The Effectiveness of Metacognitive Therapy on Anxiety Sensitivity, Psychological Distress, and Pain Indicators in Female Students with Premenstrual Syndrome
Keywords:
Metacognitive Therapy, Anxiety Sensitivity, Psychological Distress, Pain, MenstruationAbstract
Purpose: The present study aims to investigating the effectiveness of Metacognitive Therapy (MCT) on anxiety sensitivity, psychological distress, and pain indicators in individuals with PMS.
Methods and Materials: This semi-experimental study employed a pretest-posttest design with a control group and a two-month follow-up. The statistical population consisted of all female students diagnosed with PMS at Islamic Azad University of Kermanshah in 2024-2025. Thirty participants were selected using convenience sampling based on Fleiss’s formula and randomly assigned to two equal groups. The experimental group received ten weekly sessions of Metacognitive Therapy, each lasting 90 minutes. Data collection tools included the Premenstrual Symptoms Screening Tool (Steiner et al.), the Depression Anxiety Stress Scales (DASS; Lovibond & Lovibond), the Anxiety Sensitivity Index (ASI; Floyd et al.), the McGill Pain Questionnaire, and the Pain Acceptance Questionnaire (McCracken et al.). Data were analyzed using descriptive statistics and repeated measures ANOVA in SPSS-26.
Findings: The findings revealed significant reductions in anxiety sensitivity (F=17.75, p=0.005, η²=0.61), pain intensity (F=6.18, p=0.009, η²=0.54), pain acceptance (F=10.70, p=0.014, η²=0.62), and psychological distress (F=43.45, p=0.001, η²=0.60) in the experimental group compared to the control group. These improvements were sustained at the two-month follow-up.
Conclusion: Metacognitive Therapy is effective in reducing pain indicators, anxiety sensitivity, and psychological distress in individuals with Premenstrual Syndrome. This treatment plan may be recommended as a beneficial therapeutic approach for trauma and pain clinics.
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References
Afshari, A., & Hashemi, Z. (2019). The relationship between anxiety sensitivity and metacognitive beliefs and test anxiety among students. Journal of School Psychology, 8(1), 7-25.
Ali Akbari Dehkordi, M., & Bitaneh, M. (2021). The Effectiveness of Psychological Capital Elements Training on Psychological Flexibility and Psychological Distress on the Women with Breast Cancer. QUARTERLY JOURNAL OF HEALTH PSYCHOLOGY, 10(38), 7-22.
Angehrn, A., Krakauer, R. L., & Carleton, R. N. (2020). The impact of intolerance of uncertainty and anxiety sensitivity on mental health among public safety personnel: When the uncertain is unavoidable. Cognitive therapy and research, 44(5), 919-930.
Azagew, A. W., Kassie, D. G., & Walle, T. A. (2020). Prevalence of primary dysmenorrhea, its intensity, impact and associated factors among female students at Gondar town preparatory school, Northwest Ethiopia. BMC Women's Health, 20(1), 1-7.
Bailey, R., Oba, E. C., & Allen, R. (2025). The Role of Metacognitive Beliefs in Generalized Anxiety Disorder in Men Who Have Sex with Men Living with HIV in Nigeria. Journal of Health Psychology. https://doi.org/10.1177/13591053251314989
Baradaran, M. (2020). The Mediating Role of Cognitive Emotion Regulation Strategies and Defense Mechanisms in the Relationship between Perfectionism and Anxiety Sensitivity in Cosmetic Surgery Applicants Students. QUARTERLY JOURNAL OF HEALTH PSYCHOLOGY, 9(34), 57-74.
Caltekin, I., Hamamci, M., Demir Caltekin, M., & Onat, T. (2021). Evaluation of sleep disorders, anxiety and depression in women with dysmenorrhea. Sleep and Biological Rhythms, 19(1), 13-21.
Farhangi, A. (2019). Effectiveness of Mindfulness Based Cognitive Therapy Chronic Pain Management on Psycho-Social Function in Women with Breast Cancer. Journal of Excellence in counseling and psychotherapy, 8(2), 11-28.
Fereydoni, F., & Sabet, M. (2021). The Effect of Solution-Focused Brief Psychotherapy on Distress Tolerance, Decision-Making Styles and Social Adjustment in MS Patients of Sari City. Journal of Consulting Excellence and Psychotherapy, 10, 36-47.
Ferries-Rowe, E., Corey, E., & Archer, J. S. (2020). Primary dysmenorrhea: Diagnosis and therapy. Obstetrics and Gynecology, 136(5), 1047-1058.
Gardner, B. R., & Rourke, N. L. (2021). Multimodal analgesia in a Southern White Rhinoceros with pentosan polysulfate, gabapentin, amantadine and phenylbutazone to manage chronic pain. Australian Veterinary Journal, 99(3), 86-88.
Hu, Z., Tang, L., Chen, L., Kaminga, A. C., & Xu, H. (2020). Prevalence and risk factors associated with primary dysmenorrhea among Chinese female university students: A cross-sectional study. Journal of Pediatric and Adolescent Gynecology, 33(1), 15-22.
Jafari, A., & Shiralizadeh, S. (2021). The Predicting of Pain Based on Emotional Expression in Women with Breast Cancer in Pandemic COVID-19: Mediating Role of Life Style. IJCA, 2(2), 13-23.
Kabukcu, C., Basay, B. K., & Basay, O. (2021). Primary dysmenorrhea in adolescents: Association with attention deficit hyperactivity disorder and psychological symptoms. Taiwanese Journal of Obstetrics and Gynecology, 60(2), 311-317.
Kennair, L. E., Solem, S., Hagen, R., Havnen, A., Nysaeter, T. E., & Hjemdal, O. (2021). Change in personality traits and facets following metacognitive therapy or cognitive behaviour therapy for generalized anxiety disorder. Clinical Psychology and Psychotherapy, 28(4), 872-881.
Kim, H. S. (2021). Factors Affecting Perceived Stress, Depression and Sleep Disturbance on the Dysmenorrhea among Female University Students. Journal of the Korean Applied Science and Technology, 38(2), 399-410.
Kim, S. S., & Kim, H. S. (2021). Dysmenorrhea in High School Girls and Its Influencing Factors. Journal of the korea convergence society, 12(3), 409-420.
Kwon, Y. J., Sung, D. I., & Lee, J. W. (2022). Association among Premenstrual Syndrome, Dietary Patterns, and Adherence to Mediterranean Diet. Nutrients, 14(12), 2-11.
Mannes, Z. L., Ferguson, E. G., Ennis, N., Hasin, D. S., & Cottler, L. B. (2021). Pain Acceptance Among Retired National Football League Athletes: Implications for Clinical Intervention. Journal of Clinical Sport Psychology, 1(1), 1-4.
Mu, J., Wang, Q., Dun, W., Yang, J., Wang, K., & Zhang, M. (2021). The effects of long-term menstrual pain on pain empathy in women with primary dysmenorrhea. Journal of Pain, 162(7), 2051-2059.
Pan, Y. Y., Jin, S. H., Luo, S., Li, R. R., Tu, Y. Y., & Jin, D. (2021). Dysmenorrhea is associated with a higher incidence of pain after diagnostic hysteroscopy or treatment. Signa Vitae, 17(2), 63-66.
Park, S. H., Song, Y. J., Demetriou, E. A., Pepper, K. L., Thomas, E. E., & Hickie, I. B. (2020). Validation of the 21-item Depression, Anxiety, and Stress Scales in individuals with autism spectrum disorder. Psychiatry research, 291, 113300.
Paulus, D. J., Capron, D. W., & Zvolensky, M. J. (2021). Understanding hazardous drinking and suicidal ideation and suicide risk among college students: Anxiety sensitivity as an explanatory factor. Cognitive behaviour therapy, 50(5), 378-394.
Quan, S., Yang, J., Dun, W., Wang, K., Liu, H., & Liu, J. (2021). Prediction of pain intensity with uterine morphological features and brain microstructural and functional properties in women with primary dysmenorrhea. Brain Imaging and Behavior, 15(3), 1580-1588.
Requero, B., Brinol, P., & Petty, R. E. (2021). The impact of hope and hopelessness on evaluation: A meta-cognitive approach. European Journal of Social Psychology, 51(2), 222-238.
Rickardsson, J., Gentili, C., Holmstrom, L., Zetterqvist, V., Andersson, E., & Persson, J. (2021). Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up. European Journal of Pain, 25(5), 1012-1030.
Satici, B., Gocet-Tekin, E., Deniz, M., & Satici, S. A. (2021). Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. International journal of mental health and addiction, 19(6), 1980-1988.
Seow, T. X., Fleming, S. J., & Hauser, T. U. (2025). Metacognitive Biases in Anxiety-Depression and Compulsivity Extend Across Perception and Memory. PLOS Ment Health, 2(3), e0000259. https://doi.org/10.1371/journal.pmen.0000259
Shabani, M., & Khalatbari, J. (2019). The effectiveness of mindfulness-based stress reduction training on emotion regulation difficulties and psychological well-being in premenstrual syndrome. Health Psychology, 8(1), 134-152.
Shahbahrami, M., Mohammadkhani, S., & Akbari, M. (2021). The Diagnostic Role of Distress Tolerance, Metacognition, Sensation Seeking, and Perceived Social Disorganization in Methamphetamine, Opium, and Alcohol Users. Addiction Research, 15(60), 325-350.
Shomali Ahmadabadi, M., Poorjanebollahi, M., Behjat, A., & Barkhordari Ahmadabadi, A. (2021). The Role of Experiential Avoidance and Professional Assistance Orientation in Predicting COVID-19 Anxiety. Journal of Consulting Excellence and Psychotherapy, 9(36), 67-78.
Vesal, M., & Taher Neshatdoost, H. (2019). Meta-analysis of psychological intervention's effectiveness on reduction of pain intensity among patients with chronic pain. Journal of Applied Psychology, 10(3), 21-38.
Vlachos, D., & Lagattuta, C. (2021). Is osteopathic manipulative treatment effective in reducing primary dysmenorrhea? Evidence-Based Practice, 24(8), 43-44.
Warren, A. M., Zolfaghari, K., Fresnedo, M., Bennett, M., Pogue, J., & Waddimba, A. (2021). Anxiety sensitivity, COVID-19 fear, and mental health: Results from a United States population sample. Cognitive behaviour therapy, 50(3), 204-216.
Wells, A. (2025). Metacognitive therapy for anxiety and depression. Arjmand. https://drmohammadkhani.com/
Wells, A., Reeves, D., Capobianco, L., Heal, C., Davies, L., & Heagerty, A. (2021). Improving the Effectiveness of Psychological Interventions for Depression and Anxiety in Cardiac Rehabilitation: PATHWAY-A Single-Blind, Parallel, Randomized, Controlled Trial of Group Metacognitive Therapy. Circulation, 144(1), 23-33.
Yadavari, M., Naderi, F., Makvandi, B., & Hafezi, F. (2020). The Effects of Metacognitive Therapy on Pain Catastrophizing and Quality of Life in Patients with Chronic Pain. Middle Eastern Journal of Disability Studies, 10, 134-135.
Ysidron, D. W., Slepian, P. M., Ankawi, B., Himawan, L. K., & France, C. R. (2020). Pain Acceptance Partially Mediates the Relationship Between Perceived Injustice and Pain Outcomes Over 3 Months. The Clinical Journal of Pain, 36(11), 868-873.
Yu, H., Shi, Z., & Zhao, M. (2024). The Relationship between Metacognition, Rumination, and Sleep in University Students with a Tendency toward Generalized Anxiety Disorder. Behavioral Sciences, 14(6), 444. https://doi.org/10.3390/bs14060444
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Copyright (c) 2025 Zahra Solgi (Corresponding author); Alireza Merati, Parisa Yaseminejad, Zahra Naderinobandegani (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
