The cognitive therapeutic approach is based on the notion that between stimulus and response, there are factors within the individual that determine the nature and intensity of the response. Interventions in this field aim to change the behavior and feelings of the woman by teaching her to think and behave differently. To achieve this, the doctor as primary treating physician of vaginistic patients, will probably require the assistance of a psychologist/sexologist, psychotherapist, or relational therapist.
Owing to the fact that vaginismus is often a conditioned response, the role of cognitive therapy is small. The active ingredient in cognitive therapy is therefore to break the conditioned response, that is, "just get on with things" (exposure in vivo). Women with vaginismus will undoubtedly have irrational thoughts of "too thick," "does not fit," and so on, especially when the complaints have been present for some time. Although such thoughts can be removed cognitively by means of good patient education, in principle, this will have little or no effect on the occurrence of the complaints. Many patients have followed this path of little success. The most important aspect of cognitive therapy therefore is not so much removing the complaint, but instead motivating the patient, offering insight into the origination of the complaint, and further tackling the problem if it appears to contain a strong rational component. Particularly if the woman's body is expressing what she cannot put into words, cognitive therapy is suitable in the form of:
cognitive restructuring; whether or not with the aid of RET techniques, detecting, and changing dysfunctional thought patterns;
increasing the patient's ability to solve problems, for example, in the form of social expertise training in which she learns to better express her sexual feelings and motives towards her partner, particularly the dictation of her boundaries.
In summary we can say that in the treatment of vaginismus, diverse interventions can play a role at any time in the treatment process. Generally, areas for special focus are:
increasing sexual knowledge;
reformulating (aspects of) the complaint;
decreasing inhibiting thoughts;
increasing positive thoughts;
learning to tune into positive physical feelings;
learning to use one's imagination for sexual fantasies.
In relationship-oriented sexual counseling, attention can also be paid to:
increasing mutual assertiveness; improving communicative expertise.
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