The Menstruality Podcast - 236. The Power of Cycle Aware Psychotherapy and Mental Health Care (Mary-Claire Decker)

Episode Date: May 14, 2026

Today we’re exploring how to bring cycle awareness to psychotherapy and mental healthcare. Our guest is MaryClaire Decker (known as MC) who is a Registered Psychologist. MC created Mindful Cycles after seeing a gap in mental health care, and after her own struggles with chronic menstrual migraines reinforced the need for an approach that works with our cycles, not against them. At Mindful Cycles, she combines evidence-based therapy with an understanding of cyclical health to help women and people with menstrual cycles navigate their mental well-being with greater self-awareness and resilience.We talk about how menstrual health symptoms change across the cycle, the neurological and hormonal shifts that cause mental health symptoms to worsen in the second half of the cycle, how to adapt therapeutic approaches based on the phases of the menstrual cycle, and the incredible impact of cycle-informed trauma therapy.We explore:Three reasons why mental health care hasn’t been cycle-informed so far; menstrual stigma, the patriarchal, colonial historical context of psychotherapy and the huge gap in research when it comes to women and people with menstrual cycles.Why we risk pathologising people’s experiences, or even misdiagnosing them when we don’t take the fluctuations of the menstrual cycle into account, for example; 25% of people who eventually get diagnosed with PMDD are misdiagnosed with bi-polar disorder first. The beneficial impact of cycle-informed therapy for anxiety, depression, PTSD and trauma, addictions and other mental health challenges. ---Receive our free video training: Love Your Cycle, Discover the Power of Menstrual Cycle Awareness to Revolutionise Your Life - www.redschool.net/love---The Menstruality Podcast is hosted by Red School. We love hearing from you. To contact us, email [e-mail]---Social media:Red School: @redschool - https://www.instagram.com/red.schoolSophie Jane Hardy: @sophie.jane.hardy - https://www.instagram.com/sophie.jane.hardyMC Decker: @themenstrualpsych - https://www.instagram.com/themenstrualpsych

Welcome to the menstruality podcast where we share inspiring conversations about the power of menstrual cycle awareness and conscious menopause. This podcast is brought to you by Red School, where we're training the menstruality leaders of the future. I'm your host, Sophie Jane Hardy, and I'll be joined often by Red School's founders, Alexander and Sharnie, as well as an inspiring group of pioneers, activists, change makers and creatives to explore how you can unashamedly claim the power of the menstrual cycle to activate your unique form of leadership for yourself, your community and the world. Hey, welcome back to the podcast. Thank you so much for tuning in today. It's a big conversation today. We're exploring how to bring menstrual cycle awareness to psychotherapy and mental health care.

Our guest is Mary Claire Decker. She's known as MC. She's a registered psychologist, and she created her organization, Mindful Cycles, after seeing a gap in mental health care and after her own struggles with chronic menstrual migraines, which reinforce the need for an approach that works with our cycles, not against them. So at Mindful Cycles, she combines evidence-based therapy with an understanding of cyclical health to help women and people with menstrual cycles, to navigate their mental well-being with greater self-awareness and resilience. And in our conversation today, we talk about how menstrual health symptoms change across the cycle, the neurological and hormonal shifts that cause mental health symptoms to worsen in the second half of the cycle,

how to adapt therapeutic approaches based on the phases of the menstrual cycle, and this is so fascinating, it's all so fascinating, but this was probably my favorite part, the incredible impact of cycle-informed trauma therapy. So let's get started with the conversation with MC. Hi, I'm C. It's nice to be sitting here with you today. How are you doing? Hi, Sophie. It's so nice to be here with you today. I've been really looking forward to this conversation. Where are you at cycle-wise? I'm on day 25 today. So that puts me kind of squarely in my preventual face of my cycle. And I was just, yeah, I was kind of reflecting on, you know, oh, I wonder how this podcast episode would go today versus five.

days ago or 10 days ago. But today what I'm sort of noticing about myself is this often the case for me in my premenstrual phase, which is there's a like a seriousness sort of to my energy. And almost like I would describe it as a matter of factness. Like I just feel very matter of fact about things and that, you know, what I'll probably bring to some of the answers today is just like a really direct kind of response to things. That's sort of how I'm feeling right now. I might, like I said, if this were a different point in my cycle, I might have a more playful approach. But today I'm feeling very matter of fact. So we will see where that takes us. I was just suddenly thinking of like cycle phases as shapes and how there's a pointedness often

in the premenstrual phase. It's like we're triangular. Maybe ovulation were a bit round. It was spherical. And maybe for me and in the spring, I'm a bit more like a cloud. Shakedless, yeah. And you said day 25, right? Day 25. Yeah. I'm day 26.

So we're very similar to rain. I just had such a to the point conversation with aid where I was like, oh, I wish I could communicate like this all the time. Bam, bam, bam, this is how I feel. This is what I think. This is what I think should happen. He's like, cool, okay. And it was really clean.

Yeah. There's a clarity to it. But I'm also, I think I'm going to start bleeding tomorrow. And so I can feel I'd quite like to just be lying down on the earth. It was going to be curious to see how I find my words today. And I am beyond excited to be having this conversation. And I feel really serious about it because the impact that this work could have if it was rippled out across Canada, across the world is so immense.

You know, I'll tell a quick story about that, actually, Sophie, a couple years ago, I was filling out my application for the apprenticeship program with Red School. And it's quite a rigorous application, as it should be, it's a rigorous program. But one of the final questions at the end was something like, what are your big dreams, like what are your big dream visions for this work and how you're going to bring this work into the world. And I put down, like, I, you know, I want to change the whole landscape of psychotherapy. And I want, you know, cycle awareness to be in, like, university classrooms and master's programs for counseling. And then I also put, I cut them as an aside. I was like,

oh, and maybe I'll actually get to be on the menstruality podcast one day. And then in brackets, I put, ha-ha, because it was kind of a joke. And so it's really, yeah, it's so exciting to be here. but also I share that vision of let's transform the whole landscape of therapy and psychotherapy, you know, to include and incorporate the cycle awareness piece. It's so powerful. Yes. And I'm so looking forward to getting into it, like to understanding what cycle aware therapy is. Why isn't all therapy cycle aware already? And like what are the impacts of non-cyclower therapy? We're going to get into all of that. But first, I'd love to hear about your experience with cycle awareness. Like, how did you discover it, what was going on in your life that inspired you to quest for it and discover it,

and how has it changed things for you personally? I would say this journey began for me, Sophie, about 10 years ago. And it started with cycle awareness kind of at the basic level. I hadn't found Red School yet. I wasn't practicing, you know, menstrual cycle awareness as we learn in red school. But I was starting to track my cycle. because I was experiencing, and still do actually, but I was experiencing menstrual migraines. In fact, I have suffered from menstrual migraines for all of my menstruating life. I can remember getting my first migraine. I think I was like 16 years old, like quite young when they first started.

And about 10 years ago, they started to get worse. And so I got a bit more serious about tracking my cycle. Initially, just to pay attention to like, you know, when am I having these migraines? what's happening like the day before, the days leading up, what are the patterns that I'm noticing, what's happening after, really just building kind of a cyclical symptom picture. And this was really helpful for me to understand my migraine patterns better, but it was also really helpful for my, like the team of doctors that I was working with as well. It was really helpful for them to have this information. But what I started to discover, as I think many people do,

is I just started to just to learn that more about me was cyclical than I had thought. So I started to, yeah, just notice things that I had never considered to be happening in a cyclical pattern in my life were showing up cyclically. So I would say mostly for me, this was in the realm of like my emotional health and my emotions and how I was, you know, feeling day to day or feeling about myself, feeling about towards other people or relationships. And this really really, and I don't, I don't mean for this to sound like dramatic it anyway, but it really changed my life. It really opened up this new way of understanding myself that I had never known before, that I had never, you know, explored before or even knew existed.

And so getting to know myself sort of through this channel of cycle awareness was so impactful for me that I started to wonder, you know, how I could bring some of this into, therapy into my therapeutic practice because you know quite frankly it was like if this is helpful for me it's probably going to be helpful for the people who I'm working with as well and so that's sort of what set off that journey for me in terms of how do I actually integrate the cycle awareness piece into therapy and into my therapy practice as well but that's the personal journey end of it started with the menstrual migraines and has really just sort of flourished and grown from there yeah and and with your migraines now is it that are they the same now

Do you have a different relationship with them now? How has it, how has that been impacted? Yeah, so I still, I still get migraines. Unfortunately, I wish I could say that. It's, you know, solved all the problems, but it didn't. But my relationship to them is completely different. Because I have such a respect and reverence for the cycle and for the way that it's changed my life and the ways that it benefits me, it just feels less scary when those menstrual

migraine show show up because, you know, I'm not as angry at the situation. I'm not as frustrated at it. I just understand that, you know, unfortunately, this is just a part of the journey for me in terms of having a menstrual cycle. But the, you know, the relationship that I've developed with myself and my body, it's like the benefits of that far out way, the migraines that I'm getting. And so it's really transformed my relationship to pain into how I experience that chronic condition. Yeah, absolutely. It makes me think of the paradoxes and the nuances of this practice. It's not, okay, how can we hack this and fix this, make this go away?

In my experience of my cycle, it's been more about, okay, how can I lean into this? How can I relate to this differently? How can I understand this, soften into it? And of course, some people have great experiences of pain being resolved, like menstrual pain, and that's wonderful. It's so great when that happens. And, yeah, just to normalize, that's not always the case. and yeah.

Yeah, but it certainly has changed, yeah, my relationship to the pain and soften is such a good word. It's sort of softened how I see it and how I kind of approach myself around that time as well. So it's really, it's really changed things for me in a deep way. Yeah, like how you take care of yourself around it, I imagine. Absolutely what I need, you know, like informing what I need and really listening to that and trusting that. So it's been an invaluable sort of part of the journey in terms of the menstruation. the menstrual migraines for sure yeah yes and let's get into cycle aware therapy now how would you describe

your cycle aware therapy practice how would you describe cycle aware therapy yeah i'll use my definition um sophie and though sort of the the definition that informs my practice so for me what cycle aware therapy or cycle informed therapy is it's it's it's it's therapy that understands how the menstrual cycle is connected to mental health through the neurobiology, meaning how the menstrual cycle affects the brain, different structures in the brain, different neurotransmitters in the brain, how it affects the nervous system. And then in turn, what that means about how our clients might be experiencing their own mental health journey, their own symptoms, how they're going to bring those symptoms into session,

and also how they're going to engage with the therapy process in general. And then, so that's the first layer of it, I would say, is this neurobiological piece that's really understanding quite deeply, you know, the role that estrogen and progesterone play in determining mental health symptoms and how people experience, you know, their mental health. But then it's using that information then to inform the type of therapy that I'm offering. So I take that sort of foundational underpinning and then I use that to inform which interventions, what strategies I might offer clients, how I might invite them into their own experience. That's going to look different at different times in the cycle.

So I'm aligning my practice. I'm aligning my interventions with the menstrual cycle based on what I think and what I'm working with the client on that might be the most beneficial given what's happening in their brain at various times in the menstrual cycle. I'm happy to share, can I share an example, Sophie? Always. Yeah. Let's take the example of working with somebody in therapy who is experiencing anxiety, which is a con like if you're a therapist, this is a very common thing. Someone's coming, you know, to you or to your practice because they're struggling with anxiety. They're struggling to regulate that anxiety. Just say we have somebody, yeah, coming to your practice. They're feeling

anxious, they're struggling with regulation, maybe there's a social component to it. You know, they'd like to engage more socially with people, but they're feeling quite anxious about, you know, being in social settings. So as a cycle-aware therapist, what I'm going to do is I'm going to work with the client to map out how their symptoms are showing up across the menstrual cycle. So I'm going to get curious with them around, hey, do your symptoms change across the cycle? And let's presume that in this case, they do. This person has, we've tracked and we've noticed that their anxiety shifts and changes across the cycle. Okay, so what I'm going to do is I'm going to draw from that neurobiological knowledge that I have,

which is that we often see, and we see this in the research, that anxiety very often worsens in the second half of the cycle. And it does this because, primarily because of progesterone, right? Progesterone's the dominant hormone in the second half of the cycle. One of the things that progesterone does is it increases activity in the amygdala, which is this little structure in the brain that is responsible for creating fear responses. It's responsible for activating our nervous system into these kind of fight and flight and sort of hyperactivated states. So that structure in the brain has more activity in it in the second half of the cycle. So this is one of the

reasons why anxiety symptoms shows up a little bit more strongly in that second half. So I know that. I'm going to hold on to that information. I'm also holding onto the information that there's less estrogen in our system in the second half of the cycle, not no estrogen, but there's There's less. And one of the things that estrogen does is it acts on another area of the brain called the prefrontal cortex, which is right behind the forehead. And it's the part of the brain that is responsible for supporting us with regulation, for regulating our emotions, for regulating our nervous system,

and sort of bringing us back into states of rest and digest and calm. And we have a little bit less of that, so we have less activity in the prefrontal cortex. All this to say, that second half of the cycle, we're kind of set up to experience, you know, anxiety and if we're somebody who already is tending towards that or we have a diagnosis of anxiety, we're going to experience that anxiety more deeply at that point in the menstrual cycle. Okay. If we take the social component, this person also has a therapy goal of wanting to increase sociability.

Well, if we fast forward a few weeks in the menstrual cycle, one of the things that we know about estrogen is that, well, first of all, when it's higher, we have that increased ability to regulate the anxiety in our system. But we also have, it acts on the reward system, the reward centers in our brain, or the dopamine centers in our brain, which basically just means the things in our environment and the people in our environment that are in our environment, we're just a little bit more interested in them at that time in the cycle. We're more easily able to engage in the external things in our environment, the people

who are around us, the things that we enjoy doing, those things feel better to us sort of mid-cycle. So I know that, and I'm holding that information. Okay. So what I'm going to do now is I'm going to work really specifically with my client around their therapy goals, but I'm going to align it with that neurobiology. So with this I would probably offer in the second half of the cycle more regulation-based strategies. You know, I might draw from my therapy toolkit. I might engage them in some somatic, you know, therapy practices, some grounding, some resourcing, some mindfulness.

I'm really going to work and focus on regulation because I know that at that point in the cycle, that is what's more difficult to come across, to come by, and that's what will likely feel more beneficial to the client. And likewise, with their goals around wanting to be more social or engage more socially, I'm gonna offer that and suggest that to them mid-cycle when we naturally have that estrogen in our system that's making us more interested, motivated,

and driven to be social anyways. So, and I'm doing this in collaboration with the client, it's not like this is happening secretly, but I am using the menstrual cycle as a therapeutic, ally. It's like our friend. You know, it can help with this process if we know how to work with it and understand what's happening. So that's an example of, you know, that's a common example in my practice of cycle informed therapy. It's aligning the therapy to work with what's happening in the brain as a result of the menstrual cycle. Yeah. I mean, this is so much happening inside me

in response to my things. I'm like mind blown. Like I love how I've had like 240 conversations on the podcast and still like my mind can still be blown by all the things that are changing inside us with the menstrual cycle but mostly by how the world hasn't paid attention to it. I know. Why hasn't psychotherapy been cycle aware from the beginning? So let's just talk about that. Yeah. The context of it.

We've talked about this on the podcast before, but I imagine it's largely because we haven't had this data because females who had a menstrual cycle, there's the studies on stress and how the brain changes, what didn't happen on them because they were too complicated to study. Yeah, that is one of the reasons. Yeah. Yeah, it's, it's quite an astounding thing. I mean, obviously, I know you and I are biased because we love the menstrual cycle. But, you know, one of the things that I, that I, one of the comments I get quite often when I'm doing training with other therapists is it's almost your exact reaction. So if you have like, how, like, this makes so much sense. So how have we not been doing this? Like how am I only learning about this now? So,

and it is so interesting because we don't have, I mean, there is a growing body of research in this area. I will say that. It's promising there is a growing body of research, but we don't have nearly enough research on this topic as we do say in other areas. But what I would say about why we're not practicing cycle and cycle aware therapy yet is I think there's kind of three three things that kind of that have gotten in the way of that. Firstly I would say, you know, the persistence of menstrual stigma I think does get in the way. You know, unfortunately, this is changing too, but we do live, you know, in many cultures. We live in cultures where there is still menstrual stigma. We have research that tells us that that patients and clients are still

hesitant to bring up the menstrual cycle and menstruation to their doctors and to their mental health providers. So there is still this kind of, you know, hesitancy in the stigma that surrounds the topic. So I think that becomes a barrier then for people bringing up what's happening for them in therapy with their therapist. And also it brings up a barrier of even, you know, tracking that or paying attention to that. So I think menstrual stigma is one of those things. What I often like to also mention Sophie's like, I think we have to take the historical context of modern psychology and psychotherapy into context because the origins of where it came from are extremely patriarchal, extremely colonial, extremely oppressive, where women and people with menstrual cycles and people of color and indigenous people,

you know, back in the times where modern psychology was kind of developing in modern psychotherapy, you know, women and people with menstrual cycles were reduced to their biology, right? And that was weaponized against them. And this is where we see, you know, those practices around like lobotomies and hysterectomies and institutionalizing women and even killing them. in some circumstances, that is a result of reducing women down to biology. And I think there's a legacy of that in the psychotherapy and psychology world where therapists are hesitant to ask questions because they don't want to imply that they're reducing their clients down to the biology or that they're just implying, this is just your hormones or this is just you're just, this isn't real, this is cyclical, this is hormonal.

I've had some really, I've had questions around this from love, beautiful male therapists who are like, how can I ask about this in a way that is not going to perpetuate that messaging in somehow? So I do think that the legacy of the modern psychology world plays a role in this too. And then the last thing I would say is what you've already spoken to, Sophie, which is that there, it's sort of, yeah, I call it like the sorry state of affairs in women's health research. So still to this day, you know, these, I'm going to share some statistics, these are Canadian statistics but I imagine they're probably fairly similar to you know the United

States and to the UK but in Canada and in the province that I live in in Canada only three to four percent of research dollars go specifically towards researching like women's health or female specific health conditions and that number would need to increase 15-fold to be at parity where it is with men's health and men's research topics wow what wow okay okay exactly exactly Thank you for that reaction. Day 26 is a fun time to have this conversation. My blood's boiling.

Okay, yes. Wow. Okay. So that is true, right? So there's this research gap. What's also true is that this is a Canadian stat too, and I imagine probably similar to, yeah, other countries, but women were not even required to be included in health research studies until 1993. Yes. Yes. Okay. And so prior to that, you know, any study that was done, we had no data on how this was actually affecting women and people with menstrual cycles. But what's happening now is so women are being included in these studies now. And this research comes from a menstrual researcher out of the U.S. her name is Sarah Hill, and I would recommend her work. It's really

quite fascinating. But what I've learned from her work is that we are studying people, we are including women in research studies now, but we're very intentionally researching women on days one, seven of their cycle because during this time in the cycle, we don't have to contend with estrogen or progesterone. This is when hormone levels are at their lowest because it's easier. It's just quite frankly for as or from a research perspective, this is easier. But this is highly problematic because then we're not really studying women and people with menstrual cycles as women and people with menstrual cycles. We're studying a quarter of ourselves. Yeah. Which then leads to this next staggering statistic. This is an American statistic. It's Sarah's work again, but which is that

80% up to 80% of new medications that are released to market in the United States are recalled within the first year of use because of unanticipated side effects on women. Because we studied these medications and these treatments for health and mental health, not when women were experiencing higher estrogen or higher progesterone. And then they take these medications and low behold, they don't work the same, right? Of course they don't. And so then there's this massive gap in sort of women getting the treatment that they deserve and that they did that they need. So all this to say, right, these gaps in research significantly contribute to why we're not including the menstrual cycle and psychotherapy because we're just not doing that research. We're not getting

accurate research. It's a huge problem. Yeah. And we're going to get into the happy stuff, which is like what happens when when therapy is cycle around some of the beneficial impacts for like working with trauma, depression. We're going to get into all of that. But first, can you share, got these statistics that you've shared so far are really mind-blown, but I know that one more around what happens when therapy isn't cycle-aware. Can you walk us into what are some of the impacts of therapy that isn't cycle-aware? informed. Yeah, absolutely. Yeah. So, you know, at the most basic level, I think, Sophie, therapy that is not being practiced in a cycle-informed way is really missing out on opportunities

to deepen the work with clients. And so clients are missing out on opportunities to, you know, understand themselves differently and more deeply. And the therapist is missing out on opportunities to deepen the work that they're doing and to support the client kind of in the best way that they're able to. So that's kind of at a basic level. And I would argue that's, that's not even that basic. Like, that really is a loss for both the therapist and the client by not having that cycle-aware lens. But from a, probably from an even more problematic perspective, when we're not practicing or when we're taking mental health outside of the context of the cycle, what we're risking is we are risking pathologizing normal fluctuations in mental health

and in regulation, right? So we risk seeing our clients sometimes in really unhelpful ways, because we might see that this client just continues to struggle integrating some of the regulation strategies or no matter what we've tried with them. They keep running into these periods of time where it just is harder to access, you know, those tools or that regulation. And so we risk pathologizing that and we risk kind of seeing our clients as stock or resistant or all these things that can kind of show up in the therapy world around that, simply because we're just not understanding what's going on for them from a cyclical perspective. And then in even more significant way, what can also happen in this is happening is that we risk misdiagnosing people

with other mental health conditions that can significantly impact their life. So one of the, one of the stats around this, Sophia, and it's quite alarming, in my opinion, this comes from the International Association of Pre-Mensual Disorders website. and their body of work, which is that 25% of people who will go on to eventually be diagnosed with PMDD are misdiagnosed with bipolar disorder first. I just want to pause there because that is such a massive misdiagnosis. Bipolar disorder is a really significant and impactful mental health diagnosis that requires really specific therapy, medication, and treatment. And if somebody is being misdiagnosed with that, they are getting medication, therapy treatment that is actually not meeting

their needs and is not working, you know, in alignment with what's really going on for them. It's also delaying their time to get an accurate diagnosis. Okay. The other thing about bipolar disorder, just to kind of add to this, is that women are also more. likely to be diagnosed with something called rapid cycling bipolar disorder. So if we look at what bipolar disorder is, I won't get hugely into this because it's quite complex and I don't want to risk oversimplifying it. But basically somebody with bipolar disorder is experiencing times where they're they're experiencing what would be called like a like man, a time of sort of manic, a manic episode, which really just means sort of like heightened energy in the system, right? So this can show up

in many different ways and sometimes this, you know, someone's not sleeping during this time, they're getting really kind of grandiose types of ideas, they might engage in risky behavior, it can be a really impactful kind of part of the bipolar diagnosis. And then very often what follows as a depressive episode. And typically in bipolar, these cycles are quite long, like they last for several weeks at a time, several months at a time, but there's this thing called rapid cycling bipolar disorder, which is where these highs and lows change more frequently and women are more likely to be misdiagnosed with rapid cycling bipolar disorder, which is really just somebody having a menstrual cycle. And that's the context of this. It's like when

we take mental health outside of the context of this, of the menstrual cycle, we're now super pathologizing normal fluctuations in regulation and normal fluctuations in mental health. Now, how somebody doesn't ask about menstrual cycle related fluctuations is astounding to me, but it's not being done. And this is, you know, some of the impacts. So when we don't ask about the menstrual cycle, when we don't take the menstrual cycle into account, and when we don't know how to work with it. So there's quite a few, you know, impacts that way.

What I'd also say is that, you know, from a research perspective, almost every mental health diagnosis that we see that we have now that is included in the DSM has some research to support that a proportion of those people will experience cycle-related changes in their symptoms or pre-menstrual worsening of those. So we see this with depression, we see this with bipolar disorder, anxiety, PTSD and trauma, ADHD, borderline personality disorder. We see this with addictions, chronic pain. So if we take that lip, of diagnoses and symptoms and if you're a therapist, like the majority of your clients are going to be experiencing some variety of those types of experiences and symptoms. And if we're not

taking that cyclical lens into account, what are we missing? What are we missing out on as therapists? And what are our clients missing out on by not having the opportunity to view their mental health through that lens? Yeah. I'm going to pause the conversation with MC just for a moment to share a couple of invitations. So if you're a therapist, or you work in mental health care or in any profession where you're supporting women and people with menstrual cycles and you're curious to learn more about how to weave cycle awareness into your practice or your work.

You might be interested in joining Red School's menstruality leadership program. It's the world's first leadership program rooted in the wisdom and the power of the menstrual cycle and the doors are opening for the next round of the program soon so you can find out more about it discover the curriculum and everything that the course includes, and also join the waiting list at menstrualityleadership.com. That's menstrualityleadership.com. And if you're new to the practice of menstrual cycle awareness, you can also visit redschool.net forward slash chart to receive a free

cycle tracking chart and guide. So that's redschool.net forward slash chart. Right, let's get back to the conversation with MC. So let's talk about what you've seen in your practice when it comes to different mental health challenges that people experience and the benefits of bringing cycloatherapy. Like that example of anxiety earlier was awesome. I'm curious about trauma, depression. Should we start with trauma? Yeah. That's a really big one. And this is where I believe that some of the most important impacts can be made in the field of psychotherapy is in, is, in practicing trauma therapy, that is that is cycle informed. It's incredible and I get really fired up about this. So I apologize if I get a little bit louder and, and energized as we

go along here, but this stuff is. I'm with you. I'm sweating. Like, I'm intense right now. It's so amazing. It's so incredible, right? Yeah. Okay. So some, of the ways that I have seen cyclone-formed therapy really transform my practice and also the experience of my clients in therapy is when it comes to people who have histories of trauma. So I'm going to go back to some of the neurobiology around this first, just to anchor us in what's happening kind of in the brain, you know, as sort of with the intersection between the menstrual cycle and trauma. So we have consistent research that shows us that trauma symptoms worsen in the second half of the cycle. Specifically, the symptoms that are involved, that are called like the

under the intrusive category of symptoms. So these are things like flashbacks. These are things like intrusive thoughts and imagery that kind of just come into somebody's, you know, awareness, nightmares, hypervigilance and anxiety, like that kind of activated state in the nervous system. These are the symptoms that we consistently see getting worse in the second half of the cycle. What we also know is that trauma symptoms tend to improve. They don't necessarily go away, but they actually improve quite significantly mid-cycle as well. And so we'll talk a little bit about why that is and why we need to be tailoring our trauma

therapy to work in alignment with that. So we already mentioned that the second half of the cycle is when we see that increased activity in the amygdala. One of the things that's also happening in that second half of the cycle from a trauma perspective is that we are more easily able to move into that sympathetic branch of our nervous system. We flip quite quickly into that part of the nervous system, and so we move into those survival-based responses quite easily,

and it's more difficult to come back into a more regulated state in the nervous system. So there's major changes that are sort of happening from a regulation perspective in the second half of the cycle. And so this is part of what contributes to that the intrusive nature of these symptoms is they just kind of nudge their way in. We're in, our threat sensitivity is more online at that time. So we're kind of looking around in our environment and we're scanning a little bit more for signs of threat in our environment. We have higher rejection sensitivity at this time. So there's a host of things that are priming our nervous system. And if we have trauma that's alive in our body, can really start showing up here.

What's really super cool and exciting though about trauma is that mid-cycle when we have higher levels of estrogen, our brain is more effective at two important things. One, fear inhibition and two, fear extinction. And I'm going to explain what those two things are. So fear inhibition is the brain's ability to see something in the environment that triggers us. So we see something, say, you know, we've had a traumatic experience with a dog, we see a dog, we have an activation in our nervous system, we have that fear response kick in,

But then we realize that that dog is on a leash and fear inhibition kicks in and it reduces that fear response back to a baseline state. Well, it turns out that estrogen is extremely important and supportive of that process. So our ability to be triggered and then come back into a regulated state is dramatically improved when we have higher levels of estrogen. What's also true in trauma therapy is this idea of fear extinction, which is basically the brain's ability to learn over. time that's something that used to cause us to have a fear response or a trauma response is safe and no longer does. And that's part of trauma therapy that we're doing is over time we're trying to teach the brain that the thing that we used to feel really afraid of that triggers us is we actually can find safety while that thing is in our environment, right? So it turns out that

our ability to uncouple the fear response from that trigger and permanently extinguish it is increased and better done under conditions of higher estrogen. Isn't that so cool? So what that means for trauma therapy is that when we are working with clients who have experienced trauma, we want to be tailoring our interventions that are supporting them with learning how to uncouple that fear response, how to process those trauma memories.

We want to be doing that mid-cycle when we have the benefits of estrogen on our side, when the brain is more easily able to inhibit that fear response and learn new ways of being in the world, new regulated ways of being in the world. And in the second half of the cycle, we support our clients with, again, those sort of grounding and regulation pieces, that somatic-based stuff, really anchoring into that part of the work. So we have that sort of exposure-based processing work kind of early to mid-cycle, and then we pull in the other stuff in the second half of the cycle. This is like making so much sense to me from my own experience.

of trauma therapy. How come some sessions, like we were doing EMDR, for example, some sessions it's like really like fluent and we seem to make real progress and big things happen. And then some sessions I just leave feeling way worse, which is often part of the therapy journey anyway. Like, you know, that's like a straightforward thing, healing trauma. But yeah, how exciting to know. Okay, well, we need to schedule sessions every month around these cycle days if you have a cycle that you're able to track in that way. Correct, yeah. And for specific types of therapy of trauma healing, wow, so interesting. Isn't it so interesting? Yeah. And the beauty of this too, I think, is that we can still draw from

whatever modalities we're using for our trauma work like EMDR, right, or, you know, sensory motor psychotherapy or motion focus therapy, it doesn't really matter. But what we can do then is using those beautiful, wonderful trauma therapy models, we can then kind of select that the skills within the that model that are going to best align with what's happening neurobiologically for our clients at different points in the menstrual cycle. So it's really easily integrated into whatever kind of model people are using and can really help inform, you know, what will serve, what will serve the client and their needs at that time. Yeah. It's so good. What's coming up for me as you're talking is, and this term does come up a lot on the podcast, is like there's this kind of gaslighting,

pervasive gaslighting of women and people with cycles around like my experience is shifting a lot throughout my cycle but it's not being recognized by professionals kind of across the board and how how honoring it is simply to have a therapist opposite you who can say yes you're you are changing throughout the cycle it's real you're not crazy there's not something wrong with you this is a natural process of what it is to be someone with a menstrual cycle. Yeah, yeah, absolutely. That is like the education piece of this, the psychoeducation piece where we teach our clients and talk to our clients, like you said, just normalizing how the cyclical nervous system is meant to operate. That in of itself is a pretty important intervention.

Like that in of itself can really shift people's experience of their symptoms and their experience of themselves. It alleviates shame. It offers that, you know, beautiful validation. that people have been knowing inside for so long but not been getting. And so, yeah, that is, I think, part of the magic of this model as well, is even just offering that education and validating that experience alone shifts things for people. Yes. How about with symptoms that are specifically premenstrual, so premenstrual, like severe premenstrual syndrome, PMDD, premenstrual dysphoric disorder?

Yeah, I mean, first thing, I'm thinking. thinking what must happen to people who go to therapists who aren't cycle aware with those challenges and how does that go? But how can cycle-informed therapy support people who are experiencing those symptoms? Yeah, I mean, what I've heard from clients who have access, you know, therapy that isn't necessarily cycle-informed. So these are clients who might be coming to see a therapist because of, you know, severe premenstrual syndrome or PMDD, is that there, you know, there can be a benefit to that therapy, absolutely. But it kind of hits up. up against this limit.

Like it kind of bumps into something where it just can't go as far as it could if you were working with somebody who has that cycle aware or cycle-informed lens. You know, I think with something like PMDD, PMDD is, it's an entire diagnosis on its own that kind of, you know, show that the symptoms of PMDD are distinctly different than what we would call PMD,

so premenstrual exacerbation, other mental health diagnoses. And so I think when a therapist is, you know, cycle informed, being informed about PMDD is also, like it's almost a different thing in a way because PMDD, although has similar roots in those, in sort of the way that the hormones affect or impact that person's nervous system,

but somebody who has PMDD is even more sensitized to their nervous system, their body is more sensitive to the changes in, and the fluctuations in hormones in the second half of the cycle. And they very often experience even paradoxical effects of what some of these hormones are supposed to do. And they kind of show up in the brain and the nervous system of somebody with PMDD differently. And so, yeah, I mean, somebody who is coming to therapy with PMDD really, really needs to be working with somebody who has an understanding of that. What I would say is also really important for therapy that's supporting somebody with PMDD is holding

respect for the menstrual cycle, kind of bringing that into the lens here because very often for folks who have a PMDD diagnosis, there's a lot of distress around the menstrual cycle. And there can be almost this combative relationship that people have to their cycle where they're even on edge around like, oh God, have I ovulated? Is this going to, like, am I entering into this horrible time that I'm going to be suffering? And so bringing in the cycle aware lens, it's like we can start to repair the relationship to the menstrual cycle, we start to understand the role of it differently, and we can shift somewhere to how things have shifted with my menstrual migraines. It doesn't necessarily entirely solve the problem, but our relationship to the menstrual cycle and our

understanding of what's happening in the brain really takes some of that distress out and that shame out and that worry and anticipation out and just softens, you know, people again towards those, you know, really impactful and really severe symptoms of PMDD. So that's sort of how I would answer that. PMDD really is its own kind of category of experience. And working in a cycle-informed way is, in my opinion, essential, essential for therapy that is supportive of folks with PMDD. Yeah.

Yeah. And PMDD, there's a lot of it. Like, do you have a statistic off the top of your head around how many people experience PMDD? Because I've interviewed a couple of folks on the podcast, and I was surprised, but I can't remember the statistics now. because I'm 44 and my brain is changing and my memory isn't what it used to be. My understanding, and this is probably a Canadian statistic,

but I believe it's somewhere around 5 to 7% of the menstruating population. And also that that's probably a conservative number because we know that this still is dramatically underreported and overlooked. And if people are being misdiagnosed as bipolar disorder, right? There's people who are in now a different category and they're not being captured. So currently, yeah, five to seven percent, honestly, probably more than more than that. So quite a significant number of people. And how about like lastly, although I could talk to you all day, but lastly for this part of the conversation,

what about people who are in therapy because they're working on relationship challenges with intimate partners maybe or boundaries and yeah, tell me about cycle or whatever? therapy for it's so it's so helpful and important for relationship concerns because when we look at some of the challenges that often pop up for folks we can very often map that across the cycle and see that there are more or less challenging times in the menstrual cycle relationally for people for folks we often see challenges showing up premenstrually for people in terms of that being a higher time of conflict in relationships one of the reasons for that is again, this is the beauty, another beauty, beautiful gift of progesterone. But one of the, another thing

that progesterone does in our brain is that it increases our rejection sensitivity. And it makes us more attuned to the facial expressions of other people. Yes, it does. What do you mean with that look? Yeah. We're more dialed into the facial expressions of other people, specifically, the facial expressions that house things like fear, threat, anger, danger, rejection, that kind of thing, we're really dialed into that in the second half of the cycle. But the catches, in the research, what it shows is that we're not always the most accurate, unfortunately. As if we sometimes overperceive things in a facial expression that might not actually be there. And then, of course, in the second half of the cycle, we're more likely to just say it too, right?

So that is one of the things that can kind of show up for folks is that there is this rejection sensitivity. Now, it's really helpful to have that understanding and that awareness because very often we can, what we can do is we can track that rejection sensitivity piece back to some old attachment patterns and old attachment trauma in history that somebody might have around, you know, not being heard, not being listened to, you know, not being accepted for who they are. So we can work with that with the understanding that those feelings might be a little bit more heightened because of what progesterone is doing. And so this is a really important context for the individual.

struggling with the relationship patterns, but also for the partner to have as well, is that there's something actually neurobiologically going on here that can just make relationships feel a little bit more difficult. What's also true is going back to that information about the reward pathways, we actually feel less interested in other people at this time in the cycle. So progesterone also has this tendency to make us turn more inward. We're quite self-focused. We are more attuned to what's sort of happening inside of ourselves, and we're just generally less interested in our environment, including the people in it, even the people we really love. They're just not quite as shiny as they are earlier in the cycle.

So all of this can create sort of a perfect storm where we're bumping up against some more conflict with the people that we love because A, we're just not that interested. And B, we're just on higher alert for what is happening kind of relationally with people in our lives. And so as a therapist, right, I'm going to hold that information. and then I'm going to support that client and working with, okay, so then what do we need in the second half of the cycle? If we can hang on to that information, how can we work with this person to support the relationships at this point in the cycle? How can we actually then use other times in the cycle when the relationship is feeling stronger and better

to actually really anchor those good things in at the good parts of the cycle that kind of fills the cup up for when things feel a little bit more challenging or tricky later on in the cycle or when things shift? And so we can work with couples. We can work with people who are experiencing these relationship challenges, again, to kind of map it along the cycle. And to use sort of the benefits of what's naturally occurring in the nervous system there. Yeah. Yeah, the relationship concern piece is really quite common, Sophie, and really interesting to work with, really helpful to work with a cyclical lens. And imagining couples therapy, like having that lens and like if you were working over, say, six months with a couples therapist and you're doing six months of cycle. tracking both you and your partner or if you both menstruate both of you tracking your cycles and seeing

and then mapping out the patterns and honoring that there is a shift going on because there's also this belittling happens doesn't it or she's just PMSing no my brain is different in these ways yeah amazing yeah it's really quite incredible yeah there's a lot of potential here I think for the couple's therapy kind of world of things to be you know bringing this information forward as well could really really support couples yeah absolutely Yes. Yeah. So what are you up to MC? Like, what are you doing to tell everyone about this? How can people connect with you if they want to learn more? Yeah. Yeah. So I am, yeah, on a bit of a mission. So if you think you know that, to bring some more awareness to cycle informed therapy. And over the last few years, I've been training groups of therapists on how to integrate this knowledge.

into their practice and how to practice in more cycloneformed ways. And so I've been doing that through, you know, a number of mostly kind of in-person live workshops here in the area that I'm in. But upcoming, I will, I have had some requests for some people from, for some more comprehensive training. And so in the fall, I will be launching a course for therapists, specifically, on cycle-informed therapy and how to do that some of that learning around the neurobiology of the menstrual cycle and how to integrate that into practice. But before then, I am offering in June,

on June the 24th, I will be offering a live training webinar, a free live training webinar for other therapists who, you know, might have listened to this conversation, Sophie, and are feeling as fired up as we are about this topic and are curious, you know, about learning more and how they might be able to integrate this into their practice and if they're, you know, wanting to also bring this lens into the workplaces that they're in. So I would really warmly invite people to, um, to, to join that live webinar event. And so people can, um, can find some more information about that and my work, uh, if they were to go to offerings.mindful cycles.com. Um, and there you'll find I have a free resource for people on how to introduce cycle tracking into your

psychotherapy practice. So that's a free resource for therapists. And then also there'll be more information about the free live webinar there as well. People can follow me on Instagram. I don't post a lot on Instagram, but I do post sort of things that I'm up to and ways of connecting with me. So I'm on Instagram at the menstrual psych, and so people can find me that way as well. That's a great thing. Thank you. I spent some time trying to find a creative name for that. So there are a few ways that people can connect with me and learn more about the work that I'm doing. Thank you so much for everything that you're doing.

Would the course be relevant for people other than therapists? I work as a coach as well and I'm thinking, wow, I would really love to have this, especially this neurobiological level, like how the hormones are affecting neurobiology. Is it relevant for coaches and other practitioners or is it just for therapists? Yeah, that's a good question. I think it could be relevant for other practitioners as well, especially the neurobiological kind of underpinnings piece. What I would say is that there will be a significant portion of the course that will be talking

about psychotherapy types of interventions and the language that I'll be using will be kind of more psychotherapy based language, but that doesn't mean that somebody who's working in a different field couldn't benefit from that information as well. So I think folks can decide that, you know, for themselves. But I do think it could be beneficial for, you know, yeah, like you said, coaches and other people. But there will be kind of a psychotherapy heavy focus to it. So, yeah.

Amazing. I mean, my heart is pounding. I feel so strongly about this. I don't think it's just because it's on day 26. I think that, yeah, what you're doing is absolutely vital. and I'm so excited about it, and I imagine the community listening will be too. And yeah, thank you so much for everything that you're doing. Thank you. Yeah, thank you so much for having me on today and for, you know,

giving me the opportunity to chat about this work. I care so much about it and I just want to, you know, yell from the rooftops about this. And so I hope that it, you know, connects with some of the listeners today as well. So, yeah, thank you. Wow. I said it lots of times in the conversation, but my mind was blown by that conversation with MC. I'm really curious to hear how it lands for you. I always love hearing from you. You can write to me at sophy at red school.net. And that's also the place to write if you have a topic that you'd love us to speak about on the podcast or someone that you'd love us to interview. And if you know someone who would

benefit from this conversation, please forward it to them. And lastly, it really helps us if you can leave a rating and a review on Apple Podcasts. It helps the podcast to magically reach more people okay thanks again for being with us today and I'll be with you again in a couple of weeks and until then keep living life according to your own brilliant rhythm