The effects of rational-emotive therapy and relaxation training on premenstrual syndrome: A preliminary study

Short report: cognitive behavioral therapy - a primary mode for premenstrual syndrome management: systematic literature review

Most women in reproductive age experience at least one premenstrual syndrome (PMS) symptom every month over many years, and about 5% experience significant impairment, requiring professional intervention. Offering effective and sustainable treatment, is essential. While research acknowledges the effectiveness of nonpharmacological methods, cognitive behavioral therapy (CBT) and lifestyle modifications, as a treatment alternative, selective serotonin reuptake inhibitors or hormonal ovulation suppression continue to be recommended as a first-line treatment. We hypothesize that nonpharmacological methods will be sufficient for effective and sustainable PMS management. A systematic literature review was conducted for peer-reviewed original studies with the search terms: CBT, psychoeducation, PMS and premenstrual dysphoric disorder. All 32 identified studies found a significant reduction in PMS to complete remission with nonpharmacological interventions. No side effects were reported, and positive effect was sustained over time. Psychoeducational self-help packages, delivered with the affordance of modern technology, appeared to be enough for most women to manage successfully their PMS distress. Most severe PMS forms required one-to-one CBT. Nonpharmacological methods can be recommended as the primary mode for PMS management. More high-quality research is required, for developing personalized self-help packages, as well as the full use of modern technology for delivering the service.

Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial

DESIGN

A randomised control trial (RCT) was conducted to examine the efficacy of couple-based cognitive behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait-list control.

METHODS

Triangulation of quantitative and qualitative outcome measures evaluated changes pre-post intervention. Eighty three women were randomly allocated across three conditions, with 63 completing post-intervention measures, a retention rate of 76%.

RESULTS

Repeated measures analysis of variance found a significant time by group interaction identifying that women in the two CBT conditions reported lower total premenstrual symptoms, emotional reactivity/mood, and premenstrual distress, in comparison to the wait list control. Significantly higher active behavioural coping post-intervention was found in the couple condition than in the one-to-one and wait list control groups. Qualitative analysis provided insight into the subjective experience of PMDs and participation in the intervention study. Across groups, women reported increased awareness and understanding of premenstrual change post-intervention. A larger proportion of women in the CBT conditions reported reduction in intensity and frequency of negative premenstrual emotional reactivity, increased communication and help-seeking, increased understanding and acceptance of embodied change, and the development of coping skills, post-intervention. Increased partner understanding and improved relationship post-intervention was reported by a greater proportion of participants in the CBT conditions, most markedly in the couple condition.

CONCLUSION

These findings suggest that one-to-one and couple CBT interventions can significantly reduce women's premenstrual symptomatology and distress, and improve premenstrual coping. Couple based CBT interventions may have a greater positive impact upon behavioural coping and perceptions of relationship context and support. This suggests that CBT should be available for women reporting moderate-severe PMDs, with couple-based CBT offering additional benefits to a one-to-one modality.

The Effects of Mindfulness-Based Cognitive Therapy on Depression and Anxiety in Women with Premenstrual Syndrome

Objective. Little research has been done regarding the role of psychotherapy in the treatment of Premenstrual Syndrome (PMS). The aim of this study was to examine the effect of mindfulness-based cognitive therapy (MBCT) on the PMS symptoms and depression and anxiety symptoms in women with PMS. Design. In a randomized controlled trial, a total of 60 students at Mazandaran University with mild to moderate PMS who had depressive symptoms (Beck depression scores 16-47) were randomly allocated to either an experimental (n = 30) or a control (n = 30) group. The experimental group received MBCT in eight group sessions (120 min each) over 8 weeks. The control group received no intervention. All participants completed the Premenstrual Assessment Scale (PAS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) at the beginning and the end of the study. Repeated-measure ANOVA was used to analyze the data. Results. At the end of study, the experimental and control groups showed the following scores, respectively (mean ± SD): depression, 15.73 ± 6.99 and 25.36 ± 7.14; anxiety, 16.96 ± 7.78 and 26.60 ± 9.38; and total PAS, 42.86 ± 8.02 and 58.93 ± 8.47. MBCT improved depression and anxiety symptoms and total PAS score. Conclusion. MBCT intervention is acceptable and potentially beneficial in women with PMS symptoms. Psychotherapy should be considered as a treatment option for mild to moderate PMS in women with depressive symptoms.

Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review

We systematically reviewed empirical studies that investigated the use of cognitive-behavioral therapy (CBT) for premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). Our multi-database search identified seven published empirical reports. Three were identified as randomized controlled trials (RCTs). The methods utilized to investigate therapeutic efficacy of CBT in these studies varied widely from case reports to RCTs with pharmacotherapy comparison groups. Initially we provide a brief overview of CBT and justifications for its potential use to treat PMS/PMDD. Next, we provide critical evaluations of the analyses used in each study focusing on the detection of intervention effects assessed by statistically significant time by group interactions. When possible we calculate effect sizes to elucidate the clinical significance of results. Our review revealed a dearth of evidence providing statistically significant CBT intervention effects. Issues such as overall time investment, latency to treatment effects, and complementary and combined therapies are considered. We present a theoretical argument for applying mindfulness- and acceptance-based CBT interventions to PMS/PMDD and suggest future research in this area. In conclusion, to produce the necessary evidence-base support for PMS/PMDD given the limited empirical evidence reported here, researchers are called on to produce methodologically rigorous investigations of psychosocial interventions for PMS/PMDD.

Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: a randomized clinical trial, posttreatment outcomes, and six-month follow-up

A randomized clinical trial was undertaken to investigate the relative efficacy of rational-emotive behavior therapy (REBT), cognitive therapy (CT), and pharmacotherapy in the treatment of 170 outpatients with nonpsychotic major depressive disorder. The patients were randomly assigned to one of the following: 14 weeks of REBT, 14 weeks of CT, or 14 weeks of pharmacotherapy (fluoxetine). The outcome measures used were the Hamilton Rating Scale for Depression and the Beck Depression Inventory. No differences among treatment conditions at posttest were observed. A larger effect of REBT (significant) and CT (nonsignificant) over pharmacotherapy at 6 months follow-up was noted on the Hamilton Rating Scale for Depression only.

An integrative medicine approach to premenstrual syndrome

Complementary and alternative medicine (CAM) approaches are widely used by women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This article provides a comprehensive review of the medical literature on clinical applications of CAM for these conditions. The information was collected via a Medline review dating back to 1966 and subsequent selected review of bibliographies from these articles for non-Medline referenced but relevant clinical studies. For many of the therapies discussed, there is a lack of conclusive evidence either confirming or refuting efficacy. For other therapies, including certain herbal and nutritional approaches, the use of exercise, and the use of mind-body approaches, there is substantial evidence of efficacy. This review will be relevant to the practicing clinician seeking to become aware of and to understand the relevance of the complementary/alternative therapies being used by his/her patients for PMS and PMDD.

Relationship between the NEO personality inventory revised neuroticism scale and prospectively reported negative affect across the menstrual cycle

Previous research has suggested a possible link between neuroticism and premenstrual symptom changes. Results, however, are difficult to interpret given methodological problems such as retrospective reporting of premenstrual symptoms, and failure to control for the generalized influence of neuroticism on psychosomatic symptomatology. The present study aimed to address these issues. One hundred and nine women from the general population completed the modified Menstrual Distress Questionnaire daily for 70 days. Neuroticism was assessed using the NEO Personality Inventory Revised. Neuroticism accounted for a significant amount of variation in premenstrual negative affect both before and after controlling for baseline (follicular) symptom levels. The relationship between neuroticism and premenstrual negative affect could not be linked to any particular facet of neuroticism (e.g. anxiety, depression). Oral contraceptive (OC) users had significantly higher levels of neuroticism than the non-oral contraceptive (NOC) group. A significant interaction between OC use and menstrual cycle phase was also noted, with a trend toward OC users experiencing less premenstrual, but more menstrual, negative affect compared with the NOC group. The results are discussed in terms of the contribution of personality factors to the etiology of premenstrual change, and the utility of cognitive-behavioral treatment approaches.

Relationships between catastrophic thoughts, perceived control and distress during menopausal hot flushes: exploring the correlates of a questionnaire measure

OBJECTIVES

Many studies have established that highly negative or catastrophic thoughts about chronic health problems such as pain are associated with greater distress, lower self-efficacy for dealing with the problem and depressed mood. This study examined whether highly negative (or 'catastrophic') appraisals of hot flush experiences were associated with greater distress and lower perceived control regarding this menopausal problem.

DESIGN

A postal survey was carried out, with a follow-up 12 months later.

METHODS

Two questionnaires were initially completed by a volunteer sample of 61 women currently experiencing hot flushes. A mixture of qualitative and quantitative data were collected, including a Catastrophic Thoughts Questionnaire (CTQ) measure of catastrophic thoughts, based in part on Rosenstiel AK and Keefe FJ. The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 1983;17:33-44. Thirty nine women who continued to report hot flushes were followed up 12 months later.

RESULTS

Ratings to each item of the CTQ were highly intercorrelated. Women reporting more catastrophic thoughts tended to be lower in perceived control over flushes. Respondents' reported distress during hot flushes was more closely related to their frequency of negative thoughts about the problem, than to perceived control, flush chronicity or daily frequency of flushes. Over 12 months, respondents showed a highly stable pattern of catastrophic thoughts, and continued links with levels of distress during flush episodes.

CONCLUSIONS

Cognitive appraisal processes that undermine coping with other chronic health problems seem also relevant to understanding the distress triggered by intermittent, unpredictable flush episodes. The findings imply that women may develop improved tolerance for menopausal flushing through challenging negative interpretations of the experience.

Effectiveness of professional--peer group treatment: symptom management for women with PMS

The purpose of this intervention study was to determine short- and long-term effectiveness of a symptom management intervention aimed at relieving the distress associated with premenstrual syndrome (PMS). The PMS Symptom Management Program (PMS-SMP), a package of nonpharmacological strategies involving self-monitoring, personal choice, self-regulation, and self/environmental modification, was administered within a group combining peer support and professional guidance to 91 women classified with severe PMS (early treatment groups n = 40; waiting treatment groups n = 51). Repeated behavioral measures (symptom severity and personal resources/demands) were obtained on five occasions: two menstrual cycles prior to treatment and at 3, 6, 12, and 18 months after treatment. A package of symptom management strategies was effective in reducing PMS severity by 75%, premenstrual depression, and general distress by 30-54%, as well as increasing well-being and self-esteem in women experiencing severe PMS. These results compare favorably with antidepressant drug treatment studies that report a 40-52% reduction in PMS severity. The most marked improvement was found in the first 3 months after treatment; however, improvement was maintained or enhanced in the long-term follow-up. Although focused on perimenstrual symptom relief, these strategies are generally health promoting and can be applied to other women's health conditions.

The efficacy of cognitive behaviour therapy in treating premenstrual dysphoric changes

This study assesses the efficacy of cognitive behaviour therapy (CBT) in treating premenstrual dysphoric changes. The CBT condition (n = 24) aimed to modify dysfunctional thinking as a means of impacting on negative premenstrual symptoms and changes. The components of CBT were cognitive restructuring and assertion training. A comparison condition called 'information-focused therapy' (IFT) (n = 9) aimed to present information only and did not address belief restructuring. The components were relaxation training, nutritional and vitamin guidelines, dietary and lifestyle recommendations, aspects of child management training and assertion training. Results indicated that the amelioration of anxiety, depression, negative thoughts and physical changes can be effectively addressed by either CBT or IFT. The extent to which a women's belief system is critical in the experience of premenstrual distress requires further empirical investigation.

Coping styles in women with premenstrual syndrome

Sixty-five women with a prospectively confirmed diagnosis of premenstrual syndrome (PMS) were subdivided on the basis of their scores on the Beck Depression Inventory (BDI) into high-depression and low-depression groups and compared with 49 non-PMS control women on self-administered measures of coping and anxiety. The high-depression PMS group was found to utilize significantly more avoidant coping styles in dealing with stressors independent of the premenstrual phase. Implications for treatment are discussed.

Premenstrual symptoms: the role of irrational thinking

104 women, between the ages of 18 and 45 years, were surveyed to investigate the relationship between premenstrual symptomatology, as measured by the Modified Menstrual Distress Questionnaire, and irrational thinking, as measured by the General Attitude and Belief Scale. The women who reported greater premenstrual symptomatology also reported significantly higher scores in the "need for comfort" irrationality subscale. This indicated that these women had particular difficulty dealing with hassles and the resulting feelings of tension and irritability in the premenstruum. It was suggested that the absence of significant effects for other rationality-irrationality subscales could be associated with testing at different times during the menstrual cycle. Irrationality, like other conditions (such as anxiety and depression) prevalent in the premenstruum, could change in intensity across phases of the menstrual cycle.

Relationship between anxiety and premenstrual syndrome

The relationship between symptoms of the premenstrual syndrome and anxiety was assessed for 68 women. The syndrome as measured by a modified version of the Moos Menstrual Distress Questionnaire, was correlated significantly with trait anxiety, as measured by Spielberger's State-Trait Anxiety Inventory. Trait anxiety was correlated with all three subtypes from the questionnaire: behavioral, psychological, and physical, most strongly for the psychological subtype. These findings suggest a role for stress-management training in the treatment of the premenstrual syndrome.