Verhaltenstherapie einer Patientin mit Genitalkarzinom, somatoformer Schmerzstörung und Dyspareunie

The present case study describes a behavior therapy with 30
treatment sessions for a patient with genital cancer, somato-form
disorder and dyspareunia. On the basis of a bio-psycho-social
model, daily pain appraisals and relaxation techniques were used.
Treatment procedures to reduce depressive symptoms involved
cognitive strategies, diary method, pleasure scales and resource
acquisition. The patient repeatedly described her feelings of
sadness, hopelessness and fear in respect to her cancer. On the
basis of her sexual history `sensate focus' treatment was gradually
introduced. The patient underwent role-play and performance
feedback of conflict situations with her husband who was partially
involved in the psychotherapy. The patient was able to accomplish
the set objectives to a great extent after 30 treatment sessions:
The vaginal pains and the depressive symptoms strongly decreased.
The patient describes herself as being more encouraged, shows more
interests and is more active even outside of her family. Through
the instructions she was able to acquire practical knowledge which
helped her experience a more fulfilling sexual life. Having
completed treatment the couple now talks about feelings and needs
more often. The patient also learned to stand up more to her
husband and children. Finally, she was able to deal with her fears
about her genital cancer, especially regarding her fear of pain and
death. The evaluation of the therapy progress reflects these
changes: The scores obtained from the Beck-Depression-Inventory
(BDI) and the Symptom-Checklist (SCL 90-R) had decreased to normal
range at the end of the therapy ( BDI: 8; SCL 90-R: GSI: 0,49;
T-score: 55) compared to scores at the beginning of the treatment
(BDI: 26; SCL 90-R: GSI: 0,92; T-score: 67). In conclusion the
study emphasizes the importance of offering psychosomatic treatment
to gynecological patients.