HOT FLASHES AND NIGHT SWEATS

Cognitive behavioral therapy has been shown to reduce the degree to which hot flashes and night sweats are rated as a problem. CBT does not change the frequency of hot flashes, but can change the frequency of bothersome hot flashes and life interference from hot flashes.

Group CBT interventions have involved psychoeducation (physiology of VMS; how thoughts and emotions affect the perception of physical sensations), training in relaxation and paced breathing, and cognitive and behavioral strategies to manage VMS (identifying and challenging negative beliefs about VMS; monitoring and modifying triggers of VMS; relaxation exercises).

Self-guided CBT content mimics that of the group CBT and includes a self-help book completed during a 4-week period, two contacts with a clinical psychologist, weekly homework, and a compact disc for daily practice of relaxation and paced breathing.

CBT for hot flashes and night sweats has also been delivered by trained nurses or psychologists,  in person as a group or one on one,  via the internet, or an app.

MOOD, ANXIETY & DEPRESSION

CBT has long been used to help with depressive or anxiety symptoms.  With CBT for mood, the therapist or counselor helps a person become aware of ways they think that may be negative, inaccurate, or harmful. The person learns to question these thoughts, understand them, and change these unhelpful ways of thinking. CBT helps a person think about, and react differently, to situations.  Research shows that it is helpful for both anxiety and depression.

A cognitive behavioral therapist may have you keep a diary, practice mindful meditation, do role plays, identify cognitive distortions (how you think), do controlled exposure to anxiety, reintroduce rewarding activities, and other techniques to help you change (restructure) your thoughts and find new ways to react to problematic situations. It can be done individually, in groups of people with similar difficulties, or through the internet. There is often “homework”, or assignments to do between sessions. It is a problem-oriented approach to helping people cope with their lives. It is sometimes done for a specific number of sessions.

Many other types of talk therapy and counseling can be helpful for treating depression and anxiety. These therapies can support individuals as they experience life challenges. While the many other different types of therapy and counseling have not been studied specifically in midlife women, there is extensive experience delivering these treatments to women of all ages.

SLEEP

Cognitive behavioral therapy for insomnia (CBTI) is for sleep problems. CBTI can help you identify thoughts and behaviors that are causing sleep problems and replace them with better habits. CBTI helps you figure out if your sleep environment is good. It covers strategies for stress reduction and relaxation. Your therapist will have you keep a sleep diary, to check your habits and schedule. CBTI also involves a stretch of nights with less sleep, to reset your body’s rhythms.  CBT-I can be delivered by an app, but the sleep deprivation portion of the therapy is very important and can be hard to stick to without a therapist.

SEXUAL CONCERNS: LOW SEX DRIVE and PAIN DURING SEX

CBT for Sexual Concerns in the Perimenopause (CBT-SC-Peri) is a weekly, four session treatment, lasting up to 90 min per session and includes psychoeducation and cognitive and behavioral strategies designed to challenge unhelpful beliefs and promote healthy sexual behaviors. As this is an individual CBT protocol, content will be tailored to address the specific problems relevant for each participant.

CBT for sexual concerns is delivered by a trained psychologist or sex therapist, one on one.