Which instruments measure homework adherence in MBCT for FSD?

There appears to be no gold standard instrument used in assessing homework adherence among patients undergoing mindfulness-based cognitive therapy (MBCT) interventions for female sexual dysfunction (FSD), reports a study. However, some instruments with psychometric evidence may be used by clinicians to monitor homework adherence.

Investigators searched the databases of PubMed, Scopus, PsycINFO, Embase, and Web of Science. They identified 30 eligible articles for the review. [J Sex Med 2024;21:1064-1075]

Based on the main findings, no instrument was considered the gold standard for the assessment of homework adherence in patients using MBCT interventions for FSD. Most of the studies had no available information on how they evaluate homework adherence.

There were nine studies for which articles reported how homework was assessed. Of these, six used only ad hoc measures and three used psychometrically validated instruments.

“However, it is noteworthy that the use of nonvalidated instruments is something that should be avoided because such instruments may lead to mistaken conclusions and difficulty in comparing results with other studies,” the investigators said. [J Happiness Stud 2023;24:2913-2939; Front Public Health 2018;6:1-18]

“Furthermore, the creation of a new measurement instrument, even with good psychometric evidence, must be based on a sound theoretical foundation that justifies its need. For this reason, the literature review and the confirmation that there are no similar existing instruments are the first steps recommended in some best practice guidelines for instrument development,” they added.

Homework

The most common homework prescribed was mindfulness (n=28), followed by psychoeducation (n=17). Mindfulness exercises included body scan, sitting mindfulness, eating mindfulness, breathing mindfulness, stretch and breath, self-observation, and sensate focus (a couples-based exercise). For psychoeducation, the interventions included reading, performing body image exercises, learning about the sexual response cycle, and touching with pleasure.

Cognitive behavioural therapy (CBT), a less frequently prescribed homework (n=15), included worksheets, communication, behaviour exercises, monitoring sexual beliefs, progressive muscle relaxation, and taking stock of sexual concerns. Two studies also prescribed physiotherapy exercises, such as Kegel exercises and pelvic movement.

“Despite the lack of standardization in how homework adherence is assessed in trials evaluating MBCT treatment for FSD, there are instruments available in the field of CBT to measure homework in a variety of conditions, such as the Homework Rating Scale–II Client and Therapist versions for depression and the Patient Exposure and Response Prevention Adherence Scale (PEAS) for obsessive-compulsive disorder,” the investigators said. [Crim Justice Behav 2013;40:814-828; Behav Ther 2010;41:30-37]

Many instruments, such as the PEAS, specifically assess techniques or contexts related to specific psychopathology, including anxiety, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder. Notably, there remains a lack of available instruments to measure homework in patients with FSD, according to the investigators. [Behav Ther 2016;47:755-772]

“Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence,” they said.