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CBT AND MINDFULNESS

Women’s experience of the menopause and its symptoms is highly variable. Some women seek medical options, such as HRT, for problematic symptoms, while others prefer non-medical approaches. HRT may not be suitable for some women (e.g. women with a history of breast cancer), and concerns about side effects have contributed to an increased interest in non-hormonal treatments and self-management approaches.

This article was included in issue 84 (spring 2020) of The Menopause Exchange newsletter.

Mindfulness and cognitive behavioural therapy (CBT) are two psychological or ‘mind-body’ approaches that are becoming increasingly popular in the UK. These both have short and longer term benefits because they teach life skills that, once mastered, can be applied in situations long after the end of the sessions.

‘Mind-body’ approaches
In general, psychological interventions, such as CBT, clinical hypnosis and mindfulness, are considered to work better than other non-medical approaches, such as herbal and complementary therapies, in helping women to ease their menopausal symptoms and/or to improve their quality of life. These ‘mind-body’ or stress-reducing interventions are also believed to be popular because mid-life is typically a stressful time for women, who may be juggling busy careers and family responsibilities and may have health problems and additional caring roles.

Recent research shows there are two-way interactions between stress and the experience of hot flushes and night sweats. Having problematic hot flushes and night sweats can affect your sleep and mood, and feeling low or anxious can make hot flushes and night sweats worse.

Mindfulness
Mindfulness is ‘the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally, to the unfolding of experience, moment by moment’. This is typically developed with a range of simple meditation practices.

Mindfulness interventions are usually group programmes; these can include mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR). MBSR was created for people with chronic health problems, while MBCT was originally created for people with recurrent depression to reduce the chances of a relapse.

Mindfulness-based interventions have been shown to help a range of health problems. MBCT reduces relapse rates in people who have had multiple episodes of depression, and MBSR reduces stress and anxiety and helps people adjust to chronic pain and cancer. One of the key benefits reported by people who have become more mindful is a change in the way they relate to their health conditions, with an increased sense of acceptance
and self-compassion.

Three research studies have assessed eight-week courses of MBSR for women with menopausal symptoms. Overall, these studies found significant improvements in women’s moods, stress levels and quality of life; there were some improvements in hot flushes and night sweats as well, but these weren’t statistically significant when compared with a control group. The North American Menopause Society (NAMS) recommends MBSR for the management of vasomotor symptoms (flushes and sweats) with caution, highlighting the need for more research.

Cognitive behaviour therapy
CBT focuses on how our perspective in a situation (how we think) influences how we feel and how we will cope (behave) in that particular situation. CBT is a structured, collaborative and time-limited intervention; therapists and patients look at the relationships between thinking, emotions, behaviours and physiological responses in certain situations and find ways to interrupt any negative cycles that can occur.

CBT was initially created as a treatment for anxiety and depression, but over the past few decades it has been used to help people to manage physical health problems as well, such as pain, chronic fatigue and cancer, with positive results. The CBT approach has been developed to help women with difficult menopausal symptoms, particularly hot flushes and night sweats, but also to ease stress and improve sleep. Women are encouraged to examine their attitudes and beliefs about the menopause, hot flushes and night sweats, and how they behave towards these. For example, having a hot flush at work (situation), thinking ‘everyone’s looking at me’ (thought), feeling embarrassed (emotion), heart rate increases (physiological arousal) and rushing out of the meeting (behaviour), can make the situation worse. Helpful CBT strategies may include breathing from your diaphragm, focusing your attention away from the flush and calming yourself with self-talk.

CBT is delivered in a self-help format, and in groups of six to eight women, over four to six weeks. It has reduced hot flushes and night sweats in six randomised controlled trials, with improvements still there six months later. CBT can also help sleep and quality of life. On the basis of this evidence, NAMS recommends CBT as an effective treatment for hot flushes and night sweats, and CBT has also been recommended for the treatment for anxiety and low mood during the menopause.

Summary
Mindfulness and CBT can both provide benefits and life skills for women at midlife and those with menopausal symptoms. Mindfulness courses are available privately (see BeMindful or Breathworks Mindfulness websites) and some health services are offering these too. CBT for menopausal symptoms is available as a self-help book (Hunter & Smith, 2014), and a group CBT manual for healthcare professionals has been developed as well (Hunter & Smith, 2015).

We are currently working to produce an on-line CBT intervention that will be launched later this year. If you would like to see a private therapist, visit the website of the British Association for Behavioural and Cognitive Psychotherapies (www.babcp.com).

References:

Hardy C, Griffiths A, Norton S, Hunter MS. Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial. Menopause: The Journal of The North American Menopause Society 2018 25, 5, 508-19.

Hunter MS and Smith M. Managing hot flushes and night sweats: a cognitive behavioural self-help guide to the menopause. Routledge (2014). 2ndedition, 2020

Hunter MS and Smith M. Managing hot flushes and night sweats: a manual for health professionals. Routledge (2015).  

About the author
Professor Myra Hunter is emeritus professor of clinical health psychology at King’s College London. She has published extensively on women’s health and menopause (including eight books) and developed CBT interventions that have reduced the impact of menopausal symptoms in six clinical trials.

Created Spring 2020 

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