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

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, ηP = 0.21) and "bothersomeness" (GCS-vm; P = 0.04, ηP = 0.06), depressive symptoms (BDI-II; P = 0.001, ηP = 0.15), sleep difficulties (PSQI; P = 0.001, ηP = 0.17), and sexual concerns (GCS-sex; P = 0.03, ηP = 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.

Mindfulness-based cognitive therapy as an augmentation treatment for obsessive-compulsive disorder.

A significant number of obsessive-compulsive disorder (OCD) patients continue to experience symptoms that interfere with their functioning following cognitive behavioural therapy (CBT). Providing an additional augmentation treatment following CBT could help reduce these residual symptoms. Mindfulness interventions that facilitate less reactivity to thoughts and feelings may be helpful for patients suffering from residual OCD symptoms. The purpose of the current randomized waitlist control trial was to evaluate the feasibility and impact of providing an 8-week mindfulness-based cognitive therapy (MBCT) intervention following completion of a CBT intervention to OCD patients who continued to suffer from significant symptoms. Results indicated that compared to the waitlist control group, MBCT participants reported decreases in OCD symptoms (d = 1.38), depression symptoms (d = 1.25), anxiety symptoms (d = 1.02), and obsessive beliefs (d = 1.20) along with increases in self-compassion (d = 0.77) and mindfulness skills (d = 0.77). Additionally, participants reported high levels of satisfaction with the MBCT intervention. The results suggest that the use of MBCT for OCD as an augmentation therapy is acceptable to patients who continue to suffer from OCD symptoms after completing CBT and provides some additional relief from residual symptoms. KEY PRACTITIONER MESSAGE: Mindfulness interventions teach skills that facilitate disengaging from cognitive routines and accepting internal experience, and these skills may be valuable in treating obsessive-compulsive disorder (OCD), as individuals describe getting "stuck" in repetitive thoughts and consequent rituals. The results of this study suggest that teaching mindfulness skills using an 8-week mindfulness-based cognitive therapy (MBCT) intervention provides an added benefit (decreases in OCD, depression, and anxiety symptoms) for patients with OCD who have completed a cognitive behavioural therapy intervention and continued to suffer from significant symptoms. Participation in MBCT was also associated with increases in mindfulness skills including increased ability to be nonjudgmental and nonreactive. By fostering a nonjudgmental stance towards intrusive thoughts, mindfulness may discourage suppression and avoidance of thoughts and this could lead to increased habituation and a decreased reliance on compulsions. The use of MBCT as an augmentation treatment should be further explored to elucidate whether this treatment is beneficial for preventing relapse of OCD and could be compared against further cognitive behavioural therapy to see if offering participants a different and theoretically compelling intervention, such as MBCT, would outperform "more of the same" for individuals with OCD.

Cognitive-behavioral, behavioral, and mindfulness-based therapies for menopausal depression: a review.

Menopause is a natural transition that all women go through in their lives that is often accompanied by a number of physical and emotional symptoms. Upwards of 40% of women report depression symptoms associated with menopause (Timur & Sahin, 2010) [1]. Treatments for menopausal depression include pharmacological agents such as antidepressants and hormone therapy (HT) as well as psychological approaches. This paper provides a review of cognitive-behavioral, behavioral, and mindfulness based (CBBMB) therapies in treating depression during the menopausal transition. After conducting an electronic database search, only two studies specifically using CBBMB methods were found, both had positive results. Since so few studies existed that specifically evaluated CBBMB treatments for menopausal depression (n=2), a larger net was cast. Studies that assessed depression symptoms as an outcome measure in an evaluation of CBBMB treatments for hot flashes or menopausal symptoms more broadly, were included. The review revealed that interventions targeting hot flashes or menopausal symptoms using CBBMB methods mostly proved to have had a positive impact on depression symptoms in the mild range of severity. Directions for future research are discussed including the need for more CBBMB interventions targeting depression during the menopausal transition to establish their efficacy.

High trait rumination is associated with blunted nighttime diastolic blood pressure dipping.

BACKGROUND: Blunted blood pressure (BP) dipping during nighttime sleep has been associated with an increased risk of cardiovascular events. Psychological traits have been associated with prolonged cardiovascular activation and a lack of cardiovascular recovery. This activation may extend into nighttime sleep and reduce BP dipping. PURPOSE: This study aims to evaluate the association between trait rumination and nighttime BP dipping. METHODS: Sixty women scoring either high or low on trait rumination underwent one 24-h ambulatory BP monitoring session. Self-reported wake and sleep times were used to calculate nighttime BP. RESULTS: High trait rumination was associated with less diastolic blood pressure (DBP) dipping relative to low trait rumination. Awake ambulatory BP, asleep systolic blood pressure (SBP) and DBP, and asleep SBP dipping were not associated with trait rumination. CONCLUSIONS: In a sample of young women, high trait rumination was associated with less DBP dipping, suggesting that it may be associated with prolonged cardiovascular activation that extends into nighttime sleep, blunting BP dipping.

Wanting a body that's better than average: the effect of manipulated body norms on ideal body size perception.

We examined the effect of body norms on ideal and current body size perception. In Study One, female participants were randomly assigned to one of three experimental conditions: (1) a thinner body norm, (2) a heavier body norm, or (3) no body norm. Body norms were manipulated by indicating a bogus "population average," and current and ideal body size perception were subsequently measured using a body silhouettes measure. Women had a thinner ideal body size in the thinner norm condition than in the heavier norm condition. Study Two replicated these results, but in a sample of young men and with regards to muscularity rather than thinness. Men had a more muscular ideal body size in the more muscular norm condition than in the less muscular norm condition. Current body size perception was also influenced by body norms, but only for women and after controlling for BMI.

The influence of trait and state rumination on cardiovascular recovery from a negative emotional stressor.

The purpose of this study was to evaluate the influence of trait and state rumination on cardiovascular recovery following a negative emotional stressor. Cardiovascular data was collected from 64 undergraduate women during a 10-min baseline period, 5-min emotional recall stress task, and a 15-min recovery period. Trait rumination was assessed using the Stress Reactive Rumination Scale and state rumination was assessed 5 and 10 min after the stressor, using a thought-report technique. Results indicated that trait and state rumination interacted such that low trait ruminators who were ruminating at 10 min after the termination of the stressor had poorer diastolic blood pressure and high-frequency heart rate variability recovery compared to low trait ruminators who were not ruminating. State rumination was not associated with cardiovascular recovery in high trait ruminators. Results suggest that rumination may play a role in the association between stress and hypertension by prolonging cardiovascular activation following stress.

Early socioeconomic status is associated with adult nighttime blood pressure dipping.

OBJECTIVE: To examine the prognostic significance of early socioeconomic status (SES) on 24-hour blood pressure (BP) during early adulthood. Low SES has been related to poor health outcomes, in particular, cardiovascular morbidity and mortality. Recent cross-sectional research has also linked low levels of SES with several cardiovascular risk factors including poor nighttime BP dipping. METHODS: A total of 174 undergraduate university students whose childhood SES was assessed by highest level of education completed by their parents underwent 24-hour ambulatory BP monitoring. RESULTS: Initial correlation analyses revealed positive associations between childhood SES and BP dipping, indicating that lower levels of childhood SES were associated with less systolic BP (SBP) (r = .29, p < .01) and diastolic BP (DBP) dipping (r = .38, p < .01). A stepwise multiple regression analyses indicated that childhood SES explained 6.9% of the variance in SBP dipping and 11.5% of the variance in DBP dipping above and beyond other lifestyle-related factors including daytime BP, body mass index, alcohol use, smoking, and current SES. CONCLUSIONS: These findings suggest that irrespective of adult achievement, childhood SES may have lasting health implications.

A high-fat meal increases cardiovascular reactivity to psychological stress in healthy young adults.

The consumption of high levels of saturated fat over the course of several weeks may lead to exaggerated cardiovascular reactivity. The consumption of a single high-fat meal has been associated with a transient impairment of vascular function. In a randomized, repeated measures, crossover study we tested whether the consumption of a single high-fat meal by healthy, normotensive participants would affect cardiovascular reactivity when compared with an isocaloric, low-fat meal. Thirty healthy participants ate a high-fat (42 g) and a low-fat (1 g) meal on 2 separate occasions, and their cardiovascular response to 2 standard laboratory stressors was measured. Systolic blood pressure, diastolic blood pressure, and total peripheral resistance were greater in participants following the consumption of the high-fat meal relative to the low-fat meal. The findings of the present study are consistent with the hypothesis that even a single high-fat meal may be associated with heightened cardiovascular reactivity to stress and offer insight into the pathways through which a high-fat diet may affect cardiovascular function.