Woman rubbing neckMost women have experienced some symptom of premenstrual discomfort at one point or another—whether it be bloating, aches and pains, breast tenderness, fatigue, tension, headaches, or sleep, eating, and/or mood disturbances. By some estimates, up to 80% of women experience at least one symptom with some regularity. For approximately 5% of women, however, symptoms are severe enough to meet criteria for premenstrual dysphoric disorder, or PMDD.

PMDD can lead to impaired functioning and quality of life during the last week of the menstrual cycle and until about 4 days after menstruation has begun. Significant anxiety, depression, and irritability are commonly reported features of PMDD. Women with either premenstrual syndrome (PMS) or PMDD frequently seek relief in one or a combination of over-the-counter medications, a prescription, or natural remedies, but too often relief is elusive.

What Causes PMS and PMDD?

Although at present there is no definitive understanding of why some develop these syndromes and others do not, a woman’s body undergoes a number of hormonal changes throughout her cycle. It is thought that disruptions in these processes may lead to the above symptoms. Specifically, disruptions in the hormone progesterone as well as in neurotransmitters (chemicals in the brain), such as serotonin and gamma-aminobutyric acid (GABA), and the stress hormone cortisol, may be responsible for PMS or PMDD.

There has also been research examining the roles of calcium and magnesium in these conditions because both minerals vary with the menstrual cycle; however, it is not entirely clear whether imbalances in calcium and magnesium directly cause PMS/PMDD. Although there is not enough data to establish a causal relationship, being sedentary, consuming large amounts of caffeine, sugar, and alcohol, and being very stressed are among the factors associated with having PMS.

Mental, Physical, or Both?

Many women with PMDD also meet criteria for major depressive disorder or seasonal affective disorder, and some have panic or other symptoms of anxiety that are quite severe. It is important to note that although PMDD is included in the Diagnostic and Statistical Manual of Mental Disorders, it is a condition that has a physiologic basis, even though it may include psychiatric symptoms or coexist with other psychiatric disorders.

[fat_widget_left]What’s a Woman to Do?

There are a number of natural remedies that are commonly used for PMS or PMDD symptoms, including chasteberry (also known as Vitex or Monk’s Pepper), evening primrose oil, saffron, St. John’s wort, soy, B6, calcium, and magnesium. Only a few of these remedies have sufficient evidence to support their use at this time, however. These include:

Discuss any herbal or vitamin supplements you take with your doctor to make sure these are appropriate for you and that they will not interfere with other supplements or medications you may be taking.

In addition to the above, the following lifestyle changes are recommended:

It goes without saying that if you have premenstrual symptoms that make it hard to do the things you want and need to do, see your gynecologist for an accurate diagnosis. He/she can help rule out other physical or psychological syndromes that may appear similar to PMS or PMDD. If your mood symptoms are severe (e.g., you experience panic or disabling anxiety, feelings of hopelessness, or suicidal thoughts), seek professional help immediately.

For more information, consult the following:

References

  1. Pearlstein, T., & Steiner, M. (2008). Premenstrual dysphoric disorder: burden of illness and treatment update. Journal of Psychiatry & Neuroscience, 33(4): 291–301.
  2. Whelan, A. M., Jurgens, T. M., & Naylor, H. (2009). Herbs, vitamins, and minerals in the treatment of premenstrual syndrome: a systematic review. Canadian Journal of Clinical Pharmacology, 16(3), e430-e431.

Making a diagnosis of generalized anxiety is sometime a tricky proposition. Anxiety has many manifestations as well as many underlying causes. Anxiety may be chronic and always at the edge of a person’s consciousness or the condition may flare up in acute episodes called panic attacks. Appropriate treatment is essential and typically involves a mix of cognitive-behavioral therapy, pharmaceuticals, and careful follow-up by the treating physician. Xanax (alprazolam) is currently one of the preferred medications for dealing with many anxiety-related psychological illnesses. Anxiety should not be ignored, as the effects of nervous tension and fear include a decrease in quality of life, along with possible secondary effects such as high blood pressure.

Researchers in the Netherlands recently tested a model for understanding the nature of anxiety in humans. At the same time, the experiment highlighted the effectiveness of certain medications at reducing some aspects of anxiety. Specifically, these researchers used the startling effects of white noise and electric shocks to induce surprise or fear in the subjects. In addition to Xanax, subjects were given Lyrica (pregabalin), diphenhydramine (a common sedative ingredient in over-the-counter cold remedies), or placebo. Individual anxiety levels were measured through subjective reporting and a number of objective tests, including eye movements, pupil dilation, and skin conductance. The design of the experiment included random shocks and noises, both with and without prior warning.

As expected, shocking events preceded by a warning produced less anxiety than those that came by surprise. Both Xanax and diphenhydramine reduced overall levels of anxiety but for very different reasons. Whereas Xanax works by altering certain neurotransmitter levels, diphenhydramine has a more general, systemic effect. Surprisingly, subjects given Lyrica showed very little modulation of their anxiety levels. Researchers surmised that because Lyrica takes longer (up to 6 hours) to reach peak effectiveness, the experiment wasn’t capturing an accurate picture of events.

This experiment confirmed that Xanax is effective at reducing one manifestation of anxiety: the so-called “fear-potentiated startle response.” However, the results were less informative about anxiety in general than the researchers had hoped. The sample size was too small to uncover any new revelations about the nature of human anxiety. Ideally, research will one day make the work of quickly and accurately diagnosing anxiety disorders much easier and more straightforward.

References
Baas, J., Mol, N., Kenemans, J. L., Prinssen, E. P., Niklson, I., Xia-Chen, C., et al. (2009). Validating a human model for anxiety using startle potentiated by cue and context: the effects of alprazolam, pregabalin and diphenhydramine. Psychopharmacology, 205, 73-84.

Woman on Balcony Watering PlantScents, Memories, and Emotions

The use of pleasant aromas to enhance well-being dates back thousands of years. Fragrant oils were ceremonially used in the Far East, as well as in ancient Egypt and Greece. Essential oils were extracted from herbs and flowers to create medicines and perfumes, to scent one’s home, and to anoint the ill and deceased.

Smell is considered to be the most poorly understood of our senses, yet most have experienced the powerful ability of familiar scents to trigger emotions and memories of times past, such as people in our lives, places we miss, or particular events, such as the holidays.

Who among us has not passed a restaurant or bakery and been immediately transported to another time when a similar dish or baked good was enjoyed, with all of its emotional accompaniments? Have we not all smelled a particular laundry detergent or perfume and thought of a loved family member or former flame? For some, even less-than-pleasant odors can call to mind a cherished memory. I have heard people say that walking into a faintly damp or musty house reminded them of the fun and friendships of summer camp, even 30 or more years later.

Today, the term aromatherapy refers to the deliberate use of plant-derived oils to enhance physical and emotional health. Although aromatherapy is still considered to lie outside the realm of medically accepted therapies and mainstream psychotherapy, interest in this area has grown substantially over the past few decades. Most of those who use aromas for healing tend to do so as part of a whole-person approach to healthcare, rather than as a stand-alone treatment. When applied thoughtfully, aromas may be incorporated into more “mainstream” healthcare practices with good results.

The Impact of Scents on Stress and Performance: What’s the Evidence?

Research related to the impact of scents, particularly essential oils, on mood has increased since the 1970s. Specifically, there have been several studies on the use of essential oils, such as lavender and rose, as well as other pleasant aromas to reduce stress. Lavender in particular has been shown to reduce self-reports of stress. In some preliminary research,  lavender was also linked to increased peripheral blood flow (an effect associated with relaxation) and a decrease in blood pressure, as well as positive changes in heart rate variability. In another trial, peppermint and lavender essential oils were associated with increased accuracy while proofreading.

The calming benefits of pleasant aromas many not be limited to essential oils, however. In at least two studies, the scent of coconut has been associated with decreased startle response, whereas an unpleasant scent (Limburger cheese) was associated with an increased startle response. A more recent study suggested that exposure to pleasant scent (also coconut) may blunt the body’s response to performing a stressful task and also enhance recovery after the stressor has stopped. It is important to note that most of these studies have had methodological challenges, including small numbers of people participating in the trials. Nonetheless, the results are thought-provoking and may make intuitive sense to those who have experienced subjective benefits from aromatherapy.

Aroma in Psychotherapy

How might this be relevant to the practice of psychotherapy? Pleasant aromas can be paired with relaxation training, such as diaphragmatic breathing, mindfulness practice, hypnotherapy, and biofeedback. Doing so may link the experience of relaxation with the scent sufficiently so that in the future, exposure to the scent alone may be enough to elicit the relaxation response.

In cognitive behavioral therapy, this pairing is referred to as “associative learning” or “higher-order conditioning,” and the goal is for the conditioned stimulus (the scent) to trigger the same response as the biofeedback, breathing, or meditation does.

I have frequently used scent as a therapeutic adjunct during all of the above types of treatments for both children and adults. Many have reported enjoying the use of this tool in session and on their own, eventually noticing that they can more quickly and effectively access a state of calm. Even something like at-home mindfulness practice involves “taking in” and being present with the scent of what one is consuming or doing. This includes experiencing fully the aromas associated with eating, drinking, or walking in nature. Thus, being mindfully present can be “aromatherapeutic” or at least “aroma-aware”—even without deliberately introducing a specific scent.

The at-home use of pleasant aroma can be as simple as adding a few drops of an essential oil to a hand or body lotion or hair conditioner, buying natural laundry or cleaning products that feature relaxing or invigorating essential oils, chewing a stick of peppermint gum while proofreading a term paper, or mindfully sipping a cup of fragrant tea.

Common Sense with Scents

When using scent in psychotherapy, it is important to take into account people’s individual preferences for and aversions to various aromas and be aware of the fact that some dislike using any scent at all. Similarly, it is important to inquire about emotional associations to scents that may be popular but could elicit unpleasant memories (“Ugh! My old boss always wore rose oil!”).

Finally, it goes without saying that one should:

  1. Ask about allergies to any scents
  2. Place undiluted oils on tissue or another object, rather than directly on the person, as many are harmful when applied to the skin at full strength
  3. Educate oneself about the properties associated with different oils before introducing them into the work.

Additional Aromatherapy Resources

Woman with curly hair sitting on therapist's couch with head leaned on hand. Sitting next to her, a female therapist in a grey coat is listening and taking notes on a clipboard.Learning about the stages of healing can be distressing, motivating, upsetting, or uplifting. No matter how you feel, your reaction is not wrong. Acknowledging your emotional response to the stages of healing can allow you to harness your emotions’ energy and reach out to a trained therapist.

When looking for a therapist, it is vital to keep in mind that, regardless of what type of psychotherapy you pursue, your therapist should empower you and welcome you as a collaborator in your therapy, not attempt to impose control over you. Studies have found that individuals who are active participants in their therapy are more satisfied with the therapy. In addition, it is crucial that you feel safe in your therapeutic relationship.

There is no magical treatment that will heal you overnight, nor is there one form of psychotherapy that is right for everyone, but you should be able to find a therapist, as well as a therapeutic approach, that works for you. Healing is like a marathon. It requires preparation, repeated practice, courage, determination, and the support of others—including that of a professional coach or therapist.

While there are numerous therapy approaches, the purpose of all trauma-focused therapy is to integrate the traumatic event into your life, not subtract it. This article discusses the most common forms of trauma therapy. Each approach is described in its most pure form, but keep in mind that many therapists combine different types of therapies.

Pharmacotherapy

Pharmacotherapy is the use of medications to manage disruptive trauma reactions. Medications have been shown to be helpful with the following classes of reactions/symptoms:

Taking medication does not make one’s trauma reactions and pain evaporate. Medications can only help make the symptoms less intense and more manageable.

If you decide to use medications, consult a psychiatrist and continue working with that psychiatrist for as long as you take the medications. Inform the psychiatrist of how the medications are impacting you. Some medications have side effects that may or may not be tolerable to you, and some people do not respond favorably to medications. Medications are most effective when individuals pursue therapy concurrently.

Behavior Therapy

The most common form of behavior therapy is exposure. In exposure therapy, one gradually faces one’s fears–for example, the memories of a traumatic event–without the feared consequence occurring. Often, this exposure results in the individual learning that the fear or negative emotion is unwarranted, which in turn allows the fear to decrease.

Exposure therapy has been found to reduce anxiety and depression, improve social adjustment, and organize the trauma memory. There are various forms of exposure therapy:

Exposure therapy is a highly effective treatment for posttraumatic stress (PTSD).

Another form of behavior therapy is Stress Inoculation Training (SIT), also known as relaxation training. Stress Inoculation Training teaches individuals to manage stress and anxiety.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is grounded in the idea that an individual must correct and change incorrect thoughts and increase knowledge and skills. Common elements of cognitive behavioral therapy trauma therapy include:

Eye Movement Desensitization and Reprocessing (EMDR)

Therapists who perform EMDR first receive specialized training from an association such as the EMDR Institute or the EMDR International Association. An EMDR session follows a preset sequence of 8 steps, or phases. Treatment involves the person in therapy mentally focusing on the traumatic experience or negative thought while visually tracking a moving light or the therapist’s moving finger. Auditory tones may also be used in some cases. Debate regarding whether eye movements are truly necessary exists within the field of psychology, but the treatment has been shown to be highly effective for the alleviation and elimination of symptoms of trauma and other distress.

Hypnotherapy

There is no one guiding principal for hypnotherapy. In general, a hypnotherapist guides the individual in therapy into a hypnotic state, then engages the person in conversation or speaks to the person about certain key issue. Most hypnotherapists believe that the emotions and thoughts that an individual comes into contact with while under hypnosis are crucial to healing.

Psychodynamic Therapy

The goal of psychodynamic trauma therapy is to identify which phase of the traumatic response the individual is stuck in. Once this is discerned, the therapist can determine which aspects of the traumatic event interfere with the processing and integration of the trauma. Common elements of psychodynamic therapy include:

Group Therapy

There are a variety of different groups for trauma survivors. Some groups are led by therapists, others by peers. Some are educational, some focus on giving support, and other groups are therapeutic in nature. Groups are most effective when they occur in addition to individual therapy. It is important for a trauma survivor to choose a group that is in line with where one is in the healing journey:

Any therapist, regardless of which type of therapy she or he works from, desires to help you grow and heal through your traumatic experience.

Together, you and your therapist will strive to acknowledge and identify:

As always, reach out for help and know that you do not need to go it alone.

Reference:

  1. What is the actual EMDR Therapy session like? (n.d.). Retrieved from http://www.emdrresearchfoundation.org/for-the-public/what-is-the-actual-emdr-therapy-session-like

A recent study of people who are trying to quit smoking shows that Cognitive Behavioral Therapy can help reduce cigarette cravings. Overcoming cravings is an essential part of successful addiction therapy, as the craving to pick up another cigarette may, in the short term, overpower the rational reasons for quitting. Helping people overcome cravings by “retraining” the brain has the potential to help people quit smoking more effectively. The study, which was funded by the National Institute of Drug Abuse, took brain scans of people who’d been undergoing cognitive behavioral therapy with the goal of smoking cessation. The scans showed interesting behavior in two areas of the brain.

One area, known as the prefrontal cortex, helps a person control their emotions (among other things). This part was more active in people who’d undergone the smoking therapy. A second area, called the striatum, is related to reward-seeking and craving. This area was less active in people who’d been having therapy. In addition, people who’d been undergoing therapy also reported that their cravings were less intense. (more…)

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.

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