Susan F. Othmer and Siegfried Othmer, Ph.D.
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PMS, or Pre-Menstrual Syndrome, exists. However, it is not a unitary condition. The symptomatology is highly variable among individuals. In fact, PMS is not a recognized disorder within the DSM-III-R. It can perhaps best be looked at as a condition of disregulation, one to which biofeedback should be highly applicable. Cyclic hormonal variations provide the stressor, to which a particular individual, with specific systemic vulnerabilities, succumbs in a variety of ways. It is not to be expected that the condition should manifest with a high degree of homogeneity.
PMS symptoms include a variety of physical and emotional symptoms associated with a specific phase of the menstrual cycle. Premenstrual symptoms are reported by at least 75% of menstruating women, but they may not be severe or debilitating. In an effort to clinically define the PMS population with significant clinical symptoms and behavioral impairment, the DSM-III-R established criteria for Late Luteal Phase Dysphoric Disorder (LLPDD). The criteria include emotional symptoms (irritability, mood swings, anxiety, and depression), less interest in the usual activities, fatigue, trouble concentrating, change in sleep or appetite, and various physical symptoms. These symptoms must be correlated with the premenstrual phase only and result in serious impairment of relationships or interference with activities.
Many of the PMS symptoms are characteristic of depression as well, and indeed PMS may be seen as a depressive syndrome. Antidepressant and antianxiety medications often provide relief from some emotional PMS symptoms. Medical management must be maintained continuously, and generally involves some undesirable side effects. The lack of successful medical management again augurs well for a biofeedback intervention. The fundamental issue is “disregulation”, for which the remedy is “re-regulation”, rather than the more unilateral intervention implied by anti-depressants or anxiolytics.
Intervention with EEG biofeedback has been found clinically to be very helpful to individuals suffering from both physical and emotional PMS symptoms. Most of these individuals were referred for specific symptoms which troubled them, rather than for “PMS”. However, these symptoms were related to the menstrual cycle in the classical temporal PMS pattern. I.e., they appeared in the late luteal phase of the ovulation cycle. Others reported PMS symptoms unrelated to their referral. Regardless of whether a person was referred for PMS or for specific symptoms, the training of the person revolved to a large degree around the constellation of symptoms associated with PMS. Our own criteria of training outcome usually included assessment of remediation of this constellation of symptoms.
At its best, biofeedback training addresses itself to the whole individual, not to a particular symptom. And also at its best, biofeedback addresses itself to the condition of “disregulation” globally, rather than with respect to a particular symptom. The fact that EEG biofeedback simultaneously addresses a broad spectrum of symptoms successfully is powerful support for the view that training the brain directly addresses conditions of disregulation in their largest generality. Conversely, assessment of progress with EEG training requires survey of all of the client’s relevant symptomatology. Under conditions of cortical “disregulation” in our client population, almost irrespective of etiology, PMS symptoms were usually reported at intake. Conversely, when such “disregulation” was successfully remediated, this would usually manifest in the PMS symptoms as well. The premenstrual syndrome can almost be taken as a paradigm for “cortical disregulation” in menstruating women.
From this global perspective on PMS, it follows that the appropriate training protocol relates to the underlying deficiency in control mechanisms rather than to the specific symptoms which manifest. Hence, the constellation of symptoms, as well as the results of testing, are used to elicit whether the person tends toward under-or over-arousal, and to the presence of various instabilities, or volatilities in behavior. Then a priority is placed on which protocol is to be used first. This priority certainly takes into account the predominant symptoms which brought the client to us in the first place. However, that is by no means the only, or even the primary, concern.
We have stated above that PMS symptoms are to be seen in the context of underarousal. Nevertheless, symptoms we normally regard as related to overarousal, such as migraine headaches or anxiety, may be observed as well. This is true not only for PMS, but for underarousal in general. Both hyperactivity and hypoactivity arise out of the ground of underarousal. Anxiety is frequently seen in the context of depression. By increasing cortical activation via EEG training, we increase cortical control and physiological self-regulation which also addresses overarousal conditions.