Can cognitive behavioral therapy improve vasomotor symptoms and recurrent depression in postmenopausal women?

Tamashiro, Leiliane Aparecida Diniz; Soares-Jr, José Maria; Renno, Joel; Turri, José Antônio Orellana; Linhares, Iara Moreno; Baracat, Edmund Chada; Mello, Nilson Roberto de

doi:10.1590/1806-9282.20231791

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Original Article • Rev. Assoc. Med. Bras. 70 (7) • 2024 • https://doi.org/10.1590/1806-9282.20231791 copy

Can cognitive behavioral therapy improve vasomotor symptoms and recurrent depression in postmenopausal women?

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the effectiveness of cognitive behavioral therapy in the treatment of vasomotor, sexual dysfunction, and recurrent depression in postmenopausal women.

METHODS:

This prospective, open study evaluated 112 postmenopausal women with vasomotor symptoms. Sexual dysfunction has cultural, social, biological, and emotional issues and divided into two groups: G1, without depression (n=65) and G2, with recurrent depression (n=47). The subjects underwent 12 sessions of in-person cognitive behavioral therapy and 12 sessions of home-based activity over a period of 6 months. They were evaluated at 3 months following the completion of therapy. Depression, memory, and attention-related functions, as well as climactic symptoms, were assessed using a questionnaire.

RESULTS:

In the depression questionnaire, the G1 group had a lower initial score than the G2 group (p<0.01). Following 6 months of therapy, both groups had similar improved scores. In the depression questionnaire, the women in group G1 had higher baseline values. In the assessment of vasomotor symptoms, the values in both groups were similar and showed an improvement in vasomotor symptoms after 24 weeks of treatment, but these effects disappeared after the follow-up of 48 weeks in the G2 group. Both groups improved the sexual dysfunction after 24 weeks.

CONCLUSION:

Cognitive behavioral therapy may be effective in reducing vasomotor symptoms and ameliorate the sexual dysfunction and recurrent depression in postmenopausal women after 24 weeks of treatment.

KEYWORDS:
Cognitive behavioral therapy; Menopause; Depression; Recurrent; Cognition

		G1: no depression (n=65)	G2: depression (n=47)	p
Age (M /SD)		55.5 (2.7)	54.8 (3.1)	0.72
Education (n)
	Middle school	05 (7.7%)	03 (6.4%)
	High school	17 (26.2%)	21 (44.7%)
	University degree	43 (66.2%)	23 (48.9%)	0.88
Marital status (n)
	Single	13 (20%)	10 (21.3%)
	Married	26 (40%)	27 (57.4%)
	Divorced	22 (33.8%)	06 (12.8%)
	Widowed	04 (6.2%)	04 (8.5%)	0.55
Professional status (n)
	Work	33 (50.8%)	33 (70.1%)
	Pensioned off	14 (21.5%)	10 (21.3%)
	Housewife	18 (27.7%)	04 (8.5%)	0.66
Body mass index (kg/m²2 Lerner T, Bagnoli VR, Pereyra EAG, Fonteles LP, Sorpreso ICE, Júnior JMS, et al. Cognitive-behavioral group therapy for women with hypoactive sexual desire: a pilot randomized study. Clinics (Sao Paulo). 2022;77:100054. https://doi.org/10.1016/j.clinsp.2022.100054 https://doi.org/10.1016/j.clinsp.2022.10... )
	< 25	10 (15.4%)	07 (14.9%)
	≥25	55 (84.6%)	40 (85.1%)	0.94
Physical exercise (n)
	Yes	14 (21.5%)	09 (19.1%)
	No	51 (78.5%)	38 (80.9%)	0.75

Evaluation/time weeks	G1: no depression (n=65)			G2: recurrent depression (n=47)			Comparison among periods in G1			Comparison among periods in G2			Comparison between groups in different periods
Evaluation/time weeks	Basal	24	48	Basal	24	48	Basal X 24	24×48	Basal X 48	Basal X 24	24×48	Basal X 48	Basal	24	48
SCWT-"D"¹	17.48 (3.86)	18.72 (3.72)	32.40 (7.89)	17.40 (3.61)	20.70 (5.11)	35.80 (9.41)	NS	<0.001	<0.001	NS	<0.001	<0.001	NS	NS	<0.05
SCWT-Erros-"D"¹	0.27 (0.64)	0.24 (0.55)	1.64 (1.84)	0.17 (0.43)	0.27 (0.57)	2.14 (2.43)	NS	<0.001	<0.001	NS	<0.001	<0.001	NS	NS	NS
SCWT -"W"¹	14.47 (2.85)	17.72 (3.82)	29.91 (7.80)	17.40 (3.61)	20.70 (5.11)	35.80 (9.41)	<0.05	<0.001	<0.001	NS	<0.001	<0.001	NS	NS	<0.001
SCWT-Erros- "W"¹	0.07 (0.26)	0.01 (0.12)	0.10 (1.60)	0.02 (0.14)	0.06 (0. 24)	0.85 (1.23)	NS	<0.001	<0.001	NS	<0.001	<0.001	NS	NS	NS
SCWT-"CW"¹	13.48 (2.67)	16.73 (3.10)	29.02 (7.7)	13.69 (2.14)	17.98 (2.58)	30.27 (6.79)	<0.01	<0.001	<0.001	<0.005	<0.001	<0.001	NS	NS	NS
SCWT-Erros- "CW"¹	0.01 (0.12)	0.10 (0.31)	0.53 (1.22)	0.0	0.08 (0.28)	0.48 (1.1)	NS	<0.01	<0.01	NS	NS	<0.05	NS	NS	NS
TMT -"A"¹	1.10 (14.28)	24.46 (8.00)	27.54 (7.12)	31.87 (19.88)	25.05 (15.67)	28.67 (8.28)	NS	NS	NS	<0.05	<0.01	NS	NS	NS	NS
TMT- Erros- "A"¹	0.23 (0.63)	0.10 (0.35)	0.13 (0.42)	0.02 (0.14)	0.04 (0.20)	0.14 (0.41)	NS	NS	NS	NS	NS	NS	NS	NS	NS
TMT -"B"¹	76.84 (23.09)	53.39 (14.02)	63.58 (16.39)	84.14 (36.81)	54.17 (17.24)	61.93 (14.65)	<0.001	NS	<0.01	<0.001	NS	<0.001	NS	NS	NS
TMT- Erros-"B"¹	1.16 (1.45)	0.86 (1.04)	0.46 (0.88)	0.68 (0.95)	0.53 (0.77)	0.40 (0.82)	NS	NS	<0.05	NS	NS	NS	NS	NS	NS
Number and letters¹ 1 Mean (standard deviation) and unpaired Student's t-test was used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	8.24 (2.53)	11.02 (2.25)	14.61 (2.00)	7.34 (2.28)	11.17 (2.11)	13.91 (2.26)	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	NS	NS	NS
Span digts - direct² 2 Median [interquartile range] and Mann-Whitey test were used. Repeated-measures Kruskal-Wallis and post-hoc Dunn tests were applied for compassion in the same group.	10 [4-12]	11 [5-12]	11 [7-12]	10 [4-12]	11 [7-12]	12 [6-12]	NS	NS	<0.001	<0.001	NS	<0.001	NS	NS	NS
Indirect digits² 2 Median [interquartile range] and Mann-Whitey test were used. Repeated-measures Kruskal-Wallis and post-hoc Dunn tests were applied for compassion in the same group.	5 [2-12]	7 [2-12]	8 [3-12]	5 [2-11]	8 [2-12]	9 [3-12]	<0.01	NS	<0.001	<0.001	NS	<0.001	NS	NS	NS
Digital windows¹ 1 Mean (standard deviation) and unpaired Student's t-test was used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	6.23 (2.47)	9.10 (2.97)	7.86 (2.42)	6.14 (2.53)	9.10 (2.01)	7.68 (2.26)	<0.001	NS	<0.01	<0.001	NS	0.05	NS	NS	NS
List of words² 2 Median [interquartile range] and Mann-Whitey test were used. Repeated-measures Kruskal-Wallis and post-hoc Dunn tests were applied for compassion in the same group.	8 [3-14]	10 [7-16]	11 [6-17]	8 [3-14]	9 [6-15]	12 [9-19]	<0.001	NS	<0.001	NS	<0.001	<0.001	NS	NS	NS
List of words recovery² 2 Median [interquartile range] and Mann-Whitey test were used. Repeated-measures Kruskal-Wallis and post-hoc Dunn tests were applied for compassion in the same group.	8 [0-15]	11 [4-16]	14 [5-16]	7 [0-15]	10 [5-16]	14 [7-16]	<0.001	<0.05	<0.001	<0.05	<0.001	<0.001	NS	NS	NS

G1: no depression (n=65)					G2: recurrent depression (n=47)			Comparison among periods in G1			Comparison among periods in G2			Comparison between groups in different periods
Questionnaires or domains		Basal	24 weeks	48 weeks	Basal	24 weeks	48 weeks	Basal X 24 weeks	24 weeks X 48 weeks	Basal x 48 weeks	Basal X 24 weeks	24 weeks X 48 weeks	Basal x 48 weeks	Basal	24 weeks	48 weeks
BDI¹ 1 Mean (standard deviation) and unpaired Student's t-test were used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.		12.14 (3.93)	5.26 (2.78)	8.10 (4.37)	25.21 (4.62)	6.10 (2.83)	8.04 (3.94)	<0.001	<0.05	<0.001	<0.001	NS	<0.001	<0.001	NS	NS
SRQ-20¹		7.78 (4.40)	4.49 (3.84)	3.89 (2.84)	12.55 (3.84)	6.10 (4.39)	4.00 (2.96)	<0.001	NS	<0.001	<0.001	NS	<0.001	<0.001	NS	NS
Domains of Greene Climacteric Scale
	Anxiety¹	7.12 (3.47)	3.70 (2.44)	4.92 (3.27)	9.55 (2.94)	5.61 (3.19)	5.63 (2.90)	<0.01	NS	NS	<0.01	NS	<0.01	<0.01	<0.05	NS
	Depression¹ 1 Mean (standard deviation) and unpaired Student's t-test were used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	8.52 (4.78)	2.47 (1.89)	3.38 (3.08)	12.94 (3.71)	5.63 (4.58)	3.83 (2.83)	<0.01	NS	<0.01	<0.01	NS	<0.01	<0.01	<0.01	NS
	Sexual dysfunction¹ 1 Mean (standard deviation) and unpaired Student's t-test were used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	1.84 ±1.12	2.30 ±0.98	1.60 ±1.04	2.36 ±1.03	1.16 ±0.83	1.59 ±0.99	<0.01	<0.01	NS	<0.01	NS	<0.01	<0.05	NS	NS
	Vasomotor symptoms¹ 1 Mean (standard deviation) and unpaired Student's t-test were used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	2.80 ±2.15	1.10 ±1.58	0.67 ±1.07	1.66 ±2.13	1.06 ±1.35	0.72 ±1.05	<0,01	NS	<0,01	<0.01	NS	NS	NS	NS	NS
	Physical symptoms¹ 1 Mean (standard deviation) and unpaired Student's t-test were used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	5.76 ±4.24	4.04 ±3.17	4.44 ±3.56	8.93 ±5.01	3.23 ±2.75	4.12 ±2.93	NS	NS	NS	<0.01	NS	<0.01	<0.01	NS	NS
	Total¹ 1 Mean (standard deviation) and unpaired Student's t-test were used. Repeated-measures ANOVA and post-hoc Bonferroni tests were applied for comparison in the same group among periods.	25.85 ±11.43	13.55 ±7.71	14.95 ±8.46	36.60 ±11.21	18.00 ±9.51	15.96 ±7.24	<0.01	NS	<0.01	<0.01	NS	<0.01	<0.01	NS	NS

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[1] *Corresponding author:
leiliane.tamashiro@hotmail.com