Research Article: 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

Date Published: April 18, 2017

Publisher: Public Library of Science

Author(s): Jane M. Ussher, Janette Perz, Maria Kleinstaeuber.


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.

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%.

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.

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.

Partial Text

Premenstrual change is experienced by up to 90% of women, with up to 40% experiencing moderate distress, categorised by clinicians and researchers as Premenstrual Syndrome (PMS) [1], and 2–5% experiencing severe distress and disruption to their lives, categorised as Premenstrual Dysphoric Disorder (PMDD) [2]. Recognition of the continuum of premenstrual distress, and overlap between the diagnostic categories PMS and PMDD, has led to the adoption of the term ‘Premenstrual Disorders’ (PMDs) by an expert advisory panel [3]. PMDs include emotional and behavioural symptoms that have a significant impact on a woman’s quality of life during the premenstrual phase of the cycle, but are absent after menstruation and before ovulation. The symptoms most commonly reported include irritability, depression, mood swings, anxiety, concentration difficulties, feelings of loss of control and tiredness, often combined with physical symptoms such as bloating, breast tenderness, headache and general body aches [4].

This study examined the relative efficacy of a couple CBT for PMDs in comparison with a one-to-one CBT therapy, and a wait list control group. There were no pre-intervention differences between the three groups, suggesting that they were comparable in meeting the criteria for PMDs, experiencing high premenstrual distress, moderate-low levels of premenstrual coping, and mild anxiety. Levels of depression, relationship adjustment and self-silencing were in the normal range across groups. The finding of significant differences across time when the groups are collapsed (ignoring the intervention group assignment), confirms previous reports [10, 13, 14] that taking part in an intervention for PMDs can reduce psychological premenstrual symptoms and premenstrual distress [15, 16, 18, 20, 72, 73]. We also found significant reductions in depression, anxiety and self-silencing, and improvements in premenstrual coping, suggesting that taking part in the intervention also had a positive impact on women’s psychological wellbeing, her relationship communication strategies and on their ability to address premenstrual change.




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