"One week a month, I don’t want to live". Evaluation and implementation of internet-delivered cognitive behavioral therapy for premenstrual dysphoric disorder

Time period:

1 July 2025 – 30 June 2029

Project leader:

Johanna Motilla

Funder:

Forte

Type of award:

Project grant

Total funding:

4,863,000 SEK

Research problem and specific questions Hormonal changes during the menstrual cycle contribute to psychological distress, with serious consequences for up to one in ten menstruating individuals. One particularly affected group is those with premenstrual dysphoric disorder (PMDD). PMDD is characterized by multiple disabling symptoms, including depression, anxiety, irritability/anger, and emotional instability, and is also linked to increased suicidality. While pharmacological treatments exist, many patients continue to experience symptoms or stop medication due to their side effects. Therefore, there is a critical need for non-pharmacological treatment options.Cognitive behavioral therapy (CBT) is a promising candidate, but further research is required to establish its efficacy for PMDD and evaluate its feasibility in a healthcare context. Also, little is known about psychological factors influencing the development and treatment of PMDD. This project aims to pave the way for implementing an effective and scalable psychological treatment for PMDD and examine the role of emotion regulation in PMDD.Data and methods The project consists of two studies.Study 1 evaluates the effectiveness of emotion regulation-based internet-delivered CBT (eiCBT) for PMDD in a randomized controlled trial (N=164; eICBT vs waitlist control).Study 2 examines the feasibility and acceptability of eICBT within a Swedish primary care setting, using a Single Case Experimental Design and qualitative methods (N=30, eICBT).Long-term effects will be assessed 6 and 12 months posttreatment.The relationship between emotion regulation, premenstrual symptoms, and suicidal ideation in PMDD will be examined using daily assessment across multiple menstrual cycles (N=194).Societal relevance and utilization PMDD can cause severe suffering and reduced quality of life for a significant portion of an individual´s lifetime. Providing an accessible and effective psychological treatment could offer substantial benefits for affected patients, particularly those who do not tolerate pharmacological treatments or experience residual symptoms.Plan for project realization  The project is led by Uppsala University in collaboration with Linköping University (Study 1) and Region Uppsala (Study 2). It adopts an interdisciplinary approach, integrating expertise from clinical psychology, gynecology, and statistics. Patients and healthcare providers play a central role in the adaptation and evaluation of the treatment.