Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2)

Department of Psychology (at Guy's), Institute of Psychiatry, King's College London, London, UK.
Menopause (New York, N.Y.) (Impact Factor: 3.36). 02/2012; 19(7):749-59. DOI: 10.1097/gme.0b013e31823fe835
Source: PubMed


The aim of this study was to examine the effectiveness of group cognitive behavioral therapy (CBT) and guided self-help CBT in reducing hot flush and night sweat (HF/NS) problem rating at 6 and 26 weeks after randomization.
This was a randomized control trial of 140 women having 10 or more problematic HF/NS a week for at least a month. The primary outcome was HF/NS problem rating (1-10) at 6 weeks after randomization. Secondary outcomes were physiologically measured HF/NS at 6 weeks; HF/NS problem rating at 6 weeks; and frequency, mood (Women's Health Questionnaire), and health-related quality of life (General Health Survey Short Form-36) at 6 and 26 weeks. Intention-to-treat analysis was used, and between-group differences were estimated using linear mixed models.
Baseline mean (SD) HF/NS weekly frequency was 63.15 (49.24), and problem rating was 5.87 (2.28). Group and self-help CBT both significantly reduced HF/NS problem rating at 6 weeks-group CBT versus no treatment control (NTC; adjusted mean difference, 2.12; 95% CI, 1.36-2.88; P < 0.001) and self-help CBT versus NTC (adjusted mean difference, 2.08; 95% CI, 1.29-2.86; P < 0.001)-and at 26 weeks-group CBT versus NTC (adjusted mean difference, 1.33; 95% CI, 0.54-2.13; P = 0.001) and self-help CBT versus NTC (adjusted mean difference, 1.19; 95% CI, 0.36-2.02; P = 0.005). Group and self-help CBT significantly reduced night sweat frequency at 6 and 26 weeks. There were improvements in mood and quality of life at 6 weeks and improved emotional and physical functioning for group CBT at 26 weeks.
These results suggest that CBT delivered in group or self-help format is an effective treatment option for women during the menopause transition and postmenopause with problematic HF/NS.

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Available from: Myra S Hunter, Feb 19, 2014
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    • "The management of these symptoms is problematic; a recent systematic review of treatments for HFNS in PCa patients concluded that few effective and well-tolerated treatments are available, and that a priority should be the development of acceptable treatments that are free from side effects [6]. Cognitive behaviour therapy (CBT) for HFNS has been developed, by Hunter and colleagues, and found to be a safe and effective intervention for women with troublesome HFNS, going through a natural menopause [7] and experiencing HFNS following breast cancer treatments [8] [9]. HFNS in men are under researched compared to those experienced by menopausal women or by women following breast cancer treatments. "
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    ABSTRACT: Objective Hot flushes and night sweats (HFNS) are commonly experienced by men receiving treatment for prostate cancer. Cognitive behavioural therapy (CBT) has been found to be an effective treatment for HFNS in women, but cognitions and behavioural reactions to HFNS in men are under-researched. This study describes the development of the HFNS beliefs and behaviour scale for men. Methods HFNS beliefs and behaviour items were generated from a qualitative study, from pilot interviews with men with prostate cancer and HFNS, and from scales used for women. 118 men with prostate cancer, aged above 18, English-speaking, who had minimum of seven HFNS weekly for at least 1 month, completed the initial measure, and measures of HFNS frequency, problem rating, anxiety and depression (HADS). Principal components analyses with orthogonal rotation determined the most coherent solution. Results Exploratory factor analysis culminated in a 17-item HFNS beliefs and behaviour scale for men (HFBBS-Men) with three subscales: (1) HFNS social context and sleep, (2) Calm/Acceptance, (3) Humour/Openness. The subscales had reasonable internal consistency (Cronbach alpha 0.56–0.83). Validity was supported, by correlations between subscale 1, HFNS frequency, problem-rating and mood; men with locally advanced cancer more likely to adopt Calm/Acceptance and those with metastatic cancer Humour/Openness. Conclusions Preliminary analysis of the HFBBS-Men suggests that it is a psychometrically sound instrument, grounded in men's experiences. As a measure of cognitive and behavioural reactions to HF/NS, the HFBBS-Men should increase understanding of the mediators of outcomes of psychological interventions, such as CBT.
    Full-text · Article · Dec 2014 · Maturitas
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    • "Finally, a study conducted by Hunter and Liao (1996) demonstrated the efficacy of a four-session CBT group (randomized experimental group n=12 and waitlist control group n=12) for reducing vasomotor symptoms that were maintained 3 months posttreatment. Following this, the same group of researchers found similar results in a four-session CBT group clinical trial (Ayers et al. 2012). Behavioural treatments alone, including relaxation techniques such as paced respiration, progressive muscle relaxation, and slow deep breathing, have also been shown to be fairly effective in reducing hot flash distress (Freedman and Woodward 1992; Germaine and Freedman 1984; Wijma et al. 1997; Irvin et al. 1996). "
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    ABSTRACT: The menopausal transition is frequently accompanied by adverse physical and emotional changes that can significantly impact a woman's quality of life. Hormone replacement therapy has been the most commonly used menopause-related treatment to date, particularly for the alleviation of vasomotor symptoms; recent studies, however, have questioned its long-term safety for some women. We aimed to develop a cognitive-behavioral group treatment (CBGT) program as an alternative or complementary treatment option for reducing the frequency and intensity of debilitating menopausal symptoms in midlife women. Eight subjects participated in two, 10-week pilot groups (n = 4 participants per group) with participants being drawn from referrals through the Women's Health Concerns Clinic and community advertising efforts. This pilot study confirmed a reduction in the frequency and interference associated with vasomotor symptoms, less depression and general anxiety, and an overall improvement in quality of life. Participants also reported high levels of satisfaction with this type of treatment for menopausal symptoms. Furthermore, there was a trend towards a reduction in sleep difficulties and sexual concerns over the course of treatment. This pilot CBGT program appears to be a promising alternative or complementary treatment for both the physical and emotional symptoms experienced during menopause. Further studies are needed on its efficacy through larger, controlled trials.
    Full-text · Article · Apr 2013 · Archives of Women s Mental Health
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    • "In summary, this study explores relationships between HFNS measures and the findings add to previous evidence [11] [12] [17] [18] [28] that self reported frequency, physiologically measured frequency and problem-rating or interference may be measuring different aspects of HFNS and are differentially predicted by psychological factors. None of the personality, mood nor stress measures predicted physiological measures of HFNS frequency. "
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    ABSTRACT: Objective Hot flushes and night sweats (HFNS) are commonly experienced by women during the menopause transition and are particularly problematic for approximately 25% having negative impact on their quality of life. We previously developed a cognitive model of HFNS, which outlines potential predictors of HFNS. This study aims to test the model by investigating the relationships between personality characteristics, perceived stress, mood, HFNS beliefs and subjective and physiological measures of menopausal HFNS.Methods140 women (menopause transition or postmenopausal) who were experiencing at least 10 HFNS per week for at least a month, completed assessment interviews, including questionnaires assessing optimism, somatic amplification, perceived stress, depressed mood, anxiety, HFNS beliefs and HFNS frequency, problem-rating and 24-hour sternal skin conductance monitoring. Structural equation models (SEM) were used to investigate the optimum predictive model for HFNS Frequency and HFNS Problem-Rating.ResultsOn average 63 HFNS per week and moderately problematic HFNS were reported. The physiological measure of HFNS frequency was not associated with socio-demographic variables, personality or mood. The final SEM explained 53.2% of the variance in problem rating. Stress, anxiety and somatic amplification predicted HFNS problem rating but only via their impact on HFNS beliefs; HFNS frequency, smoking and alcohol intake also predicted HFNS problem rating.Conclusions Findings support the influence of psychological factors on experience of HFNS at the level of symptom perception and cognitive appraisal of HFNS.
    Full-text · Article · Apr 2013 · Journal of psychosomatic research
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