by Liisa Hantsoo, Ph.D.
By Liisa Hantsoo, Ph.D.
While millions of women worldwide experience premenstrual dysphoric disorder (PMDD) [1], surprisingly there are no manualized psychotherapy treatments specifically for PMDD. Manualized treatments are the gold standard in psychotherapy, and have been developed for disorders ranging from major depressive disorder (MDD) [2,3] to specific phobias [4]. A manualized treatment is an evidence-based psychotherapy protocol that has been established as effective via randomized clinical trials. Often, manualized treatments are based in cognitive behavioral therapy (CBT), a form of therapy that focuses on connections among a person’s cognitions, behaviors, and emotions.
A new study from researchers in Germany and Sweden has looked at a CBT intervention specifically for women with PMDD [5]. The CBT protocol, called Praemensis, included typical cognitive-behavioral techniques such as identifying dysfunctional automatic thoughts, with lifestyle changes such as exercise and nutrition. A novel aspect of this therapy was that it was internet-based. Internet-based CBT (iCBT) is an emerging trend in mental healthcare, and allows patients to access psychotherapy online, regardless of barriers such as geography or perceived stigma. iCBT has been studied for adults with depression [6], anxiety [7], and even women with mental health concerns in the perinatal period [8,9]. This was the first study to look at iCBT for PMDD. The Praemensis program comprised an 8-week protocol of 14 internet modules that included education about PMDD, CBT techniques, and lifestyle modification, along with weekly email check-ins from a psychologist.
The study included nearly 200 women with PMDD, half of whom received the Praemensis intervention and half who were in a control group. After the 8-week treatment, a majority of women experienced improvement in PMDD symptoms, including less intense symptoms, less impact of symptoms on daily functioning, and less functional impairment. This study is an important step toward developing a manualized treatment for PMDD, which has unique symptoms that may not be fully addressed by existing manualized treatments. The study also emphasizes the potential utility of internet-based psychotherapy, particularly for a disorder such as PMDD for which there is a shortage of qualified providers. Finally, CBT or iCBT would provide women with PMDD an alternative to selective serotonin reuptake inhibitors (SSRIs), which are the first-line treatment approach for PMDD [10].
References
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3. Gilson M, Freeman A, Yates MJ, Freeman SM. Overcoming Depression: A Cognitive Therapy Approach: Therapist Guide [Internet]. Oxford University Press; [cited 2019 Feb 26]. Available from: http://www.oxfordclinicalpsych.com/view/10.1093/med:psych/9780195300000.001.0001/med-9780195300000
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5. Weise C, Kaiser G, Janda C, Kues JN, Andersson G, Strahler J, et al. Internet-Based Cognitive-Behavioural Intervention for Women with Premenstrual Dysphoric Disorder: A Randomized Controlled Trial. Psychother Psychosom. 2019;1–14.
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