An online expressive writing intervention for the psychosexual well-being of women with a history of childhood sexual abuse : theory, mechanisms, and effectiveness in a randomized clinical trial

As roughly 20% of women have experienced childhood sexual abuse (CSA), the development of interventions for the associated decrements in psychosexual well-being is critically important. One such intervention, sexual schema expressive writing, has demonstrated promising efficacy in improving the psychosexual well-being of women with CSA histories. This treatment has been associated with reductions in the prominence of CSA themes in women’s sexual schema. Other research has shown that a greater prominence of CSA themes in women’s sexual self-schema is associated with decrements in sexual functioning. The current study is a randomized clinical trial of an online sexual schema expressive writing intervention compared to a daily events control condition for the improvement of women’s psychosexual well-being. The primary aims of the study were to test the intervention in an online modality and assess sexual schema change as a mechanism of action. After being randomized to one of the two conditions, women with CSA histories (N = 125) wrote in response to condition-respective treatment prompts for five sessions across three weeks. Psychosexual well-being and sexual schemas were assessed at baseline, post- treatment, and one-month follow-up. Both the daily events and the sexual schema conditions demonstrated significant gains in psychosexual well-being across the course of the treatment. Sexual schema change was supported as the mechanism of action for the sexual schema condition. These results suggest that targeting change in maladaptive schemas is an important treatment avenue for improving the psychosexual well-being of women with CSA histories. The online expressive writing intervention is an efficacious and accessible way to target schema change.