Therapy

Cognitive-behavioral therapy (CBT) is proving to be very effective in reducing PMS symptoms and improving functioning. In one study of women who had undergone an intensive behavioral program, PMS symptoms were reduced by 75%, and well-being and self-esteem increased. Improvement was most significant in the first 3 months of treatment, but some benefits persisted.

Several cognitive-behavioral strategies are being investigated for PMS. Techniques include:

• Identifying sources of stress
• Restructuring priorities
• Reframing perception of menstruation as a positive experience
• Defining and practicing methods for managing and reducing stress

The benefits of CBT are comparable to antidepressants.

Identifying Sources of Stress

Step 1. The Daily Diary. Oftentimes, women do not recognize that the decline in their mood and the premenstrual phase coincide. Keeping a diary can help. It is useful to start the process of stress reduction with an informal record of daily events and activities tracked by days of the menstrual cycle. While this exercise might itself seem stress-producing, it need not be done in painstaking detail. A few words accompanying a time and date will usually be enough to serve as reminders of significant events or activities.

Negative experiences should be noted such as:

• Those that put a strain on energy and time
• Those that trigger anger or anxiety
• Those that precipitate a negative physical response (such as a sour stomach or headache)

Positive experiences should also be noted, including:

• Those that are mentally or physically refreshing
• Those that produce a sense of accomplishment

Step 2. Questioning the Sources of Stress. After reviewing the diary, women should try to identify two or three events or activities that have been significantly upsetting or overwhelming during the premenstrual phase. Priorities and goals should then be carefully examined. Women should ask themselves the following questions:

• Do the stressful activities meet my own goals or someone else's?
• Have I taken on tasks that I can reasonably accomplish?
• Which tasks are in my control and which ones aren't, specifically during the premenstrual phase?

Restructuring Priorities

The next step is to attempt to shift the balance from stress-producing to stress-reducing activities. While it is impossible to completely eliminate stress, there are ways to reduce its impact. In most cases, small daily decisions for improvement can accumulate and work to reconstruct a stressed existence into a pleasant and productive one.

Planning ahead for pleasurable activities during the premenstrual phase may be specifically helpful. In fact, adding pleasurable events has more benefit than simply reducing stressful or negative ones. (Studies suggest that daily pleasant events even have positive effects on the immune system and help protect health.)

Making time for recreation is as essential as paying bills or shopping for groceries. Many people are afraid of being perceived as selfish if they make decisions that benefit only themselves. The truth is that self-sacrifice may be inappropriate and even damaging if the person making the sacrifice is unhappy, angry, or physically unwell as a result.

Keep Perspective

Learning to focus on positive outcomes during the premenstrual phase helps to reduce tension levels. Negative feelings not only foster hostility but also hamper people from achieving goals. Some of the following may be helpful:

• Keep in mind that the premenstrual phase will end.
• Try to be conscious of the difference between negative emotions and thoughts that occur during the premenstrual phase and those that occur outside it.
• Envision undertaking activities during other times of the month when symptoms are not as severe.
• Retain as much of a sense of humor as you can. Laughing releases the tension of pent-up feelings and helps keep perspective. Research has shown that humor is a very effective coping mechanism for acute stress.