The Treatment of Low Sexual Desire: Comparative Efficacy of Self -Help Books and Placebo Pills Laurie B. Mintz Ph.D., Alexandra M. Balzer Ph.D., Meenakshi Palaniappan B.A., Kathleen Connelly M.S., Katherine Vogel Anderson Pharm.D., Tessa Wimberley B.A., Danielle C. Pierini Pharm.D., & Cristina D. Tremante B.S. University of Florida and University of Missouri, USA Introduction Although bibliotherapy occupies a stable position in treating sexual dysfunctions (van Lankveld, 2009), this series of studies is the first to examine the efficacy of this intervention for low sexual desire in women, the most frequent sexual concern brought to healthcare providers (Brotto et al., 2008). Study 1 compared a self-help book (A Tired Woman’s Guide to Passionate Sex; Mintz, 2009) to a wait-list control (WLC) group. Study 2 compared the efficacy of A Tired Woman’s Guide to Passionate Sex, another self -help book (Reclaiming Y our Sexual Self: How Y ou Can Bring Desire Back into Y our Life ; Hall, 2004), and a WLC group. Study 3 compares the efficacy of A Tired W oman’s Guide to Passionate Sex and a placebo pill purported to be a nutritional supplement shown in prior research to enhance desire. Lastly, the objective of Study 4 is to compare the efficacy of A Tired W oman’s Guide to Passionate Sex with an erotic fiction book; this study is underway. Method All four studies recruited married, heterosexual women who reported being bothered by low sexual desire yet currently satisfied in their marital relationship. In all four studies, women were randomly assigned to condition. In all, participants completed the Hurlbert Index of Sexual Desire (HISD; Apt & Hurlbert, 1992) and the Female Sexual Function Index (FSFI; Rosen et al., 2000) at both at pre -test and following a six-week intervention period. All FSFI subscales were analyzed including: Desire, Satisfaction, Lubrication, Orgasm, Arousal, and Pain. The three completed studies employed repeated measures ANOVAs to examine group differences. Results In Study 1, participants who read A Tired W oman’s Guide to Passionate Sex made significantly greater gains in desire, satisfaction, and arousal than those in the WLC group [HISD: F (1,43) = 42.69, p < .001, Cohen’s d = 1.19; FSFI Desire: F (1, 43) = 38.47, p < .001, Cohen’s d = 1.36; FSFI Satisfaction: F(1, 41) = 14.00, p < .001, Cohen’s d = 1.34; FSFI Arousal: F (1, 43) = 8.41, p < .01, Cohen’s d = 1.12]. See Graph 1 for HISD results. In Study 2, participants who read A Tired W oman’s Guide to Passionate Sex made significantly greater gains in desire (as measured by the HISD), lubrication, orgasm, and satisfaction than those in the WLC group [HISD: F(1, 42) = 24.20, p < .001, Cohen’s d = 1.86; FSFI Lubrication: F(1, 42) = 22.54, p < .001, Cohen’s d = 1.42; FSFI Orgasm: F (1, 42) = 14.00, p < .001, Cohen’s d = 1.26; FSFI Satisfaction: F(1, 42) = 8.83, p < .01, Cohen’s d = .54]. Similarly, those who read Reclaiming Your Sexual Self made significantly greater gains in desire (as measured by the HISD), lubrication, and orgasm than those in the WLC group [HISD: F (1, 42) = 8.62, p < .01, Cohen’s d = 1.22; FSFI Lubrication: F (1, 42) = 5.91, p < .05, Cohen’s d = .59; FSFI Orgasm: F(1, 42) = 11.73, p < .001, Cohen’s d = 1.09). Participants who read A Tired W oman’s Guide to Passionate Sex made greater gains in desire (as measured by the HISD) and lubrication than those who read Reclaiming Y our Sexual Self [HISD: F (1, 42) = 5.44 , p < .05, Cohen’s d = .77; FSFI Lubrication: F(1, 42) = 6.99, p < .05, Cohen’s d = .85]. See Graph 2 for HISD results. In Study 3, participants who read A Tired Woman’s Guide to Passionate Sex made significantly greater gains in satisfaction than those who took the placebo pill [ F (1, 44) = 14.75, p < .001, Cohen’s d = 1.33]. Conversely, those who read the book did not differ significantly from those who took the pills in terms of desire, arousal, lubrication or pain. However, for all, there was a significant main effect for time [HISD: F (1, 42) = 25.34, p < .001; FSFI Desire: F(1, 44) = 42.56, p < .001; FSFI Arousal: F(1, 44) = 17.66, p < .001; FSFI Lubrication: F (1, 44) = 6.52, p < .05; FSFI Pain: F(1, 44) = 7.48, p < .01], indicating that both conditions resulted in improvement from pre- to post-test. Cohen’s d for FSFI Desire was 1.0 for both groups. For all other variables the effect size (Cohen’s d) for bibliotherapy was greater than that for placebo, respectively: HISD: 1.01, 0.64; FSFI Arousal: 0.74, 0.48; FSFI Pain: 0.53, 0.22; FSFI Lubrication: 0.57, 0.11. See Graph 3 for HISD results. Discussion Collectively, this series of studies lends support to the efficacy of bibliotherapy for low sexual desire. Specifically, both A Tired W oman’s Guide to Passionate Sex (in Studies 1, 2, and 3) and Reclaiming Y our Sexual Self (in Study 2) were found to increase sexual desire and other aspects of sexual functioning in women who read them. However, in Study 2, one book outperformed the other in terms of both gains in desire and lubrication. Still, the question remains as to whether gains from bibliotherapy are due to the content of the books or simply doing something to help oneself. Study 3 examined this question by comparing the efficacy of A Tired Woman’s Guide to Passionate Sex to placebo pills. Reading the book resulted in increases in sexual satisfaction, whereas taking the pills did not. Conversely, both were effective in decreasing pain and increasing desire, arousal, and lubrication, although these effects were generally stronger for bibliotherapy. The occurrence of a strong placebo response is similar to those reported in previous trials in women with sexual dysfunctions (e.g., Berman et al., 2003), indicating that attentional, motivational, and belief factors contribute to the efficacy of interventions. Additional research is needed. Particularly useful studies might compare bibliotherapy and an efficacious in-person treatment (e.g., Brotto et al., 2008), or compare therapist-assisted and self-guided bibliotherapy. Studies of the efficacy of bibliotherapy for non-heterosexual women struggling with low sexual desire are sorely needed. Until such time, therapists can feel comfortable utilizing both Reclaiming Y our Sexual Self and A Tired Woman’s Guide to Passionate Sex for low sexual desire in married, heterosexual women. Footnote. Cohen’s d effect sizes: small = 0.2; medium = 0.5; large = 0.8.