Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial

Abstract

Objective: To evaluate the effectiveness of cognitive behavioral therapy for menopausal symptoms (CBT-Meno) compared with a waitlist condition (no active intervention). A randomized controlled trial was conducted with 71 perimenopausal or postmenopausal women who were seeking treatment for menopausal symptoms. Methods: Blind assessments were conducted at baseline, 12 weeks postbaseline, and 3 months post-treatment. An intention-to-treat analysis was conducted. CBT-Meno sessions included psychoeducation, and cognitive and behavioral strategies for vasomotor and depressive symptoms, anxiety, sleep difficulties, and sexual concerns. Primary outcomes were scores on the Hot Flash Related Daily Interference Scale (HFRDIS) and Beck Depression Inventory (BDI-II). Secondary outcomes were scores assessing vasomotor and sexual concerns on the Greene Climacteric Scale (GCS-vm, GCS-sex), the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI), and the Female Sexual Function Index (FSFI). Results: There were significantly greater improvements in CBT-Meno compared with waitlist in vasomotor symptom interference (HFRDIS; P < 0.001, η2 P = 0.21) and “bothersomeness” (GCS-vm; P = 0.04, η2 P = 0.06), depressive symptoms (BDI-II; P = 0.001, η2 P = 0.15), sleep difficulties (PSQI; P = 0.001, η2 P = 0.17), and sexual concerns (GCS-sex; P = 0.03, η2 P = 0.07). These results were found even when controlling for menopausal staging and medication use. Gains were maintained at 3 months post-treatment. Conclusions: CBT-Meno was particularly effective in improving self-reported vasomotor symptoms, depressive symptoms, sleep difficulties, and sexual concerns. Although future studies will be needed to confirm the impact of CBT-Meno on anxiety symptoms, these results suggest that this protocol is effective in targeting commonly reported menopausal symptoms. Video Summary: Supplemental Digiatl Content 1, http://links.lww.com/MENO/A416

Effects of Group and Individual Culturally Adapted Cognitive Behavioral Therapy on Depression and Sexual Satisfaction among Perimenopausal Women

“…The findings were in line with Jalal et al [ 76 ] which provided evidence of the effectiveness of CA-CBT among the Muslim population in Egypt, and in line with Zakaria and Akhir [ 75 ] for the Malaysian population. Also, these findings are consistent with that of prior studies that suggested depression will often improve following CA-CBT intervention [ 5 , 76 , 77 , 78 , 79 , 80 ].…”

“…Thus, cognitive distortion as the component of false beliefs and assumptions was distinctly emphasized. Apart from that, it was found that in addition to depressive symptoms, women's sexual functions were largely influenced by a lack of social skills, such as assertiveness, and problem-solving appraisal, which could affect the severity of depression, which is in line with the study by Peleg-Sagy and Shahar [84] and Green et al [79]. The treatment protocol was adjusted to meet the participants' needs as a Muslim woman, as in the study conducted by Zakaria and Akhir [75].…”

Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms?

“…There was good compliance and CBT intervention was considered to be acceptable and feasible for women with psychological disorders. Using a different protocol (CBT‐Meno), Green et al ( 2019 ) evaluated a 12‐session CBT group‐based treatment for women who had both problematic VMS and moderate to severe depressed mood in an exploratory trial with significant reductions in VMS interference and bother, and in self‐reported depressive symptoms at 3‐month follow‐up.…”

Cognitive Behavioral Therapy for Sexual Concerns During Perimenopause: A Four Session Study Protocol

“…Psychological therapy, specifically Cognitive Behavioral Therapy (CBT), has been proposed as a low-risk treatment for menopausal symptoms with studies showing CBT as effective in reducing several common menopausal symptoms [e.g., vasomotor symptoms, depression, anxiety, and sleep difficulties; (17)(18)(19)]. Sexual concerns, however, have either not been directly targeted at all in current CBT protocols, or the two protocols that have included sessions on sexual concerns (19,20), have only demonstrated modest gains in a single domain (e.g., sexual desire).…”

“…Psychological therapy, specifically Cognitive Behavioral Therapy (CBT), has been proposed as a low-risk treatment for menopausal symptoms with studies showing CBT as effective in reducing several common menopausal symptoms [e.g., vasomotor symptoms, depression, anxiety, and sleep difficulties; (17)(18)(19)]. Sexual concerns, however, have either not been directly targeted at all in current CBT protocols, or the two protocols that have included sessions on sexual concerns (19,20), have only demonstrated modest gains in a single domain (e.g., sexual desire). Further, most CBT studies for menopause have included broad measures of menopausal symptoms (e.g., the Greene Climacteric Scale, Menopause Rating Scale), which do not allow us to determine the impact of CBT on important domains of sexual functioning and satisfaction specifically sexual desire, interest, and self-image.…”