Lori Brotto
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Eye tracking studies of women with sexual dysfunction; online RCT of mindfulness-based treatment for sexual dysfunction
Gynecologic cancer survivors and sexual health interventions
Detail oriented, proficient in statistics and strong training and experience in the scientific method. Passionate about women's health.
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Dissertations completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest dissertations.
A growing body of research points to notable parallels between eating disorders and sexual dysfunctions. In addition to being highly comorbid, sexual dysfunctions and eating disorders have similarities in affective and cognitive characteristics, overlapping neurobiological features, and a shared treatment approach. These features provide theoretical evidence for an underlying, shared vulnerability which may serve as risk factors for the development and maintenance of both sexual concerns and disordered eating symptoms. Within the Hierarchical Taxonomy of Psychopathology (HiTOP) – an empirically derived dimensional system of nosology - sexual dysfunctions, eating disorders, and disorders of mood and anxiety are classified under an overarching spectrum of internalizing psychopathology. The current series of studies examines associations between eating disorder symptoms and sexual difficulties across multiple samples from an internalizing disorder perspective. Undergraduate women (n = 656) and clinical samples of women with an eating disorder (n = 120) and women with a chronic vulvar pain condition (n = 166) completed a series of online questionnaires assessing sexual function, sexual distress, sexual insecurities, eating disorder symptoms, body dissatisfaction, negative affect, and psychological features characteristic of eating disorders. In each sample, disordered eating symptoms, body dissatisfaction, and psychological features characteristic of eating disorders were associated with more sexual difficulties, and both psychological features characteristic of eating disorders and negative affect were found to mediate these associations. Women with an eating disorder also reported more sexual concerns than women in the undergraduate sample. These findings suggest that sexual difficulties are common among women with an eating disorder, and that the severity of eating disorder symptoms may be associated with the severity of sexual concerns. Examining sexuality in individuals with an eating disorder has the potential to inform prognosis, case conceptualization, and treatment planning. These findings lend support for the consideration of sexual concerns being included in the internalizing spectrum with specific reference to shared latent liability with eating disorders.
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Young Chinese men and women living in Canada frequently report lower levels of sexualresponse and behaviour compared to their Euro-Caucasian peers. These differences are likelyrelated to cultural factors and acculturation, but has not been well-integrated into more generalmodels of sexual response regulation. The current investigation used the dual control model toorganize and better understand these patterns in three studies in university men and women ofChinese and Euro-Caucasian descent. The first study examined whether dual control processes ofsexual excitation and inhibition were applicable to between-group ethnic differences in sexualresponse and behaviour. Lower sexual excitation explained a significant proportion of thedifference in mean sexual response and activity between Chinese and Euro-Caucasian women,and this effect was mediated by sexual attitudes. Sexual attitudes was separately associated withhigher sexual inhibition and lower dyadic sexual response and activity in Chinese compared toEuro-Caucasian men. The second study examined the association of heritage and mainstreamacculturation with sexual excitation, inhibition, attitudes, response, and activity among theChinese individuals. For heterosexual men and women, mainstream acculturation was theprimary predictor of sexuality variables, while heritage acculturation had a moderating role.Exploratory analyses for non-heterosexual Chinese men and women were also conducted; eachsexual orientation group displayed different patterns of associations between acculturationfactors and sexuality variables. The third study examined whether between-group differences insexual excitation and inhibition were associated with sexual dysfunctions, asexuality, or sexualabstinence. The results did not conclusively suggest more dysfunction in Chinese women, butdid suggest more dysfunction in Chinese men. Abstinence versus engagement in partnered sexhad a moderation role on other outcomes. Theoretical implications for understanding the role ofivChinese culture, and culture in general, in regulating sexual response and behaviours werediscussed for all three studies. Clinical implications for treatment of sexual concerns in youngChinese men and women were also discussed.
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Human asexuality is generally defined as a lack of sexual attraction. Various theories have been proposed to explain how asexuality should best be conceptualized, including that asexuality should be classified as a sexual orientation, that it is due to a mental health difficulty, that it is an extreme variant of hypoactive sexual desire disorder (HSDD), or that some asexual individuals actually experience a paraphilia of some kind. This dissertation employed a series of Internet-based research studies to investigate these three topics: an examination into mental health correlates of asexuality, a comparison of asexual individuals with individuals who meet diagnostic criteria for HSDD, and an investigation into patterns of sexual fantasy among asexual individuals. By investigating these topics, I sought to test whether asexuality might be a psychopathology, sexual dysfunction, or a paraphilia, with the ultimate goal of testing my hypothesis that asexuality is, in fact, a unique sexual orientation. My findings suggested that asexuality may be associated with higher prevalence of mental health and interpersonal problems, including anxiety, hostility, phobic anxiety, psychoticism, and suicidality, but that it is not, itself, a mental disorder. I concluded that this may be in response to perceived stigma against their sexual orientation, which might lead to psychological symptoms, or that lack of sexual attraction may arise from an underlying difficulty such as Autism Spectrum Disorder. Next, I found that asexuality is unique from the well-known sexual dysfunction HSDD. In my test of whether asexuality was a paraphilia, I found that asexual individuals were less likely to masturbate than sexual individuals, and that they were more likely to report never having had a sexual fantasy. Further, there was a large amount of unexpected overlap in the content of sexual fantasies between asexual and sexual participants. Together, these findings suggest that at least some asexual individuals may have a paraphilia. Overall, this dissertation highlights that no single theory can explain asexuality, and underscores the diversity among the asexual population. This dissertation leads to a number of new hypotheses about the nature of asexuality that will be the focus of future research.
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Master's Student Supervision
Theses completed in 2010 or later are listed below. Please note that there is a 6-12 month delay to add the latest theses.
No abstract available.
Sexual dysfunction is the most common consequence of prostate cancer (PCa) treatment and has been shown to directly impact the sexual function and quality of life of survivors’ partners. Best evidence on the psychosexual adjustment of PCa survivors after treatments indicates that patients can benefit from psychological interventions that address the emotional needs of patients, and such interventions should involve their partners. However, prostate cancer care programs often lack psychological therapies for their patients. Through this project, I aimed to address the need for these therapies in both academic research and clinical care, with two distinct objectives: 1) To test two therapies, cognitive behavioural therapy (CBT) and mindfulness, in a sample of PCa survivor and partner couples through an RCT study design, and 2) to utilize Knowledge Translation to disseminate RCT findings to PCa patients and their partners through a Prostate Cancer Supportive Care program (PCSC). We first randomized PCa survivors and their partners to four consecutive weeks of either couples’ mindfulness therapy, couples’ CBT, or no treatment (control). Sexual distress and sexual satisfaction were significantly improved six weeks after both CBT and mindfulness interventions compared to the control group, but only sexual distress remained significantly improved at six months, and quality of life improved, particularly for survivors. For the second phase of this project, we used two Knowledge Translation (KT) frameworks--the Knowledge to Action Cycle and the Consolidated Framework for Implementation Research, to bring this evidence into practice. We partnered with the PCSC to collect data from PCa patients and staff, and used those data to implement patient education materials in the program. We created 1) an information card that explained CBT and mindfulness, which contained a link to 2) a patient education video that instructed patients on how to practice these skills at home, hosted on 3) a webpage with external CBT and mindfulness resource links (https://pcscprogram.ca/module-2/mind-cbt/). By testing and establishing therapies for these populations, and then moving them into clinical practice, we successfully brought together two areas in health research to improve the psychological aspects to sexual health for PCa patient and partner couples.
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One third of cisgender women report experiencing low sexual desire and 8% of these women meet the diagnostic criteria for Sexual Interest/Arousal Disorder (SIAD), yet treatment research for SIAD remains scarce. Research on sexual concerns among transgender women and non-binary individuals is also scarce and requires further investigation to better inform clinical practice. The Approach-Avoidance Motivation Model may be relevant to addressing sexual concerns. This model posits that different motivations for sex can be classified as either pursuing desired outcomes (approach motivation) or avoiding unwanted outcomes or consequences (avoidance motivation), and these reasons are related to sexual outcomes. The treatment utility of the Approach-Avoidance Motivation Model for SIAD was tested in a sample of cis- and transgender women, and non-binary individuals, who either met criteria for SIAD or reported no sexual concerns. Sixty-seven participants with SIAD and 96 participants with no sexual concerns completed baseline measures of sexual motivation, sexual desire, sexual satisfaction, relationship satisfaction, and partnered sexual behaviours. Participants then completed an online assessment from home that involved a writing exercise previously found to increase the salience of approach or avoidance sexual motivation, or a control writing task, then viewed a nature film and erotic film while self-reporting levels of attention. Seventy-two hours following the online assessment participants completed sexual outcome measures again. A repeated measures MANOVA assessing the impact of SIAD status and writing task condition found that participants with SIAD in the approach condition significantly increased in approach sexual motivation immediately following the manipulation but these improvements did not persist at 72 hours follow up. Interestingly participants without SIAD were found to decrease in avoidance motivation, dyadic sexual desire, and partnered sexual behaviours 72 hours following the manipulation, regardless of writing condition. There were no differences in self-reported attention to the erotic film between those with and without SIAD, or between writing condition groups. Overall, these findings did not show support for the treatment utility of this approach-avoidance motivation manipulation for SIAD given that increases in approach motivation were not maintained. Future studies might explore more long-term interventions targeting approach-avoidance motivation to address sexual difficulties.
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Asexuality is defined as a lack of sexual attraction to others. Though scholars have classified it as a sexual orientation, this has been challenged, with some experts positing that it is better explained as a sexual dysfunction. Sexual Interest/Arousal Disorder (SIAD) is characterized by absent/reduced sexual interest/arousal paired with personal distress, with two subtypes: acquired and lifelong. Research suggests that while asexuality and acquired SIAD are distinct entities, there may be overlap between asexuality and lifelong SIAD. Findings from studies of visual attention to and appraisals of sexual cues suggest that these methodologies might differentiate these two groups on the basis of their neural mechanisms. However, no study has compared these groups’ cognitive processing of sexual cues, and the literature on lifelong SIAD is minimal. The current study aimed to test differences between asexuality and SIAD (both lifelong and acquired) on cognitive processing of sexual cues. Forty-two asexual individuals and 25 heterosexual women with SIAD (16: acquired; 9: lifelong) completed three study components: a visual attention task, a sex SC-IAT, and the Sex Semantic Differential Scale. One-way ANOVAs examined group differences in: 1) visual attention to erotic cues, 2) implicit appraisals of sexual words, and 3) explicit appraisals of sex. Women with SIAD displayed a controlled attention bias for erotic images and areas of sexual contact, making a greater number of fixations and having longer dwell times to these areas relative to asexual individuals, who did not gaze preferentially at erotic cues. There were no differences in gaze behavior between women with different SIAD subtypes. For implicit appraisals, there were minimal group differences, with asexual individuals and women with both SIAD subtypes demonstrating negative – neutral implicit associations with sexual words. For explicit appraisals, women with acquired SIAD reported more positive evaluations of sex relative to asexual individuals and women with lifelong SIAD, with no notable differences between the latter groups. This project sheds light on key differences between asexuality and low desire, and has important implications for best clinical practice guidelines for the assessment of lifelong SIAD.
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Despite approximately 10% of new mothers in Canada developing postpartum depression (PPD), they face many barriers when accessing care. eHealth offers a unique opportunity to provide psychosocial skills and support to new mothers; however, treatment development does not consistently engage women directly in this process, thus often ignoring the unique needs that women express and the diversity of women who may use those tools. This study engaged women from a variety of backgrounds and locations around British Columbia who had previously experienced PPD, for the purposes of determining the unmet psychoeducational needs of women with PPD and how a web-enabled platform used to deliver psychosocial skills and education to assist in the treatment of PPD could fulfill those needs. Focus groups were conducted in seven cities across British Columbia with a total of 31 women (mean age = 34.5 years), discussing participants’ needs, ideas, and opinions as they relate to the use of technology in treatment. Transcripts were analyzed using the approaches of qualitative description and emergent thematic analysis.Five themes emerged: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. At the intersection of these themes was the overarching idea of promoting agency for women experiencing PPD.Ultimately, new mothers require accessible mental health care that ensures their agency in mental health care decision-making. Our participants believed a web-enabled intervention could help meet this need. These data will be used to guide the design of such an intervention, with the eventual implementation of this resource as a first-line treatment option for PPD.
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