Cognitive Behavioral Therapy in Endometriosis, Psychological Based Intervention: A Systematic Review

Abstract

Introduction Endometriosis is an inflammatory disease that affects women of reproductive age, causing pain and the possibility of infertility. Endometriosis was associated to low life quality and research shows the impact of endometriosis in several areas of life, justifying how these patients are more likely to develop depression, anxiety, and stress.

Objective The aim of the present systematic review was to explore the field of psychology in endometriosis, identifying studies that used the cognitive behavioral therapy technique as a treatment for endometriosis and chronic pelvic pain.

Methods The keywords used were Endometriosis and Behavioral Therapy; Behavioral Disciplines and Activities; Cognitive Behavioral Therapy; Mental Health; Psychological Techniques; Psychology; Psychotherapy; Mental Health Services; and the search was performed in the following databases: PubMed/Medline, Scielo, Lilacs, and Capes. The study followed the PRISMA guidelines and all studies whose intervention strategy used was related to cognitive-behavioral therapy were considered.

Results Of the 129 articles found, only 5 were selected, and it was possible to identify that the psychological intervention whose approach brought cognitive-behavioral therapy techniques promoted a decrease in the sensation of pain, improvements in the scores of depression and stress, and significant changes in aspects of quality of life such as vitality, physical and social functioning, emotional well-being, control, and autonomy.

Conclusion Cognitive-behavioral therapy can be very promising to take care of the emotional side of those who have endometriosis However, the present systematic review highlights the need to develop more structured studies with consistent, clear and replicable methods to reach a psychological intervention protocol for patients who live with this gynecological-physical-emotional condition.

Resumo

Introdução A endometriose é uma doença inflamatória que afeta mulheres em idade reprodutiva, causando dor e possibilidade de infertilidade. A endometriose foi associada a baixa qualidade de vida e pesquisas mostram o impacto da endometriose em diversas áreas da vida, justificando como tais pacientes têm maior probabilidade de desenvolver depressão, ansiedade e estresse.

Objetivo O objetivo da presente revisão sistemática foi explorar o campo da psicologia na endometriose, identificando estudos que usaram a técnica da terapia cognitiva comportamental como tratamento da endometriose e da dor pélvica crônica.

Métodos As palavras chaves utilizadas foram Endometriose AND Terapia comportamental; Disciplinas e atividades comportamentais; Terapia cognitiva comportamental; Saúde mental; Técnicas psicológicas; Psicologia; Psicoterapia; Serviços de saúde mental, e a busca foi realizada nos bancos de dados PubMed / Medline, SCIELO, LILACS e CAPES. O estudo seguiu as diretrizes dos Principais Itens para Relatar Revisões Sistemáticas e Metanálises (PRISMA, na sigla em inglês) e foram considerados todos os estudos cuja estratégia de intervenção utilizada estava relacionada à terapia cognitivo-comportamental.

Resultados Dos 129 artigos encontrados, somente 5 foram selecionados, e foi possível identificar que a intervenção psicológica cuja abordagem trouxe técnicas da terapia cognitivo-comportamental promoveu diminuição na sensação de dor, melhora nos escores de depressão e estresse e mudanças significativas em aspectos da qualidade de vida como vitalidade, funcionalidade física e social, bem-estar emocional, controle e autonomia.

Conclusão A terapia cognitivo-comportamental pode ser muito promissora para o tratamento psicológico/emocional de quem tem endometriose. No entanto, a presente revisão sistemática destaca a necessidade de desenvolver estudos mais estruturados com métodos consistentes, claros e replicáveis para se chegar a um protocolo de intervenção psicológica para pacientes que convivem com esse quadro ginecológico-físico-emocional.

Keywords

endometriosis - cognitive behavioral therapy - psychological intervention - chronic pelvic pain - quality of life - systematic reviews

Palavras-chave

endometriose - terapia cognitivo-comportamental - intervenção psicológica - dor pélvica crônica - qualidade de vida - revisões sistemáticas

Publication History

Received: 30 May 2021

Accepted: 16 November 2021

Article published online:
16 May 2022

• References

• 1 American Society for Reproductive Medicine. Endometriosis: guía para pacientes [Internet]. 2013 . Available from: https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/spanish-fact-sheets-and-info-booklets/endometriosis-spanish.pdf
• 2 Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 2003; 18 (04) 756-759
• 3 Malvezzi H, Marengo EB, Podgaec S, Piccinato CA. Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology. J Transl Med 2020; 18 (01) 311
• 4 Bellelis P, Dias Jr JA, Podgaec S, Gonzales M, Baracat EC, Abrão MS. Epidemiological and clinical aspects of pelvic endometriosis–a case series. Rev Assoc Med Bras (1992) 2010; 56 (04) 467-471
• 5 Goncalves MO, Podgaec S, Dias Jr JA, Gonzalez M, Abrao MS. Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod 2010; 25 (03) 665-671
• 6 Abrao MS, Gonçalves MO, Dias Jr JA, Podgaec S, Chamie LP, Blasbalg R. Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 2007; 22 (12) 3092-3097
• 7 Andres MP, Mendes RFP, Hernandes C, Araújo SEA, Podgaec S. Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis. Einstein (Sao Paulo) 2019; 17 (02) eAO4583
• 8 Donatti L, Ramos DG, Andres MP, Passman LJ, Podgaec S. Patients with endometriosis using positive coping strategies have less depression, stress and pelvic pain. Einstein (Sao Paulo) 2017; 15 (01) 65-70
• 9 Lorençatto C, Vieira MJ, Marques A, Benetti-Pinto CL, Petta CA. Avaliação de dor e depressão em mulheres com endometriose após intervenção multiprofissional em grupo. Rev Assoc Med Bras (1992) 2007; 53 (05) 433-438
• 10 Facchin F, Barbara G, Saita E, Mosconi P, Roberto A, Fedele L. et al. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstet Gynaecol 2015; 36 (04) 135-141
• 11 Bellelis P, Podgaec S, Abrão MS. [Environmental factors and endometriosis: a point of view]. Rev Bras Ginecol Obstet 2014; 36 (10) 433-435
• 12 Bonocher CM, Montenegro ML, Rosa E Silva JC, Ferriani RA, Meola J. Endometriosis and physical exercises: a systematic review. Reprod Biol Endocrinol 2014; 12: 4
• 13 Mira TAA, Buen MM, Borges MG, Yela DA, Benetti-Pinto CL. Systematic review and meta-analysis of complementary treatments for women with symptomatic endometriosis. Int J Gynaecol Obstet 2018; 143 (01) 2-9
• 14 Zhao L, Wu H, Zhou X, Wang Q, Zhu W, Chen J. Effects of progressive muscular relaxation training on anxiety, depression and quality of life of endometriosis patients under gonadotrophin-releasing hormone agonist therapy. Eur J Obstet Gynecol Reprod Biol 2012; 162 (02) 211-215
• 15 Meissner K, Böhling B, Schweizer-Arau A. Long-term effects of traditional Chinese medicine and hypnotherapy in patients with severe endometriosis–a retrospective evaluation. Forsch Komplement Med 2010; 17 (06) 314-320
• 16 Meissner K, Schweizer-Arau A, Limmer A, Preibisch C, Popovici RM, Lange I. et al. Psychotherapy with somatosensory stimulation for endometriosis-associated pain. Obstet Gynecol 2016; 128 (05) 1134-1142
• 17 Kold M, Hansen T, Vedsted-Hansen H, Forman A. Mindfulness-based psychological intervention for coping with pain in endometriosis. Nordic Psychol 2012; 64 (01) 2-16
• 18 Hansen KE, Kesmodel US, Kold M, Forman A. Long-term effects of mindfulness-based psychological intervention for coping with pain in endometriosis: a six-year follow-up on a pilot study. Nordic Psychol 2017; 69 (02) 100-109
• 19 Friggi Sebe Petrelluzzi K, Garcia MC, Petta CA. et al. Physical therapy and psychological intervention normalize cortisol levels and improve vitality in women with endometriosis. J Psychosom Obstet Gynaecol 2012; 33 (04) 191-198
• 20 Beck JS. Terapia cognitivo-comportamental: teoria e prática. 2a ed. Porto Alegre. Art Med 2013
• 21 Evans S, Fernandez S, Olive L, Payne LA, Mikocka-Walus A. Psychological and mind-body interventions for endometriosis: A systematic review. J Psychosom Res 2019; 124: 109756
• 22 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8 (05) 336-341
• 23 Thoma N, Pilecki B, McKay D. Contemporary cognitive behavior therapy: a review of theory, history, and evidence. Psychodyn Psychiatry 2015; 43 (03) 423-461
• 24 Vernon A, Doyle KA. Cognitive behavior therapies: a guidebook for practitioners. Alexandria: American Counseling Association; 2018
• 25 Ribeiro JP, Rodrigues AP. Questões acerca do coping: a propósito do estudo de adaptação do Brief COPE. Psicol Saude Doencas 2004; 5 (01) 3-15 http://www.scielo.mec.pt/pdf/psd/v5n1/v5n1a01.pdf
• 26 Minshall C, Ski CF, Apputhurai P, Thompson DR, Castle DJ, Jenkins Z. et al. Exploring the impact of illness perceptions, self-efficacy, coping strategies, and psychological distress on quality of life in a post-stroke cohort. J Clin Psychol Med Settings 2021; 28 (01) 174-180
• 27 Lucena-Santos P, Pinto-Gouveia J, Oliveira MS. Terapias comportamentais de terceira geração: guia para profissionais. Novo Hamburgo: Sinopsys; 2015
• 28 Williams M, Penman D. Atenção plena: Mindfulness. Rio de Janeiro: Sextante; 2015