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
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.
Examine the feasibility of RESPECT in treating this population.
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).