Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review

Mindfulness-based cognitive therapy (MBCT) includes regular home practice of mindfulness exercises as a key means of cultivating mindfulness. Although there are instruments available for measuring homework adherence following cognitive behavioral therapy (CBT), little is known about measuring homework practice in MBCT studies for sexual dysfunction. In this review we sought to investigate which items and instruments are the most used for the assessment of homework adherence in studies evaluating MBCT for the treatment of female sexual dysfunction (FSD). We also investigated the types of homework used in these interventions. Five databases (PubMed, Scopus, PsycINFO, Embase, and Web of Science) were searched and a total of 30 articles were included in this review. Our main findings revealed that there was no gold standard instrument used to assess homework adherence in patients using MBCT interventions for FSD, and that most of the reported studies did not provide information on how they assess homework adherence. Six of the 9 studies for which the articles reported how homework was assessed used only ad hoc measures. Only 3 studies used psychometrically validated instruments. We also found that mindfulness, psychoeducation, and CBT exercises were the most prescribed homework. This review uniquely integrates homework adherence measures with studies on FSD that evaluate mindfulness, finding no gold standard for assessing adherence. However, limitations including both MBCT and CBT interventions, limiting generalization to MBCT alone, the predominance of Western-based studies, and the lack of reporting on instruments used to assess adherence, indicating a gap in the field. Further studies should consider adapting existing instruments that assess homework adherence in studies of CBT for other psychopathologies or seek to develop new psychometrically validated instruments for MBCT interventions that assess homework adherence.