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Management of vasomotor symptoms in women who have a contraindication for taking hormone therapy or who do not wish to take hormone therapy remains a challenge. Among various non-hormonal alternative therapies, psycho-educational and cognitive behavior therapy (CBT) has been suggested as a possible alternative treatment for hot flushes [1]. CBT is defined as a combination of behavioral and cognitive interventions guided by principles of applied science. The behavioral interventions aim to decrease maladaptive behaviors and increase adaptive ones by modifying their antecedents and consequences and by behavioral practices that result in new learning. The cognitive interventions aim to modify maladaptive cognitions, self-statements or beliefs. The hallmark features of CBT are problem-focused intervention strategies that are derived from learning theory [as well as] cognitive theory principles [2].

 

In a recent paper, Hunter and colleagues have reported the results of a randomized, controlled trial (RCT) investigating the efficacy of a group and a self-help CBT program specifically developed for the treatment of menopausal symptoms [3,4]. In this RCT, 140 women having frequent hot flushes/night sweats (HF/NS) (mean weekly frequency 63.15, standard deviation (SD) 49.24), with a mean problem rating of 5.87, SD 2.28 [4], were randomized into three groups: women in group CBT received four sessions of 2 hours each with a psychologist; the self-help CBT group received CBT material with telephonic support from the psychologist; and the third group received no treatment, as the control group (NTC). The primary outcome was the reduction in problem rating for HF/NS (defined as improvement in HF and NS problem rating by > 2 on the Hot Flush Rating Scale of 1–10) at 6 weeks and 26 weeks from randomization. The authors also assessed effects on subjectively and physiologically measured frequency of hot flushes and night sweats, mood (Women’s Health Questionnaire) and health-related quality of life (General Health Survey SF-36). 

 

At 6 weeks, women receiving group CBT and self-help CBT reported significant improvement in the problem rating for hot flushes and night sweats compared to the NTC control group (adjusted mean difference in problem rating: group CBT 2.12, 95% confidence interval (CI) 1.36–2.88; self-help CBT 2.08, 95% CI 1.29–2.86). A similar proportion of women benefited in both treatment groups (group CBT 65% (95% CI 51–77%); self-help CBT 73% (95% CI 57–84%), NTC 21% (95% CI 11–35%)). There was no significant difference in the subjectively or physiologically measured frequency of hot flushes in either of the groups; however, women receiving group CBT reported reduced frequency of night sweats at 6 weeks and 26 weeks. The self-help CBT group also had significantly fewer night sweats at 26 weeks (at 26 week: group CBT 53%, self-help CBT 43%, NTC 12%). Women receiving group CBT reported improvements in mood at 6 weeks and improvement in emotional and physical functioning at 26 weeks.

Author(s)

  • Pratima Gupta
    Obstetrics & Gynaecology, Heart of England Foundation Trust, Birmingham, UK

Citations

  1. Tremblay A, Sheeran L, Aranda SK. Psychoeducational interventions to alleviate hot flashes: a systematic review. Menopause 2008;15:193-202.
    http://www.ncbi.nlm.nih.gov/pubmed/17589375
  2. Arch JJ, Craske MG. First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatr Clin North Am 2009;32:525-47.
    http://www.ncbi.nlm.nih.gov/pubmed/19716989
  3. Hunter MS, Mann E. A cognitive model of menopausal hot flushes and night sweats. J Psychosom Res 2010;69:491-501.
    http://www.ncbi.nlm.nih.gov/pubmed/20955869
  4. Ayers B, Smith M, Hellier J, Mann E, Hunter MS. Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause 2012 Feb 14. Epub ahead of print.
    http://www.ncbi.nlm.nih.gov/pubmed/22336748
  5. Rada G, Capurro D, Pantoja T, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev 2010, Issue 9. Art. No. CD004923.
    http://www.ncbi.nlm.nih.gov/pubmed/20824841
  6. Mann E, Smith MJ, Hellier J, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncol 2012;13:309-18.
    http://www.ncbi.nlm.nih.gov/pubmed/22340966
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