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Abstract

The present case details the use of Acceptance and Commitment Therapy (ACT) with “June,” a 26-year-old biracial woman presenting with generalized anxiety disorder (GAD) and premenstrual dysphoric disorder (PMDD). Across 37 sessions in a community-based training clinic, treatment focused on reducing psychological inflexibility and strengthening flexibility processes, including acceptance, defusion, present-moment awareness, values clarity, and committed action. June entered treatment with severe anxiety, marked mood lability during her luteal phase, and significant relationship and occupational stress. The therapist tracked progress with standardized measures and qualitative reports. June showed clinically meaningful improvements in anxiety, psychological flexibility, wellbeing, and valued living. Though some of her premenstrual symptoms persisted, she no longer met criteria for PMDD at termination. This case highlights ACT’s relevance as a transdiagnostic approach for clients managing both GAD and cyclical mood disturbances. It also underscores ACT’s emphasis on relating flexibility to overarching values to help clients maintain motivation and consistent application of skills.

Keywords

acceptance and commitment therapy (ACT)premenstrual dysphoric disorder (PMDD)generalized anxiety disorder transdiagnostic process-based

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References

Altman

B. R.

Earleywine

(2020). Treating a cluster of internalizing disorders with the unified protocol for transdiagnostic treatment of emotional disorders: A case study. Clinical Case Studies, 20(2), 147–164. https://doi.org/10.1177/1534650120967993

American Psychiatric Association . (2013). Diagnostic and statistical manual of mental health disorders (5th ed.). American Psychiatric Association.

Ara

B. S.

Khosropour

Zarandi

H. M.

(2023). Effectiveness of acceptance and commitment therapy (ACT) on emotional processing, irrational beliefs and rumination in patients with generalized anxiety disorder. Journal of Adolescent and Youth Psychological Studies (JAYPS), 4(4), 34–44. https://doi.org/10.61838/kman.jayps.4.4.5

Arch

J. J.

Eifert

G. H.

Davies

Vilardaga

J. C. P.

Rose

R. D.

Craske

M. G.

(2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80(5), 750–765. https://doi.org/10.1037/a0028310

Arch

J. J.

Finkelstein

L. B.

Nealis

M. S.

(2025). Acceptance and Commitment Therapy (ACT) for anxiety disorders. Psychiatric Clinics of North America, 48(3), 443–456. https://doi.org/10.1016/j.psc.2025.02.003

Askari

Behroozi

Abbaspoor

(2018). The effect of mindfulness-based cognitive-behavioral therapy on premenstrual syndrome. Iranian Red Crescent Medical Journal, 20(1), 1–7. https://doi.org/10.5812/ircmj.57538

Blome

Augustin

(2015). Measuring change in quality of life: Bias in prospective and retrospective evaluation. Value in Health, 18(1), 110–115. https://doi.org/10.1016/j.jval.2014.10.007

Borkovec

T. D.

Ray

W. J.

Stober

(1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22(6), 561–576. https://doi.org/10.1023/a:1018790003416

Carlini

S. V.

Lanza di Scalea

McNally

S. T.

Lester

Deligiannidis

K. M.

(2022). Management of premenstrual dysphoric disorder: A scoping review. International Journal of Women’s Health, 14, 1783–1801. https://doi.org/10.2147/IJWH.S297062

10.

Cheng

P.-H.

Merrick

(2017). Cultural adaptation of dialectical behavior therapy for a Chinese international student with eating disorder and depression. Clinical Case Studies, 16(1), 42–57. https://doi.org/10.1177/1534650116668269

11.

Cotter

D. D.

(2011). Psychometric evaluation of the valued living questionnaire: Comparing distressed and normative samples. Western Michigan University.

12.

Doss

R. A.

Lowmaster

S. E.

(2022). Validation of the DSM-5 level 1 cross-cutting symptom measure in a community sample. Psychiatry Research, 318(1), 114935. https://doi.org/10.1016/j.psychres.2022.114935

13.

Eisenlohr-Moul

(2019). Premenstrual disorders: A primer and research agenda for psychologists. Clinical Psychologist, 72(1), 5–17. https://pmc.ncbi.nlm.nih.gov/articles/PMC7193982/

14.

Forsyth

J. P.

Eifert

G. H.

(2016). The mindfulness and acceptance workbook for anxiety: A guide to breaking free from anxiety, phobias, and worry using acceptance and commitment therapy. New Harbinger Publications.

15.

Gloster

A. T.

Walder

Levin

M. E.

Twohig

M. P.

Karekla

(2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009

16.

Grégoire

Gagnon

Lachance

Shankland

Dionne

Kotsou

Rogge

R. D.

(2020). Validation of the English and French versions of the multidimensional psychological flexibility inventory short form (MPFI-24). Journal of Contextual Behavioral Science, 18(1), 99–110. https://doi.org/10.1016/j.jcbs.2020.06.004

17.

Harris

(2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.

18.

Hayes

S. C.

Strosahl

K. D.

Wilson

K. G.

(2012). Acceptance and commitment therapy: The process and practice of mindful change. Guilford press.

19.

Hines

J. L.

King

T. S.

Curry

W. J.

(2012). The adult ADHD self-report scale for screening for adult attention deficit-hyperactivity disorder (ADHD). The Journal of the American Board of Family Medicine, 25(6), 847–853. https://doi.org/10.3122/jabfm.2012.06.120065

20.

Hofmann

S. G.

Hayes

S. C.

(2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37–50. https://doi.org/10.1177/2167702618772296

21.

Hofmann

S. G.

Kasch

Reis

(2025). Effect sizes of randomized-controlled studies of cognitive behavioral therapy for anxiety disorders over the past 30 years. Clinical Psychology Review, 117(12), 102553. https://doi.org/10.1016/j.cpr.2025.102553

22.

Islam

M. S.

Majlish

M. K.

Mahabub

M. S.

Rahman

Islam

M. S.

Uddin

M. S.

Potenza

M. N.

Kamrun

N. K.

(2025). Investigating the psychometric properties of the premenstrual symptoms screening tool (PSST) among Bangladeshi adolescent girls. BMC Psychiatry, 25(1), 606.

23.

Jespersen

Lauritsen

M. P.

Frokjaer

V. G.

Schroll

J. B.

(2024). Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database of Systematic Reviews, 8(8), CD001396. https://doi.org/10.1002/14651858.CD001396.pub4

24.

Kessler

R. C.

Adler

Ames

Demler

Faraone

Hiripi

Howes

M. J.

Jin

Secnik

Spencer

Ustun

T. B.

Walters

E. E.

(2005). The World Health Organization Adult ADHD self-report scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/s0033291704002892

25.

Kim

Newman

M. G.

(2022). Avoidance of negative emotional contrast from worry and rumination: An application of the contrast avoidance model. Journal of Behavioral and Cognitive Therapy, 32(1), 33–43. https://doi.org/10.1016/j.jbct.2021.12.007

26.

Kim

S. B.

Lee

Y. J.

(2022). Factors associated with mental health help-seeking among Asian Americans: A systematic review. Journal of Racial and Ethnic Health Disparities, 9(4), 1276–1297. https://doi.org/10.1007/s40615-021-01068-7

27.

Kornstein

S. G.

Pearlstein

T. B.

Fayyad

Farfel

G. M.

Gillespie

J. A.

(2006). Low-dose sertraline in the treatment of moderate-to-severe premenstrual syndrome: Efficacy of 3 dosing strategies. The Journal of Clinical Psychiatry, 67(10), 1624–1632. https://doi.org/10.4088/jcp.v67n1020

28.

Lambert

Hunter

Cocker

Gurvich

Chalder

(2025). Emotion regulation in premenstrual dysphoric disorder and premenstrual syndrome: A systematic review. BMC Psychology, 13(1). https://doi.org/10.1186/s40359-025-03587-y

29.

LeJeune

Luoma

J. B.

(2019). Values in therapy (pp. 60–63). New Harbinger Publications.

30.

Maheswaran

Weich

Powell

Stewart-Brown

(2012). Evaluating the responsiveness of the Warwick Edinburgh mental well-being scale (WEMWBS): Group and individual level analysis. Health and Quality of Life Outcomes, 10(1), 1–8. https://doi.org/10.1186/1477-7525-10-156

31.

Miller

K. N.

Standeven

Morrow

A. L.

Payne

J. L.

Epperson

C. N.

Hantsoo

(2024). GABAergic neuroactive steroid response to sertraline in premenstrual dysphoric disorder. Psychoneuroendocrinology, 160, 106684. https://doi.org/10.1016/j.psyneuen.2023.106684

32.

Osborn

Wittkowski

Brooks

Briggs

P. E.

O’Brien

P. M. S.

(2020). Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: A qualitative investigation. BMC Women’s Health, 20(1), 242. https://doi.org/10.1186/s12905-020-01100-8

33.

Roberts

M. Z.

Tifft

E. D.

Forsyth

J. P.

Boswell

J. F.

(2024). Acceptance and commitment teletherapy for mixed anxiety and depressive symptoms during the COVID-19 pandemic: A case study. Clinical Case Studies, 24(1), 3–20. https://doi.org/10.1177/15346501241283059

34.

Rolffs

J. L.

Rogge

R. D.

Wilson

K. G.

(2018). Disentangling components of flexibility via the hexaflex model: Development and validation of the multidimensional psychological flexibility inventory (MPFI). Assessment, 25(4), 458–482. https://doi.org/10.1177/1073191116645905

35.

Ruscio

A. M.

Hallion

L. S.

Lim

C. C.

Aguilar-Gaxiola

Al-Hamzawi

Alonso

Andrade

L. H.

Borges

Bromet

E. J.

Bunting

Caldas de Almeida

J. M.

Demyttenaere

Florescu

de Girolamo

Gureje

Haro

J. M.

Hinkov

Scott

K. M.

(2017). Cross-sectional comparison of the epidemiology of DSM-5 generalized anxiety disorder across the globe. JAMA Psychiatry, 74(5), 465–475. https://doi.org/10.1001/jamapsychiatry.2017.0056

36.

Spitzer

R. L.

Kroenke

Williams

J. B. W.

Löwe

(2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092

37.

Stefan

Cristea

I. A.

Szentagotai Tatar

David

(2019). Cognitive-behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. Journal of Clinical Psychology, 75(7), 1188–1202. https://doi.org/10.1002/jclp.22779

38.

Steinberg

E. M.

Cardoso

G. M.

Martinez

P. E.

Rubinow

D. R.

Schmidt

P. J.

(2012). Rapid response to fluoxetine in women with premenstrual dysphoric disorder. Depression and Anxiety, 29(6), 531–540. https://doi.org/10.1002/da.21959

39.

Steiner

Macdougall

Brown

(2003). The premenstrual symptoms screening tool (PSST) for clinicians. Archives of Women’s Mental Health, 6(3), 203–209. https://doi.org/10.1007/s00737-003-0018-4

40.

Stratford

P. W.

Binkley

J. M.

Riddle

D. L.

(1996). Health status measures: Strategies and analytic methods for assessing change scores. Physical Therapy, 76(10), 1109–1123. https://doi.org/10.1093/ptj/76.10.1109

41.

Tennant

Hiller

Fishwick

Platt

Joseph

Weich

Parkinson

Secker

Stewart-Brown

(2007). The Warwick-Edinburgh mental well-being scale (WEMWBS): Development and UK validation. Health and Quality of Life Outcomes, 5, 1–13. https://doi.org/10.1186/1477-7525-5-63

42.

Toussaint

Hüsing

Gumz

Wingenfeld

Härter

Schramm

Löwe

(2020). Sensitivity to change and minimal clinically important difference of the 7-item generalized anxiety disorder questionnaire (GAD-7). Journal of Affective Disorders, 265, 395–401. https://doi.org/10.1016/j.jad.2020.01.032

43.

Underwood

S. B.

White

S. V.

Forsyth

J. P.

(2024). Acceptance and commitment therapy (ACT) and self-compassion for generalized anxiety disorder and comorbid major depressive disorder: A case study. Clinical Case Studies, 23(6), 479–496. https://doi.org/10.1177/15346501241278297

44.

Ussher

J. M.

Perz

(2019). Premenstrual mood disorders: A feminist psychosocial perspective. In Ussher

J. M.

Chrisler

J. C.

Perz

(Eds.), Routledge international handbook of Women’s sexual and reproductive health (pp. 70–82). Routledge.

45.

Vasquez

M. J.

Johnson

J. D.

(2022). Multicultural therapy: A practice imperative. American Psychological Association.

46.

Wang

Wong

Y. J.

Chung

Y. B.

(2018). Family perfectionism, shame, and mental health among Asian American and Asian international emerging adults: Mediating and moderating relationships. Asian American Journal of Psychology, 9(2), 117–126. https://doi.org/10.1037/aap0000098

47.

Wilson

K. G.

Sandoz

E. K.

Kitchens

Roberts

(2010). The valued living questionnaire: Defining and measuring valued action within a behavioral framework. Psychological Record, 60(2), 249–272. https://doi.org/10.1007/bf03395706

48.

Wolitzky-Taylor

K. B.

Arch

J. J.

Rosenfield

Craske

M. G.

(2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80(5), 786–799. https://doi.org/10.1037/a0029418

49.

Yen

J. Y.

Lin

P. C.

Huang

M. F.

Chou

W. P.

Long

C. Y.

C. H.

(2020). Association between generalized anxiety disorder and premenstrual dysphoric disorder in a diagnostic interviewing study. International Journal of Environmental Research and Public Health, 17(3), 988. https://doi.org/10.3390/ijerph17030988

Acceptance and Commitment Therapy (ACT) for Comorbid Generalized Anxiety Disorder and Premenstrual Dysphoric Disorder: A Transdiagnostic Approach

Abstract

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