Elsevier

Psychiatry Research

Volume 256, October 2017, Pages 212-218
Psychiatry Research

Premenstrual mood and empathy after a single light therapy session

https://doi.org/10.1016/j.psychres.2017.06.052Get rights and content

Highlights

  • Using a participant-blind between-subjects design, premenstrual women underwent morning light therapy or a sham session.

  • Mood was assessed using the Positive Affect and Negative Affect Schedule and the Affect Grid.

  • A computerized empathic accuracy task was used to assess cognitive empathy.

  • Cognitive empathy was not significantly altered after the light-therapy session.

  • Light therapy improved mood in women not using hormonal contraceptives.

Abstract

To examine whether acute changes in cognitive empathy might mediate the impact of light therapy on mood, we assessed the effects of a single light-therapy session on mood and cognitive empathy in 48 premenstrual women, including 17 who met Premenstrual Symptoms Screening Tool criteria for moderate-to-severe premenstrual syndrome / premenstrual dysphoric disorder (PMS/PMDD). Using a participant-blind between-groups design, 23 women underwent 30 min of morning light therapy (5,000 lx; blue-enriched polychromatic light, 17,000 K) while 25 women had a sham session (200 lx, polychromatic light, 5,000 K). We administered the Positive Affect and Negative Affect Schedule and the Affect Grid right before and after the intervention, and 60 min later upon completion of a computerized empathic accuracy task. There were no significant effects of light condition on cognitive empathy as assessed using the computer task. Nonetheless, bright light reduced negative affect, specifically in women not using hormonal contraceptives. No effects of bright light on mood were observed in women who were using contraceptives. If a single light-therapy session does not alter cognitive empathy, then cognitive empathy may not mediate the impact of light therapy on mood in premenstrual women.

Introduction

For women with distressing premenstrual symptoms, several treatment options exist (Pearlstein and Steiner, 2008, Rapkin, 2003). The ideal intervention should work rapidly once premenstrual symptoms emerge, have few side effects, and not require continuation during other ovulatory cycle phases. While light therapy is a potential candidate, there have been few controlled studies (Krasnik et al., 2005). As acute psychological changes might mediate its impact on mood, we assessed the effects of a single morning light therapy session on mood and cognitive empathy in 48 premenstrual women.

Women experience varying degrees of somatic and psychological changes during the ovulatory cycle. Distressing premenstrual symptoms can result in a diagnosis of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). In PMS functional impairment may be mild and related to either somatic or psychological symptoms; in PMDD at least one psychological symptom is markedly present and associated with functional impairment (American Psychiatric Association, 2013). PMS affects ~20% of reproductive women; for PMDD this is 2–8% (Borenstein et al., 2003, Dennerstein et al., 2012, Epperson et al., 2012).

In the current fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, PMDD is considered a depressive disorder. Women with PMDD have a relatively high risk of being diagnosed with another depressive disorder as well; the risk of co-morbidity may be as high as 69% (Kim et al., 2004) and includes major depressive disorder with seasonal pattern, or seasonal affective disorder (SAD; Rosenthal et al., 1984b). PMDD has been associated with worse mood and social functioning in winter compared to summer (Maskall et al., 1997), which suggests there is a link with SAD. Similarly, the prevalence of PMDD among women with SAD is many times higher than among women without a depressive disorder (Praschak-Rieder et al., 2001). A positive correlation between seasonality and premenstrual symptom severity has also been found in non-clinical samples (Portella et al., 2006).

Light therapy, which involves controlled exposure to bright light for at least 30 min, is the first choice for SAD treatment (Gordijn et al., 2012, Meesters et al., 2011, Rosenthal et al., 1984b, Winkler et al., 2006). It is also considered acceptable for non-seasonal depression (Even et al., 2008, Lam et al., 2016, Terman and Terman, 2005). Moreover, a review of four placebo-controlled studies of light therapy for PMDD found small to large effect sizes for its impact on depressive symptoms (Krasnik et al., 2005). However, the largest effect was observed in an unpublished study that did not conceal the sham condition from the active condition, which suggests expectancies may have driven the effect. This has previously been found in SAD patients (Knapen et al., 2014). Nonetheless, many studies of SAD and non-seasonal depression support the use of light therapy for depressive disorders (Golden et al., 2005).

The working mechanism of light therapy is thought to involve serotonin. Experimental evidence comes from acute tryptophan depletion (ATD) studies in which brain serotonin levels were temporarily reduced (Nishizawa et al., 1997). In SAD patients, ATD reverses the antidepressant effect of light therapy (Lam et al., 1996, Neumeister et al., 1997). ATD may also worsen mood in healthy women (Ruhe et al., 2007). Two studies have found that bright light exposure during ATD can prevent this mood worsening (aan het Rot et al., 2008; Defrancesco et al., 2013). Importantly, as both studies lasted only several hours, bright light exposure can apparently have fairly immediate effects on mood.

In line with this, Leppamaki et al. (2003) exposed nurses repeatedly to brief bright light periods during their night shift and found they reported less stress. When Goel and Etwaroo (2006) exposed students to evening bright light, within 30 min their depression scores were lower. Moreover, in several studies a single light therapy session had rapid effects on the circadian rhythm of melatonin secretion, subcortical brain responsiveness, sleepiness, fatigue, core body temperature, and heart rate (Parry et al., 2011, Ruger et al., 2006; St Hilaire et al., 2012; Vandewalle et al., 2006).

While most placebo-controlled studies on light therapy for depression have involved at least one week of daily therapy sessions and only tested participants before and after treatment, even a single session has been found to improve mood in SAD patients (Reeves et al., 2012). This finding confirms anecdotal reports of antidepressant effects of light therapy after 2–4 days (Rosenthal et al., 1985), within 5 h (Kripke et al., 1983), and within 1 h (Sher et al., 2001). In the latter study, early improvement predicted clinical benefit after 1–2 treatment weeks.

Depressive disorders have been associated with interpersonal problems. Social interaction impairments (Baddeley et al., 2013) and social withdrawal (Goel et al., 2002) are common. Patients often exhibit social skill deficits (Hames et al., 2013). For example, they experience high distress when others are suffering, considered a form of affective empathy, and are less able to interpret others’ affective states, i.e. cognitive empathy is impaired (Schreiter et al., 2013).

Derntl et al. (2013) studied empathy in menstrual and premenstrual women. The two groups scored comparably on several trait questionnaires of affective and cognitive empathy. Nonetheless, the premenstrual group responded faster to sentences describing others in emotional situations than the menstrual group, and performed worse on an emotion recognition task. This suggests affective empathy may increase premenstrually, and cognitive empathy may decrease.

Depressed individuals who benefit from light therapy experience improved mood and global functioning. However, no prior studies have considered the effects of light therapy on specific aspects of interpersonal functioning such as empathy. In one relevant study, healthy men received light therapy and underwent functional brain imaging to measure the effects on “threat-related brain function” (Fisher et al., 2014), but no behavioral data were reported.

The objective of our study was to answer some unresolved questions on light therapy. Primarily, as bright light exposure may have rapid positive effects on mood in both healthy women and individuals with depressive disorders, we examined the impact of a single light therapy session on mood in premenstrual women with complaints indicating a premenstrual disorder. Previous light-therapy studies have often been limited by their within-subject design, with participants receiving the active treatment and the sham treatment in counterbalanced order. This compromises the blind and may yield different expectations about the active treatment in the two treatment-order groups. We employed a between-groups design and did not inform participants about the two conditions. We hypothesized that women who received the active treatment (light therapy) would show a larger mood improvement than women who received the sham treatment.

A second aim was to study the acute effects of light therapy on cognitive empathy. If cognitive empathy is relatively poor in the premenstrual phase, then it might be improved by light therapy. Consequently, after the intervention participants completed a cognitive empathy task. We hypothesized that women who received light therapy would perform better on this task than women who did not.

Section snippets

Participants

The local Psychology Ethics Committee approved the study. Healthy women aged 18–40 years with regular ovulatory cycles, no current or past psychological/psychiatric treatment, no current use of confounding medication (e.g., antidepressants, antibiotics), no light hypersensitivity, no history of allergic reactions to ECG electrode stickers, and the ability to not smoke during the study, were recruited using a participant pool and advertisements in university buildings, public spaces, and local

Baseline data

The final sample averaged 23.1 years in age. There were 30 hormonal contraceptive users, 6 smokers, and 17 cases of PMS including 1 with PMDD (see below). Mean scores on the GSS, QIDS, and MSFsc were 8.5 (SD 4.3), 8.2 (SD 3.6), and 7.4 (SD 7.2), respectively, indicating the sample was characterized by subsyndromal seasonality (Rosenthal et al., 1984a), mild depression (Rush et al., 2003), and a late chronotype (Antypa et al., 2016). There were no significant baseline differences between the two

Discussion

A single, 30-min light therapy session at 5000 lx of blue-enriched polychromatic light can improve mood in premenstrual women. Specifically, while there were no significant changes in mood in contraceptive users who underwent the light therapy session, we found a decrease in negative affect in women who were not using hormonal contraceptives (Fig. 1). In contrast, we found no evidence that the light therapy session altered cognitive empathy.

We had hypothesized that the light therapy session

Conflict of interest statement

M. aan het Rot, K. Miloserdov, and A.L.F. Buijze, declare no conflicts of interest. Y. Meesters has received research funding and been a consultant for The Litebook Company Ltd. M.C.M. Gordijn is a consultant for Philips Consumer Lifestyle, Drachten, Netherlands, and founder and director of Chrono@Work, Groningen, Netherlands.

Acknowledgement

The study was made possible thanks to the Netherlands Organization for Scientific Research NWO (Veni subsidy 451-09-013 awarded to M. aan het Rot).

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