Mediators and Moderators of Treatment Outcome Following Online Mindfulness and Cognitive-Behavioral Treatment for Female Sexual Interest/Arousal Disorder

eSense is a digital tool delivering mindfulness-based therapy (MBT) and cognitive behavioral therapy (CBT) to individuals with female sexual interest/arousal disorder (SIAD). eSense is feasible, usable, satisfying, and efficacious, and helps overcome barriers to care. We sought to examine potential mediators and moderators of improvements in sexual desire and distress following use of eSense. Women with SIAD (n = 129, mean age 44.8 ± 12.3 in the MBT arm and 41.9 ± 13.1 in the CBT arm) were randomly assigned to arm and completed self-report measures at baseline, mid-treatment, immediately post-treatment, and 6-month follow-up. Potential mediators were changes in depression, posttraumatic stress disorder symptoms (PTSD), and avoidance of sexual activity. We examined treatment expectations after module 1 as a potential moderator, and partner involvement, homework completion, and modules completed as process indicators that may predict magnitude of improvement. Decreases in depressive and PTSD symptoms were associated with improvements in sexual desire and distress in the MBT arm, and reductions in sexual avoidance were associated with improvements in both arms. Higher expectations for treatment were associated with greater improvements in desire and distress for those in the CBT arm only, whereas partner involvement, homework completion, and number of eSense modules completed were associated with improvements in both arms. This study helps identify putative mechanisms by which digital health tools for SIAD, like eSense, may be effective, and to identify participant characteristics as well as treatment engagement factors that might be associated with differential responses to online MBT and CBT.