Self-administered cognitive behavioural therapy for women with chronic pelvic pain: design and pilot evaluation

Abstract

The aim of the research reported in this thesis was to develop and pilot-test a technology-based CBT intervention for women experiencing chronic pelvic pain (CPP) utilising a co-design approach. In the first phase of this project, out-patients and clinicians from the Chronic Pelvic Pain Clinic of the Royal Women’s Hospital in Melbourne (Australia) took part in a series of focus groups and interviews. This provided a rich understanding of the condition and helped determine the suitability of a technology-based CBT intervention for women with CPP. The data from this phase were then used to create a set of design specifications which informed the development of a smartphone app, appEase.

The smart-phone intervention delivered a 28-day CBT intervention involving mindfulness relaxation, cognitive restructuring, and pain education which women experiencing CPP would use daily. The final phase of the project involved pilot-testing appEase. Twenty-four women completed a series of baseline measures and took part in a screening interview. Of these women, eighteen completed post-intervention measures, and participated in a mid-intervention and post-intervention interview. Survey and usage data were also collected from within the app while participants were engaging with the therapy. Two women underwent surgery during the pilot study, and of the sixteen women who met the full criteria for data inclusion, twelve (75%) completed all 28 sessions. Although the app was designed to be used over 28 days, the mean completion time was 64 days. Most women found it difficult to find 15 minutes every day to utilise the app. Nevertheless, ten participants (63%) experienced clinically significant reductions in Pain Catastrophising, and nine (56%) experienced clinically significant increases in Pain Self-Efficacy.

The co-design methodologies utilised produced some useful insights into how women engaged with the therapy, and what mechanisms may have led to favourable outcomes. Interviews with participants during and after the pilot study confirmed that appEase was engaging, simple to use, and provided helpful tools and strategies for managing CPP. Furthermore, some participants reported that they felt a therapeutic relationship between themselves and the intervention. These results suggest that a self-administered technology-based CBT intervention may be suitable for women experiencing CPP, and could play a role in helping them manage their pain.

This project is the first to apply co-design methodologies to the treatment of CPP in women. Furthermore, the app created, appEase, is the first technology-based CBT intervention developed for this population. Using co-design methodologies also yielded some rich insights into the personal experiences and complexities of CPP in women. It provided some helpful information into how intervention could be evaluated and has produced a sound empirical basis for testing the efficacy of appEase in a randomised control trial.