Randomized Comparison of Mindfulness Versus Group Support for Treatment of Low Sexual Desire in Women
Phase: NA
Conditions: Low Female Sexual Desire
Sponsor: University of British Columbia

Randomized Comparison of Mindfulness versus Group Support for Treatment of 
Low Sexual Desire in Women
Study Protocol and Statistical Analysis Plan
Note: No separate study protocol exists. This attachment includes a 
description of the study and data analysis plan.

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Proposal for “Randomized Comparison of Mindfulness versus Group Support for Treatment of 
Low Sexual Desire in Women" 
JUSTIFICATION: 
Population-based studies suggest that difficulties with low sexual desire and insufficient sexual 
arousal are extremely common in women across the life cycle. Our understanding of the precise 
mechanisms that control female sexual response is at present incomplete.  Sexual response, 
which includes sexual motivation, interest, and arousal, has been conceptualized as a complex 
interaction between physiological and psychological components (Everaerd, Laan, Both, van der 
Velde, 2000; Rosen & Beck, 1988), and mounting evidence suggests that sexual desire and 
arousal may be two aspects of the same sexual response process.  Several studies have found 
a high degree of comorbidity between Hypoactive sexual desire disorder (HSDD) and Female 
sexual arousal disorder (FSAD; Brotto 2011; Fugl-Meyer& Fugl-Meyer, 2002). Moreover, scores 
on desire and arousal domains, using different instruments, are typically highly correlated with 
one another (Brauer, Lakeman, van Lunsen, and Laan 2010; Laan, Termeer, van Lunsen, 
Zimmerman, Coelingh Bennink, 2010; Nobre, Pinto-Gouveia, Gomes, 2006; Rosen et al., 2000; 
ter Kuile, Brauer, and Laan, 2006). This high correlation was found both in women with and 
without FSAD (Wiegel, Meston, and Rosen, 2005). In their longitudinal research on mid-life 
women, which contributed to the development of a model of women’s sexuality, Dennerstein 
and colleagues found that items tapping into women’s sexual arousal and responsiveness could 
not be separated from items tapping into sexual desire (Dennerstein, Lehert, and Burger, 2005). 
A central tenet of the Incentive Motivation Model for sexual response is that sexual desire and 
sexual arousal emerge, together, in response to effective sexual cues. Sexual desire and sexual 
arousal may even represent different sides of the same sexual coin. If desire and arousal are to 
be distinguished, it is likely only at a phenomenological level, with desire defined as the 
willingness to behave sexually and sexual arousal reflecting the subjective experience of genital 
changes (Laan and Both, 2008).  
In one of the most recent examinations of population prevalence of low desire, the 
“Prevalence of Female Sexual Problems Associated with Distress and Determinants of 
Treatment Seeking” (PRESIDE) study examined 31,581 American women aged 18-102 (mean 
age 49; Shifren et al. 2008). The Female Sexual Distress Scale (FSDS; Derogatis et al., 2002) 
was used to measure sex-related distress and the item “How often do you desire to engage in 
sexual activity” was used to capture low desire. Low desire, defined as a response of “never” or 
“rarely” to this item, was found in 38.7% of the sample and distress, defined as a score > 15 on 
the FSDS, was found in 22.8%. The overall estimate of HSDD, taking into account both criteria, 
was found to be 10.0%. Even considering the drop in prevalence when low desire and distress 
together are assessed, this continues to be the most frequent complaint seen in sex therapy 
clinics, and the majority of women with any sexual difficulty (i.e., desire, arousal, orgasm, or 
pain-related) state that their low sexual desire is the cause of their sexual difficulties (Hayes, et 
al., 2006).  
Population-based estimates suggest that lubrication difficulty, as a specific symptom of 
Female Sexual Arousal Disorder (FSAD), affects from 11-19% of women younger than 30, up to 
24-27% of women older than 50 (Fugl-Meyer & Fugl-Meyer, 1999;  Laumann, Paik, & Rosen, 
1999), and may be as high as 75% for those women seeking routine gynecological care
(Nusbaum et al., 2000). Lack of subjective (sometimes called cognitive or mental) sexual 
arousal during the sexual experience, especially when intercourse frequency is more tuned to 
the higher needs of the partner, is a more common complaint among women presenting 
clinically. Despite the fact that complaints of sexual arousal difficulty and associated distress are 
extremely common in the clinical setting, evidence based treatments to address FSAD are non-
existent.

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Despite their high prevalence, sexual interest, desire, and arousal concerns remain 
without effective treatment today. Moreover, there are no Food and Drug Administration (FDA) 
or Health Canada approved pharmaceutical products available to treat these highly distressing 
symptoms. 
Our laboratory has published evidence showing the efficacy of a mindfulness-based 
cognitive behavioural therapy for the treatment of distressing loss of desire/arousal in women 
(Brotto, Basson, Luria, 2008;  Brotto, Heiman, et al., 2008;  Brotto, Erskine, Carey, et al., 2012; 
Brotto, Seal, & Rellini, 2012). Our protocol included four sessions delivered in group format with 
two facilitators and was based on empirically supported techniques in other areas of female 
sexual dysfunction (e.g., sensate focus, challenging maladaptive cognitions and sexual myths). 
The ingredients were adapted from a variety of sources including (1) Becoming Orgasmic by 
Heiman and LoPiccolo (1988), which is an empirically-supported behavioural treatment for 
women with lifelong orgasmic disorder, (2) Seven principles for making marriage work by 
Gottman (1999); (3) The Miracle of Mindfulness by Thich Nhat Hahn (1976); (4) Full 
Catastrophe Living  by Jon Kabat-Zinn (1990) and (4) Progressive Relaxation by Edmund 
Jacobson (1938).  It involved in-session didactic material as well as in-session mindfulness 
practices followed by daily homework activities between sessions. 
In our clinical experience, mindfulness techniques, with the aim of guiding attention into 
the present, can be a very effective component of care among women with sexual difficulties 
and we have been using mindfulness techniques for women with loss of desire and arousal. The 
proposed study, “Randomized Comparison of Mindfulness versus Group Support for Treatment 
of Low Sexual Desire in Women” compares the effectiveness of group mindfulness-based 
cognitive therapy (MBCT) and support. The MBCT group expands on our previous 4-session 
intervention by incorporating a larger proportion of mindfulness practice and information in 
session, and expanding the sessions to eight weekly sessions to make it more in line with other 
mindfulness based interventions for depression that have received widespread empirical 
attention and support. 
PURPOSE:  
This study utilizes a mindfulness-based psychoeducational treatment approach that is based on 
our 4-session effective treatment protocol. As with the 4-session treatment, the currently 
proposed 8-session MBCT group is based on a variety of empirically supported techniques, and 
integrates elements of education, mindfulness skills, and sex therapy. The purpose of this study 
is to determine whether an 8-session intervention is effective in reducing women’s sexual 
distress, improving their sexual response, and increasing their mindful skills. To date, many 
women who have received our 4-session intervention have indicated that having more than 4 
sessions would be beneficial. As well, other integrated mindfulness/cognitive behavioral 
treatments (e.g., Mindfulness-Based Cognitive Therapy for depression; Segal, Williams, & 
Teasdale, 2002) are 8-sessions in length and provide increased opportunity for participants to 
practice the skills they are learning in session.  
HYPOTHESES: 
1. Compared to baseline, the MBCT group will have significant post-treatment
improvements in self-report measures of: (a) sexual distress; (b) sexual desire,
subjective sexual arousal, perception of genital arousal, and sexual pleasure; (c)
relationship satisfaction; (d) depressive symptoms and rumination; (e) perceived stress,
general anxiety, anxiety sensitivity, and sexuality-related situational anxiety (as self-
reported at the sexual arousal assessment); and (f) mindfulness, self-compassion, non-
attachment, and interoceptive awareness.
2. Compared to baseline, the MBCT group will have significant post-treatment
improvements in laboratory physiological measures of: (a) genital sexual response as
measured by a vaginal photoplethysmograph, (b) interoceptive awareness, as measured

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by a heart rate perception task, (c) cortisol:DHEA ratio as measured by hormonal assays 
of saliva samples, and (d) a significant decrease in C-reactive protein as measured by 
hormonal assays of saliva samples. 
3. We hypothesize that the changes in the endpoints listed in #1 or #2 will be significantly 
greater in the MBCT group than in the support group.  
4. We hypothesize that participation in the MBCT group will significantly increase 
concordance.  
5. Mindfulness, self-compassion, and interoceptive awareness will significantly mediate 
improvements in sexual distress and desire in the MBCT group at all post-treatment 
assessment points.  
6. Expectations of change with treatment will not significantly moderate improvements in 
sexual distress and desire in the MBCT group. 
7. Participants’ impressions of change will be significantly greater in the MBCT group 
compared to the support group at all post-treatment assessment points. 
8. We hypothesize that participants with sexual desire issues will see an improvement 
(fewer breaks in the cycle) throughout the course of the eight-week treatment. 
 
 
OBJECTIVES:  
The main objective for this study is to test the MBCT group with women who are currently 
seeking treatment for low sexual interest/desire and/or arousal and compare it to a support 
group.  
 
RESEARCH METHOD: 
Recruitment: Women who are currently seeking treatment at the BC Centre for Sexual Medicine, 
who have participated in other studies in our laboratory and expressed interest in being 
contacted for future research, and who see our advertisements in the community (including 
public transit advertising) will be candidates for this study. Patients from BC Women’s Hospital 
and Health Centre’s Complex Chronic Diseases Program who have provided permission to be 
contacted for future research will be candidates for the study.  Those who are seen for an initial 
assessment by one of the Co-Investigators, or any of the clinicians at the BC Centre for Sexual 
Medicine will be informed about the study at the conclusion of their assessment if they are 
determined to meet inclusion criteria.  After briefly mentioning the study, the clinician will give 
interested women a handout (one-page information sheet) that briefly outlines the methods of 
the study and the criteria for inclusion, as well as contact information for the study coordinator. A 
copy of the consent form will be included with the handout to allow the woman to review the 
consent prior to contacting the study coordinator about the study. Specific instructions will be 
included informing women that the consent form provided at this time is for information purposes 
and should not be returned until the woman has spoken to the study coordinator. For women in 
our database of former participants, the study coordinator of the study in which they participated 
will contact them by phone or email, inform them about the study, and email them the handout 
with instructions to contact the study coordinator if they are interested in participating. For 
women in the “permission to be contacted for research” database from the Complex Chronic 
Disease program at BC Women’s Hospital, they will be contacted by the coordinator from the 
program and interested women can contact the DESIRE study coordinator. Interested 
candidates from the community will contact the study coordinator directly. She will perform a 
detailed telephone screen for all potential participants that further assesses study eligibility and 
explains the methods in more detail, and then mail/email a copy of the consent form to 
participants. If, after reading the consent form, the woman is interested in taking part, she will 
contact the Study Coordinator to set up an in-person meeting with a trained graduate student in 
clinical or counselling psychology at UBC who will carry out the in-person assessments under 
the supervision of the PI. At this time, her eligibility will be confirmed and she will sign the 

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consent form. Following enrolment, she will be randomized to either group mindfulness-based 
therapy or support group therapy and will be registered for the next study group. Arrangements 
will also be made to complete the saliva sampling, pre-treatment questionnaires, and the sexual 
psychophysiological assessment. 
Inclusion criteria for treatment group includes:  any woman between the ages of 19-65, 
fluent in English, and who experiences distressing sexual interest/desire and or sexual arousal 
concerns. Exclusion criteria include: a psychiatric or medical condition precluding group 
attendance or homework completion, and Borderline Personality Disorder (for which 
mindfulness meditation may cause dissociation and is therefore counter-indicated; Sachse, 
Keville, & Feigenbaum, 2011). 
 
 
Procedures: Participants will be randomly assigned to either the MBCT group or the support 
group (control condition). The purpose of the support group is to control for any effect of the 
sexuality education, discussion, and support provided in the MBCT group.  
All participants will meet in-person with a trained graduate student in clinical or 
counselling psychology to ask any further questions about the study, to review study protocol, 
and discuss participant remuneration- $55/assessment ($25 per questionnaire package plus 
$30/ per laboratory-based assessment and at-home saliva sample collection) for each of the 
four times completed. Participants will receive their saliva sampling kit (which includes all 
necessary sampling equipment) and detailed written and verbal instructions on how to collect 
their samples. 
After saliva samples have been collected, participants will return their saliva sampling 
kits to the Study Coordinator when they take part in an individual sexual psychophysiological 
assessment in the PI's laboratory (UBC Sexual Health Lab) located in the Diamond Health Care 
Centre at Vancouver Hospital.  Women will be asked to undergo a heartbeat perception task 
and a sexual arousal assessment. 
The Heartbeat Perception task, performed according to the Mental Tracking Method 
proposed by Schandry (1981), involves the silent counting of  perceived heartbeats during four 
intervals of varying duration (25, 35, 45, and 55 seconds) separated by a 30 second resting 
period. After each counting period participants will be asked to report the number of counted 
heartbeats. Electrocardiogram measurements will be taken to determine actual heart rate. 
Participants will wear non-polarized Ag-AgC1 electrodes attached to two points on the body (mid 
right clavicle and lower left ribcage). Signals will be recorded and analyzed by a computer-based 
data acquisition system (MP150; Biopac Systems, Inc.)  The Heartbeat Perception task is a 
well-validated measure of the ability to detect changes within the body known as Interoceptive 
Awareness (Dunn et al., 2007; Jones, 1994; Wildmann & Jones, 1982). 
The sexual arousal assessment will involve exposure to brief audiovisual films which 
include erotic content.  While viewing the film, a woman's vaginal pulse amplitude (VPA) will be 
measure with a Vaginal Photoplethysmograph which has been found to be a sensitive and 
specific measure of genital arousal (Laan & Everaerd, 1995). Participants will indicate their 
levels of subjective arousal while viewing the film by using a device manufactured for the UBC 
Sexual Health Lab called the “arousometer”- a computer mouse mounted on a metal track 
divided into 10 equally spaced intervals corresponding to “sexually turned off” (-2) to “the most 
sexually aroused you have ever been or could imagine being” (7). This device allows continuous 
self-report measurement of subjective sexual arousal while viewing the erotic films. Immediately 
before and after watching the films, participants will complete a pre and post film questionnaire 
that assess mood and reactions to the erotic film (Heiman & Rowland, 1983). This assessment 
is performed pre-treatment, 2-4 weeks post treatment and 6 and 12 months post treatment. 
Women who enroll in the study and complete their pre-treatment physiological assessment more 
than 2.5 months before their group starts will undergo an additional sexual arousal assessment 

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prior to the group. Each woman will be provided with an individualized link to online 
questionnaires to be completed before their assessments. 
Each group will have between 6-8 women and we hope to run approximately four groups 
per year. The group will be led by the PI, the Co-Investigator (Dr. Paterson), and/or the team of 
trained clinicians at the BC Centre for Sexual Medicine who have been involved in designing 
and carrying out similar groups over the past six years. Groups will have at least 2 facilitators. 
All groups will take place in a private group room at the Diamond Health Care Centre, located at 
Vancouver General Hospital, at 2775 Laurel Street, Vancouver.   
The 8-session MBCT group is based on a variety of empirically supported techniques, 
and integrates elements of education, mindfulness skills, and sex therapy. It consists of eight, 
two-hour long sessions spaced one week apart.  Each woman will participate for 16 hours of 
group time. In addition, participants are also given handouts and asked to complete 
approximately 10-60 minutes/day of at-home practice/skills, which may include reading material, 
mindfulness exercises, and behavioural exercises between sessions. The treatment in the 
MBCT group is very similar to that of the 4-session PED previously tested and found effective in 
our centre; participants who receive the expanded version will, however, be given more time to 
practice the various exercises (e.g., mindfulness exercises) in session, and more time will be 
devoted to inquiry about participants’ in-session practice experiences.  The support group will 
include all of the same material except for the mindfulness practice in session and at home.  
Approximately 10% of the group sessions will be audio-recorded to ensure facilitator adherence 
to the treatment manual. 
Participants will complete brief questionnaires online and over the telephone between 
sessions 4 and 5 of their therapy group, in order to establish the temporal sequence of changes 
in the main outcome variable and hypothesized mediators.  
After the conclusion of group session 8, women will be provided with an individualized link to 
online questionnaires, which will be nearly identical to those completed prior to their first 
assessment, and a second saliva sampling kit.  In addition, women will repeat their sexual 
psychophysiological assessment at the UBC Sexual Health Lab. Women will also be asked 
about their experience with the mindfulness practices and/or sexuality worksheets at each post-
treatment assessment.  Questionnaires, at-home saliva sample collection, and the in-lab 
psychophysiological assessments will also be done 6 and 12 months after completing the 8-
session group treatment.All online questionnaires for women in both treatment groups will be 
administered with SurveyMonkeyTM.  
Participants who have completed the study will be invited to take part as a "patient 
partner," which will involve attending a focus group meeting with the study investigators to 
provide insight and feedback on their experience living with Sexual Interest/Arousal Disorder, as 
well as get their feedback on what they would find most interesting and relevant to viewers 
regarding the findings of another study called MODEST (Mood, Stress, and Sexual Desire in 
Women, CREB number = H10-02067), which also examined women’s low sexual desire. This 
will help to develop a script to create a knowledge translation infographic video in the future. 
This meeting would take approximately 2 hours and patient partners would receive $50 for their 
time and cost of parking. This is not a required study procedure but rather an invitation if former 
participants would like to share their experience. The meeting will be a single 2 hour session 
with up to three women with low desire, two facilitators, and a note-taker from the study team. 
The entire session will be audio-recorded and later transcribed. No individual names will be 
used in the transcript. Patient Partners will be asked to respect the confidentiality of those who 
attend this focus group meeting, and will be told that facilitators cannot control what other 
participants do with the information discussed, so that they can make an informed decision 
about whether or not to participate in the focus group. 
 
Specification of Endpoints: The primary endpoint in this study will be sexual distress given that 
distress associated with impaired sexual functioning is the reason that women provide for 

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seeking treatment. Sexual distress will be measured with the revised version of the Female 
Sexual Distress Scale-R (Derogatis et al., 2008). Measurement of sexual interest/desire, arousal 
(both self-report and psychophysiological), stress hormone ratios, and Interoceptive Awareness 
represent secondary endpoints. Psychophysiological sexual arousal will be measured with a 
vaginal photoplethysmograph in the UBC Sexual Health Laboratory. Stress hormone ratios will 
be measured through calculating the cortisol:DHEA slope within participants’ saliva samples. 
This will be done by measuring the change in cortisol:DHEA secretions over the course of the 
day, and calculating a simple difference score (PM minus AM values). Interoceptive Awareness 
will be measured using the Heartbeat Perception task (Schandry, 1981) at the time of the sexual 
arousal assessment and with the Multidimensional Assessment of Interoceptive Awareness 
(MAIA; Mehling et al., 2012) questionnaire. Self-reported sexual desire and arousal will be 
assessed with the Female Sexual Function Inventory (FSFI; Rosen et al., 2000), the Sexual 
Pleasure Questionnaire (a two-question supplement to the FSFI developed for this study), and 
the Sexual Interest and Desire Inventory (SIDI; Clayton et al. 2006). Other endpoints include: 
relationship satisfaction, which will be measured with the Relationship Assessment Scale 
(Hendrick, 1988); motivations for sex, which will be measured with the Motivations for Sex 
Measure (Muise et al., 2013); disruptions to the sexual response cycle, which will be measured 
using the Sexual Response Cycle Worksheet (Basson, 2000); perceived stress, which will be 
measured with the Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983); depression, 
which will be measured with the Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, 
1996) or the Hamilton Depression Scale – Short Form (McIntyre et al., 2005); rumination, which 
will be measured with the Ruminative Responses Scale (Treynor, Gonzalez, & Nolen-
Hoeksema, 2003) or the Rumination-Reflection Questionnaire – Adapted Rumination Subscale 
(adapted from Trapnell & Campbell, 1999 to inquire about sexuality-related rumination); trait 
anxiety and situational anxiety at the sexual arousal assessments, which will be measured with 
the State-Trait Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970); and anxiety 
sensitivity, which will be measured with the Anxiety Sensitivity Index – 3 (Taylor et al., 2007). 
Mindfulness, self-compassion, and non-attachment will be measured with the Five Factor 
Mindfulness questionnaire (Baer, Smith, Hopkins, Krietemeyer & Tony, 2006), Self-Compassion 
Scale (Neff, 2003), and Non-Attachment Scale (Sahdra, Shaver, & Brown, 2010), respectively. 
We will assess socially desirable responding (impression management and self-deceptive 
enhancement) with the Balanced Inventory of Desirable Responding-6 (BIDR-6; Paulhus, 1998), 
expectations of change with treatment with the Expectations Measure [a two-item questionnaire 
completed following the session 1, designed for and used in our approved mindfulness-based 
treatment study for provoked vestibulodynia (H12-02358)], and participants’ impressions of 
change with treatment with the Patient Global Impression of Change Scale – Revised (adapted 
from Hurst & Bolton, 2004; as used in H12-02358).  
 
Measures:  Questionnaires to be included in this study will be administered to women online. 
Women choosing to have a hard copy of the questionnaire will be provided with such 
questionnaires at the time of their in-person sexual arousal assessment.  The following 
instruments will be used at all testing times:  (1) Beck Depression Inventory-II (Beck et al., 1996) 
or the Hamilton Depression Scale – Short Form (McIntyre et al., 2005); (2) Female Sexual 
Distress Scale-Revised (Derogatis et al., 2008); (3) Female Sexual Function Index (Rosen et al., 
2000); (4) Five Facet Mindfulness Questionnaire (Baer et al., 2006); (5) Sexual Interest and 
Desire Inventory (Clayton et al., 2006); (6) State-Trait Anxiety Inventory – State Form 
(Spielberger et al., 1970); (7) Sexual Pleasure Questionnaire; (8) Multidimensional Assessment 
of Interoceptive Awareness (Mehling et al., 2012); (9) Ruminative Responses Scale (Treynor et 
al., 2003) or Rumination-Reflection Questionnaire – Adapted Rumination Subscale (adapted 
from Trapnell & Campbell, 1999); (10) Anxiety Sensitivity Index – 3 (Taylor et al., 2007); (11) 
Self-Compassion Scale (Neff, 2003); (12) Non-Attachment Scale (Sahdra, Shaver, & Brown, 
2010); (13) Perceived Stress Scale (Cohen, Kamarck, & Mermelstein, 1983); (14) Relationship 

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Assessment Scale (Hendrick, 1988); (15) Film Scale Before and After -1983 (Heiman & 
Rowland, 1983). 
The following questionnaires will be used at baseline only: (16) Balanced Inventory of 
Desirable Responding-6 (Paulhus, 1998); (17) State-Trait Anxiety Inventory – Trait Form 
(Spielberger et al., 1970); and (18) Expectations Measure (following session 1).  
The following questionnaires will be used at post-treatment (approximately 4-6 weeks after 
session 8), and at 6- and 12-month follow-ups only: (19) Patient Global Impression of Change 
Scale – Revised (adapted from Hurst & Bolton, 2004). For post-treatment assessments only, 
participants will complete an investigator-derived MIND or STEP Follow-Up Form in order to 
assess completion of group homework, which will be administered by a trained research assistant 
at each assessment point. 
All questionnaires for the study will be completed online using Survey Monkey, except for the 
Hamilton Depression Scale – Short Form, which will be administered by a trained research 
assistant at each assessment point. Women who prefer to receive a hard copy of the 
questionnaires will be sent the questionnaire package via mail.  
At baseline, participants will complete an investigator-derived Dysmenorrhea Questionnaire 
in order to assess painful menstruation. This questionnaire is being used in the COMFORT study 
(H12-02358) with women with provoked vestibulodynia, as dysmenorrhea has been linked to the 
development of chronic pain conditions. When the COMFORT study’s data are analyzed, rates of 
dysmenorrhea in the two different studies will be compared. 
The following questionnaires will be used at pre-treatment and post treatment (approximately 
4-6 weeks after session 8) only: (20) Pelvic Floor Distress Inventory – short form 20 (Barber, 
Walters, & Bump, 2005); (21) Pelvic Floor Impact Questionnaire – short form 7 (Barber, Walters, 
& Bump, 2005). 
For the control group, data collected from the VENUS study will be used in the DESIRE Study 
from participants who consent to participating. Demographic information and the following 
validated measures will be analyzed from the VENUS Study: (1) Female Sexual Interest and 
Desire Inventory (SIDI-F; Clayton et al, 2006); (2) Female Sexual Distress Scale (Derogatis, 
Rosen, Leiblum, Burnett, & Heiman, 2002).  
For control group participants recruited from the community, demographic information and the 
following validated measures will be analyzed: (1) Female Sexual Interest and Desire Inventory 
(SIDI-F; Clayton et al, 2006); (2) Female Sexual Distress Scale (Derogatis, Rosen, Leiblum, 
Burnett, & Heiman, 2002).  
 
 
Data analyses 
Analyses of measures of sexual distress, sexual functioning (sexual desire, subjective 
sexual arousal, perception of genital arousal, sexual pleasure, and VPA), relationship 
satisfaction, mood and anxiety (depressive symptoms, rumination, perceived stress, general 
anxiety, anxiety sensitivity, and sexuality-related situational anxiety), stress hormone ratios, 
mindfulness, self-compassion, non-attachment and interoceptive awareness will be carried out 
with a repeated measures ANOVA with group (MBCT vs. support) entered as a between-
subjects variable, time (waitlist, pre-group, post-group, and 6- and 12-month follow ups) entered 
as the within-subjects variable, and age entered as a between subjects covariate.  We will 
attempt to control for socially desirable responding and degree of homework completion in these 
analyses.  Multiple regression analyses will be used to determine effects of predictor variables 
on treatment efficacy (including participants’ impressions of change). These might include:  
depression scores and mindfulness scores at pre-treatment, and demographic variables such as 
relationship duration and menopausal status.  We will conduct mediation analyses of 
mindfulness, self-compassion, and interoceptive awareness, and moderation analyses of 

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treatment expectations. We will examine (1) the number of breaks in their sexual response 
cycle, and (2) the locations of the breaks in their sexual response cycle. We will also carry out a 
qualitative analysis comparing the themes arising from reasons for sex, as well as the factors 
that impair information processing.  These analyses will be repeated during the initial completion 
of the sexual response cycle, and again during week 5. 
 
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