CBT and Mindfulness-Based Interventions for the Treatment of Anxiety and Depression in Perimenopausal Women

The menopausal transition can be an emotionally turbulent time for many women. The hormonal shifts that occur during this transition bring not only physical symptoms but psychological ones as well, with many women experiencing anxiety, depression, and changes in cognitive functioning.

Various studies have explored the use of psychosocial interventions, including cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs), for women who experience psychological difficulties during the menopausal transition.  A recent systematic review and meta-analysis of 30 studies provides important information on the use of these psychosocial interventions to alleviate psychological symptoms in menopausal women. 

CBT and Mindfulness-Based Interventions

The meta-analysis included 30 studies and a pooled sample size of 3501 participants. On average, participants were between 47 to 59 years of age; 2686 were undergoing natural menopause, and 815 were experiencing treatment-induced menopause. 

Ten studies delivered CBT-based interventions including psychoeducation about menopausal symptoms, cognitive and behavioral strategies, relaxation techniques, and symptom monitoring. The average total “dose” of CBT-based interventions was 11.3 hours, ranging from 5 to 24 hours.  Nine studies provided Mindfulness-Based Interventions that promoted focus on present-day experiences and non-judgmental understanding of symptoms.  The average total dose of MBIs was 18.6 hours (range 16–29.4 hours). The remaining eleven studies encompassed Acceptance and Commitment Therapy (ACT), group counseling, marital support, health promotion coaching, and Emotional Freedom Techniques. Most psychosocial interventions were group-based and conducted in person.

The meta-analysis revealed that both CBT and MBIs significantly improved anxiety and depressive symptoms in menopausal women. CBT demonstrated a small but significant effect in reducing anxiety (d = -0.22) and depression (d = -0.33). MBIs exhibited a medium effect size for anxiety (d = -0.56) and a small effect for depression (d = -0.27). These psychosocial interventions also positively impacted cognition, with CBT leading to a small but notable improvement in memory and concentration (d = -0.23).

In addition, the analysis found that these therapeutic approaches substantially enhanced the overall quality of life for menopausal women, with medium to large effect sizes observed. 

Tailored Interventions for Peri- and Post-Menopausal Women

The results of the meta-analyses demonstrate the overall effectiveness of psychosocial interventions in improving mood, anxiety and quality of life in women experiencing menopausal symptoms. For anxiety, CBT had a small effect and MBI had a medium effect. However, there was significant heterogeneity across the studies, and the authors note that differences in effectiveness may reflect the fact that women participating in mindfulness-based interventions typically received a higher “dose” than women receiving CBT  (18.6 hours versus 11.3 hours.  Further study is needed to better understand the ideal dose, as well as the “active ingredients”, of these psychosocial interventions.  

One of the limitations of this meta-analysis is that data regarding menopausal status were not collected, thus it limits our ability to identify the optimal timing of interventions.  The needs of a woman in the early stages of menopause when she is experiencing a high burden of physical symptoms (vasomotor symptoms and sleep disruption) may differ from the needs of a woman who is at the end of the menopausal transition. 

The authors emphasize the importance of interactive group settings, where women can share experiences, perceptions, and gain social support during this transition. Psychosocial therapies should encourage a biopsychosocial understanding of menopause, acknowledging the interplay of physical, psychological, and social factors.

Common challenges during this period may include caring for aging parents, adjusting to children leaving home, and dealing with changes in physical and cognitive functioning associated with menopause.  By fostering a supportive environment and equipping women with coping strategies, these interventions can help them to navigate this transition with greater resilience and well-being.

The findings of this meta-analysis argue for the integration of mindfulness and CBT into conventional healthcare services for menopausal women. Internet-based programs and community support groups could increase accessibility to these valuable psychosocial resources.  Moreover, the authors note that professional medical organizations are crucial in promoting public awareness about menopause and advocating for integrated approaches that combine medical and psychosocial interventions. By destigmatizing this natural process and providing comprehensive support, 

Ruta Nonacs, MD PhD

Spector A, Li Z, He L, Badawy Y, Desai R.  The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis.  J Affect Disord. 2024 May 1;352:460-472.