1. Changes in sympathetic nervous system activity are associated with changes in sexual wellbeing in women with a history of childhood sexual abuse: Results from a randomized clinical trial Tierney K. Lorenz 1,2, Christopher B. Harte 3, 4, Cindy M. Meston 5 1 Center For Integrative Study Of Animal Behavior, Indiana University Bloomington 2 The Kinsey Institute For Research In Sex, Gender, And Reproduction, Indiana University Bloomington 3 VA Boston Healthcare System 4 Boston University School of Medicine 5 Department Of Psychology, University of Texas at Austin This research was supported by a grant from the National Institute of Child Health and Human Development (NICHD, RO1 HD051676) to Cindy M. Meston. Tierney Lorenz was supported by a grant from the NICHD (T32HD049336). The views presented here are solely those of the authors and do necessarily not represent the official views of the National Institutes of Health or the Department of Veterans Affairs. BACKGROUND Women with a history of childhood sexual abuse (CSA) have higher rates of sexual difficulties as well as very high sympathetic nervous system (SNS) response to sexual stimuli. METHOD REFERENCES Lorenz, T. A., Harte, C. B., Hamilton, L. D. and Meston, C. M. (2012), Evidence for a curvilinear relationship between sympathetic nervous system activation and women's physiological sexual arousal. Psychophysiology, 49: 111–117. Meston, C. M., Lorenz, T., & Stephenson, K. R. (2013). Effects of Expressive Writing on Sexual Dysfunction, Depression, and PTSD in Women with a History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial. Journal of Sexual Medicine, 10(9), 2177 – 2189. Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162 - 166. Meston, C. M., & Trapnell, P. (2005). Development and validation of a five-factor sexual satisfaction and distress scale for women: The Sexual Satisfaction Scale for Women (SSS-W). Journal of Sexual Medicine, 2(1), 66 - 81. Wiegel, M., Meston, C. M., & Rosen, R. C. (2005). The Female Sexual Function Index (FSFI): Cross-validation and development of clinical cutoff scores. Journal of Sex and Marital Therapy, 31(1), 1 - 20. RESULTS Pre-treatment, participants had significantly lower than healthy women of the same age; t(84) = -35.14, p <.001. Following treatment, women’s HRV increased, F(5,133.67) = 3.46, p =.006, d pre-post =.28, d total =.76. Participants who had increased HRV during sexual stimuli showed larger gains in sexual desire, arousal and overall sexual function and sexual satisfaction. The HRV x treatment condition interaction was significant in predicting sexual function (F(4,167.99) = 2.64 p =.04, d pre-post =.20, d total =.65); women in the Sexuality-focused condition whose HRV increased over time showed the greatest improvements in sexual function. DISCUSSION This was the one of the first studies to show that changes in SNS activity in response to psychological treatment lead to changes in sexual function. As women’s SNS responses to sexual stimuli decreased, they reported enhanced sexual function and satisfaction. In addition to the impact on cognitive and emotional effects, psychological treatments may impact sexual function via changes in autonomic response to sexual cues. The deleterious effects of CSA on sexual function may be attenuated through treatments that target SNS activity. Measures Heart rate variability (HRV) Heart rate (HR) and beat to beat (RR) intervals were gathered via a 3-lead electrocardiograph. We used the standard deviation of the RR interval (SDRR) as our index of HRV. Each session had two 20 minute recordings: Neutral (writing about the previous day) Sexual (writing about sex and their sexual experiences) Sexual wellbeing Female Sexual Function Index (FSFI; Wiegel, Meston, & Rosen, 2005). Measured sexual desire, arousal, and overall sexual function. Sexual Satisfaction Scale for Women (SSS-W; Meston & Trapnell, 2005). Central question Do changes in SNS response to sexual stimuli lead to changes in sexual wellbeing? (Reproduced from Lorenz, Harte, Hamilton & Meston (2012), with permission) TABLE 1. Demographics Trauma-focused condition (n = 47) Sexual-focused condition (n = 38) Total (n = 85) Age (years), M (SD)35.30 (9.90)37.34 (10.68)36.21 (10.23) Married or in committed relationship, n (%) 39 (83%)25 (66%)64 (75%) White, n (%)35 (74%)23 (61%)58 (68%) Latina, n (%)12 (26%)9 (24%)21 (25%) At least some college education, n (%) 36 (77%)31 (82%)67 (79%) Exclusively/predominantly heterosexual, n (%) 33 (70%)17 (45%)50 (59%) Resting HR (bpm), M (SD) a 82.57 (10.80)81.72 (10.70)82.21(10.74) Several cross- sectional studies have shown that moderate levels of SNS activity are associated with optimal female sexual arousal. Procedures Participants completed assessment sessions pre- and post- treatment that included measures of sexual wellbeing and heart rate variability (see above). Treatment consisted of five sessions of an expressive writing therapy shown to improve sexual function in women with a history of CSA (Meston, Lorenz, & Stephenson, 2013). Participants were randomized to write about either: Trauma (adapted from Pennebaker, 1997) Sexuality (including but not limited to their sexual abuse) Participants 85 women with a history of CSA, defined as “unwanted oral, anal, or vaginal intercourse, penetration of the vagina or anus using objects or fingers, or genital touching or fondling” that occurred before age 16. Clinical pearl Reducing SNS hyperactivity during sex may improve sexual wellbeing in women with a history of childhood sexual abuse. Non-medication SNS- reducing therapies include expressive writing, cognitive-behavioral therapy (especially exposure therapy), meditation, exercise, and biofeedback.