Integrated Mindfulness-based Cognitive Behaviour Therapy Versus Cognitive Behaviour Therapy for Provoked Vestibulodynia (COMFORT)

• Change in pain intensity from baseline to one month post-treatment [ Time Frame: one week pre-treatment to one month post-treatment ] [ Designated as safety issue: No ]
  The investigators have selected pain intensity during a controlled examination as the primary endpoint in this study. Specifically, pain intensity at the vulvar vestibule will be assessed using a vulvalgesiometer (Pukall et al., 2004, 2007). The vulvalgesiometer is an instrument that provides a measure of pain/sensitivity that can be standardized across time points. The vulvalgesiometer is calibrated to exert a fixed amount of pressure. In this study, 30 grams of pressure at the 1, 3, 4, 6, 8, 9, and 11 o'clock positions (randomly) around the vestibule will be applied using the vulvalgestiometer. Women will also report their pain at each site using a numeric rating scale from 0 (no pain) to 10 (worst pain ever).
  
  
• Change in pain intensity from baseline to 6 months post-treatment [ Time Frame: One week pre-treatment to 6 months post-preatment ] [ Designated as safety issue: No ]
  The investigators have selected pain intensity during a controlled examination as the primary endpoint in this study. Specifically, pain intensity at the vulvar vestibule will be assessed using a vulvalgesiometer (Pukall et al., 2004, 2007). The vulvalgesiometer is an instrument that provides a measure of pain/sensitivity that can be standardized across time points. The vulvalgesiometer is calibrated to exert a fixed amount of pressure. In this study, 30 grams of pressure at the 1, 3, 4, 6, 8, 9, and 11 o'clock positions (randomly) around the vestibule will be applied using the vulvalgestiometer. Women will also report their pain at each site using a numeric rating scale from 0 (no pain) to 10 (worst pain ever).
  
  
• Change in pain intensity from baseline to 12 months post-treatment [ Time Frame: one week pre-treatment to 12 months post-treatment ] [ Designated as safety issue: No ]
  The investigators have selected pain intensity during a controlled examination as the primary endpoint in this study. Specifically, pain intensity at the vulvar vestibule will be assessed using a vulvalgesiometer (Pukall et al., 2004, 2007). The vulvalgesiometer is an instrument that provides a measure of pain/sensitivity that can be standardized across time points. The vulvalgesiometer is calibrated to exert a fixed amount of pressure. In this study, 30 grams of pressure at the 1, 3, 4, 6, 8, 9, and 11 o'clock positions (randomly) around the vestibule will be applied using the vulvalgestiometer. Women will also report their pain at each site using a numeric rating scale from 0 (no pain) to 10 (worst pain ever).
  
  

• Sexual distress [ Time Frame: Pre-treatment,one month post-treatment, and 6- and 12-months follow-up. ] [ Designated as safety issue: No ]
  The investigators will examine women's self-reported sexual distress by administering the the Female Sexual Distress Scale-Revised (Derogatis, Clayton, Lewis-D'Agostino, Wunderlich, & Fu, 2008).
  
  
• Pain Catastrophizing [ Time Frame: Pre-treatment,one month post-treatment, and 6- and 12-months follow-up. ] [ Designated as safety issue: No ]
  The investigators will examine women's self-reported pain catastrophizing by administering the Pain Catastrophizing Scale (Sullivan, Bishop & Pivik, 1995).
  
  
• Pain hypervigilance [ Time Frame: Pre-treatment,one month post-treatment, and 6- and 12-months follow-up. ] [ Designated as safety issue: No ]
  The investigators will examine women's self-reported hypervigilance about pain by administering the Pain Vigilance and Awareness Questionnaire (McCracken, 1997).
  
  
• Self-reported pain during penetration [ Time Frame: Pre-treatment,one month post-treatment, and 6- and 12-months follow-up. ] [ Designated as safety issue: No ]
  The investigators will measure self-report of pain during attempted or completed intercourse (or dildo entry for non-heterosexual women).
  
  

PURPOSE:

The purpose of this study is to determine whether an 8-session MBCT intervention for PVD is more efficacious than an 8-session CBT intervention for improving women's pain intensity and reducing their sexual distress, catastrophizing and hypervigilance towards pain. The investigators will also examine whether pain improvements at follow-up are mediated by changes in self-compassion and mindfulness (in the MBCT arm only) and moderated by pre-treatment credibility, personality, and anxiety sensitivity.

HYPOTHESES:

1. At follow-up (4 weeks, 6 months and 12 months post-treatment), women in the MBCT arm will experience a greater decline (vs. pre-treatment) in vestibular pain intensity compared to women in the CBT arm.
2. At follow-up (4 weeks, 6 months and 12 months post-treatment), women in the MBCT arm will experience a greater decline (vs. pre-treatment) in sex-related distress, pain catastrophizing, hypervigilance, and self-reported pain during intercourse/other penetrative sex compared to women in the CBT arm.
3. The investigators hypothesize that improvements in pain intensity during vestibular touch will be mediated by changes in self-compassion and mindfulness in the MBCT arm only at 6 and 12 months follow-up.
4. The investigators hypothesize that pre-treatment credibility, personality, and anxiety sensitivity will significantly moderate improvements in pain intensity during vestibular touch at 6 and 12 months follow-up.
5. The investigators hypothesize improvements in both arms on the "Patient Global Impression of Change Scale" and significantly greater improvements in the MBCT arm relative to the CBT arm at follow-up (4 weeks, 6 months and 12 months post-treatment).