Traditional Workshop 4 - Integrating the Menstrual Cycle into Assessment and Treatment: Practical Overview and Applied Strategies

While most menstruating individuals do not experience significant menstrual cycle effects on their mood, approximately 5% experience intense and debilitating changes (premenstrual dysphoric disorder, PMDD) and at least 50% of those with emotional disorders experience cyclical worsening of their symptoms (premenstrual exacerbation, PME). Accordingly, clinicians need to understand how to assess and treat menstrual cycle-related effects on symptoms. Our workshop, led by three licensed clinical psychologists with expertise in PMDD/PME, will cover the following topics:

Psychoeducation: We will review the menstrual cycle, including how hormone flux can affect mood and behavior, the distinction between PMDD and PME, and common clinical presentations such as heightened suicide risk. Participants will learn how to provide psychoeducation and a broad range of resources to clients.

Assessment: Participants will be taught how to validly assess menstrual cycle effects, including the rationale behind and methods for using prospective daily DSM-5 PMDD symptoms over two cycles. Case examples will illustrate assessment principles. Small groups discussions will brainstorm and create action plans for implementing these assessment strategies in participants’ practices, followed by Q&A to address specific concerns or challenges.

Interdisciplinary Treatment Collaboration: Participants will be introduced to strategies for collaborating with other types of treatment providers (e.g., psychiatry, gynecology) for evidence-based pharmacological, medical, and surgical treatments of PMDD/PME. Case examples will be discussed.

Skills Training: Introduce CBT-based strategies for management of PMDD/PME, including integrating this knowledge into existing approaches like DBT. Topics include leveraging awareness of symptom flux; targeted distress tolerance and interpersonal skills; and risk assessment, safety planning, and skill building for perimenstrual increases in suicidality. Case examples will demonstrate practical application of these strategies. Participants will break out into small groups to create action plans for integrating these strategies into their own practices, followed by a final Q&A to address any remaining questions.

Recommended Reading 1: Eisenlohr-Moul, T. (2019). Premenstrual disorders: a primer and research agenda for psychologists. The Clinical psychologist, 72(1), 5.

Recommended Reading 2: Schmalenberger, K. M., Tauseef, H. A., Barone, J. C., Owens, S. A., Lieberman, L., Jarczok, M. N., ... & Eisenlohr-Moul, T. A. (2020). How to study the menstrual cycle: Practical tools and recommendations. Psychoneuroendocrinology, 104895.

Recommended Reading 3: Weise, C., Kaiser, G., Janda, C., Kues, J. N., Andersson, G., Strahler, J., & Kleinstäuber, M. (2019). Internet-based cognitive-behavioural intervention for women with premenstrual dysphoric disorder: a randomized controlled trial. Psychotherapy and psychosomatics, 88(1), 16-29.

Recommended Reading 4: Ross, J. M., Barone, J. C., Tauseef, H., Schmalenberger, K. M., Nagpal, A., Crane, N. A., & Eisenlohr-Moul, T. A. (2024). Predicting acute changes in suicidal ideation and planning: a longitudinal study of symptom mediators and the role of the menstrual cycle in female psychiatric outpatients with suicidality. American journal of psychiatry, 181(1), 57-67.

Recommended Reading 5: Peters, J. R., Schmalenberger, K. M., Eng, A. G., Stumper, A., Martel, M. M., & Eisenlohr-Moul, T. A. (2024). Dimensional Affective Sensitivity to Hormones across the Menstrual Cycle (DASH-MC): A transdiagnostic framework for ovarian steroid influences on psychopathology. Molecular psychiatry, 1-12.

Outline:
1. Introduction
2. Psychoeducation
a. Review of the menstrual cycle
i. How hormone flux can affect mood and behavior
ii. Distinction between PMDD and PME
iii. Common clinical presentations
b. Providing psychoeducation and a broad range of resources to clients.
3. Assessment
a. Rationale behind prospective assessment
b. How to assess prospective daily DSM-5 PMDD symptoms over two cycles
c. Case examples illustrating assessment principles
d. Small groups discussions to create action plans
e. Q&A to address specific concerns or challenges.
4. Interdisciplinary Treatment Collaboration
a. Roles of other types of treatment providers for pharmacological, medical, and surgical treatments
b. Strategies for collaborating
c. Case examples
5. Skills Training
a. Integrating PMDD/PME content into CBT/DBT treatment
i. Leveraging awareness of symptom flux
ii. Targeted distress tolerance and interpersonal skills
iii. Risk assessment, safety planning, and skill building for perimenstrual increases in suicidality
b. Case examples demonstrating practical application
c. Small group discussion to create action plans
d. Final Q&A to address any remaining questions.