Women In Residential Treatment Research Articles

Impulsivity Dimensions Predict Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders.

Residential treatment for substance use disorders (SUDs) is effective at reducing substance use, dependence, and other related problems. However, dropout from treatment against medical advice (AMA) is common in residential treatment settings. Studies have shown that impulsivity is associated with substance misuse and treatment dropout in predominately male samples, but less is known regarding whether impulsivity dimensions predict treatment dropout among women. This study examined impulsivity dimensions (ie, negative urgency, positive urgency, lack of perseverance, lack of premeditation, and sensation seeking) as predictors of dropout AMA among women in a residential substance use treatment facility (N = 229). Logistic regression results demonstrated that elevations in lack of perseverance and sensation seeking were associated with an increased odds of treatment dropout AMA and that lack of premeditation was associated with a decreased odds of treatment dropout AMA. Study findings suggest that early evidence-based interventions for sensation seeking and lack of perseverance may improve retention of women in residential treatment.

Cumulative exposure to traumatic events and craving among women in residential treatment for substance use disorder: The role of emotion dysregulation and mindfulness disposition.

Strong evidence links exposure to traumatic life events with subsequent substance use disorders (SUD). Compared to men, women in SUD treatment are more likely to have a history of trauma, characterized in part by emotion dysregulation known to negatively influence treatment outcomes. Existing research has been conducted with predominantly male and non-Hispanic White samples, with an emphasis on adverse childhood experiences. Little is known about how exposure to cumulative traumatic events across the lifespan affects emotion dysregulation and how this may influence craving, particularly among racial and ethnic minoritized women with SUD. Mindfulness disposition may serve as a protective factor that could buffer the impact of trauma exposure and emotion dysregulation on substance use craving among underrepresented minoritized women with SUD. This study examined the association between cumulative exposure to traumatic events, emotion dysregulation, and mindfulness disposition on substance use craving in a sample of predominantly Hispanic and non-Hispanic Black women in residential treatment for SUD. Cross-sectional data were analyzed for a baseline sample of 241 women (56.96% Hispanic, 20.7% non-Hispanic White, 20.7% non-Hispanic Black; age: M = 32.11) entering a SUD residential treatment facility who agreed to participate in a parent randomized controlled trial. Findings indicated that greater cumulative exposure to traumatic events and emotion dysregulation were associated with higher levels of craving. Cumulative traumatic event exposure was indirectly associated with higher craving via lower levels in the mindfulness dimension of acting with awareness. Interaction effects also revealed greater exposure to traumatic events was associated with higher levels of craving among women with low and average (but not high) levels of mindfulness disposition. These findings provide insight into the potential benefits of targeting emotion regulation and mindfulness-building strategies such as acting with awareness in interventions among racial-ethnically diverse women with SUD. These strategies may be particularly beneficial among those that have experienced extensive histories of trauma exposure. Overall, knowledge gained from the present study can be particularly valuable towards informing treatment models in minoritized groups that currently experience disparities in treatment utilization and outcomes.

Development, feasibility, acceptability, and impact of a positive psychology journaling intervention to support addiction recovery

ABSTRACT Recovery from substance use disorders can be an arduous, lengthy process, yet there exist few interventions specifically designed to make recovery more reinforcing. This single-group mixed-methods study describes the development, feasibility, acceptability, and impact of a novel journaling intervention that combines aspects of positive psychology and behavioral activation to make recovery more reinforcing. We taught the journaling to women in residential treatment for substance use disorders during eight group sessions, after which participants journaled independently for 2 weeks. The journaling practice was found to be feasible and acceptable. Quantitative data showed improvement in a range of well-being, recovery, and mental health–related factors. Qualitative data showed that the intervention helped participants to recognize what was positive about recovery, to achieve meaningful short-term goals, and to experience a sense of optimism and pride in their accomplishments.

A pilot randomized trial of CBT4CBT for women in residential treatment for substance use disorders

IntroductionDespite the effectiveness of cognitive behavioral therapy (CBT) for treatment of substance use disorder, dissemination to clinical practice is limited due to a range of barriers (e.g., time, cost). Computer-based training for cognitive behavioral therapy (CBT4CBT) offers a feasible and cost-effective opportunity to improve the quality and reach of SUD treatment. Research to date has supported the effectiveness of CBT4CBT in outpatient settings; however, research has not yet tested it in residential treatment. MethodsThe current study evaluated the feasibility of CBT4CBT as an adjunct to residential treatment in a sample of women with SUDs using a two-arm pilot RCT comparing women randomized to either standard residential treatment plus access to the CBT4CBT program (N = 34) or residential treatment alone (TAU; N = 29). Assessments occurred at baseline, discharge from residential care, and at 4- and 12-weeks post-discharge. The study compared the two groups over the 12-week follow-up period on relapse to any substance (Y/N), relapse to primary substance (Y/N), and days of use using chi-square for categorical and t-tests for continuous measures. The study team also performed a Kaplan-Meier analysis to compare the two groups on time to relapse. ResultsDemographically, the sample was predominantly African American (79.4%), with a mean age of 41.2 years (SD = 12.1). Although the current study was not powered for statistical significance, findings were in the predicted direction, with women in the CBT4CBT group reporting lower likelihood of relapse, longer time to relapse, and fewer days of substance use in the follow-up period compared to women in TAU. ConclusionsThis study expands the current literature supporting the use of CBT4CBT in outpatient settings. While a fully powered trial should confirm our findings, the current study provides benchmark data on the use of CBT4CBT in residential treatment for women with SUDs.

Examination of referral source and discharge outcomes among women in residential substance use disorder treatment

BackgroundCourt-mandated substance use disorder (SUD) treatment, compared to nonmandated treatment, has been associated with increased retention and completion. However, due to limitations of previous studies, whether child protective services (CPS) and criminal justice (CJ) mandated treatment improve treatment completion and retention among women in residential treatment remains unclear. PurposeThis study investigated differences in treatment completion and progress based on three clinical discharge outcomes (i.e., completer, noncompleter with significant progress, and noncompleter without significant progress). We hypothesized that women mandated by (1) CJ will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to women who are CPS mandated; (2) CPS will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to nonmandated women. MethodsStudy staff conducted multinomial logistic regression analyses on data for a diverse sample of 161 women mandated or nonmandated (CJ: N = 71, CPS: N = 66, nonmandated: N = 24) into residential SUD treatment to determine each group's clinically defined treatment discharge outcomes while controlling for covariates. ResultsMultinomial logistic regression analyses revealed that being mandated by the CJ system predicted being a treatment completer compared to those who were CPS mandated (RR = 9.88, p = .009). The study found no differences in discharge status of completer without satisfactory progress between those who were CPS mandated and those who were CJ mandated or nonmandated. For women mandated by the CPS system compared to nonmandated women, the risk of being a treatment completer relative to noncompleters with satisfactory progress was not significant (RR = 1.08, p = .897). Analyses showed that being mandated by the CJ system predicted an improved clinically defined discharge outcome of treatment completer compared to women who were nonmandated to treatment (RR = 10.74, p = .016). In several of the models, drug and alcohol craving was associated with increased odds of being a noncompleter of treatment without satisfactory progress. ConclusionsThis study demonstrates that improved treatment completion and discharge status cannot be assumed based solely on being mandated by the CJ or CPS systems. As evidenced by variability in treatment discharge outcomes within and among referral groups, the paper suggests directions for future research.

Mindfulness-Based Intervention Effects on Substance Use and Relapse Among Women in Residential Treatment: A Randomized Controlled Trial With 8.5-Month Follow-Up Period From the Moment-by-Moment in Women's Recovery Project.

We tested the efficacy of Moment-by-Moment in Women's Recovery (MMWR), a mindfulness training program adapted for ethnoculturally diverse women with complex social and clinical histories in residential treatment for substance use disorder, on substance use and relapse outcomes. Participants were randomized to MMWR (n = 100; 60% Hispanic/Latina, 18% non-Hispanic Black) or the attention control condition, Neurobiology of Addiction (n = 100; 56% Hispanic/Latina, 21% non-Hispanic Black). Substance use outcomes (days until first use, days of use, and relapse status: abstained, lapsed, relapsed) were obtained from interviewer-assisted timeline followback for an 8.5-month follow-up period spanning the intervention start through the 6-week intervention period and 7 months after the intervention ended. An intent-to-treat survival analyses showed that time delay to first marijuana use favored MMWR (hazard ratio = 0.44, 95% confidence interval = 0.20-0.98, p = .049) with a medium-to-large effect size. In negative binomial hurdle models, the MMWR group showed fewer days of marijuana use at 3.5 months (B = -1.71, SE = 0.79, incidence rate ratio = 0.18, p = .030) and a trend at 7 months after the intervention (B = -0.90, standard error = 0.55, incidence rate ratio = 0.41, p = .10). For marijuana, mindfulness practice time during the intervention predicted time delay to first use (B = 0.28, p = .006) and total abstinence days (B = 0.34, p = .002) across the 7 months after MMWR. No other substance use outcomes showed differential response to MMWR relative to controls. Only in MMWR, number of study intervention sessions attended (dose) correlated with a greater length of time to alcohol intoxication (r = .48, p < .001), fewer days of alcohol intoxication (r = -.24, p = .020), and greater improvement in mindfulness skills (r = .61, p < .01). MMWR added to an ongoing intensive residential treatment program serving vulnerable women is protective against marijuana use but no other substance use outcomes. Mindfulness practice time predicted a delay in time to first marijuana use. MMWR class attendance, an indicator of intervention dose, appears protective of alcohol intoxication at follow-up; thus, extended MMWR exposure might be useful.

Mothers’ alexithymia in the context of parental Substance Use Disorder: Which implications for parenting behaviors?

BackgroundMaternal substance use disorder (SUD) represents a severe risk for caregiving, affecting diverse domains of parenting behaviors, such as sensitivity, structuring, intrusiveness, and hostility. Various studies highlighted that difficulties in parenting behaviors in the context of SUD are exacerbated by the co-occurrence of psychopathological symptoms. A large body of research points out the presence of high rates of alexithymia in individuals with SUD, and some studies provide evidence of an association between this psychopathological aspect and parenting. Nevertheless, no prior research has explored how alexithymic traits could affect quality of parenting behaviors in mothers with SUD. ObjectiveTo investigate the impact of maternal alexithymia on parenting behaviors in mothers with SUD. MethodsSixty women in residential treatment for SUD and their children participated in the study. The participants were assessed with respect to alexithymia, quality of parenting behaviors, and depressive symptoms. ResultsForty-three percent of the mothers reported the presence of alexithymia. These mothers presented with significantly low scores on sensitivity (β = -.25, p < .05) and structuring (β = -.32, p < .05). After controlling for depressive symptomatology, the effect of alexithymia on parenting behaviors remained only for structuring (β=.35, p < .05). ConclusionsIn the context of SUD, maternal alexithymia significantly impacts the quality of parenting behaviors, specifically structuring, indicating that difficulties in becoming aware of one’s own feelings jeopardize the ability to scaffold interactions and set age-appropriate limits in an emotionally attuned way. Clinical implications of the findings are discussed.

Electronic monitoring devices during substance use treatment are associated with increased arrests among women in specialty courts

ABSTRACT Background: Electronic monitors (EMs) are commonly used as a sanction and to improve compliance with substance use treatment and reduce re-arrest in criminal justice settings. However, there is minimal evidence for their effectiveness, especially among women. Objectives: We examined whether the use of EMs (i.e., devices placed on one’s body to encourage treatment compliance) increased rates of substance use treatment completion, and as a result, reduced re-arrest and substance use among women offenders. Methods: We sampled 114 women referred to residential substance use treatment and a subsample of 102 women charged with felonies. Logistic regression models accounting for clustering of time within person were fit. Results: Overall, EMs were associated with 3.13 greater odds of re-arrest after accounting for criminogenic risk indicators; however, no association was detected among women charged with felonies only. Women who were assigned to EMs were significantly less likely to report illicit drug use in the past 30 days, and women charged with felonies were less likely to report both alcohol and illicit drug use in the past 30 days. There was no association between EM assignment and treatment completion or positive urinalysis result. Conclusion: EM provision did not enhance the retention of women in residential treatment and the presence of an EM was associated with a more than tripling in the odds of re-arrest. Results also suggest that EM use for women in Specialty Courts may have some limited utility in reducing substance use; however, the mechanism driving this effect remains unclear.

Pilot Tobacco Treatment Intervention for Women in Residential Treatment for Substance Use Disorder

ObjectiveTo test the feasibility, acceptability, and efficacy of Get Fit and Quit (GFAQ), a community-engaged, holistic tobacco treatment program for women of childbearing age in a residential substance use disorder treatment facility. DesignA quasi-experimental, one-group, longitudinal design. SettingA local Young Men’s Christian Association (YMCA) location. ParticipantsTwenty-three women of childbearing age were enrolled in the study. Nearly all (21/23) participants were White, and most were nonpartnered and unemployed. More than one third of participants had more than high school educations, and five (22%) were pregnant at enrollment. MethodsThe program was conducted in 10 sessions over 6 months. For each 90-minute session, approximately 45 minutes were dedicated to smoking cessation, and 45 minutes were dedicated to group physical activity. Means and 95% confidence intervals were used to summarize nicotine dependence, expired carbon monoxide, urine cotinine, and exercise self-efficacy at baseline and 5-week, 8-week, and 6-month assessments. Cigarettes smoked per day were summarized using medians and interquartile ranges over time. Program satisfaction and regular exercise were presented as percentages with 95% confidence intervals. ResultsOf the 23 women who enrolled in GFAQ, 7 (30%) completed the program. Compared with baseline results, participants who completed GFAQ had lower nicotine dependence and smoked fewer cigarettes per day. Additionally, at 5 weeks, more GFAQ participants exercised regularly (64%) compared with baseline (14%). Most participants viewed the program favorably. ConclusionSmoking in women of childbearing age with substance use disorders is an important public health issue. GFAQ is a promising intervention for tobacco treatment for this high-risk population, although the number of initial participants who completed the program was low.

Moment-by-Moment in Women's Recovery: Randomized controlled trial protocol to test the efficacy of a mindfulness-based intervention on treatment retention and relapse prevention among women in residential treatment for substance use disorder

Although therapeutic treatments exist for substance use disorder (SUD), about half of individuals who enter treatment leave early and relapse to substance use. Early dropout from residential treatment places individuals at risk of relapse, and women in SUD residential treatment represent a vulnerable population. Evidence gaps persist for the use of mindfulness-based interventions (MBIs) among racially and ethnically diverse women with SUDs, especially regarding the efficacy of MBIs adapted to prevent residential dropout and relapse. We previously developed and pilot tested an MBI, Moment-by-Moment in Women's Recovery (MMWR), adapted to support women with SUD during residential treatment. The 12-session MMWR program tested in the present study integrates relapse prevention, addresses literacy level and trauma experiences and mental health problems, and is relevant to issues surrounding treatment- and relapse-related stressors among women. The primary objective of the current Phase II randomized controlled trial is to adequately test the efficacy of MMWR on residential treatment retention and substance use relapse and determine psychosocial and neural mechanisms of action underlying MMWR. Participants are women in residential SUD treatment from a community-based residential site that serves mainly women who are low-income and racially and ethnically diverse. A subgroup of participants from each treatment group also completes functional and structural neuroimaging assessments before and after the intervention to explore possible structural and functional brain correlates of change associated with participation in the MMWR program. Findings are expected to inform the utility of adapting MBIs to improve treatment success among vulnerable women in SUD residential treatment.

Dispositional Mindfulness and Compulsive Sexual Behavior Among Women in Residential Treatment for Substance Use Disorders

Compulsive sexual behaviors (CSB) are prevalent among populations with substance use disorders (SUD). The risk of relapse following SUD treatment is increased if CSB are not addressed. Despite this risk, few studies have examined protective factors for CSB among individuals with SUD, and none have examined protective factors unique to women with CSB and SUD. Women’s CSB are believed to be motivated by efforts to avoid painful affective experiences (e.g., trauma symptoms, loneliness, and shame). Dispositional mindfulness was shown to reduce one’s risk for engaging in maladaptive responses to aversive experiences. Thus, we hypothesized that dispositional mindfulness would negatively relate to CSB among women with SUD. For the present study, we reviewed cross-sectional, self-report measures which were included in the medical records of 429 women in residential treatment for SUD. Results of hierarchical multiple regression analyses revealed that, controlling for age, and drug, and alcohol problems and use, dispositional mindfulness negatively related to the core dimensions of CSB. These findings suggest that women with CSB and SUD are less likely to willingly approach present-moment experiences with acceptance. These preliminary findings suggest that researchers and clinicians should consider the utility of mindfulness-based approaches in treating women with CSB and SUD.

Women’s perceptions of the usefulness of group music therapy in addictions recovery

ABSTRACTThis study represents our attempt to uncover aspects of group music therapy that women with addictions perceive as useful toward recovery – factors that have yet to be clearly identified in existing literature. Women in residential treatment for addictions to heroin and other substances were surveyed following group music therapy sessions involving vocal and instrumental re-creation, listening, and improvisation. Qualitative content analysis of data revealed four major findings. We learned that treatment is, in fact, seen as useful by these particular women and that Yalom’s theory provides a meaningful framework for identifying, understanding, and fostering mechanisms within the group music therapy experience that contribute to improved well-being, such as catharsis, self-understanding, group cohesiveness, and instillation of hope. We also learned that certain intrapersonal aspects of therapy are thought to be helpful, such as those leading to desired changes in mood state, energy, sense of self, and level of enjoyment. Finally, we learned that aspects of therapy appearing in the women’s responses tended to be those emphasized in the therapists’ session planning and facilitation.

Is General or Alcohol-Specific Perceived Social Support Associated with Depression among Adults in Substance Use Treatment?

ABSTRACTAlcohol use disorders are among the most common mental health disorders in the world and incur considerable costs for individuals and society. Previous research has demonstrated that perceived social support (PSS) may decrease rates of depression and relapse in individuals seeking treatment for alcohol use. The current study developed and investigated a self-report measure for perceived social support for sobriety from alcohol (PSSA) in a sample of men and women in residential treatment for substance use (N = 231), and examined the relationship between general or alcohol-specific perceived social support and depression. Analyses demonstrated sound factor structure, reliability, and validity for the PSSA. Additionally, the new measure of PSS for alcohol sobriety was negatively and uniquely associated with depression, even after controlling for general PSS, enacted social support, and negative social interactions. Overall, findings demonstrated that the PSSA was associated with fewer depressive symptoms, even after accounting for other known correlates of depression. Future research should replicate and extend these findings and examine whether this new measure predicts abstinence from alcohol following treatment.

The Relationship Between Generalized Anxiety Symptoms and Treatment Dropout Among Women in Residential Treatment for Substance Use Disorders

ABSTRACTBackground: Generalized anxiety disorder (GAD) co-occurs with substance use disorders (SUDs) at an alarmingly high rate, and the presence of anxiety is associated with an increased risk for relapse to substance use following treatment. Furthermore, comorbid SUDs and other forms of psychopathology are associated with an increased risk for leaving treatment against medical advice (AMA). Objective and Method: Research has yet to examine whether the presence of GAD symptoms is associated with leaving treatment AMA in SUDs populations. Thus, the current study sought to address this important gap in the literature by examining this relationship among a sample of 122 women in residential treatment for SUDs. Results: Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, problematic alcohol and drug use, and depression symptoms. Conclusions/Importance: Our finding indicates the potential importance of assessing and targeting GAD in treatment for SUDs, which may increase treatment compliance.

A preliminary investigation of the relationship between early maladaptive schemas and compulsive sexual behaviors in a substance-dependent population

Past research has consistently demonstrated high co-occurrence between substance use disorders (SUDs) and compulsive sexual behaviors (CSBs). Numerous studies have also indicated that maladaptive core beliefs and early maladaptive schemas (EMS) are prevalent among individuals with SUDs and CSBs. However, research has yet to examine the relationship between EMS and CSBs among substance-dependent populations. Thus, the purpose of the current study was to examine this relationship in a sample of 198 men and 62 women in residential treatment for SUDs. Findings demonstrated that the five EMS domains were positively associated with CSBs. Results further demonstrated that patients meeting the cutoff score for CSBs scored significantly higher than patients not meeting the cutoff score for CSBs on the EMS domains of disconnection/rejection, impaired autonomy, and impaired limit. These findings suggest that there is an important and significant relationship between EMS and CSBs among adults in substance use treatment. Results from the current study indicate that EMS may provide a potentially important focus for treatment, particularly among individuals with co-morbid CSBs and SUDs. Given the preliminary nature of this study, continued research is needed to replicate and extend the findings from the current study.

Personal networks of women in residential and outpatient substance abuse treatment

This study compared compositional, social support, and structural characteristics of personal networks among women in residential (RT) and intensive outpatient (IOP) substance abuse treatment. The study sample included 377 women from inner-city substance use disorder treatment facilities. Respondents were asked about 25 personal network members known within the past 6 months, characteristics of each (relationship, substance use, types of support), and relationships between each network member. Differences between RT women and IOP women in personal network characteristics were identified using Chi-square and t-tests. Compared to IOP women, RT women had more substance users in their networks, more network members with whom they had used substances and fewer network members who provided social support. These findings suggest that women in residential treatment have specific network characteristics, not experienced by women in IOP, which may make them more vulnerable to relapse; they may therefore require interventions that target these specific network characteristics in order to reduce their vulnerability to relapse.

Changes in personal networks of women in residential and outpatient substance abuse treatment

Changes in personal network composition, support and structure over 12months were examined in 377 women from residential (n=119) and intensive outpatient substance abuse treatment (n=258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment.

Factors Associated with Drug Treatment Entry Patterns Among Hispanic Women Injection Drug Users Seeking Treatment

SUMMARY This paper examines patterns of drug treatment entry and factors that are associated with these patterns among 1,849 Hispanic women injection drug users (IDUs). The data analyzed originates from a statewide drug-treatment database covering seven years, 1996–2002. Through the use of logistic regression analyses, the study identified significant differences in predisposing, need and enabling factors in the use of detoxification only, residential treatment, or methadone maintenance. Compared to other Hispanics, Puerto Rican women were 40 percent less likely to use only detoxification services and one and a half times more likely to use methadone maintenance. Having health insurance was an especially important factor associated with methadone treatment utilization. Two of the most important factors associated with residential treatment use were history of mental health services utilization and involvement with the criminal justice system. This article discusses specific social work practice implications including the need for social work practitioners to promote services such as residential treatment, to be trained in treatment of co-occurring mental health disorders, especially among women in residential treatment, and the need to establish close linkages with the mental health and criminal justice systems.

The Role of Self-Objectification in the Experience of Women with Eating Disorders

Objectification theory has linked self-objectification to negative emotional experiences and disordered eating behavior in cultures that sexually objectify the female body. This link has not been empirically tested in a clinical sample of women with eating disorders. In the present effort, 209 women in residential treatment for eating disorders completed self-report measures of self-objectification, body shame, media influence, and drive for thinness on admission to treatment. Results demonstrated that the internalization of appearance ideals from the media predicted self-objectification, whereas using the media as an informational source about appearance and feeling pressured to conform to media ideals did not. Self-objectification partially mediated the relationship between internalized appearance ideals and drive for thinness; internalized appearance ideals continued to be an independent predictor of variance. In accordance with objectification theory, body shame partially mediated the relationship between self-objectification and drive for thinness in women with eating disorders; self-objectification continued to be an independent predictor of variance. These results illustrate the importance of understanding and targeting the experience of self-objectification in women with eating disorders or women at risk for eating disorders.

Differences in perimenstrual symptoms between cocaine‐abusing and non‐cocaine‐abusing women

Cocaine abuse among women has become a major health problem in the United States, yet there is little information in the literature concerning the effects of this form of substance abuse on a woman's reproductive system. This study of 65 women in residential treatment for cocaine abuse and 65 non‐cocaine‐abusing women was undertaken to determine if there are differences in frequency or severity of perimenstrual symptoms between these two groups of women. Data were collected by questionnaire and included demographics, a substance use history, and the Menstrual Distress Questionnaire developed by Moos. Findings suggested that there are statistically significant differences in frequency and severity of perimenstrual symptoms between the two groups of women.