Cognitive Therapy and Research

, Volume 40, Issue 6, pp 747–763 | Cite as

Emotion Regulation in Women with Premenstrual Syndrome (PMS): Explicit and Implicit Assessments

  • Lisa Eggert
  • Michael Witthöft
  • Wolfgang Hiller
  • Maria KleinstäuberEmail author
Original Article


Psychological factors, such as cognitive-emotional processes, are proposed to play an important role in the etiology of premenstrual syndrome (PMS). Our aim was to determine whether there are differences in emotion regulation between women with PMS and non-PMS controls. The study included 54 women who suffered from PMS (confirmed by prospective daily ratings during two menstrual cycles), as well as 52 non-PMS controls. All participants completed the Cognitive Emotion Regulation Questionnaire (CERQ) as an explicit and the affect misattribution procedure (AMP) as an implicit measure of emotion regulation. Each participant conducted the self-report as well as the experimental assessments twice, once during the follicular phase and once during the luteal phase of the menstrual cycle. The AMP was conducted with neutral and negative picture and facial stimuli. Three different interstimulus intervals (100, 500, 1500 ms) were used to examine implicit emotion regulation processes. Women with PMS reported a significantly higher use of three dysfunctional emotion regulation strategies in the CERQ (p values < .001). In the AMP with picture stimuli, women with PMS showed stronger implicit negative affective reactions compared to non-PMS women, independent of menstrual cycle phase (p = .008). In the AMP with facial stimuli, this stronger negative affect misattribution appeared in women with PMS compared to the control group only in the luteal phase and only for medium interstimulus intervals of 500 ms (p = .050). The results suggest that PMS is associated with alterations in the processes of emotion regulation, as assessed both on an explicit and on an implicit level. Further research on the etiology of PMS should focus more on cognitive-emotional processing and its interaction with biological changes relating to the menstrual cycle.


Premenstrual syndrome Affect misattribution procedure Emotion regulation Cognition Emotion Implicit Explicit 



American Congress of Obstetricians and Gynecologists (ACOG)


Affect misattribution procedure


Analysis of variance


Cognitive behavior therapy


Cognitive Emotion Regulation Questionnaire


Diagnostic and Statistical Manual of Mental Disorders, 4th edition


Emotional Stroop task


Gamma-aminobutric acid


International Affective Picture System


International Classification of Diseases and Related Health Problems 10th revision


International Diagnostic Checklists


Interstimulus interval


Karolinska Directed Emotional Faces


Major depressive disorder


Premenstrual dysphoric disorder


Premenstrual syndrome


Brief Web-Based Screening Questionnaire for Mental Disorders

5-HT system

Serotonin system


Compliance with Ethical Standards

Conflict of interest

Lisa Eggert, Michael Witthöft, Wolfgang Hiller and Maria Kleinstäuber declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lisa Eggert
    • 1
  • Michael Witthöft
    • 1
  • Wolfgang Hiller
    • 1
  • Maria Kleinstäuber
    • 2
    Email author
  1. 1.Department of Clinical Psychology and PsychotherapyJohannes Gutenberg-University MainzMainzGermany
  2. 2.Department of Clinical Psychology and PsychotherapyPhilipps-University MarburgMarburgGermany

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