Effectiveness of Online Versus Telephone Counseling of Rational-Emotional-Behavioral Therapy on Sexual Function of Women Undergoing Cardiac Rehabilitation: A Randomized Clinical Trial

  • Tahmineh Farajkhoda Research Center for Nursing and Midwifery Care, Shahid Sadughi University of Medical Sciences, Yazd, Iran
  • Fatemeh Zahra Memar International Campus of Shahid Sadoughi University of Medical Science, Yazd, Iran
  • Mahdi Khanabadi Department of Counseling, School of Education Sciences and Psychology, Allameh Tabataba'i University, Tehran, Iran
  • Mohammadtaghi Sarebanhassanabadi Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Keywords: Cardiovascular Diseases, Rational-Emotional-Behavioral Therapy, Cardiac Rehabilitation, Sexual Activities, Internet-Based Intervention, Counseling


Background: Sexual function in patients with cardiovascular disease (CVDs) is often associated with anxiety and irrational beliefs. Moreover, 60-78% of patients with CVDs report sexual problems. Some studies suggest that sexual counseling is necessary for these patients but is not usually provided for them. Online or telephone counseling may be helpful during the covid-19 pandemic, but studies on its application to sexual function appear to be limited. This study aimed to investigate the effectiveness of online vs. telephone counseling of rational-emotional-behavioral therapy (REBT) on the sexual function of women undergoing cardiac rehabilitation. Materials and Methods: In this randomized clinical trial study, 46 women diagnosed with CVDs under rehabilitation were assigned into online and telephone groups. Overall, eight 60-min intervention sessions were held (once a week). The Female's Sexual Function Index (FSFI) questionnaire was completed by the women at baseline, week 8th, and follow-up week 12th (main outcome). Results: FSFI scores between the two groups at baseline (online: 13.28±2, telephone: 12.68±1.52, P=0.254) compared to week 12th (online 28.86±2.44, telephone, 26.6±2.10, P=0.002) were significantly different. As for within-group comparison in baseline compared to week 12th statistically significant difference was observed in all subscales of FSFI (P<0.05). Conclusion: Online and telephone REBT counseling can improve the sexual function of women undergoing cardiac rehabilitation, but online counseling appears to be more effective. Thus, this method is recommended to improve the sexual function of these women during the covid-19 pandemic


De Marvao A, Alexander D, Bucciarelli-Ducci C, Price S. Heart disease in women: a narrative review. Anaesthesia. 2021;76(Suppl 4):118-30.



Bakhshayeh S, Sarbaz M, Kimiafar K, Vakilian F, Eslami S. Barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation programs. Physiother Theory Pract. 2021;37(1):158-68.



Aghababaei S, Heshmatian T, Roshanaei G, Rohani Mahmoodabadi SM, Refaei M. Sexual Function and Related Factors in Lactating Women with Decreased Sexual Desire referred to Sonqor Health Centers in 2018. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2021;24(2):23-32.

Lin CY, Broström A, Årestedt K, Mårtensson J, Steinke EE, Pakpour AH. Using extended theory of planned behavior to determine factors associated with help-seeking behavior of sexual problems in women with heart failure: a longitudinal study. J Psychosom Obstet Gynaecol. 2020;41(1):54-61.



Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part I. Risk Factors and Potential Pathophysiological Underpinnings for Female Vasculogenic Sexual Dysfunction Syndromes. Sex Med Rev. 2018;6(4):508-24.



Mornar Jelavić M, Krstačić G, Perenčević A, Pintarić H. Sexual Activity in Patients with Cardiac Diseases. Acta Clin Croat. 2018;57(1):141-8.


PMid:30256023 PMCid:PMC6400344

Murphy PJ, Noone C, D'Eath M, Casey D, Doherty S, Jaarsma T, et al. The CHARMS pilot study: a multi-method assessment of the feasibility of a sexual counselling implementation intervention in cardiac rehabilitation in Ireland. Pilot Feasibility Stud. 2018;4:88.


PMid:29988602 PMCid:PMC6027553

Farquhar JM, Stonerock GL, Blumenthal JA. Treatment of Anxiety in Patients With Coronary Heart Disease: A Systematic Review. Psychosomatics. 2018;59(4):318-32.


PMid:29735242 PMCid:PMC6015539

Kazemi Rezaei SV, Kakabraee K, Hosseini SS. The effectiveness of emotion regulation skill training based on dialectical behavioral therapy on cognitive emotion regulation and quality of life of patients with Cardiovascular Diseases. Journal of Arak University of Medical Sciences. 2019;22(4):98-111.


Khodadad Hatkeh Poshti Z, Hassanzadeh R, Emadian S. The Effectiveness of Emotional Schema Therapy on Neuroticism and the Life Style of Cardiovascular Patients. Journal of Babol University of Medical Sciences. 2021;23(1):46-52.

Nekonam A, Etemadi S, Pornaghash Tehrani S. The effectiveness of excited family therapy approach on improving Sexual Satisfaction and Marital stress in patients with Coronary artery bypass graft. Journal of psychologicalscience. 2018;17(65):61-77.

Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. Eur J Prev Cardiol. 2018;25(3):247-59.



Dos Santos André F, Regina Maria VL. Sexuality of postinfarction patients: diagnosis, results and nursing intervention. J Clin Nurs. 2014;23(15-16):2101-9.



Ellis A. The evolution of Albert Ellis and rational emotive behavior therapy. In: Zeig JK. The Evolution of Psychotherapy. 1st Edition. New York: Routledge; 2019. p. 69-82.


Nequee F, Oraki M, Janbozorgi M, Alipoor A. The effectiveness of cognitive-behavioral intervention based on stress-induced immunization training on psycho-physiological and psychological characteristics of patients with coronary artery bypass surgery (CABG). Medical Science Journal of Islamic Azad Univesity-Tehran Medical Branch. 2021;31(2):195-204.


Byrne M, Doherty S, Fridlund BG, Mårtensson J, Steinke EE, Jaarsma T, et al. Sexual counselling for sexual problems in patients with cardiovascular disease. Cochrane Database Syst Rev. 2016;2(2):Cd010988.


PMid:26905928 PMCid:PMC6464754

Ozaki Y, Nagao K, Saigo R, Tai T, Tanaka N, Kobayashi H, et al. Sexual Problems among Japanese Women: Data from an Online Helpline. Sex Med. 2015;3(4):295-301.


PMid:26797064 PMCid:PMC4721042

Hyde EK, Martin DE, Rieger KL. Factors shaping the provision of sexual health education for adults with acute coronary syndrome: A scoping review. Patient Educ Couns. 2020;103(5):877-87.



Rabbe S, Blankart CR, Franz WM, Hager L, Schreyögg J. Impact of a telemonitoring intervention in patients with chronic heart failure in Germany: A difference-in-difference matching approach using real-world data. J Telemed Telecare. 2021:1357633x20984024.



Xiao C. A Novel Approach of Consultation on 2019 Novel Coronavirus (COVID-19)-Related Psychological and Mental Problems: Structured Letter Therapy. Psychiatry Investig. 2020;17(2):175-6.


PMid:32093461 PMCid:PMC7047000

Dewitte M, Otten C, Walker L. Making love in the time of corona - considering relationships in lockdown. Nat Rev Urol. 2020;17(10):547-53.



Lopes GP, Vale FBC, Vieira I, da Silva Filho AL, Abuhid C, Geber S. COVID-19 and Sexuality: Reinventing Intimacy. Arch Sex Behav. 2020;49(8):2735-8.


PMid:32696154 PMCid:PMC7373209

Pascoal PM, Carvalho J, Raposo CF, Almeida J, Beato AF. The Impact of COVID-19 on Sexual Health: A Preliminary Framework Based on a Qualitative Study With Clinical Sexologists. Sex Med. 2021;9(1):100299.


PMid:33482611 PMCid:PMC7837091

Alavinia SE, Lamir AR, Khajei R, Barjaste Yazdi A. Effect of Cardiac Rehabilitation Program Based on Combined Training on VEGF/Endostatin Gene Expression Ratio in Patients with Acute Coronary Syndrome. Journal of Medical Council of Iran. 2020;38(3):187-93.

Ranjbaran M, Chizari M, Matori Pour P. Prevalence of female sexual dysfunction in Iran: Systematic review and Meta-analysis. Journal of Sabzevar University of Medical Sciences. 2016;22(Special Issue):1117-25.

Haji Mohammad Hoseini M, Ghanbari Afra L, Ghanbari Afra M, Goudarzi Rad M. Impact of Self-care Educational Program on Sexual Function among Ischemic Heart Disease Patients. Journal of Vessels and Circulation. 2020;1(1):13-8.


Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208.



Ryding EL, Blom C. Validation of the Swedish version of the Female Sexual Function Index (FSFI) in women with hypoactive sexual desire disorder. J Sex Med. 2015;12(2):341-9.



Mohammadi K, Heydari M, Faghihzadeh S. The female sexual function index (FSFI): validation of the Iranian version. Payesh. 2008;7(3):269-78.

Arip M. The effect of REBT Structured Group Counseling towards the psychology aspects of adolescents of divorced parent. Advances in Environmental Biology. 2016;10(4):44-50.

Wijayanti A, Sugiharto DYP, Wibowo ME. The effectiveness of rational emotive behavior therapy (rebt) group counseling to reduce cheating behavior. Jurnal Bimbingan Konseling. 2019;8(2):102-7.

Zahrakar K, Kasaee A. The Effectiveness of Training Based on Rational-Emotional-Behavioral Therapy on Career Decision-Making Self-Efficacy. International Clinical Neuroscience Journal. 2019;6(2):69.


Şahin E, Güleç Keskin S, Terzi M. The effect of a psychoeducation program based on the rational emotional behavioral approach in individuals with multiple sclerosis diagnosis: A randomized controlled trial. Perspect Psychiatr Care (in press). 2021.



Grove AB, Kurtz ED, Wallace RE, Sheerin CM, Scott SM. Effectiveness of a Rational Emotive Behavior Therapy (REBT)-Informed Group for Post-9/11 Veterans with Posttraumatic Stress Disorder (PTSD). Mil Psychol. 2021;33(4):217-27.


PMid:34334948 PMCid:PMC8324018

Kabadayi F, Yuksel G. Rational-Emotive Behavior Therapy for Dysfunctional Anger: A Case Study. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 2021;39(4):522-37.


Sommers-Flanagan J, Sommers-Flanagan R. Counseling and psychotherapy theories in context and practice: Skills, strategies, and techniques. 3rd Edition. John Wiley & Sons; 2018.

Abrams M. REBT and sexual problems. In: Dryden W, Bernard ME. REBT with diverse client problems and populations. Springer Cham; 2019. p. 127-47.


Moon JR, Huh J, Song J, Kang IS, Park SW, Chang SA, et al. The effects of rational emotive behavior therapy for depressive symptoms in adults with congenital heart disease. Heart Lung. 2021;50(6):906-13.



Murphy PJ, Mc Sharry J, Casey D, Doherty S, Gillespie P, Jaarsma T, et al. Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention. BMJ Open. 2016;6(6):e011219.


PMid:27342240 PMCid:PMC4932312

Grieger R, Alexander KA. REBT with couples. In: Dryden W, Bernard ME. REBT with diverse client problems and populations. Springer Cham; 2019. p. 265-82.


Farzandipour M, Farkhian A, Nabovati E, Mir AK, Anvari Tafti S, Rajabi Moghadam H. Smartphone-based application for training outpatient cardiac rehabilitation: Design and usability evaluation. Koomesh. 202;22(4):686-95.


Farajkhoda T, Ashrafi F, Bokaie M, Zareei Mahmoodabadi H. Online Compared to Face-to-Face Sexual Intimacy Enhancement Training Program Counseling with Cognitive-Behavioral Approach on Sexual Intimacy in Pregnant Women. J Sex Marital Ther. 2021;47(5):446-59.



Raisi M, Jahan F, Moazedian A. Comparison the Effectiveness of Online Text Messenger-Based Cognitive-Behavioral Therapy and Telephone-Based Cognitive-Behavioral Therapy on Persistent Depression Desorder. Rooyesh-e-Ravanshenasi Journal (RRJ). 2021;10(5):139-50.

Bagheri I, Memarian R, Hajizadeh E, Pakcheshm B. The effect of sex education on patients and their spouses satisfaction after myocardial infarction. Jorjani Biomed J. 2014;2(1):46-0.

How to Cite
Farajkhoda , T., Memar, F. Z., Khanabadi, M., & Sarebanhassanabadi, M. (2022). Effectiveness of Online Versus Telephone Counseling of Rational-Emotional-Behavioral Therapy on Sexual Function of Women Undergoing Cardiac Rehabilitation: A Randomized Clinical Trial. Galen Medical Journal, 11, 2396. https://doi.org/10.31661/gmj.v11i.2396
Original Article