Intervention
thyroid disorders, sexual dysfunction
THYROID DISORDERS, SESSION, DISEASE, THYROID DISORDER
In addition to standard pharmacotherapy, participants in the case group (n = 33) received CBT in 8 sessions, while the control group received only standard pharmacotherapy. After coordination with eligible individuals, treatment sessions were held regularly on a specific day, once a week, for the case group, each sessions lasting from 1.5 to 2 h. CBT was performed by one of the researchers (AS) who had received the necessary training and received the relevant certificate. All treatments were performed under the supervision of an experienced psychiatrist.A brief description of the sessions is as follows:Session 1: This session involved introducing the program to the participants, establishing relationships with them, providing a definition and explanation of thyroid disorders and its effect on sexual dysfunction, examining the causes of thyroid disorders, effective factors and history of the problem, examining the medical history of the clients and their physiological condition, examining the relationship between the couple’s interest in each other, the type of their marriage, and the type, frequency and quality of sexual relations between them, conducting sexual interviews, stating the logic, value and importance of treatment, stating the goals of counseling based on CBT, providing a brief explanation about the course and type of treatment, assigning homework.Session 2: This session was devoted to evaluation of dysfunctional sexual thoughts and beliefs in thyroid disorder. This included the following: Assessment of Illness-related thoughts, emotions, beliefs, behaviors and physical symptoms, evaluating dominant negative sexual attitudes, examining irrational sexual beliefs and explaining them from a scientific point of view, examining sexual preferences and desires of couples and how to express them to each other, reviewing sexual attitudes of women with thyroid disorders, examining the physical and emotional phases of couples during intercourse, assigning homework.Session 3: This session addressed the cognitive reconstruction and transformation of negative attitudes towards sexual issues in thyroid disorder. This included the following: review of the second session, cognitive reconstruction for psychological adjustment to chronic health problems, cognitive reconstruction for increase the ability to deal with annoying thoughts and negative attitudes related to the disease, cognitive reconstruction for increase the patient’s ability to improve mood, cognitive reconstruction of sexually dysfunctional thoughts in patients with thyroid disorders, homework assignment.Session 4: This session provided sexual information and knowledge in relation to thyroid disorder. This included the following: introducing the factors contributing to proper sexual dysfunction, getting familiar with sexual organs, physiological functions and their hormones, offering training on sex sensitive points, the benefits of sexual intercourse from a psychological and physical point of view, the role of women in sexual relations, communication skills, assigning homework.Session 5: This session dealt with training on non-sexual sensate focus. This included the following: reviewing the fourth session, training on body sensate focus, training on developing concentration and attention skills with respect to non-genital organs, examining verbal communication and how couples express their emotions to each other, teaching emotion expression, verbalization of emotional feelings, and sexual self-expression, enhancing intimacy between couples, assigning homework.Session 6: This session was concerned with training on sexual sensate focus. This included the following: reviewing the fifth session, providing more information about the genitals and sexually sensitive points, increasing self-awareness and sexual self-efficacy, offering training on concentration on sexual organs, attention to excitement and pleasure of the genitals, and sexual fantasies, assigning homework.Session 7: This session focused on teaching how to have sex in relation to an existing problem. This included the following: reviewing the fifth and sixth sessions, teaching different types of intercourse methods, teaching different types of intercourse methods tailored to the couple’s problem and related techniques, assigning step-by-step homework, G spot point maneuvering, teaching how to reach simultaneous orgasm in accordance with the couple’s sensitive points, assigning homework.Session 8: This session was dedicated to the assessment of the achievement of therapy goals. This included the following: reviewing the seventh session, evaluating various techniques used by couples, giving feedback on the effectiveness or ineffectiveness of therapy, resolving the existing problems, evaluating the positive results of the therapy program.In addition, participants were asked to practice the assignments presented in the therapy sessions for 30 min a day, 6 days a week, using the handouts provided.Because the control group received only standard medical treatment and the routine training provided in health centers, in order to observe ethical considerations and acknowledge their participation, they were given a manual along with a training CD at the end of the intervention.