The Effects Of A Life-Stress Interview For Women With Chronic Urogenital Pain: A Randomized Trial

Chronic urogenital pain, pressure, and dysfunction are common, affecting nearly one in seven women in the U.S., who are commonly diagnosed with pelvic floor dysfunction, painful bladder syndrome, or interstitial cystitis. Women with these symptoms tend to have co-morbid anxiety and depression, relatively high rates of lifetime trauma and abuse, and conflicts or stress from key relationships. There is theory and evidence indicating that unresolved abuse or emotional conflicts can trigger or exacerbate urogenital pain and other symptoms (Abbass, 2009), but assessment of the presence and role of psychological stress is rarely done in women’s health care settings. When mental health is assessed, it is typically done using brief self-report measures, which do not provide a comprehensive view of stress, emotions, and health, motivate patients to change, or relieve their symptoms. There is little research on procedures for assessing stress, emotional processes, and their effect on physical symptoms in medical settings. We created a comprehensive life-stress interview that focuses on increasing awareness of the links between stress, emotions, psychological conflicts and physical health through use of experiential techniques. We hypothesized that engaging in life-stress interview would increase awareness and motivation to change view of mind-body links and reduce physical and psychological symptoms. Participants were 62 women with chronic urogenital pain conditions recruited from a tertiary care clinic for women’s urology. Participants were randomized to either the life-stress interview group or to a wait-list control group. Participants completed measures of physical health (BPI, PFDI-20-SF, PHQ-15, and GRA), psychological health (BSI and SWLS), and interpersonal difficulties (IIP-32) at baseline and 6-week follow-up. The life-stress interview was a one-session, 90-minute interview conducted by a trained interviewer. ANCOVA analyses, controlling for depression, were conducted to determine the effects of the life-stress interview compared to a wait-list control group. Findings from this study suggest that a life-stress interview can be effective in improving health, specifically pain severity and pelvic floor symptom distress. Participants in the interview group showed increases in interpersonal domineering/control and decreases in vindictive/self-centeredness and social inhibition, suggesting the interview was effective in improving assertive, active engagement in interpersonal relationships, allowing for health balanced emotional expression and increased comfort in relationships. However, no effects were found on psychological health and only minimal effects were found on mind-body awareness. Participants in the interview group were less likely to attribute their pelvic symptoms to environmental causes and decreases in precontemplation of change, suggesting minimal shifts in mind-body awareness. In general, it appears that this novel, emotion-focused interview can be effective in improving health for women with chronic urogenital pain within tertiary care clinics for women’s health. Further, this study suggests that for this complex patient group emotion-focused interviews can be a useful alternative to cognitive-behavioral interviews.