Efficacy of an environmental enrichment intervention for endometriosis: a pilot study

Grace De Hoyos, Darlenne I. Ramos-Sostre, Darlenne Ramos-Sostre, Annelyn Torres-Reverón, Bárbara Barros-Cartagena, Verónica López-Rodríguez, Cristina Nieves-Vázquez, Cristina I. Nieves-Vázquez, Fanny Santiago-Saavedra, Caroline B Appleyard, Eida M Castro, Eida Castro, Idhaliz Flores
Frontiers in psychology · 2023 · vol. 14 , pp. 1225790 · doi:10.3389/fpsyg.2023.1225790 · PMID:37885745 · W4387493684
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This pilot RCT found that an environmental enrichment intervention significantly improved anxiety and depressive symptoms, quality of life, and perceived stress in endometriosis patients, although pain levels did not change.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This pilot randomized clinical trial tested a translated environmental enrichment (EE) psychosocial intervention, adapted from prior rat work, in 56 women with surgically diagnosed endometriosis and symptomatic pelvic pain, comparing six EE modules delivered on alternate weeks (n=29) versus a wait-list control receiving education only (n=27). Using surveys and saliva cortisol collected at baseline, end-of-intervention, and 3-month follow-up, the study found significantly lower GAD-7 anxiety scores in the EE group at end-of-intervention and at 3 months, with improvements in depression, perceived stress, and endometriosis-related quality of life at the 3-month follow-up; however, pain levels did not improve, though pain correlated with anxiety, depression, quality of life, and pain catastrophizing. The authors also note this was a pilot study with a wait-list control, and the intervention’s primary efficacy appeared stronger for mental health and stress outcomes than for pelvic pain. This paper is centrally about endometriosis — it is a pilot RCT evaluating an environmental enrichment intervention to improve anxiety/depression, perceived stress, quality of life, and systemic measures in endometriosis patients.

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Abstract

Introduction: We have previously shown that Environmental Enrichment (EE), a multi-modal psychosocial intervention consisting of increased social interaction, novelty, and open spaces, improved disease presentation, anxiety, and immune-related disturbances in the rat model of endometriosis. However, there is a knowledge gap regarding the effects of EE interventions in patients with this painful, inflammatory chronic disease. Aim: To adapt and test the efficacy of an EE intervention on pelvic pain, mental health, perceived stress, quality of life, and systemic inflammation in endometriosis patients through a randomized clinical trial (RCT). Materials and methods: = 29); controls received education only. Survey data and biospecimens were collected at baseline, end-of-study, and 3-months post-intervention to assess pain (Brief Pain Inventory, BPI), endometriosis-related quality of life-QoL (Endometriosis Health Profile-30, EHP30), anxiety (Generalized Anxiety Disorder 7, GAD7), depression (Patient Health Questionnaire for Depression 8, PHQ8), pain catastrophizing (Pain Catastrophizing Score, PCS), stress (Perceived Stress Scale-14, PSS14), and saliva cortisol levels (AM, PM). Results: Compared to the wait-list controls, participants in the EE intervention showed significantly decreased GAD-7 scores at the end of the intervention and 3-month follow-up. Depression, perceived stress, and QoL improved at the 3-month follow-up compared to baseline. While pain levels did not improve, they significantly correlated with anxiety, depression, QoL and pain catastrophizing scores. Conclusion: This pilot RCT demonstrated significant improvements in anxiety and depressive symptoms, QoL, and perceived stress, supporting enriched environments as an integrative psychosocial intervention to be used as adjuvant to the standard of care for endometriosis pain.

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Outcome instruments

EHP-30

Condition tags

endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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