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Table of Contents
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 198-202

The effect of resilient counseling on the symptoms of premenstrual syndrome among adolescent girls in Hamadan, Iran, 2018: A clinical trial

1 Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Psychology, Faculty of Economic and Social Sciences, BU-Ali Sina University, Hamadan, Iran
3 Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

Date of Submission11-Jun-2022
Date of Decision26-Sep-2022
Date of Acceptance12-Oct-2022
Date of Web Publication18-Nov-2022

Correspondence Address:
Seyedeh Zahra Masoumi
Department of Midwifery, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/nms.nms_3_22

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Background: Premenstrual syndrome (PMS) is one of the most common causes of poor performance in girls and women. Objectives: The aim of this study was to examine the effect of group resilience counseling on PMS severity in adolescent girls. Methods: A randomized controlled trial was conducted on 120 high school girls in Hamadan, Iran. Participants were recruited conveniently and randomly assigned to an intervention group (n = 60) and a control group (n = 60). The intervention group participated in eight 1-h resilience counseling sessions, whereas the control group received no intervention. Data were collected using a demographic characteristics form, the Premenstrual Symptoms Screening Tool, and the Connor-Davidson Resilience Scale. The primary and secondary outcome measures were PMS severity and resilience score. The independent samples and paired samples t-tests were used to analyze the data. Results: Most of the participants in the intervention and control groups had severe PMS symptoms at baseline (61.7% and 63.3%, respectively). However, after the intervention, the majority of the intervention group reported mild (36.7%) or moderate (46.4%) symptoms (P < 0.001). No significant changes occurred in the control group. The mean total resilience score in the intervention group increased from 50.5 ± 14.9 to 67.3 ± 15.2 (P < 0.001). Conclusion: Resilience counseling for girls with PMS can reduce the severity of PMS.

Keywords: Adolescent, Premenstrual syndrome, Resilience

How to cite this article:
Babakhani N, Masoumi SZ, Khodakarami B, Mohagheghi H, Farhadian M. The effect of resilient counseling on the symptoms of premenstrual syndrome among adolescent girls in Hamadan, Iran, 2018: A clinical trial. Nurs Midwifery Stud 2022;11:198-202

How to cite this URL:
Babakhani N, Masoumi SZ, Khodakarami B, Mohagheghi H, Farhadian M. The effect of resilient counseling on the symptoms of premenstrual syndrome among adolescent girls in Hamadan, Iran, 2018: A clinical trial. Nurs Midwifery Stud [serial online] 2022 [cited 2023 Feb 2];11:198-202. Available from: https://www.nmsjournal.com/text.asp?2022/11/3/198/361523

  Introduction Top

Premenstrual syndrome (PMS) has discomforting symptoms and interferes with a person's daily life. The prevalence of PMS is reported to be 40%, 85%, 46%, and 60% in Europe, Africa, Asia, and South America, respectively.[1] A large study of Iranian female high school students found a prevalence of 83.1%, of whom 57.7% suffered from severe symptoms.[2] The most common symptoms are anger and irritability, anxiety, fatigue, and mood swings.[3] PMS is also more prevalent in adolescents than in adults and makes them stressed and nervous.[4],[5] PMS can lead to increased absence in industrial and educational centers and may result in hospital admissions,[6] interferes with personal and family relationships, and increases the risk of child abuse.[7],[8] Since its exact pathophysiology is unknown, PMS is usually treated symptomatically.[9] Due to the side effects of medications, PMS treatment has shifted to complementary therapies such as diet and reflexology,[10] life skills training,[11],[12] and cognitive-behavioral therapy.[13],[14]

People's adaptive responses to stressful and challenging situations[11],[12] such as PMS[15] are influenced by their mental health and resilience.[16] Resilience is the ability to cope with and recover from difficult situations and adverse life experiences.[17],[18] High levels of resilience can prevent mental health problems in adolescents and youth,[19] resulting in less anxiety and depression.[20] Due to the destructive effects of PMS on adolescent girls' academic and social performance, the need for nonpharmacological interventions for this sensitive group is emphasized. Some studies have examined the effects of life skills training[11] and cognitive-behavioral therapy[13] on PMS symptoms. Some studies also reported that resilience indirectly mediates people's responses to anxious situations.[21],[22],[23] However, we found no study examining the effect of resilience counseling on the severity of PMS symptoms in Iranian adolescent girls.


This study was conducted to determine the effect of resilience counseling on the severity of PMS in adolescent girls.

  Methods Top

Design and participants

This randomized controlled pretest–posttest clinical trial was conducted in 2018. We calculated the sample size based on the results of a former study,[3] where an educational program about PMS could increase the resilience score of female students from 50.47 ± 14.09 to 62.00 ± 11.67. Accordingly, with a type I error of 0.05, a power of 0.90, a μ1 of 50.47, a μ2 of 62, an S1 of 14.09, and S2 of 11.67, and the sample size was set at 32 per group. However, considering the possibility of dropout, we recruited 60 students in each group.

The statistical population included all female high school students of Hamadan aged 15–17 years with moderate-to-severe PMS. First, 57 high schools and vocational schools in Hamadan were divided into three districts in terms of socioeconomic classes. A total of six high schools (i.e., two from each upper, middle, and lower socioeconomic classes) were then selected by lot. The initial sample consisted of 215 girls aged 15–17 years in grades 9–11 who completed the Premenstrual Symptoms Screening Tool (PSST) to identify those with moderate-to-severe PMS. A total of 124 girls were diagnosed with moderate-to-severe PMS, four of whom were excluded because they were taking psychotropic medications. Then, 120 participants were selected and randomly assigned to a control group (n = 60) and an intervention group (n = 60) through a block randomization method with a block size of 10.

Inclusion criteria were: being 15–17 years old high school girls, living in Hamadan city, having a moderate-to-severe PMS score (scores of 19 and up from the PSST), receiving no medication for PMS (e.g., psychotropic drugs, hormones, and antiprostaglandins), no history of physical and mental diseases, and passing at least six menstrual cycles. Exclusion criteria included taking any medication for PMS during the study, experiencing events such as the death or illness of a loved one, and not attending two consecutive sessions.

Data collection instruments

Three instruments were used to collect data in this study. The instruments included a demographic data questionnaire (developed by the research team), the PSST, and the 25-item Connor–Davidson Resilience Scale (CD-RISC-25). The demographic questionnaire included items on parents' job, education, illnesses residence with parents, and characteristics of the menstrual cycle. The PSST includes 19 items. All items are answered on a 4-point scale ranging from “never = 0” to “severe = 3.” Hariri et al. evaluated the content validity and reliability of the Persian version of PSST and reported its Cronbach's alpha as 0.9.[24]

The CD-RISC-25 includes 25 items and all items are rated on a 5-point Likert scale ranging from “Not true at all = 0” to “True nearly all the time = 4.” The total score ranges between 0 and 100, with higher scores indicating higher resilience. Ahangarzadeh Rezaei examined and confirmed the psychometric properties of the Persian CD-RISC-25 and reported its Cronbach's alpha as 0.82.[25] All participants completed the demographic questionnaire at baseline. They also answered the PSST and CD-RISC-25 both at baseline and 3 months after completing the intervention.


The intervention group received resilience group counseling sessions for 4 weeks (twice weekly). Each session included questions and answers, resilience group counseling, group discussion (in groups of 8–12), and slide presentation. However, the control group received no intervention and did not participate in the group counseling sessions. All counseling sessions were conducted by a counselor based on the program of resilience sessions in similar studies and related books.[14],[26] Accordingly, the resilience counseling and training sessions included materials on self-awareness, coping skills, knowledge raising, positive thinking, support-seeking, hardiness, emotional management, openness, agreeableness, conscientiousness, individual competence, and positive acceptance of change[14],[26] as summarized in [Table 1]. The research assistants who collected and analyzed the data had no information about the intervention and control groups.
Table 1: Outline of the counseling sessions

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Ethical considerations

This study was approved by the Institutional Review Board and the Ethics Committee of Hamadan University of Medical Sciences, Hamadan, Iran (IR.UMSHA.REC.1395.220). Informed consent was obtained from all participants, and they were assured of the confidentiality of their personal information. Further, this research has been registered in the Iranian Registry of Clinical Trials under the number IRCT2015052615341N6.

Data analysis

Data were analyzed using the SPSS, version 16 (IBM company from America). The normal distribution of the variables was assessed by the Kolmogorov–Smirnov test. The independent and paired-samples t-tests were used to analyze the data with a normal distribution. The chi-square test was also used to compare the categorical variables between the study groups. P < 0.05 were considered statistically significant.

  Results Top

The intervention and control groups were homogeneous with respect to demographic characteristics such as parents' job, education, illnesses residence with parents, and menstrual cycle characteristics (P > 0.05).

Most of the participants in the intervention and control groups had severe PMS before the intervention (61.7% and 63.3%, respectively). However, after the intervention, the majority of the intervention group reported mild (36.7%) or moderate PMS (46.4%). No significant changes occurred in the control group [Table 2].
Table 2: Comparison of the frequency and severity of premenstrual syndrome in control and intervention groupsa

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The intervention was able to decrease the mean scores of the intervention group in all PSST subscales. The mean total PSST score decreased from 31.6 ± 6.9 to 21.5 ± 6.8 in the intervention group, confirming the effect of the intervention [Table 3]. In addition, the mean total resilience score in the intervention group increased from 50.5 ± 14.9 to 67.3 ± 15.2 [P < 0.001; [Table 4]].
Table 3: Comparison of the mean scores of premenstrual syndrome and its subsets

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Table 4: Comparison of resilience scores in the intervention and control groups before and after the intervention

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  Discussion Top

Three months after the completion of the intervention, a significant decrease in PMS severity was observed in the intervention group, indicating the effectiveness of resilience counseling in reducing PMS symptoms. Consistent with our findings, Masumi et al. also studied the effect of coping skills training on PMS in 140 undergraduate students in Hamadan, Iran, and reported that the training was effective in reducing students' complaints of PMS symptoms.[12] Self-awareness is one of the components of resilience skills[27] and was of the basic components of the intervention in both our study and the aforementioned studies.[12],[27]

In a descriptive study, Ng et al. also investigated the moderating role of resilience on Singaporean adolescent students' coping with anxiety, depression, anger, and aggression. They found that positive thinking, request for support, and hardiness played a direct role, whereas resilience had an indirect effect on coping with challenging psychological conditions.[21] Positive thinking, persistence, and seeking help and support were also among the components of resilience counseling in our intervention. A study also reported the positive effect of 10 weekly sessions of emotional intelligence training on introspection, aggression, and resilience in teenage girls. They concluded that controlling emotions can help teenagers control their aggression.[28] Since emotional intelligence is also one of the components of resilience, their results are comparable to those of the present study. In a review study of the relationships between resilience and personality traits, Oshio et al. concluded that personality traits have a great influence on perceived personal competence, tolerance of negative events, and personal relationships, and all of these are components of resilience.[29] Shahabi et al. also found that an individual's perceived competence and positive acceptance of change can increase resilience in patients with cardiac diseases.[26] All of these components were considered in the counseling sessions held in this study. Based on the findings of this study and those of similar studies, resilience group counseling seems to play an important role in reducing the severity of PMS.

Limitations of this study include the short length of the study period. The effectiveness of these counseling interventions can be further explored through a study with a larger number of participants and a longer period of intervention and follow-up.

  Conclusion Top

Overall, resilience counseling could alleviate the severity of PMS in adolescent girls. We suggest that school counselors use resilience counseling to reduce the impact and severity of PMS in the lives of adolescent girls.


The current article has been derived from a dissertation approved by Hamadan University of Medical Sciences.

Financial support and sponsorship

The authors would like to thank the deputy of the research of Hamadan University of Medical Sciences for their financial support, faculty members of the school of nursing and midwifery and students who collaborated with us in this study.

Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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