DBT, PMDD

On Emotional Regulation and PMDD

Anxiety

A few years ago while at a red light on my way to my son’s swimming lesson, I was accosted by the sound of a car horn blaring. Stopped at an intersection turning left, there was an SUV ahead of a car, seemingly not turning fast enough.

The person behind the SUV leaned on the horn, aggressively, and loudly, practically yelling at the SUV to hurry up and go. Suddenly, the SUV backed up and rammed into the car. 

While I should tell you I was shocked, to be honest, I felt elated.  I was reminded of so many, many times I wanted to do the same when annoying and aggressive drivers were pushing me to do something, triggering an anxious reaction. The car driver was obnoxiously rude and he got EXACTLY what he deserved.

When the drivers emerged, at the helm of the SUV was a teenage girl who appeared to be in the midst of a driving lesson with her father. The car driver was a seemingly understanding middle-aged man. The girl may have been jarred by the noise, got confused, and made a mistake. The car driver understood, and they shook hands and exchanged insurance information. All were very relaxed and congenial and in no way was the vengeful scene enfolding in my head. 

I have a confession: I have wanted to do the same to mean drivers tool liberal with their horns ever since I moved to Toronto 20 years ago. Oh, how I daydreamed that I would turn my car around, flip ‘em off and drive right into them – just like that teenage girl. But, in truth, I only feel like this sometimes: when I’m in my luteal phase. 

Rage is a common symptom of pre-menstrual dysphoric disorder (PMDD) sufferers during the luteal phase, and often can be one of the most telling in terms of diagnostic criteria. When a typically calm, level-headed woman suddenly loses her cool on a minor inconvenience, it’s often during our luteal phase (the time between ovulation and menstruation when PMDD symptoms emerge). 

Emotional Regulation and DBT

It is during this time that one of the pillars of Dialectical Behavioural Therapy (DBT) is most important: Emotional Regulation. Simply put, emotional regulation is our ability to recognize, manage, and respond to our emotions. Most often, emotions happen to us. We can awake on a beautiful sunny day determined to be happy, but as we reach for our first cup of coffee, it spills all over the counter. We are confronted by a feeling of annoyance. This might be enough to ruin our morning, and for PMDD sufferers in luteal, we may even throw the coffee cup onto the floor in frustration. 

To help with Emotional Regulation, I like to play a little DBT game called, “But if I did…” We think of a situation and describe what we want to do. Something like, “I hate my job and my boss. I can’t take a second more minute here and I’m going to quit!” Then, we imagine doing it, and the wave of emotion that comes over us as we do it. Ah, such fun! 

Then, we take a breath and add, “But if I did…” reasons like “I would have no money, “my work reputation would suffer,” “I need to pay rent,” “I actually like my job most days,” reminds us that just because we think and feel something, we don’t need to act on it. 

Like all things therapy-related, it’s easier said than done. However, using the “But if I did…” game, we learn to slow down a little, allowing the emotions to linger a little before they take us over. Once we engage our brains to ponder the difference between how we want to act and how we actually should act, it helps reduce the emotional intensity. We still feel the emotions, but we learn to remain in control. 

Looking back to that scared teenage driver all those years ago, I wonder how she’s doing. Did she ever get her license? Did her insurance rates go through the roof? And while I know she didn’t do it on purpose, I expect she regrets that satisfying moment. 

About Impart Therapy
Impart Therapy is an Ontario-based virtual based psychotherapy practice specializing in providing care for clients (ages 14 +) who are facing anxiety, depression, ADHD, stress, and anger, as well as women with menstrual issues such as pre-menstrual dysphoric disorder (PMDD), severe PMS, and PME, menopause. For more details and to book a complimentary meet and greet, please visit www.imparttherapy.com – Therapy, Counselling