Menstruation – the good, the bad, and the ugly

Femineity is beautiful. Along with our curves, intuition, nurturing souls and strength, we are blessed to be bearers of the wombs from which all human life begins in this world. Every human alive today, begun life in the womb of their mother. Regardless of whether a woman bears children, or how many she bears in her lifetime, there is a special process her body goes through each month to prepare for this potential event. Each step in this process, signalled by hormones, ideally occurs without interrupting, or negatively impacting, a woman’s daily activities. Unfortunately, however, this is not the experience for all women. For some, menstruation is a heavy burden and the monthly reminder of this life-giving cycle is most un-welcomed.

Understanding the menstrual cycle…

The menstrual cycle can be divided into stages – the first stage, known as the ‘follicular phase’, orchestrates the release of the egg and begins preparing a cosy cushion of lining for the egg to take lodging in, should it become fertilised. The second stage, known as the ‘luteal phase’ continues building up the comfy cushion wall and watches for the signal a fertilised egg has arrived. If a fertilised egg arrives, a special glue sticks the egg to the cosy cushion lining, where it is nurtured and grows into a little person over the ensuing 9 months. If, however, a fertilised egg does not arrive, the cushion wall is deconstructed and the materials that formed it are removed from the body – this is known as menstruation, or a woman’s ‘period’.

Image: https://en.wikipedia.org/wiki/Luteal_phase#/media/File:MenstrualCycle2_en.svg
Wikipedia link for more information: https://en.wikipedia.org/wiki/Menstrual_cycle

Introducing PMS… when being a woman becomes unpleasant

Premenstrual symptoms are the changes in mood, behavioural and physical health that some women experience prior to menstruation. Common symptoms include breast tenderness, abdominal bloating, food cravings (how often have you reached for chocolate pre-menstruation!) depression, and anxiety. Symptoms diminish after menstruation but come back again the following month, as the woman’s body prepares itself yet again for the prospective arrival of a fertilised egg.

Commonly, 90% of women experience at least one premenstrual symptom at some stage during their childbearing years, and for most of these women, symptoms are minor, non-disruptive and nothing more than a quiet reminder of the life-giving process going on deep within their body.

And PMDD… most unpleasant

Approximately 30% of women experience more than one premenstrual symptom, at an intensity or frequency that is unpleasant and somewhat disrupting to their daily lives.

Of these women, 5-8% experience moderate to severe symptoms that cause significant distress and functional impairment, interfering with their ability to go about their daily activities, and leading them to seek treatment.

Premenstrual Dysphoric disorder (PMDD) is what practitioners call this most severe form of PMS. It is a disorder classified in the DSM-5, and able to be diagnosed by Psychologists, who can also provide treatment to support reduction in symptoms and severity. You can see a Psychologist as a private patient or speak to your GP about getting a referral – it’s recommended you call and inquire after a Psychologist with experience seeing PMS/PMDD patients, as not all are.

At our practice, we recommend Psychologist Michelle Nolan.

If you would like additional diet, exercise and supplement support, our Exercise Physiologist and Clinical Nutritionist, Felicia McQueen can support you. You may choose to see one practitioner only, however if you choose to see both, we will work collaboratively with you as a team to address your concerns and help you achieve your goals.

Reducing your risk for developing PMS/PMDD

Although imbalances in the steroidal hormones progesterone and estrogen were once believed to be the cause of PMS/PMDD, hormone therapy has been shown to be ineffective for symptom resolution in many cases. Despite ongoing, rigorous research, scientists have not yet been able to identify the pathophysiological cause and effect of PMS & PMDD. They do however have several theories, and thus far have identified four proven risk factors associated with its development.

The four proven physical, environmental, and psychological risk factors associated with the development of PMS/PMDD are:

  1. Cigarette smoking – if you smoke or have previously smoked (especially if you began smoking during your teenage years), you have an elevated risk for moderate to severe PMS symptoms. Risk for developing PMS increases with the number of cigarettes you smoke.
  • Obesity – For every kg/m2 you are above a healthy BMI, your chance of getting PMS rises by 3%.
  • Past traumatic events – although the underlying mechanism is unknown, experiencing a traumatic event increases your risk for PMDD.
  • Anxiety – if you have a pre-existing anxiety disorder, you’re at increased risk for developing PMDD.

Reducing your existing PMS/PMDD symptoms…

Addressing the above risk factors has proven to be successful in reducing symptoms, improving function and restoring quality of life.

If you are overweight, our Clinical Nutritionist and Exercise Physiologist can review your dietary and lifestyle practices, help you develop a plan and provide support to achieve your weight loss goals.

Psychological interventions such as trauma-focused therapy, EMDR, CBT, ACT, are utilised by our Psychologists in an individually tailored course of therapy to reduce your anxiety and psychological symptoms, and improve your coping skills, mental health and wellbeing.

For support in cessation of smoking – we recommend talking to your GP, Psychologist, Nutritionist and your other treating Health practitioner team about your decision to stop smoking – to put together a plan and support network to help you achieve your goal. The Australian government have put together a resource guide to stop smoking: https://www.health.gov.au/health-topics/smoking-and-tobacco/how-to-quit-smoking. There’s also handy apps available to track your progress and provide support from this US government site: https://smokefree.gov/tools-tips/apps

Stepping forward to a more comfortable you…

We invite you to contact us on 07 4637 9097 or thriveadmin@thrivewellness.com.au to discuss our professional services and how we can assist you to achieve your goals. Although we are based in Toowoomba, we provide support to women Australia-wide through video and telephone consultations.

When contacting us to book your appointment, we recommend you request a 50min appointment with Psychologist Michelle Nolan, and a separate appointment with Clinical Nutritionist & Exercise Physiologist, Felicia McQueen. Service provided and costs associated with these appointments are listed in the ‘Fees’ section of our website. You may also wish to discuss your concerns with your GP, and ask about your referral options and eligibility for Medicare’s Better Access Initiative, which provides partially funded Psychology appointments through Medicare. A valid GP Mental Health Care Plan referral is required for this.

A person holding a frisbee on a beach

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“Don’t Panic!” – Your Virus Survival Guide

Update: Medicare has introduced special items to enable access to treatment via telehealth for people who may be required to self-isolate, or who are in high-risk groups. Please contact us via the links at the bottom of this page if you feel this might be applicable to your situation.

We’ve now produced a video introducing similar concepts to this post. If you prefer a video format, check it out here: How to cope and thrive in the face of COVID-19

We’ve all no doubt heard the advice by now to not panic in the face of the arrival of COVID-19 in Australia and the beginnings of its spread within our communities. But what is the purpose of this advice – “don’t panic”?

As a situation that carries danger unfolds – like the bushfires Australia faced a few months ago, and now the outbreak of this virus globally – there are certain natural, self-protective human instincts that spring into action. These are instincts that have helped our species to weather many crises, over many thousands of years, before now. But tied up with these instincts that have allowed us to become what we are today is a strange paradox – these same instincts that help us can cause us harm. Those instincts that drive us to keep ourselves and our loved ones safe can wind up with us fighting in the aisle of a supermarket over a packet of toilet paper!

As a psychologist, I get to work with people daily who are battling with the harmful side of these protective instincts, and try to pass on to them some strategies and skills that can help them regain balance, so their instincts are once again working for them.

So I wanted to offer a few simple, practical pieces of advice to anyone who might be finding themselves feeling uneasy about the outbreak of COVID-19, and uncertain what to do with that recommendation: “don’t panic.”

Water over log

Tip 1: understand there are two sides to your response to danger

Imagine your response to danger as involves two different pieces of machinery: one primitive and imprecise, but reasonably effective; the other more intricate and advanced. Imagine, too, that the more advanced piece of machinery actually requires the primitive one to be operating in order to function properly.

When we are confronted with a potential danger or threat, our “primitive” machine is our emotional fear response. It is something that we feel. That feeling is an extremely powerful motivator of action.

When our fear response is triggered it sets of a chain reaction of events in our body: release of adrenaline; increased heart rate; faster breathing; changes in the operation of our digestive system; … and so-on. These events in the body are all orchestrated to help us either fight the danger, run away from it, or freeze (in the hope the danger passes without “catching” us).

The “advanced” machinery of our danger response is our problem-solving ability. This is appropriate to dangers that are urgent, but not immediate: such as listening to news reports warning that bush fires are approaching your area. In such a situation our problem-solving responses help us to make a rational assessment of the options before taking action. This problem-solving process can, potentially, be the difference between a life-saving decision and a life-ending one: just checking what roads are safe to travel before leaving, for example, might save your life.

In the right balance, the primitive machinery of our fear emotions gives us the motivation and urgency to put to work the advanced machinery of problem-solving without delay.

However, there is a kind of “safety-mechanism” built-in to this. This mechanism is meant to prevent us from pausing to solve a problem in circumstances where immediate action is critical. For example, if you are being chased by something and running to safety, the last thing you want is to be slowed down by your problem-solving mechanism having you hesitate between two paths you could take, trying to pick the “better” path! So, when the primitive system assesses the level of danger to be sufficiently high and immediate, it starts to take the other system off-line. This means that there is a literal change in the blood-flow in our brains, shutting down the areas responsible for more complex planning and decision-making!

This is why you might have experienced occasions where under high pressure and high stress you made decisions that on later reflection did not seem very wise or rational.

The balance between the primitive and advanced systems of danger response can be directly experienced by playing a modified game of chase: the person who is “it” calls out a simple maths sum, like 8+4. They can immediately start chasing the other players – but the other players aren’t allowed to run away until they’ve called out the correct answer!

Because even a game of chase partially activates our primitive danger responses, we suddenly find it a bit harder to solve a simple maths problem! And the closer the person who is “it” gets to us, the more the solution eludes us!

Moon over mountains

Tip 2: get informed, and make a simple plan

Gather the right information from reliable, trustworthy sources. In this process, try to limit the load on your problem-solving to free up the resources of your advanced machinery for doing the real job of keeping you safe. Don’t try to understand the whole situation from first principles. Don’t go asking questions like “where did this come from?” and “why is this happening?” that can lead you down an unhelpful path into irrelevant information, or even conspiracy theories. None of that will help you address your immediate threat. However, understand your brain will want to go there because the primitive system is driving you with the feelings of urgency.

The useful questions to ask are these:

  • What do I need to know to stay safe?
  • What do I need to do to be prepared?

In answering the questions, try to remember that usually, even for really major crises, the steps to preparedness are relatively simple. It is easy to try to know everything and do everything to be prepared – but this quickly becomes more costly to us than it is beneficial (and ends up fueling our fear instead of quelling it). Luckily for us humans, we are by nature social and altruistic (believe it or not), so most people will instinctively team up to help each other out: meaning you don’t need to be perfectly prepared and resourced.

Trust the doctors, scientists and officials who are studying the situation and offering advice genuinely want to help you be safe, and if they are advising against certain strategies (such as limiting use of face masks to protect supplies), there are good reasons for that.

For some great places to start for up-to-date information and advice:

Australian Government Department of Health Coronavirus (COVID-19) resources

Tasmania Government Department of Health Coronavirus information and resources

Because this step is reasonably simple, keep your plan to the well-established advice and stop there. Going further will actually make things worse – which brings us to tip 3.

Snaking river

Tip 3: soothe the fear response (unless your house is actually on fire)

The final tip, and the key to execution of the advice “don’t panic”, is to understand that once you have taken those simple steps of preparation you still won’t feel like everything is going to be okay … and that’s okay.

At this point our instincts are continuing to motivate us to either find more solutions, fight, or run. But once you are prepared, every one of those is going to make your situation worse! We seek to find more solutions by staying glued to the news, and searching the internet for the latest details on the situation. Unfortunately, though, this only makes the crisis continue to feel ever bigger, further triggering our fear response, further compelling us to search for more solutions, spiralling around until we break – into a fist-fight in Woolworths!

… or we seek to run, or freeze. We stay home from work even though the virus isn’t yet in our community; we wear face-masks wherever we go; we try to fight the pathogen: taking the advice to wash our hands well beyond sensibility to where our skin red, cracked and bleeding from excessive washing. All the while, instead of feeling better like we are trying to do, we are feeling progressively worse.

To soothe your fear response, the following strategies are known to be effective:

  • first and foremost: accept your fear, tell yourself it is okay to have this feeling – that you don’t need to make it go away;
  • practice slowing down your breathing – this counteracts your fear response and signals to your brain “we’re all okay down here in the body” (but be aware for the first 30+ seconds slowing down your breathing will feel a bit wrong and uncomfortable);
  • prove to yourself that the world is not falling apart by continuing to engage in your normal activities – within the guidelines of the recommendations established in tip 2, do everything you can to maintain normality, as this soothes your brain!
  • take up mindfulness – try out the Smiling Mind app. Accept that your mind will resist this and keep pushing you to jump back into problem-solving, fighting or running – just observe all of those urges, and accept that trying to be “mindful” will seem strange and frustrating at a time like this – yet that is the very thing that makes it worth doing;
  • limit your exposure to news and information to what is strictly necessary to getting informed and making a plan – the continuous news cycle unnecessarily fuels unhelpful fear responses.

I wish you all the best in putting these strategies into practice.

If you’re in the Launceston, Tasmania region and would like an opportunity to discuss any of these concepts further, please contact the Prospect Medical Centre to make a booking to see me in person. For those in other areas, Skype appointments may be able to be arranged by contacting us through our Toowoomba office, or you may like to book in person with one of our psychologists in Toowoomba.

Water over rocks

Learning to be anxious: the conditioning of fear

Cartoon scary ghost

In one of Psychology’s dark moments, an 8 month old baby was taught to have a phobia of harmless furry things.

These unethical experiments, conducted in the 1920s by psychologist John Watson, were seen as evidence of how fear of harmless things can be learned through a process called classical conditioning. A careful observer will note numerous problems in the above video with how Watson conducted his research. However, better-controlled studies have since confirmed that fear, or anxiety, can indeed be learned through clasical conditioning.

What is classical conditioning?

Classical conditioning is a process by which we learn to associate an automatic response (such as fear, hunger, sleepiness) with a particular cue (a sound, object, sensation) because that cue has repeatedly been experienced to coincide with something that already caused that response. In the little Albert experiment, poor Albert was repeatedly distressed by a loud sound, causing fear, at the same time as he was exposed to a white rat. With time the rat (or more probably Watson himself) became a trigger of fear.

This is one way that we can learn to fear a thing – by its coincicidence with something scary. If I happen to be watching The Wiggles on tv at the moment a car crashes into my lounge room wall it is possible I might experience trepidation when I next hear a Wiggles song.
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It gets worse before it gets better

There is a common paradox for psychological therapy: many times the strategies we have found to provide us relief from our problems are at the same time perpetuating our problems. For example, a man suffering depression may find that staying in bed all day is the only way to get some slight relief from his persistent sadness and guilt. Yet, at the same time, staying in bed is keeping him isolated from social supports that could play an important part in his recovery. It is also feeding back into his guilt when, at the end of the day, he reflects on all the things he “should” have done instead of being in bed.

A woman with a phobia of mice may find running and hiding in another room if she sees a mouse gives her relief from her feelings of terror – yet in doing so she has unintentionally reinforces her automatic fear response to seeing mice.

Therapy generally involves, at some point, changing unhelpful patterns in one way or another. Initially this means stopping use of strategies that have had at least short-term benefits. Consequently, therapy can at times be very uncomfortable: you make a choice to confront difficult feelings and experiences that you have developed a range of strategies for avoiding. Because of this I often caution clients that “it gets worse before it gets better.” It is often necenssary to sit through discomfort, sometimes considerable discomfort, to experience the reward of mastering a problem.
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