Bier, M., Kazarian, D. & Peper, E. (2005). Reducing
PMS through biofeedback and breathing. Poster presentation at the 36th Annual
Meeting of the Association for Applied Psychophysiology and Biofeedback.
Reducing the Severity
of PMS Symptoms:
A Self Regulation
Pilot Study[1]
Mary Bier, Delainya Kazarian, Erik
Peper PhD, Katherine Gibney
“Previously my world seemed so out of control during the
pre-menstrual time of my cycle. I
finally feel that I have control over my body and my emotions. I wish I had started this program years ago!”
--Participant
BACKGROUND
Premenstrual syndrome (PMS)
is a cyclic, complex, interactive disorder, which includes physical, emotional
and behavioral symptoms. These symptom
clusters occur only in the two weeks prior to menstruation and typically taper
off several days after the onset of menstruation and do not reappear until at
least day 13 of the cycle. The symptom clusters include physical symptoms
(abdominal pain or cramps, weight gain, breast tenderness, swelling or
bloating, headaches, backaches, acne, appetite changes and tiredness) and
psychological symptoms (depression, fatigue, irritability, mood swings,
inability to cope with everyday demands, difficulty concentrating, insomnia,
uncontrollable sadness or anger) (Rapkin, 2003; Moline et al., 2000; ACOG,
2000).
The medical treatment for
severe PMS includes selective serotonin re-uptake inhibitors (SSRI), ovulation
suppression (estrogen/progesterone) therapies and anti-anxiety (Prozac)
medications. Concerns about the harmful
side effects of long-term medications use, as well as the desire to control
one’s own health, drives the interest to develop behavioral interventions to
reduce discomfort associated with PMS (Rapkin, 2003; Dickerson et al.,
2003).
We hypothesize that a
significant component of PMS is psychophysiological dysregulation and enhanced
reactivity to internal/external stimuli. Earlier studies by Mathew, et al.
(1979) and Konandreas (1990) have shown that PMS symptoms could be ameliorated
with peripheral temperature training and relaxation. With the association
between PMS and increased emotional arousal and autonomic reactivity (Stroebel,
1982), self-regulation strategies that include relaxation, breathing, quieting
response and biofeedback may reduce the discomfort linked with PMS (Peper, 1990). Therefore, if women could learn to listen to,
and respond to, emotionally activating internal and external triggers by
relaxing and breathing diaphragmatically, the discomfort of PMS may be reduced
The purpose of this study is to investigate whether
biofeedback training and self-regulation skills can reduce the severity of PMS symptoms.
PROCEDURE
Subjects: Nine
participants, average age 26, with an average14 year history of PMS volunteered
for the study.
Equipment: Pro-Comp+, Biograph 2.1 (Thought Technology, Ltd,
Respiration:
monitored with a strain gauge placed around the waist.
Blood Volume Pulse (BVP): monitored with a photoplethysmograph
placed on the pad of the non-dominant thumb.
Heart Rate: derived from the BVP.
Skin Conductance: recorded with an electrodermograph (EDA) from the pads of the second
and fourth distal phalanx on the dominant hand.
Temperature:
recorded with a thermistor placed on the dorsal surface of the
non-dominant hand.
Pre - Baseline Physiological
Profile: sequential trials consisted of sitting eyes open (2 min), eyes closed (2
min), cognitive math serial thirteen stressor (2 min), and sitting eyes open
post baseline (2 min).
METHOD
Fig 1. Flow diagram of procedure
TRAINING SESSIONS
·
Collection
and discussion of home practices and subjective experiences.
·
Individual
biofeedback modulated training
·
Feedback
and review of physiological data.
·
Practice
of diaphragmatic breathing as response to internal and external triggers (adapted
from Peper et al, 2000).
·
Handout
of daily symptom rating logs and diaphragmatic breathing home practices.
·
Discussion
of training concepts.
POST BASELINE
·
Replication
of the initial physiological profile.
·
Post
training symptom rating assessment.
RESULTS
·
Severity
of emotional and somatic discomfort associated with PMS was significantly
reduced for all subjects (p< 0.01) after training and maintained during one
month follow-up as shown in figure 2. In
the delayed treatment group symptoms were slightly reduced following
self-monitoring and much more reduced following shown in figure 3.
·
Respiration
rate during stressor was significantly reduced in the post-baseline as compared
with the pre-baseline conditions for all subjects (p<0.01) (see figure 4). A
representative individual pre- and post-baseline recordings are shown in figures
5 and 6.
All participants
reported in the 4 week post training subjective follow-up:
·
Continued
reduced symptoms.
·
Positive
outcomes from generalization of skills into daily life in response to stressful
stimuli such as menstrual cramping, stress during an exam or when writing
papers, arousal during arguments with their partners, and while driving in
traffic.
·
A
renewed sense of self awareness and self control throughout their entire cycle
and a significant reduction in PMS discomfort.
Fig.
2 Change in psychological and physical symptoms following training for all
subjects.
Fig. 3. Change in psychological and physical
symptoms for experimental subjects (Pre-exp to Post-exp) and delayed treatment
controls. Observe the slight decrease in symptoms during self-monitoring for
the controls (Pre-controls to Pre1-controls) followed by a larger decrease in
symptoms following training (Pre1-controls to Post-controls).
Fig. 4. Decrease in respiration rate across all conditions
following training.
Fig. 5. Representative pre-baseline physiological recording
Fig. 6.
Representative post-training physiological recording.
DISCUSSION
This pilot study suggests that biofeedback
training and respiration based relaxation with a strong emphasis on slow
diaphragmatic breathing in response to internal and external stimuli and
stressor, PMS sensations, reduces the severity of PMS discomfort. The major difficulties for participants were
finding time and remembering to practice as well as loosening their belts to
allow diaphragmatic breathing to occur (limiting ‘designer’s jean’ syndrome).
Some, especially those who tended to breathe shallowly and rapidly in their
chests, would benefit from more training sessions. Charting symptoms appeared to increase
self-awareness and reduce symptoms as shown by the decrease in symptoms of in
the delayed treatment group. As one
subject said: “Not
just during my pre-menstrual week but overall I am having good days, my
relationship with my boyfriend is going really good now. I love breathing.”
An underlying factor associated with success was
learning to breathe in response to stressors and develop a non-striving
attitude. This developed a “time-out
experience,” which stopped the escalating arousal and led to a new sense of
openness, a positive outlook and a desire for more training sessions.
With all nine
participants gaining personal control over both physiological and psychological
symptoms of PMS, replications of the study should be conducted over an extended
period of time. This pilot study
suggests that women with PMS should use self-regulation strategies to reduce
discomfort as the first intervention before using medications.
“Biofeedback and breathing training have
allowed me to reconnect with my physiology and regain control over my reactions
and emotions during stressful times. I
now feel a sense of empowerment and balance that I have been missing for many
years.”
REFERENCES
ACOG (
Dickerson, L.M., Mazyck,P.M. &
Hunter M.H. (2003). Premenstrual Syndrome. American
Family Physician. 67(8):1743-53.
Konandreas,G.K. (1990). The effect
of biofeedback and relaxation on premenstrual syndrome. Dissertation Abstracts International, 51(1-B).
Luthe, W. &
Schultz, J.H. (1969). Autogenic Therapy Volume II: Medical
Applications.
Mathew, R.J., Claghorn, J.L.,
Largen, J.W., & Dobbins, K. (1979). Skin Temperature control for
premenstrual tension syndrome: A pilot study. American Journal of Clinical Biofeedback, 2(1), 7-10
Moline, M.L.
& Zendell, S.M. (2000). Evaluating and managing premenstrual syndrome. Medscape Womens Health. 5:1-16.
Peper, E. (1990). Breathing For Health.
Peper, E, Gibney, K. & Holt, C.
(2002). Make Health Happen.
Rapkin, A. (2003). A review of treatment of
premenstrual syndrome & premenstrual dysphoric disorder. Psychoneuroendocrinology. 28, 39-53
Stroebel, C. F. (1982). QR The Quieting Reflex.