Table 1.

Cognitive behavioral therapy approach in managing symptoms of premenstrual syndrome

Session 1	Introduction of therapist and group members. Students filled out questionnaires. Therapist gave a description of PMS; elimination of signs and symptoms; therapeutic agents; outcomes and impacts; the role of environmental stressors and psychological factors. Assignment: Fill out forms on PMS
Session 2	Description of group therapy, cognitive-behavioral interventions, duties and norms; description of group meeting to increase motivation and group cohesion; description of group objectives, determining behavioral changes, encountering initial anxiety of group members; opening up resistance and promoting self-disclosure. Assignment: Record moods one week before start of menstrual cycle, and note down physical changes caused by moods.
Session 3	Evaluation of automatic thought and cognitive distortions; emotional reasoning, generalized extreme, discussion and analysis of anxiety, depression, and symptoms that occur periodically. Reviewing the basis of specific experiences by retaining confidentiality and providing feedback. Assignment: Detect thoughts, moods and behaviors experienced in different life situations and identify which parts of those experiences need to be changed.
Session 4	Training members on emotional reactions and their relation to internal dialogue; exploring situations; having a broader and more objective perspective; dealing with resistance, tension, and anxiety. Assignment: Consider a recently experienced mood, identify moods during or immediately after it, and observe and classify mood swings.
Session 5	Explain, interpret, and describe the relationship between situation and emotion; awareness of situations and thoughts that relate to mood changes; describe thoughts, beliefs, concerns, perceptions, and concepts related to situations. Assignment: Note down support for the inaccuracy of “hot thoughts”. Gather evidence to confirm or reject a hot thought.
Session 6	Evaluating thoughts and challenging them; role playing in the group to reform and challenge automatic thoughts; analyzing behavioral changes in various situations; assessing personal responsibility; identifying main beliefs. Assignment: Test new experiences, experiments and practical plans.
Session 7	Identifying underlying principles and assumptions; therapeutic interventions; identifying worries and their benefits and harms; investigating ways to manage negative events of the past; identifying and classifying violent thoughts and emotions associated with them; mental imagery. Assignment: Fill out the Metacognitions Questionnaire
Session 8	Treatment of depression; cognitive restructuring; improving interpersonal relationships; timed schedule of activities; recording weekly activities; taking a lesson from these schedules; understanding anxiety ,its characteristics, and cognitive aspects; practicing relaxation, controlled breathing, visualization, and distraction; understanding anger, guilt and shame; anger restraint methods; assertiveness training; overcoming feelings of guilt.