of the authors tweeted it, I read it, and I was so excited that I had to tell y’all about it right away.
The title is Group mindfulness-based therapy significantly improves sexual desire in women, and its authors are Lori Brotto and Rosemary Basson, two of the most fantastic sex researchers currently working in the field of women’s sexual functioning.
The paper is an outcome evaluation of their Mindfulness-based cognitive behavioral sex therapy (MBCST), a four-session combined group psychosexual education and mindfulness education program that they’ve been developing for the past several years (see also this). They did pre- and post-test surveys to assess a bunch of things, including sexual arousal, desire, and distress; mood, relationship health, and mindfulness.
There are two questions you ask when you do outcome evaluation on a health intervention: (1) Did participants experience change? and, if so, (2) what variables were significantly predictive of that change?
In this case, the answer to (1) is Yes. Sexual functioning improved significantly after the treatment, compared to a control group, and was sustained by the six month follow-up survey. Yay!
The answer to (2) is amazing to me, and a little bit of a surprise. I will explain:
They measured “mindfulness” with the Five Factors of Mindfulness Questionnaire (FFMQ (PDF), which is a great instrument and lots of people use it. The five factors are:
- : e.g., “I remain present with sensations and feelings even when they are unpleasant or painful.”
- : e.g., “I’m good at finding words to describe my feelings.”
Acting with Awareness
- : e.g., “I rush through activities without being really attentive” (reverse scored)
Nonjudging of inner experience
- : e.g., “I tend to evaluate whether my perceptions are right or wrong.” (reverse scored)
Nonreactivity to inner experience
- : e.g., “Usually when I have distressing thoughts or images, I step back and am anaware of the thought or image without getting taken over by it.”
I talk about this survey in the last chapter of my book, because I learned something surprising in the course of reviewing the research on mindfulness:
It’s the nonjudging.
That is, for most domains of mental health, the factor on the FFMQ most strongly associated with positive outcomes and high functioning is the ability not to evaluate or judge your thoughts or feelings.
I had thought, before I started writing the book, that “observing,” the awareness of your internal experience and sensations, is what would make the difference. But no. It’s the nonjudging.
So of course I read Brotto and Basson’s paper with eager interest, to see if Nonjudging was also correlated with MBCST’s positive outcomes. Here’s the amazing, astonishing, slightly breathtaking result:
The only mindfulness factor that was really significantly correlated with positive outcome was:
Not nonjudging, not acting with awareness, not even observing, though “Nonreactivity” approached significance.
It was Describing that made the most difference.
Look at what the describing survey items are like:
- I’m good at finding words to describe my feelings.
I can easily put my beliefs, opinions, and expectations into words.
When I have a sensation in my body, it’s difficult for me to describe it because I can’t find the right words. (reverse scored)
Even when I’m feeling terribly upset, I can find a way to put it into words.
I can usually describe how I feel at the moment in considerable detail.
What Brotto and Basson’s result says to me is that the most significant element of their four-week intervention was not the mindfulness component, but the SEX EDUCATION component. According to the description in the paper, the psychosexual education component of MBCST taught participants Basson’s cyclical model of sexual response, including responsive desire (in contrast to “spontaneous” desire), along with Gottman’s model of healthy relationships.
In short, the sex education component gave participants language with which to describe their experience.
Underscoring the importance of straight-up EDUCATION on sexual satisfaction, one of the important results in the paper is that BOTH the treatment group and the control group experienced reduced sexual distress. Why? Brotto and Basson suggest it’s because of the assessment process preceding the treatment:
Clinical experience confirms the therapeutic effect of a careful assessment, with validation of symptoms and their sequelae on relationships and self-image, along with an explanation of the many factors involved in a woman’s low desire.
In other words, “Even the women in the control group learned that what their going through is normal and that women’s sexual desire isn’t a light switch you can turn on or off at will.”
Even though the title of the paper emphasizes “mindfulness-based group therapy,” what the results suggest to me is it might perhaps most accurately be called “sex education class with a mindfulness component.”
Look, I could easily be imposing my own experience as an educator, hearing the difference that knowledge makes in a woman’s sexual wellbeing. Sex education is my hammer, so maybe I’m seeing nails where they aren’t really.
But I really do think it could be that learning about the twenty-first century science of women’s sexuality – just learning about it – empowers women to experience their sexuality on its own terms, rather than on the terms the stupid, wrong, patriarchal world taught them to.