How Do Emotion Regulation Strategies Affect Mood and Stress in Women with Premenstrual Dysphoric Disorder?

What you need to know

• Women with premenstrual dysphoric disorder (PMDD) reported using less mindfulness and reappraisal, and more repetitive negative thinking compared to women without PMDD.
• In women with PMDD, using more mindfulness and reappraisal and less repetitive negative thinking was linked to better mood overall, but did not protect against premenstrual mood worsening.
• Higher mindfulness was associated with higher cortisol levels during menstruation in women with PMDD, which may help reduce pain.

Premenstrual Dysphoric Disorder and Emotion Regulation

Premenstrual dysphoric disorder (PMDD) is a condition that affects about 5% of women of reproductive age. It involves severe mood symptoms and other issues that occur in the week or two before menstruation and improve within a few days after the period starts. PMDD can significantly impact quality of life and daily functioning.

While the exact causes are not fully understood, researchers believe PMDD likely involves a complex interaction between hormonal changes, brain chemistry, and psychological factors. One area of interest is how women with PMDD regulate their emotions, especially during times of premenstrual distress.

Emotion regulation refers to the processes by which we influence which emotions we have, when we have them, and how we experience and express them. Some common emotion regulation strategies include:

• Mindfulness: Paying attention to the present moment in an open, non-judgmental way
• Reappraisal: Changing how we think about a situation to alter its emotional impact
• Repetitive negative thinking: Dwelling on negative thoughts and experiences

This study aimed to examine how these different emotion regulation strategies relate to mood and biological stress responses across the menstrual cycle in women with PMDD.

How the Study Worked

The researchers recruited 61 women diagnosed with PMDD and 61 women without PMDD to participate in the study.

First, all participants completed questionnaires assessing their typical use of mindfulness, reappraisal, and repetitive negative thinking.

Then, the women used smartphone apps to report on their moods and collect saliva samples to measure cortisol (a stress hormone) levels at multiple time points throughout the day. They did this for two days during four phases of the menstrual cycle:

1. Menstrual phase (during menstruation)
2. Follicular phase (after menstruation ends)
3. Ovulatory phase (around ovulation)
4. Late luteal phase (premenstrual phase)

This allowed the researchers to examine how emotion regulation strategies related to mood and cortisol patterns across the menstrual cycle in women with PMDD.

Key Findings on Emotion Regulation in PMDD

Differences Between Women With and Without PMDD

As expected, women with PMDD reported:

• Lower levels of mindfulness
• Less use of reappraisal
• Higher levels of repetitive negative thinking

Compared to women without PMDD. This suggests women with PMDD tend to use less adaptive and more maladaptive emotion regulation strategies in general.

Effects on Mood Across the Menstrual Cycle

In women with PMDD, greater use of mindfulness and reappraisal, and less repetitive negative thinking predicted:

• Lower negative mood
• Higher positive mood

However, this was only true during the menstrual, follicular, and ovulatory phases. Interestingly, during the late luteal (premenstrual) phase, there was no relationship between emotion regulation strategies and mood.

This means that while adaptive emotion regulation strategies were linked to better mood overall in women with PMDD, they did not seem to protect against the mood worsening that occurs premenstrually.

Effects on Cortisol Levels

The study found that higher mindfulness was associated with higher cortisol levels, but only during the menstrual phase.

Cortisol is often thought of as a “stress hormone,” but it also plays a role in pain reduction. The researchers speculate that higher cortisol during menstruation may help reduce menstrual pain in women who use more mindfulness.

There were no significant relationships between reappraisal or repetitive negative thinking and cortisol levels.

What This Means for Understanding and Treating PMDD

These findings have several important implications:

1. Women with PMDD may benefit from interventions to increase mindfulness and reappraisal skills and reduce repetitive negative thinking. This could help improve mood overall.

2. However, these emotion regulation strategies alone may not be enough to prevent premenstrual mood worsening. This suggests that other factors, like hormonal changes, likely play a strong role in premenstrual symptoms.

3. Mindfulness may have biological effects, potentially increasing cortisol in ways that could reduce pain during menstruation. More research is needed to confirm this.

4. Treatments for PMDD may need to combine approaches that target both psychological factors (like emotion regulation) and biological factors to be most effective.

Limitations and Future Directions

While this study provides valuable insights, it’s important to note some limitations:

• The PMDD diagnosis was based on a retrospective interview rather than prospective daily ratings over two months, which is the gold standard.
• The study only looked at a few specific emotion regulation strategies. Other strategies may also be important.
• The study measured typical use of strategies rather than actual use in the moment.

Future research could address these limitations by:

• Using prospective diagnosis methods
• Examining a wider range of emotion regulation strategies
• Assessing emotion regulation as it happens in daily life
• Investigating how emotion regulation interacts with hormonal factors

Conclusions

This study sheds light on how emotion regulation relates to mood and biological stress responses across the menstrual cycle in women with PMDD. While adaptive strategies like mindfulness and reappraisal seem beneficial overall, they may not be enough to counteract premenstrual mood changes.

These findings underscore the complex nature of PMDD and highlight the need for multifaceted approaches to treatment that address both psychological and biological factors. By better understanding the interplay between emotion regulation, mood, and physiology across the menstrual cycle, researchers can work towards developing more effective interventions for women with PMDD.