Ericka first thought something was amiss when she was 17. Usually a bubbly, fun-loving person, about a week or so before her period, she felt horrible. She was depressed, tired, angry, with bouts of crying that sometimes took hours before she stopped. At 22 in her last year of university, during extremely stressful final exams, Ericka lost all emotional control. Knowing something was terribly wrong, she went to the university clinic and was officially diagnosed with Pre-menstrual Dysphoric Disorder (PMDD), an endocrine disorder that among other physical ailments, causes severe mental distress during one’s luteal phase (the time between ovulation and start of period).
For many people who experience PMDD, it can feel like their emotions are out of control, with mood swings, irritability, anxiety, and frustration mounting during our luteal phase.
For Ericka, medication and lifestyle changes helped, but she learned that incorporating therapy skills made a significant difference in managing the emotional rollercoaster that came with her PMDD. Her favourite skill is the Dialectical Behavior Therapy (DBT) skill STOP. Here’s how to use the STOP skill to manage PMDD.
What is the STOP Skill?
The STOP skill is a simple, four-step process that allows us to interrupt our automatic reactions, refocus our minds, and make more thoughtful decisions. It’s particularly useful for those of us with PMDD, giving us a valid and easy-to-remember tool to help manage our emotional intensity and impulsivity.
The acronym STOP stands for:
- S: Stop
- T: Take a step back
- O: Observe
- P: Proceed mindfully
By practicing STOP, you can create a buffer between your emotional reaction and your behavior, helping you stay grounded and present, even during challenging PMDD moments.
How to Use STOP for PMDD
- Stop
The first step is to stop (very easy to remember this!). We can hold up our hand to show ourselves to stop, or simply say “STOP!” Use this when you start to intensity of PMDD taking over (sadness, anxiety, irritation, etc), just pause. This moment of stopping is crucial because it gives you a chance to step out of the automatic emotional response that PMDD often triggers. This step interrupts our autopilot mode so we can begin to regain control of the situation.
- Take a Breath
The T for STOP is to take a breath. There are several tools you can use for breathing: boxed breathing (4 in, 4 hold, 4 exhale, 4 pause repeating four times), even breaths in and out (3 in, 3 out), or my favourite, 3/5 (inhale through the nose for a count of three, exhale through the mouth for a count of five). Breathing allows your nervous system to begin to calm, gaining some further distance from your PMDD-powered emotions.
- Observe
The O stands for Observe. The third step is to observe what’s going on internally, labeling this out loud (if possible). First, pay attention to your physical sensations, noticing what is happening in your body. Are you hot? Tense? Where do you feel this in your body? (chest, stomach, neck, etc). Next, label how you feeling emotionally. Are you angry? Sad? Frustrated? If you feel more than one emotion (as many of us do), label all that you feel. Finally, track your thoughts. What are you thinking? This step is especially important for PMDDers because it gives us a chance to notice if our emotions are out of proportion to the situation due to our luteal phase.
- Proceed Mindfully
The final step is to proceed mindfully. This step is a little vague, as it is entirely dependent on you. After taking the time to stop, breathe, and observe, you can now move forward more intentionally. Proceeding mindfully means responding thoughtfully rather than reacting impulsively. For Ericka, most of the time her P step included not doing something – not sending an angry text to her fiancé, not yelling at her friends, or not snapping at her boss. Mindful action provided her the tools to help manage her emotional outbursts during the worst of her PMDD symptoms, stopping her from saying or doing something she would later regret.
Benefits of Using STOP for PMDD
- Reduces Reactivity: PMDD can make it easy to react impulsively but STOP gives you the space to pause and consider your actions, leading to less regret and fewer outbursts.
- Promotes Emotional Awareness: By observing your emotions, you gain better awareness of your PMDD triggers and learn to manage your emotional responses more effectively.
- Increases Mindfulness: Using STOP encourages a mindful approach to daily life, which can decrease stress and emotional overwhelm.
- Empowers You to Make Thoughtful Decisions: Instead of being at the mercy of your emotions, STOP empowers you to choose how to respond, leading to healthier coping strategies.
Conclusion
Ericka’s regular use of STOP gave her a powerful way to manage the intense emotions that come with PMDD. By stopping, breathing, observing, and proceeding mindfully, she learned to break the cycle of emotional reactivity and make more intentional, thoughtful choices, particularly when challenged during her luteal phase. For her (and you), it is not about eliminating difficult emotions but learning to accept and respond to them in a balanced and empowered way.
About Us
Think you have PMDD? Impart Therapy specializes in DBT and CBT therapy treatments for PMDD and PMS-related issues. All of our therapists are trained in PMDD therapy and can help. To learn more about us, or to book a free consultation, please visit: PMDD Therapists: Counselling and Therapy for Severe PMS
