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Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats): moderators and mediators of treatment effects

Norton, Sam PhD; Chilcot, Joseph PhD; Hunter, Myra S. PhD

doi: 10.1097/GME.0000000000000095
Original Articles

Objective: Cognitive-behavior therapy (CBT) has been found in recent randomized controlled trials (MENOS1 and MENOS2) to reduce the impact of hot flushes and night sweats (HFNS). In the MENOS2 trial, group CBT was found to be as effective as self-help CBT in reducing the impact of HFNS. This study investigates for whom and how CBT works for women in the MENOS2 trial.

Methods: This study performed a secondary analysis of 140 women with problematic HFNS who were recruited to the MENOS2 trial: 48 were randomly assigned to group CBT, 47 were randomly assigned to self-help CBT, and 45 were randomly assigned to usual care. Self-report questionnaires were completed at baseline, 6 weeks postrandomization, and 26 weeks postrandomization. Potential moderators and mediators of treatment effects on the primary outcome—hot flush problem rating—were examined using linear mixed-effects models and path analysis, respectively.

Results: CBT was effective at reducing HFNS problem rating regardless of age, body mass index, menopause status, or psychological factors at baseline. Fully reading the manual in the self-help CBT arm and completing most homework assignments in the group CBT arm were related to greater improvement in problem rating at 6 weeks. The effect of CBT on HFNS problem rating was mediated by changes in cognitions (beliefs about coping/control of hot flushes, beliefs about night sweats and sleep) but not by changes in mood.

Conclusions: These findings suggest that CBT is widely applicable for women having problematic HFNS, regardless of sociodemographic or health-related factors, and that CBT works mainly by changing the cognitive appraisal of HFNS.

From the Institute of Psychiatry, King’s College London, London, UK.

Received June 26, 2013; revised and accepted August 8, 2013.

M.S.H. conceptualized and designed the study. J.C. and S.N. analyzed and interpreted the data. All authors contributed to the writing of the manuscript and approved its final version.

Funding/support: This study was supported by the National Institute for Health Research Biomedical Research Center for Mental Health, South London and Maudsley NHS Foundation Trust, and the Institute of Psychiatry, King’s College London.

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Myra S. Hunter, PhD, Health Psychology Section, Fifth Floor Bermondsey Wing, Guy’s Campus, King’s College London, London SE1 9RT, UK. E-mail:

© 2014 by The North American Menopause Society.