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CBT Today: keeping up with the literature - UK sex survey - winter '13/14 (1st post)

This is an extended, online, hyperlinked version of a regular quarterly column - "Keeping up with the literature" - that I write for "CBT Today, the official magazine of the British Association for Behavioural & Cognitive Psychotherapies".  In October's column, I commented that new CBT-relevant research flows past constantly like a great river.  I track forty to fifty different journals - many more than most sensible health professionals try to monitor - but this is still just a small subsection of the multitude of potentially relevant publications.  And if I get behind with my reading, a wave of literature rapidly builds up - I've already spent fifteen hours this week alone in a catch up blitz.  Of course there is then the challenging task of what to select for a short column like this.  I marked over a hundred articles as possible candidates from a sweep of the last three months of 2013.  After a good deal of thought, in this column I comment on sex (usually piques people's interest), new findings in exposure therapy, and insights into mindfulness & reappraisal.

Sex is obviously absolutely central to our existence - without it we wouldn't be here.  It can be a source of great pleasure & intimacy, but also of great pain & distress.  I find it sad that treatments for sexual difficulties can be so hard to access here in the United Kingdom ... and that cognitive-behavioural therapists (who potentially have much to offer in this situation) typically seem to ignore this crucially important area.  An article in a recent Journal of Sexual Medicine - "Why don't healthcare professionals talk about sex? A systematic review of recent qualitative studies conducted in the United Kingdom" - comments "Sexuality is considered to be an important aspect of holistic care, yet research has demonstrated that it is not routinely addressed in healthcare services. A greater understanding of this can be achieved through synthesizing qualitative studies investigating healthcare professionals' experiences of talking about sex ... Primary research studies were included in the review if they explored health professionals' experiences of discussing sexuality with adult service users, used qualitative methods, and were conducted in the United Kingdom over the last 10 years ... Nineteen interconnected themes emerged relating to healthcare professionals' experience of discussing sexuality with service users, including fear about “opening up a can of worms,” lack of time, resources, and training, concern about knowledge and abilities, worry about causing offense, personal discomfort, and a lack of awareness about sexual issues ... Conclusions. The majority of healthcare professionals do not proactively discuss sexuality issues with service users, and this warrants further attention. An understanding of the perceived barriers and facilitators indicates that interventions to improve the extent to which sexuality issues are addressed need to take organizational, structural, and personal factors into consideration."  

Meanwhile our understanding of sexual issues in the UK evolves encouragingly - in 1990 and again in 2000, we had the first & second UK National Surveys of Sexual Attitudes and Lifestyles (Natsal). This work parallels similar efforts in the United States - see my 2011 blog post "Sexual behavior, sexual attraction and sexual identity".  Results from the third UK Natsal study were recently published in the Lancet and there are six freely downloadable papers available covering changes in sexual attitudes & behaviours; details on sexually transmitted diseases; prevalence & information on unplanned pregnancies; levels of sexual function; health & sexual lifestyle associations; and lifetime prevalence and information on non-volitional sex.  Key points are covered in a roller coaster three & a half minute "infographic" video - all this is very good material if you want to update your background knowledge in this area.  And a couple of other relevant papers are the practically useful advice in "Exercise improves sexual function in women taking antidepressants: Results from a randomized crossover trial" and the impressive example of therapeutic behavioural skill in the JCCP trial "Therapist-aided exposure for women with lifelong vaginismus" ... which leads us neatly into tomorrow's post and recent work being published on exposure-based approaches. 


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