Prédicteurs cognitivo-affectifs de la douleur et de l’ajustement de couples dont la femme souffre de douleur génito-pelvienne
Why this work is in the frame
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Bibliographic record
Abstract
Pain during sexual intercourse, now classified under the single term of genito-pelvic pain/penetration disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), would affect up to 34% of young women and 45% of older women. Provoked vestibulodynia, a chronic pain elicited via pressure to the vulvar vestibule or attempted vaginal penetration, is the most common form of pain during intercourse. Controlled studies have shown that provoked vestibulodynia has multiple deleterious physical, psychological, sexual and relational impacts and thus greatly affects women’s quality of life, as well as their partners’. Provoked vestibulodynia occurs in the very intimate context of sexual intercourse. In that context, women’s self-concept could be negatively affected. Moreover, research among couples with provoked vestibulodynia has demonstrated the role of interpersonal factors in the modulation of women’s pain and associated consequences for both partners. Considering the documented efficacy of cognitive-behavioural therapy for chronic pain, including provoked vestibulodynia, and the importance of the relational context for this condition, a new cognitive-behavioural couple therapy has been developed by our team. It is the first treatment to take into account the interpersonal context of provoked vestibulodynia. Furthermore, we lack empirical evidence on mediators of change of cognitive-behavioural therapy for provoked vestibulodynia and on positive psychological factors that could foster better adjustment for women and their partners. The objective of this thesis was to use a dyadic perspective to examine the role of self-compassion in the adjustment of couples coping with provoked vestibulodynia, as well as the roles of both partners’ pain self-efficacy and pain catastrophizing as mediators of change in cognitive-behavioural couple therapy. The first study examined the associations between self-compassion of women with provoked vestibulodynia and their partners and their depression, anxiety, sexual distress and relational satisfaction as well as women’s pain intensity during intercourse. Forty-eight couples with provoked vestibulodynia completed self-report questionnaires. For both women and their partners, higher levels of self-compassion were associated with their own lower anxiety and depression. When partners reported higher levels of self-compassion, they were more satisfied with their relationship, and both partners and women reported lower sexual distress. No significant association was found for pain during intercourse. The second article examined pain self-efficacy and catastrophizing as mediators of therapeutic change regarding pain, sexual distress and sexual function in cognitive-behavioural couple therapy for provoked vestibulodynia. Because cognitive-behavioural couple therapy did not improve significantly more pain self-efficacy relative to lidocaine treatment, this variable was not included in subsequent mediation models. In women with provoked vestibulodynia, greater decreases in pain catastrophizing in cognitive-behavioural couple therapy, as compared to the lidocaine control condition, mediated reductions in pain intensity and sexual distress as well as improvement of sexual function. In partners, greater decreases in pain catastrophizing in cognitive-behavioural couple therapy, as compared to the lidocaine control condition, mediated reductions in sexual distress and improvement of sexual function. Partners’ pain catastrophizing reductions also mediated women’s decrease in sexual distress. Implications of results, as well as theoretical, methodological and clinical contributions of the thesis are discussed.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.082 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it