Emotion-focused group therapy among women with premenstrual dysphoric disorder: A randomized clinical trial

A brief package of tele-sexual counseling based on Islamic emotion-focused therapy versus tele-sexual health education on sexual intimacy in pregnant women: A randomized clinical trial

BACKGROUND

Physical and emotional changes in pregnancy may reduce sexual intimacy. Pregnant women need empowerment through short-term cultural-based interventions regarding sexual intimacy for better expression of sexual beliefs and expectations. Since studies are limited regarding Islamic emotion-focused therapy (IEFT), this study was conducted to compare the effect of tele-sexual counseling (IEFT) versus tele-sexual health education on sexual intimacy in pregnant women.

MATERIALS AND METHODS

A parallel randomized clinical trial was conducted among 52 pregnant women with gestational age at least 20-24 weeks through convince sampling referred to Amir Social Welfare Clinic, who were randomly assigned into two groups (each group = 26 women). The intervention group received online six weekly IEFT, and the control group participated in online sexual health education. Primary outcome sexual intimacy was measured via Botlani's sexual intimacy questionnaire at baseline, end of intervention at week 6, and follow-up at week 10. Secondary outcome satisfaction was assessed via a satisfaction scale at weeks 6 and 10 of the intervention. Data were analyzed using Mann-Whitney, the T-test, the analysis of variance, and repeated measures in SPSS.

RESULTS

Sexual intimacy was not significantly different between the two groups at baseline. Sexual intimacy was significantly high in the intervention group in weeks 6 (intervention group: 83.12 ± 5.22 versus control group: 70.62 ± 4.42) (P < 0.001) and 10 (intervention group: 84.08 ± 5.03 versus control group: 70.54 ± 4.37) (P < 0.001). Satisfaction in week 6 was 52.38 ± 10.48 in the intervention group versus 42.69 ± 10.98 in the control group (P = 0.001), and at week 10, it was 55.58 ± 10.71 in the intervention group versus 45.12 ± 11.56 in the control group (P = 0.001), with more satisfaction in the intervention group.

CONCLUSION

Both short-term tele-interventions, IEFT or sexual health, improved sexual intimacy and satisfaction, but Islamic EFT was significantly superior. It seems women need cultural-religious-based interventions such as IEFT to facilitate positive sexual relationship changes, assertiveness in sexual emotion expression, and compassion through the sharing of skills with the husband that can continue individually even after intervention. The study findings can be applied to midwifery education, prenatal care booklets, couple and sex counselors and therapists, and other health care providers.

Emotion-focused therapy for women with premenstrual dysphoric disorder: a randomized clinical controlled trial

BACKGROUND

Premenstrual dysphoric disorder (PMDD) is a debilitating condition, affecting women of reproductive age. It is characterized by severe periodic physical and psychological symptoms, which end after the onset of menstruation. This study aimed to evaluate the effectiveness of emotion-focused therapy (EFT) for PMDD patients.

METHODS

A total of 48 PMDD women, in the age range of 18-44 years, were randomly assigned to two intervention and control groups. The intervention group participated in 16 weeks of EFT treatment, while the control group was selected based on the waiting list (waitlist control group) and followed-up after three months. Forty-four patients finally completed this study. The participants completed the Premenstrual Syndrome Screening Tool (PSST), Difficulties in Emotion Regulation Scale (DERS), and Depression Anxiety Stress Scale-21 (DASS-21) in the first premenstrual period before treatment, the first premenstrual period after treatment, and the premenstrual period three months after treatment.

RESULTS

Based on the repeated measure analysis of variances, the total score of DERS and the total score of PSST decreased significantly (P < 0.05). Also, in DASS-21, the scores of depression and stress subscales reduced significantly (P < 0.05), while there was no significant decrease in the score of anxiety subscale (P > 0.05).

CONCLUSION

Based on the present results, EFT can be an effective treatment for alleviating the symptoms of PMDD. This treatment can reduce the emotion regulation difficulties of women with PMDD and alleviate the symptoms of depression and stress.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials, IRCT ID: IRCT20220920055998N1, Registered on: 12/2/2023.

Management of Premenstrual Dysphoric Disorder: A Scoping Review

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account. Reprinted from Int J Womens Health 2022; 14:1783-1801, with permission from Dove Medical Press Ltd. Copyright © 2022.

Diagnostic validity of premenstrual dysphoric disorder: revisited

The World Health Organization (WHO) and American Psychiatric Association (APA) have recognised premenstrual dysphoric disorder (PMDD) as an independent diagnostic entity, legitimising the distress and socio-occupational impairment experienced by affected women. However, the biological validity of this diagnosis remains inexplicit. This illness has also been criticised for a feminist-led, sympathetic reaction to the modern cultural challenges of urban, literate, employed, high-functioning women. This article systematically reviews existing literature on PMDD using the criteria established by Robins and Guze for the validity of a psychiatric diagnosis (clinical description, laboratory study, exclusion of other disorders, follow-up study, and family study). Despite the early recognition of premenstrual syndrome (PMS) in the 1950s, the research has encountered challenges due to two groups of proponents viewing it with psychologising bias and medicalising bias. PMDD is currently understood as the most severe form of PMS, characterised by the presence of psychological features. Recent evidence suggests that PMDD perhaps has neurodevelopmental underpinnings (attention deficit hyperactive disorder, adverse childhood experiences) affecting the fronto-limbic circuit that regulates the emotions. In addition, the affected individuals exhibit an increased sensitivity to gonadal hormonal fluctuations as observed during premenstrual, pregnancy, and perimenopausal phases of life. The prevalence is comparable between high-income countries and low- and middle-income countries (LAMIC), refuting the notion that it mostly affects modern women. Instead, a greater prevalence is observed in LAMIC. Despite the fact that educated women possess knowledge regarding the importance of getting help, there is a prevalent issue of inadequate help-seeking behaviour. This can be attributed to the perception of seeking help as an isolating experience, which is influenced by profound internalised stigma and discrimination in the workplace. Future studies must aim to develop culturally validated assessment tools and more research to understand the life course of the illness, in addition to systematically examining for more biological validators (animal models, genetics, imaging, neurotransmitters).

The effectiveness of dialectical behavior group therapy on stress, depression, and cognitive emotion regulation in mothers of intellectually disabled students: A randomized clinical trial

INTRODUCTION

This study aimed to evaluate the effectiveness of dialectical behavior group therapy (DBGT) regarding stress, depression, and cognitive emotion regulation in mothers of intellectually disabled students.

MATERIAL AND METHODS

This was an experimental study with a pretest-posttest design and a control group. The statistical population included 133 mothers with intellectually disabled children divided into wait-list control and experimental groups. Then, DBGT was performed on the treatment subjects. Data collection tools included the Emotion Regulation Questionnaire, Beck Depression Inventory-II, Depression-Anxiety-Stress Scale, Clinical Global Improvement Scale, Client Satisfaction Questionnaire, and Working Alliance Inventory-Short Form. A p-value less than 0.05 was considered statistically significant.

RESULTS

A significant difference in depression, stress, and cognitive emotion regulation was observed between the intervention and control groups (p < 0.001). In the post-test, the adjusted mean of depression and stress in the intervention group showed a significant decrease compared to the control group mothers. Also, cognitive reappraisal, expressive suppression, and total cognitive emotion regulation scores increased following DBGT. Participants in DBGT had a good therapeutic relationship, were satisfied with the treatment, and showed notable improvements.

CONCLUSION

The results indicated that DBGT might affect stress, depression, and cognitive emotion regulation in mothers of intellectually disabled students.

Management of Premenstrual Dysphoric Disorder: A Scoping Review

Premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS) refer to physical, cognitive, or affective symptoms that arise in the late luteal phase and remit with menses. The present work is a clinically focused scoping review of the last twenty years of research on treatment for these disorders. A search of key terms using the PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases was performed, and 194 studies of adult women met initial inclusion criteria for review. Research studies concerning medications, pharmacological and non-pharmacological complementary and alternative medicine treatments, and surgical interventions with the most available evidence were appraised and summarized. The most high-quality evidence can be found for the use of selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs), with gonadotropin releasing hormone (GnRH) agonists and surgical interventions showing efficacy for refractory cases. While there is some evidence of the efficacy of alternative and complementary medicine treatments such as nutraceuticals, acupuncture, and yoga, variability in quality and methods of studies must be taken into account.

Cognitive behavioural group therapy for insomnia (CBGT-I) in patients undergoing haemodialysis: a randomized clinical trial

Background:

Given the many complications of drug therapy, it seems reasonable to use non-pharmacological therapies that can improve mental and physical disorders in haemodialysis patients.

Aims:

This study aims to determine the effectiveness of cognitive behavioural group therapy for insomnia (CBGT-I) in sleep quality, depression, anxiety and general psychological health of haemodialysis patients.

Method:

This randomized clinical trial was conducted on 116 haemodialysis patients who were randomly assigned to experimental (n=58) and control (n=58) groups. In the experimental group, CBGT-I was provided during nine weekly sessions. Data collection tools included Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II (BDIII), Beck Anxiety Inventory (BAI), General Health Questionnaire (GHQ-28), Clinical Global Improvement Scale (CGI), Client Satisfaction Questionnaire (CSQ) and Working Alliance Inventory-Short Form (WAI-S). Data were analysed by SPSS-25 and p<.05 was considered significant.

Results:

The findings demonstrated that CBGT-I compared with control group was effective in improving sleep quality (p<.001, η2=.790), depression (p<.001, η2=.616), anxiety (p<.001, η2=.682) and general psychological health (p<.001, η2=.871). Participants of CBGT-I showed notable improvements as a result of the treatment, were satisfied with treatment, and had a good therapeutic relationship.

Conclusions:

CBGT-I is effective in reducing depression and anxiety in addition to improving sleep quality and general psychological health in haemodialysis patients. Therefore, it is recommended to be used as a complementary treatment for these patients.