Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach

Abstract

Introduction Sexual health and intimacy are consistently reported among the top unmet supportive care needs of prostate cancer (PC) survivors. With an aging population and advances in PC detection and treatment, the need for better PC sexual health interventions is acute. Aim Examine the feasibility of a mindfulness-based therapy group aimed at improving sexual intimacy for couples following PC treatments. Methods A 4-session mindfulness-based group intervention was developed for PC survivors (mean age 65.6 yrs) and their partners (mean age 61.4 yrs). A mixed-methods approach was adopted to account for small sample sizes ( N = 14 couples). Findings will guide future treatment refinement via participants’ lived experiences. Main Outcome Measures Quantitative outcomes assessed pretreatment, immediately after treatment, and 6 months later included relationship adjustment, sexual satisfaction, sexual function, depression, anxiety, and mindfulness. Qualitative outcomes used Grounded Theory Approach following posttreatment exit interviews. Results Effect sizes 6 months posttreatment indicated moderate improvements in overall sexual satisfaction and large increases in mindfulness in PC survivors, small decreases in sexual intimacy reported by partners, and small increases in anxiety in PC survivors and partners. Qualitative outcomes revealed 6 themes: (i) PC treatments must view PC as a couple’s disease; (ii) PC treatments must consider the impact of illness on individuals and the couple; (iii) Mindfulness was a valued treatment modality; (iv) Individual factors contribute to outcomes, and therefore, must be considered; (v) Multiple perceived mechanisms for change exist; (vi) Group format is a therapeutic element of the process. Conclusion An acceptance-based approach to sexual intimacy needs among PC survivors and their partners is feasible. While this small-scale preliminary study suggests that mindfulness may address some currently unmet needs among this population, randomized clinical trials are needed. JA Bossio, CS Higano, LA Brotto. Preliminary Development of a Mindfulness-Based Group Therapy to Expand Couples’ Sexual Intimacy after Prostate Cancer: A Mixed Methods Approach. Sex Med 2021;9:100310.

A Scoping Review of the Influence of Mindfulness on Men’s Sexual Activity

“…The results support the feasibility of tailoring a mindfulness-based group treatment for situational erectile dysfunction and represent a promising treatment pathway for men with this sexual dysfunction. In another study by Bossio, Higano, and Brotto [ 48 ], a 4-session mindfulness-based group intervention was applied to prostate cancer (PC) survivors and their partners. Effect sizes 6 months post-treatment indicated “moderate” improvements in overall sexual satisfaction and “large” improvements in increased mindfulness in prostate cancer survivors.…”

“…The review of scientific literature has revealed that there are a limited number of studies that allow a reliable evaluation of the efficacy of mindfulness-based interventions in treating male sexual problems and the impact on the experience of male sexuality. However, these studies begin to indicate that the practice of mindfulness can improve various aspects of the experience of male sexuality, for example, in sexual functioning [ 45 , 52 ]; erectile function [ 36 , 44 ]; ejaculation [ 47 ]; the degree of sexual desire [ 26 ]; arousal, marital satisfaction, and sexual satisfaction [ 30 , 48 , 50 ]; protection against sexual insecurities [ 40 , 46 , 49 ], or even partner relationships [ 30 , 50 ], among others.…”

“…The conclusions of these studies suggest that mindfulness-based interventions could be a relevant component to be integrated in the treatment of men at different stages of their life cycle, with and without physical disabilities [ 52 ], and for males who may or may not present symptoms of anxiety or a sexual disorder [ 26 , 44 , 47 , 53 ]. It is worth noting that several studies highlight that the use of mindfulness and third-generation therapies could offer significant effects on men’s sexual health, e.g., [ 47 , 48 , 52 ].…”

Experiences of sexual well-being interventions in males affected by genitourinary cancers and their partners: an integrative systematic review

“…The impact of peer support was valued among patients and their partners [ 15 , 34 , 35 , 40 , 45 , 46 ]. Likewise, peer support was recognised as beneficial in providing the opportunity for patients and partners to discuss and normalise their treatment and sexual well-being recovery [ 35 ].…”

“…The Bossio (2021) study explored a mindfulness group–based intervention. Group interventions allowed patients and their partners to experience acceptance-based communication around intimacy and agreement of a “new sexual normal” [ 45 ]. These interventions improved communication between couples and promoted sexual intimacy beyond penetrative intercourse [ 40 ].…”