Medical (fluoxetine) and psychological (cognitive-behavioural therapy) treatment for premenstrual dysphoric disorder: a study of treatment processes.
OBJECTIVE
To investigate (i) the differential changes in premenstrual symptoms, mood, cognitions, and coping strategies during two treatments [cognitive-behavioural therapy (CBT) and fluoxetine] for premenstrual dysphoric disorder (PMDD) and (ii) the characteristics of those with good vs. poor outcome post treatment and at 1 year follow-up.


METHODS
Premenstrual symptoms, mood (Hospital Anxiety and Depression Scale, HADS), causal attributions, and use of cognitive and behavioural coping strategies were examined during 6 months of both treatments. The two treatment groups were then combined and divided on the basis of good vs. poor outcome posttreatment and at 1 year follow-up. Baseline measures were used to predict posttreatment outcome, and baseline and posttreatment measures were examined when attempting to predict outcome at 1 year follow-up.


RESULTS
Both treatments were equally effective at the end of 6 months (prospective daily diary measure). Fluoxetine treatment had a more rapid effect and greater impact upon anxiety symptoms, while CBT was associated with increased use of cognitive and behavioural coping strategies and a shift from a biomedical to a biopsychosocial causal attribution of premenstrual symptoms. Depressed mood at baseline assessment was associated with poorer response to both treatments, and learning active behavioural coping strategies was associated with a good outcome at 1 year follow-up.


CONCLUSIONS
These results provide evidence of differential treatment effects of fluoxetine and CBT for PMDD and offer information that will enhance clinical decision-making.
Hunter
Myra S
MS
Department of Psychology, University College London, London, UK.
Ussher
Jane M
JM
Cariss
Margaret
M
Browne
Susannah
S
Jelley
Rosanne
R
Katz
Maurice
M
D000223:Adaptation, Psychological; D000284:Administration, Oral; D000328:Adult; D001008:Anxiety Disorders / Q000188:drug therapy / Q000209:etiology; D015928:Cognitive Behavioral Therapy; D005260:Female; D005473:Fluoxetine / Q000494:pharmacology*; D006801:Humans; D011293:Premenstrual Syndrome / Q000188:drug therapy* / Q000523:psychology*; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D016896:Treatment Outcome
D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors