Tailored and comprehensive psychotherapy options have been requested by individuals experiencing negative premenstrual change (PMC) – inclusive of premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME). Whilst some studies present psychotherapy programmes or interventions for PMC, few provide detailed descriptions of the session contents or the rationale behind them. Only a small number of studies have explored participants’ acceptability of these programmes, and none have been codesigned with individuals who experience PMC themselves. This paper addresses the need for practice-led research by outlining the development process and session content of a codesigned psychotherapy programme tailored to PMC: a person-centred programme involving internal family systems (IFS) aspects and arts-based therapeutic activities. A case study using a single participant who completed the programme is used to illustrate the sessions, and the rationale behind them is discussed.
BrownD.SmithD. M.OsbornE.WittkowskiA. (2024). The experiences and psychological impact of living with premenstrual disorders: A systematic review and thematic synthesis. Frontiers in Psychiatry, 15(1), 1440690. https://doi.org/10.3389/fpsyt.2024.1440690
3.
BrownL. S. (2018). Feminist therapy. American Psychological Association.
4.
BurdettT.InmanJ. (2022). Person-centred integrated care with a public health approach to improve population health and wellbeing: A systematic literature review. International Journal of Integrated Care, 22(S1), Article 96. https://doi.org/10.5334/ijic.ICIC21055
5.
BusseJ. W.MontoriV. M.KrasnikC.Patelis-SiotisI.GuyattG. H. (2008). Psychological intervention for premenstrual syndrome: A meta-analysis of randomized controlled trials. Psychotherapy and Psychosomatics, 78(1), 6–15. https://doi.org/10.1159/000162296
6.
BuysM. E. (2024). Beyond abjection: Exploring narratives after premenstrual dysphoric disorder. Feminism & Psychology, 34(2), 290–308. https://doi.org/10.1177/09593535231223915
7.
BuysM. E. (2025a). ‘I’m sick of being called insane’: Experiences of Australian healthcare support for premenstrual distress. Australian Journal of Primary Health, 31(5), Article PY25133. https://doi.org/10.1071/PY25133
ChanK.RubtsovaA. A.ClarkC. J. (2023). Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: A qualitative investigation. BMC Women’s Health, 23(1), Article 272. https://doi.org/10.1186/s12905-023-02334-y
10.
ChrislerJ. C.GormanJ. A.StreckfussL. (2014). Self-silencing, perfectionism, dualistic discourse, loss of control, and the experience of premenstrual syndrome. Women’s Reproductive Health, 1(2), 138–152. https://doi.org/10.1080/23293691.2014.966597
11.
CitilE. T.CanbayF. C. (2024). The effect of art on premenstrual syndrome symptoms: A randomized controlled study. Holistic Nursing Practice. Advance online publication. https://doi.org/10.1097/HNP.0000000000000659
12.
De JagerA.TewsonA.LudlowB.BoydellK. (2016). Embodied ways of storying the self: A systematic review of body-mapping. Forum: Qualitative Social Research, 17(2), 1–32. https://nbn-resolving.org/urn:nbn:de:0114-fqs1602225
13.
DewA.SmithL.CollingsS.Dillon SavageI. (2018). Complexity embodied: Using body mapping to understand complex support needs. Forum Qualitative Social Research, 19(4), 1–26. https://doi.org/10.17169/fqs-19.2.2929
14.
Direkvand-MoghadamA.SayehmiriK.DelpishehA.KaikhavandiS. (2014). Epidemiology of premenstrual syndrome (PMS): A systematic review and meta-analysis study. Journal of Clinical and Diagnostic Research, 8(2), 106–109. https://doi.org/10.7860/JCDR/2014/8024.4021
15.
FunnellE. L.Martin-KeyN. A.BahnS.SpadaroB. (2024a). Help-seeking behaviours and experiences for mental health symptoms related to the menstrual cycle: A UK-wide exploratory survey. npj Women’s Health, 2(1), Article 2. https://doi.org/10.1038/s44294-023-00004-w
16.
FunnellE. L.Martin-KeyN. A.BahnS.SpadaroB. (2024b). Improving care experiences for premenstrual symptoms and disorders in the United Kingdom (UK): A mixed-methods approach. BMC Health Services Research, 25(1), Article 70. https://doi.org/10.1186/s12913-024-12140-3
GrewalJ. K.MuE.LiQ.ThomasE. H. X.KulkarniJ.ChenL. (2024). The prevalence of traumatic exposure in women with premenstrual dysphoric disorder (PMDD): A systematic review. Archives of Women’s Mental Health, 21(1), 723–740. https://doi.org/10.1007/s00737-024-01536-z
19.
HabibS.BaileyK. A.GriffinM. (2024). Off-label: Lived, embodied, and temporal experiences of premenstrual dysphoric disorder (PMDD) in Canada. Women’s Reproductive Health, 12(2), 310–329. https://doi.org/10.1080/23293691.2024.2436925
20.
HanJ.ChaY.KimS. (2019). Effect of psychosocial interventions on the severity of premenstrual syndrome: A meta-analysis. Journal of Psychosomatic Obstetrics & Gynecology, 40(3), 176–184. https://doi.org/10.1080/0167482X.2018.1480606
21.
HantsooL.EppersonC. N. (2015). Premenstrual dysphoric disorder: Epidemiology and treatment. Current Psychiatry Reports, 17(11), Article 87. https://doi.org/10.1007/s11920-015-0628-3
22.
HantsooL.SajidH.MurphyL.BuchertB.BaroneJ.RajaS.Eisenlohr-MoulT. (2022). Patient experiences of health care providers in premenstrual dysphoric disorder: Examining the role of provider specialty. Journal of Women’s Health, 31(1), 100–109. https://doi.org/10.1089/jwh.2020.8797
23.
HardyC.HardieJ. (2017). Exploring premenstrual dysphoric disorder (PMDD) in the work context: A qualitative study. Journal of Psychosomatic Obstetrics and Gynaecology, 38(4), 292–300. https://doi.org/10.1080/0167482X.2017.1286473
24.
HardyC.HunterM. S. (2021). Premenstrual symptoms and work: Exploring female staff experiences and recommendations for workplaces. International Journal of Environmental Research & Public Health, 18(7), Article 3647. https://doi.org/10.3390/ijerph18073647
25.
Hojjati NajafabadiS.VakilianK.GhaemmaghamiM.ZamanianM.BeigiM. (2023). Investigating the effect of mindfulness counselling on sexual functioning of women with premenstrual syndrome. Sexual & Reproductive Healthcare, 37(1), 100886. https://doi.org/10.1016/j.srhc.2023.100886
26.
HunterM. S.UssherJ. M.BrowneS. J.CarissM.JelleyR.KatzM. (2002a). Medical (fluoxetine) and psychological (cognitive-behavioural therapy) treatment for premenstrual dysphoric disorder: A study of treatment processes. Journal of Psychosomatic Research, 53(3), 811–817. https://doi.org/10.1016/S0022-3999(02)00338-0
27.
HunterM. S.UssherJ. M.BrowneS. J.CarissM.JelleyR.KatzM. (2002b). A randomized comparison of psychological (cognitive behavior therapy), medical (fluoxetine) and combined treatment for women with premenstrual dysphoric disorder. Journal of Psychosomatic Obstetrics and Gynaecology, 23(3), 193–199. https://doi.org/10.3109/01674820209074672
28.
JandaC.KuesJ. N.KleinstäuberM.WeiseC. (2015). A therapeutic approach to premenstrual syndrome (PMS): Modularized treatment program. Verhaltenstherapie, 25(4), 294–303. https://doi.org/10.1159/000439336
29.
Kancheva LandoltN.IvanovK. (2021). Short report: Cognitive behavioral therapy − a primary mode for premenstrual syndrome management: Systematic literature review. Psychology, Health & Medicine, 26(10), 1282–1293. https://doi.org/10.1080/13548506.2020.1810718
30.
KingM.UssherJ. M. (2012). It’s not all bad: Women’s construction and lived experience of positive premenstrual change. Feminism & Psychology, 23(3), 399–417. https://doi.org/10.1177/0959353512440351
31.
KleinstauberM.WitthoftM.HillerW. (2012). Cognitive-behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: A meta-analysis. Journal of Clinical Psychology in Medical Settings, 19(3), 308–319. https://doi.org/10.1007/s10880-012-9299-y
32.
KuesJ. N.JandaC.KleinstäuberM.WeiseC. (2014). Internet-based cognitive behavioural self-help for premenstrual syndrome: Study protocol for a randomised controlled trial. Trials, 15, Article 472. https://doi.org/10.1186/1745-6215-15-472
33.
KulkarniJ.LeydenO.GavrilidisE.ThewC.ThomasE. H. X. (2022). The prevalence of early life trauma in premenstrual dysphoric disorder (PMDD). Psychiatry Research, 308, Article 114381. https://doi.org/10.1016/j.psychres.2021.114381
34.
LoshnyH. (2004). Meditations of the premenstrual self: The conceptualisation of self in the origins and development of the PMS discourse [Masters dissertation, Simon Fraser University].
35.
LoukzadehZ.EslamyN.DehghanM.Houshang MehrparvarA. (2024). The impact of premenstrual disorders on work disruptions among working women: A cross-sectional study. International Jornal of Reproductive Biomedicine, 22(2), 149–156. https://doi.org/10.18502/ijrm.v22i2.15712
36.
LustykM. K.GerrishW. G.ShaverS.KeysS. L. (2009). Cognitive-behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: A systematic review. Archives of Women’s Mental Health, 12(2), 85–96. https://doi.org/10.1007/s00737-009-0052-y
37.
MahmoodiM.FarajkhodaT.NadjarzadehA.Zareei MahmoodabadiH. (2023). Online positive-oriented counseling, taking vitamin D3 tablet, online lifestyle modification training on premenstrual syndrome: A 3-armed randomized clinical trial. Scientific Reports, 13(1), Article 16631. https://doi.org/10.1038/s41598-023-43940-y
38.
MalchiodiC. A. (2007). Expressive therapies. The Guilford Press.
39.
NeubauerJ. (2024). Internal relational illustration: A pilot clinical case study. The American Journal of Family Therapy, 52(1), 73–91. https://doi.org/10.1080/01926187.2022.2059795
40.
NordlanderA. (2018). Agency, resistance and embodiment in the context of PMS [Masters dissertation, Linköping University].
41.
OsbornE.WittkowskiA.BrooksJ.BriggsP. E.O’BrienP. M. S. (2020). Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: A qualitative investigation. BMC Women’s Health, 20(1), Article 242. https://doi.org/10.1186/s12905-020-01100-8
42.
RapkinA. J.WinerS. A. (2009). Premenstrual syndrome and premenstrual dysphoric disorder: Quality of life and burden of illness. Expert Review of Pharmacoeconomics & Outcomes Research, 9(2), 157–170. https://doi.org/10.1586/erp.09.14
43.
RyanS.UssherJ. M.HawkeyA. (2021). Managing the premenstrual body: A body mapping study of women’s negotiation of premenstrual food cravings and exercise. Journal of Eating Disorders, 9(1), Article 125. https://doi.org/10.1186/s40337-021-00478-6
44.
RyanS.UssherJ. M.HawkeyA. (2022). Mapping the abject: Women’s embodied experiences of premenstrual body dissatisfaction through body-mapping. Feminism & Psychology, 32(2), 199–223. https://doi.org/10.1177/09593535211069290
45.
SchwartzR. C. (2023). No bad parts: Healing trauma & restoring wholeness with the internal family systems model. Random House.
46.
SchwartzR. C.SweezyM. (2020). Internal family systems therapy (2nd ed.). The Guilford Press.
47.
SharehH.GhodsiM.KeramatiS. (2022). Emotion-focused group therapy among women with premenstrual dysphoric disorder: A randomized clinical trial. Psychotherapy Research, 32(4), 440–455. https://doi.org/10.1080/10503307.2021.1980239
48.
SlatteryP.SaeriA. K.BraggeP. (2020). Research co-design in health: A rapid overview of reviews. Health Research Policy and Systems, 18(1), Article 17. https://doi.org/10.1186/s12961-020-0528-9
49.
SmithJ. B.WillisE. M.Hopkins-WalshJ. (2022). What does person-centred care mean, if you weren’t considered a person anyway: An engagement with person-centred care and black, queer, feminist, and posthuman approaches. Nursing Philosophy, 23(3), Article e12401. https://doi.org/10.1111/nup.12401
50.
SveinsdottirH.LundmanB.NorbergA. (2002). Whose voice? Whose experiences? Women’s qualitative accounts of general and private discussion of premenstrual syndrome. Scandinavian Journal of Caring Sciences, 16(1), 414–423. https://doi.org/10.1046/j.1471-6712.2002.00077.x
51.
SweezyM. (2023). Internal family systems therapy for shame and guilt. Guilford Press.
52.
TuttyL. M.BarryL.NixonK. L. (2021). ‘Mommy’s having a bad day’: The impact of premenstrual symptoms on mothering. Women’s Reproductive Health, 9(2), 81–99. https://doi.org/10.1080/23293691.2021.2016137
53.
UssherJ. M. (2003). The ongoing silencing of women in families: An analysis and rethinking of premenstrual syndrome and therapy. Journal of Family Therapy, 25(4), 388–405. https://doi.org/10.1111/1467-6427.00257
54.
UssherJ. M. (2004a). Premenstrual syndrome and self-policing: Ruptures in self-silencing leading to increased self-surveillance and blaming of the body. Social Theory & Health, 2(3), 254–272. https://doi.org/10.1057/palgrave.sth.8700032
55.
UssherJ. M. (2004b, May 16-19). Reconceptualising reproductive disorders: The development of a material-discursive-intrapsychic approach [Conference session]. Conference of Psychosomatic Obstetrics and Gynaecology, Edinburgh, UK.
56.
UssherJ. M. (2006). Managing the monstrous feminine: Regulating the reproductive body. Routledge.
57.
UssherJ. M. (2008). Challenging the positioning of premenstrual change as PMS: The impact of a psychological intervention on women’s self-policing. Qualitative Research in Psychology, 5(1), 33–44. https://doi.org/10.1080/14780880701863567
58.
UssherJ. M.HunterM.CarissM. (2002). A woman-centred psychological intervention for premenstrual symptoms, drawing on cognitive-behavioural and narrative therapy. Clinical Psychology & Psychotherapy, 9(5), 319–331. https://doi.org/10.1002/cpp.340
59.
UssherJ. M.PerzJ. (2006). Evaluating the relative efficacy of a self-help and minimal psycho-educational intervention for moderate premenstrual distress conducted from a critical realist standpoint. Journal of Reproductive and Infant Psychology, 24(4), 347–362. https://doi.org/10.1080/02646830600974147
60.
UssherJ. M.PerzJ. (2011). PMS as a gendered illness linked to the construction and relational experience of hetero-femininity. Sex Roles, 68(1–2), 132–150. https://doi.org/10.1007/s11199-011-9977-5
61.
UssherJ. M.PerzJ. (2013). PMS as a process of negotiation: Women’s experience and management of premenstrual distress. Psychology & Health, 28(8), 909–927. https://doi.org/10.1080/08870446.2013.765004
62.
UssherJ. M.PerzJ. (2014). ‘I used to think I was going a little crazy’: Women’s resistance to the pathologization of premenstrual change. In McKenzie-MohrS.LafranceM. N. (Eds.), Women voicing resistance (pp. 84–101). Routledge.
63.
UssherJ. M.PerzJ. (2017). Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for premenstrual disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial. PLoS One, 12(4), Article e0175068. https://doi.org/10.1371/journal.pone.0175068
64.
UssherJ. M.PerzJ. (2020a). ‘I feel fat and ugly and hate myself’: Self-objectification through negative constructions of premenstrual embodiment. Feminism & Psychology, 30(2), 185–205. https://doi.org/10.1177/0959353519900196
65.
UssherJ. M.PerzJ. (2020b). Resisting the mantle of the monstrous feminine: Women’s construction and experience of premenstrual embodiment. In BobelC.WinklerI. T.FahsB.HassonK. A.KisslingE. A.RobertsT. A. (Eds.), The Palgrave handbook of critical menstruation studies (pp. 215–231). Palgrave Macmillan. https://doi.org/10.1007/978-981-15-0614-7_19
66.
UssherJ. M.PerzJ.MayE. (2014). Pathology or source of power? The construction and experience of premenstrual syndrome within two contrasting cases. Feminism & Psychology, 24(3), 332–351. https://doi.org/10.1177/0959353514539650
67.
VargasC.WhelanJ.BrimblecombeJ.AllenderS. (2022). Co-creation, co-design, co-production for public health – A perspective on definition and distinctions. Public Health Research & Practice, 32(2), Article e3222211. https://doi.org/10.17061/phrp3222211
68.
WhiteM.EpstonD. (1990). Narrative means to therapeutic ends. W. W. Norton & Company.
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