Psychological Components of Pelvic Floor Disorders: Behavioral Treatment Strategies and New Directions

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This 2025 American Urogynecologic Society (AUGS) educational presentation by Dr. James W. Griffith focuses on the psychological aspects of pelvic floor disorders (PFDs), emphasizing behavioral treatment strategies and future directions.<br /><br />Key objectives include understanding best practices for assessing mental health comorbidities in PFD patients using patient-reported outcomes (PROs) and semi-structured interviews, evaluating psychometric properties like reliability and validity, and exploring behavioral interventions—especially cognitive-behavioral therapy (CBT)—for comorbidities.<br /><br />The presentation highlights that mental health is essential for coping, functioning, and human dignity, and that PFDs—such as urinary and fecal incontinence—are strongly linked with psychiatric disorders including anxiety, depression, and notably suicidal ideation. Studies show patients with PFDs have higher rates of psychiatric comorbidity, missed follow-ups, and psychosocial distress.<br /><br />Assessment tools covered include validated PRO questionnaires such as PROMIS (Patient-Reported Outcomes Measurement Information System), PHQ-9 (depression), GAD-7 (anxiety), and the Columbia-Suicide Severity Rating Scale, all designed for reliable, patient-centered evaluation of symptoms and mental health status.<br /><br />The behavioral intervention focus is primarily on CBT, which targets distorted thoughts and avoidance behaviors linked to PFD symptoms (e.g., anxiety over urinary urgency leading to activity avoidance). CBT strategies include cognitive reappraisal, behavioral activation, and self-monitoring to reduce distress and improve coping. Evidence supports CBT’s efficacy across related disorders, including overactive bladder.<br /><br />Patients value interventions that reduce stigma and psychosocial burden, with home-based models improving accessibility. Despite advances, human therapists currently outperform AI (e.g., ChatGPT) in delivering CBT.<br /><br />Additional content covers psychometrics, assessment strategies, and resources for clinicians. Overall, the webinar advocates integrated mental health assessment and behavioral treatments alongside urologic care to improve quality of life for PFD patients.

Keywords

Pelvic Floor Disorders

Psychological Aspects

Behavioral Treatment

Cognitive-Behavioral Therapy

Patient-Reported Outcomes

Mental Health Comorbidities

Psychometric Assessment

Urinary Incontinence

Anxiety and Depression

Integrated Care