Pre-menstrual dysphoric disorder (PMDD) (with Aimee Oliveri)

[00:00:05] Bronwyn: Hey, mental workers. You're listening to the Mental Web podcast. The podcast about working in mental health for early career mental health workers. As always, I'm your host, Bronwyn Milkins, and today we are talking about what early career mental health workers need to know about Premenstrual Dysphoric Disorder or PMDD for short.

In this episode, we're gonna chat about the under-recognized but severely impairing condition of PMDD, what it is, how to spot it, how to talk about it with clients, and how to support clients who experience it. The aim of the episode is to help you feel a bit more equipped and less overwhelmed by this presentation.

Here to help us out with this topic is our guest today, Aimee Olivieri. Hi Aimee.

[00:00:44] Aimee: Hi Bronwyn, thanks so much for having me.

[00:00:47] Bronwyn: It's such a pleasure to have you on and I'm so glad that you could come on for this topic. I think it's so important and I'm really looking forward to hearing what you have to share with listeners.

[00:00:55] Aimee: Thank you and hopefully I can provide some helpful insights as well.

[00:01:01] Bronwyn: Yeah, not to make you too nervous. I'm sure you'll be great.

[00:01:05] Aimee: Fingers crossed.

[00:01:07] Bronwyn: Could you please tell listeners who you are and what your non-work passion is?

[00:01:11] Aimee: Yeah, so my name is Aimee Olivieri. I'm a clinical psychologist and the founder of Flourishing Women's Psychology. Um, so that's where I provide psychological services tailored to women, where I primarily focus on menstrual conditions such as premenstrual dysphoric disorder or PMDD, as well as things like PCOS, endometriosis, et cetera. But I also, you know, work just more generally with women's mental health, so perinatal conditions and things like that too.

In terms of my non-work passion... It would be along the creative spectrum of things. I like to write, so things like, blog posts and reflective pieces on different concepts that I think about when I'm in the shower. I, I like to sing. I like to engage in kind of like resourceful creativity. So sometimes I'll just find pieces on the side of the road and do them up and resell them on marketplace or-

[00:02:17] Bronwyn: That's so cool.

[00:02:18] Aimee: Yeah. Or if there's something that I want instead of buying it, I try to challenge myself to make it from something I've already got at home. I love movement as well, so I often do things like calisthenics or AcroYoga where it's about kind of balancing your body in different ways and yeah... so a lot of kind of different things, but I think they all fall in some way under creative expression or movement.

[00:02:46] Bronwyn: Yeah. It does sound like you're very in touch, yeah, with creative expression and movement, which is wonderful to hear. And maybe that leads us into our next question, which is, how did you come to be interested in PMDD? What led you to this area?

[00:02:59] Aimee: It's definitely been a journey and it's definitely been a process. I suppose it's not somewhere I just landed. I think I started off in women's health. That was where I'd had a lot of experience, especially, um, in the perinatal area. And with that I was working with a lot of clients who had PMDD, though I didn't start really focusing on it, until I got my own diagnosis of PMDD.

Basically, I had been struggling for quite a long time, not really knowing what was going on. I, I definitely suspected it was related to my menstrual cycle, but I didn't really know much more than that. And when I got diagnosed, it made a lot of sense, but I also realized there was a lot I probably didn't know about PDD or didn't understand about it.

I wanted to learn more, so I did a lot of research. I started looking into things like the International Association for Prevental Disorders or the IAPMD, but the more I looked, the more I realized, especially in Australia, there just wasn't a lot of information or it wasn't easily accessible. I was trying to find, I guess, support and treatment, um, as a patient or as a client. All the wait lists were really long, and I was really struggling, so I was like, well, what if I took this from a different angle and tried to learn about it from a professional capacity?

So I did, I, I started to kind of look into whether there were professionals who I might be able to learn from, you know, either through, um, training or supervision. And I found, um, my supervisor, Sharon Muir, so she's a clinical psychologist and has been working in the PMDD space for 10 years now. So I reached out to her and it was, I think, um, it was really aligned. It just, something about it just was meant to happen. I think both her and I have said that a lot. Um, we connected instantly and what started, I suppose, was like a supervisee supervisor relationship, we, we ended up becoming colleagues, which, and, and really like working together to advocate in the PMDD space.

So Sharon mentioned first of all that she was working on a paper and I love research, so I was like, can I please help you? Um, and so we, we worked to create a DBT informed treatment model, um, for PMDD. For those who don't what DBT is. It's dialectical behavior therapy.

So yeah, we worked to create this model and one thing just kind of led to another. We just, um, we started speaking at conferences and connecting with different professionals in the area. Started doing professional development talks, and yeah, the, this kind of, I guess, opportunity that I felt quite privileged to have to learn about PMDD from a different angle, um, became an opportunity to really advocate for PDD in that space too.

And, um, then I started to also notice, I suppose, that there's just not a lot of, like- so many people that we were speaking to about PDD with saying, yeah, you know, I treat PMDD. We were meeting all these amazing clinicians, um, who just didn't know about each other. So everyone was thinking they were treating PMDD in isolation. They were the only ones doing it. So I started to think, well, what if, what if I created a database that, um, allowed, clients and patients to find professionals who treat PMDD in Australia? Started to do that and that kind of evolved to peer supervision for professionals who treat PMDD through the MHPN, the Mental- Mental Health professionals network.

And yeah, so it kind of just kept evolving really in this really organic, um, way, which was so lovely. And, um, that network led to this really tight knit community who all now we, you know, as professionals, we know about each other and we can refer to each other and we can connect our pa our clients with them, but also for clients that now, there's these different avenues to access support all across Australia to, um, not just, I'm based in New South Wales, but I've tried to find people who are practicing all over so... It just kind of one thing led to another. Um, and here I am, I suppose.

[00:07:32] Bronwyn: It's really an amazing journey. Like, um, it's, it's so cool that, um, I mean, it's not, it's not great that you have PMDD, but from your personal experience, you've been able to learn about it and then be on the other side from a professional lens, I guess, knowing that personal experience yourself, but having the research and practice behind you as well. It's a perfect merging of both worlds and you're able to connect with a lot of colleagues as well in the space. It sounds really awesome.

[00:08:00] Aimee: Has, it's been incredible and I think through that, also meeting other people who have PMDD, it's, um, it definitely helps you to feel less isolated and alone and, you know, feel much more connected in what you're going through and helps you know, what, what's normal as well and what's not, and what's to be expected and what's not.

[00:08:23] Bronwyn: Yeah, I totally resonate with that because one of the reasons I was excited to reach out to you for the podcast is that I have PMDD, and I feel like in the past five years, awareness has exploded. Whereas in my twenties, I was educating every GP that I saw about PMDD, what what I thought was PMDD, because I was only diagnosed about five years ago as well. And I think that was when I guess there was an overlap and increased awareness. Somehow it made it through to the health professionals I was seeing, and then they finally made the connection. But it, it does feel like a very isolating illness because it wasn't, it wasn't recognized for a really long time.

[00:09:00] Aimee: Yeah, absolutely. It's, you know, you mentioned the explosion in the last five years and everybody who's in this space is really noticing that not just for PMDD, for women's health. and it's been amazing to watch and witness even just in the last couple of years from where I didn't know a single person with PMDD to now, you know, this huge network of people who both have and treat PMDD. It's- yeah, it's really been, um, incredible.

[00:09:29] Bronwyn: Really incredible because like you said, it's like I, I didn't know there was other people who treated PMDD, like other psychologists. It's, it's really incredible to unearth everybody and bring everyone together. So I'm really glad that you're doing that. So maybe for listeners who are not familiar with PMDD, what exactly is it and how is it different from PMS or other conditions?

[00:09:50] Aimee: Yeah, sure. So, um, there's definitely a lot of aspects to premenstrual dysphoric disorder or PMDD that are important to know about. Um, and so it's not the simplest of things to explain, but I will do my best to kind of at least cover the important concepts from it.

So first of all, I start just by breaking down the name, premenstrual dysphoric disorder. Premenstrual means before menstruation. So menstruation, other words we use are menses, the period, the bleed. So yes, premenstrual meaning before menstruation. Dysphoric meaning the opposite of euphoria. So dysphoric is a state of profound emotional distress. So the name itself really captures, I guess, a big aspect of what PMDD is. I, I like to define PMDD, I suppose, as a chronic mood disorder characterized by the cyclical recurrence of debilitating emotional and physical symptoms that occur in the two weeks leading up to menstruation.

So even in, just in that definition alone, you can hear there's a few components there, but even the definition doesn't fully capture what PNDD is. Um, I think it's something where you need to understand the symptoms, the menstrual cycle, the timing. There's a lot of things to it that differentiate PMDD from other conditions.

So, um, first of all, usually PNDD is diagnosed in relation to, um, using the DSM five, which I'm imagining most people would be familiar with on this podcast.

[00:11:36] Bronwyn: Yeah!

[00:11:37] Aimee: Um, so that's usually how it's diagnosed. Um, and with that there are usually core symptoms like mood swings, rejection, sensitivity, irritability, anger, interpersonal conflict, depressive symptoms, anxiety symptoms. So they're kind of the core symptoms, the things that, primarily is what PMDD is known for.

And then there's a number of additional symptoms that often come along for the ride. So things like, having less interest in things and finding it difficult to concentrate, fatigue, appetite changes, sleep changes, feeling out of control as well as a host of physical symptoms like breast tenderness, swelling, joint or muscle pain, bloating.

So there's, there's a whole lot of symptoms that are associated with PMDD but the thing that I guess really defines PMDD is the timing of the symptoms. That's kind of the key to being able to know, like if we are seeing these symptoms, 'cause for those who are familiar with the DSM5, you might've heard those symptoms and they probably sound like a lot of other conditions. Like there's a lot of overlap.

[00:12:57] Bronwyn: Yeah, like when I hear those symptoms I'm like, loss of interest, oh, that sounds like depression.

[00:13:01] Aimee: Exactly. So when people hear that list of symptoms, they go, oh, but that could be anything really. But what really defines PMDD is the timing of those symptoms. To understand the timing, it is helpful to understand the menstrual cycle. So I might just provide very brief explanation of that.

[00:13:20] Bronwyn: I am excited. We're gonna be talking about the ludial phase just to, but I'm excited. Go on.

[00:13:26] Aimee: So, um, so to understand the menstrual cycle, the day, day one of the cycle is day one of the bleed. From day one through to ovulation is known as the follicular phase of the menstrual cycle, and then from ovulation through to just before the next period is the luteal phase of the menstrual cycle.

[00:13:50] Bronwyn: I'm like in my, I'm actually smiling. 'cause in my head I'm like, yes, the cursor, luteal phase. Um, because yeah, for PMDD people experience, I'm like, oh, this is, this is the bad phase.

[00:14:01] Aimee: Yes, absolutely. Absolutely. It's it. So, yes, exactly as you said, PMDD. The symptoms are associated with the luteal phase. The timing in which the symptoms start, it differs for everybody who has PMDD, but generally speaking, symptoms can start basically straight after ovulation. So there's like a two week window or 14 day window in which symptoms might arise, um, before the period in the luteal phase and as these symptoms start to kind of show their face, usually what will happen is they get worse the closer it gets to the period, so the DSM five, actually it says in that diagnostic criteria, that symptoms should exist a week before the period, um, which can cause some confusion because, you know, I'm saying two weeks and the DSM five is saying one week. Um, but that's just because that's the timing in which symptoms are often the worst. So they're sort of restricting it to capture that window where the symptoms tend to be more clear cut, more intense, more obvious.

But yeah, basically from ovulation some women will get symptoms at that point and it will kind of continue to increase and worsen` in the lead up to the period. Um, for some women, the moment the period starts, the symptoms just stop. It's like the flick of a switch and these symptoms no longer exist and she's feeling a lot better. Um, for other women, it can be a couple of days into the bleed but the main thing is that there does have to be a symptom free time during the follicular phase. So after the period stopped, usually they would have, you know, again, varying, depending on the woman, a week or two weeks of feeling pretty good, feeling, you know, pretty normal, feeling like they can cope, feeling, like they can function.

[00:15:59] Bronwyn: Productive relationships are all right. I can sleep.

[00:16:02] Aimee: Absolutely. Yeah, and that, that has to be the case for it to be PMDD. So if it was kind of like they had all of these symptoms all of the time, and it got worse in the lead up to the period that would be probably more related to another condition like depression, for example, that is existent all the time, but gets worse, you know, because of the menstrual cycle and those kind of, interrelating factors. For PMDD, um, there does have to be this onset offset of symptoms and this confinement of symptoms to mainly the luteal phase.

[00:16:41] Bronwyn: I find that really helpful to understand because, I guess, like you said before, a lot of the symptoms of PMDD could look like depression, um, or even anxiety or another mood disorder, and so I find the timing, like you were saying, is a really helpful way to differentiate those conditions from each other. Obviously, if you've got depression, well, maybe not so obviously, but it does tend to be continuous, and the DSM says that symptoms are relatively continuous. Um, but for PMDD, you do see these shifts in symptoms that correspond with phases of the menstrual cycle.

[00:17:13] Aimee: Yeah. Like if you track PMDD over time, you do see this very consistent kind of onset offset of symptoms as well. Um, sometimes it can take a little while 'cause, you know, life happens and other things can, um, impact on the severity of symptoms and things like that. But, yeah, there, there is very much this cyclical nature that, um, you can really see as you build that picture over time, especially when you understand that it can be two weeks out from the period. I think that's something a lot of people don't realize. They, they think about, you know, the period, they think about PMS, which is often associated as just a couple of days before it. And so they think it can only be related to their period if it's a couple of days before the period starts. So in reality, yeah, it can be this two week window, and yeah, that, that's I think what, when you understand that creates this clearer picture of what PMDD is and what it isn't as well.

[00:18:17] Bronwyn: Yeah, so for people who, uh, are thinking that they might be experiencing PDD or a clinician is considering this, um, how do we know if it's normal or not? And I guess for women themselves, like a lot of women have been told that say heavy periods or pain before the bleeding is normal and you just gotta deal with it. Um, how do we know if it's normal or something to be more concerned or, or pay attention to?

[00:18:46] Aimee: Yeah. Yeah, absolutely. I think that's such an important question. I think this is coming up with a lot of conditions like endometriosis as well.

[00:18:55] Bronwyn: Yes, I was thinking of endo.

[00:18:57] Aimee: Yeah. Yeah. So, we know premenstrual syndrome is probably like, if we're talking about a spectrum, it's, it's the more normal end. PMS affects about 80% of women, um, approximately. So it's a-

[00:19:13] Bronwyn: I didn't know it was that high.

[00:19:14] Aimee: Yeah, yeah, yeah. So PMS specifically, right? So like this is, this is a smaller cluster of symptoms that you're looking for. It tends to be closer to the period, and it's, it's anything from like breast tenderness to a bit of discomfort to, to mild emotional shifts. Um, so yeah, it's, I think approximately between 75 to 80%. But yeah, it affects a lot of women.

In terms of prevalence, PMS is about 80%, and then PMDD is about 5.5% of women. So prevalence differs significantly. Um, but severity as well. So PMS, it, it shouldn't be... it should be relatively mild. It shouldn't be interfering with your functioning. It shouldn't be debilitating. It shouldn't be derailing your relationships and things like that. And it certainly shouldn't be causing things like suicidality, um, and suicidal thinking.

Whereas we know for PMDD that it is moderate to severe in terms of its impact, and it can be extremely debilitating. You know, a lot of women who talk about having PMDD, they talk about it like, you know, they're not themselves. They, something is hijacked their brain. They, they they feel like they're losing control. They feel like they're going crazy. They, it's impacting their ability to think, their ability to work, their ability to have... to, to be in relationship with others, their, their relationship with their selves.

So it's extremely debilitating and, and really like, we call it a systemic issue in the sense that it's just impacting a number of different systems in the body. So there's definitely a huge difference in terms of the severity, and this is why I have a big bit of a pet peeve with people saying that PMDD is just severe PMS, um,

[00:21:15] Bronwyn: Yeah, it, hurts my brain.

[00:21:16] Aimee: Yeah, it's, it's not like I understand the terminology, understand why we communicated in that way, 'cause it's a very quick way of being able to help people. Yeah, it's a shortcut, you know? You know, most people know what PMS is. So if I say, oh yeah, it's just a severe form, most people can imagine what that might look like. But I do think it gets in the way a lot for people actually recognizing that they have PMDD and that it's actually quite...

[00:21:44] Bronwyn: It might not capture the full breadth and depth of the experience.

[00:21:47] Aimee: Yeah, absolutely. The other thing of like, you know, is this kind of normal menstrual experiences versus something like PMDD is, we know PMDD, for example, more often correlates with suicidal thinking and things like that.

[00:22:06] Bronwyn: Yeah, so it underscores the severity of it.

[00:22:09] Aimee: Yeah. Yeah, absolutely. So, if you are looking at it in terms of, you know, the timing, the severity, how much it's impacting your functioning, you know how much it's impacting on your mood and even, you know, your entire bodily system... it's, if it's starting to get in the way of you being able to do day to day life, it's probably not PMS, if that makes sense.

[00:22:36] Bronwyn: Yeah, it's such a, it's such a tricky condition as well. I mean, just speaking from personal experience, it's like the PMDD phase is so bad that when I feel really good, um, at the start of the follicular phase, I'm like, oh, nothing to worry about, nothing to complain. And then I'll go to my GP and be like, just a few days ago I wanted to die. Now I feel fine. Um, and it's really hard to, um, I guess get support and treatment when you look so incongruent to a health provider about the distress that you're in because it's so hard almost to relate to those feelings that were literally only a few days ago. Um, but you feel so fine in the present. It's, it's just such a tricky condition, I think for people lived experience. But I feel like for a clinician looking into that, it's also tricky for them.

[00:23:18] Aimee: It's so tricky. And I think, like, what you just explained just then is such a common experience for women with PMDD where it's like we don't really know the reason behind it yet. I think this is still kind of something we're, we're learning about and we're trying to understand, but a lot of women with PMDD talk about like feeling like when they're in the luteal phase, when they're in the PMDD phase, they can't remember that it gets better. So it's, it's, it feels really bad and it feels like it's gonna be that way forever. It kind of impacts on your memory as well.

And then when they're in the follicular phase, um, you know, they, they feel amazing and they can't remember how bad it gets. Like it, they're like, oh, am I, am I cured? Am I better? Like, you know, there's this, this common description that women talk about where it's like that access to insight varies depending on what phase they're in, and it's almost like the information is not translating across those different phases.

[00:24:27] Bronwyn: Yeah. Which, but I think like even just you explaining the menstrual cycle... with a good basic understanding of the menstrual cycle, these symptoms are, are, are much more easily understood, I feel.

[00:24:37] Aimee: What I'll explain next is why does PMDD happen and that might help understand the role of the hormones and things like that. A lot of people have this misconception that PMDD is a, um, hormone imbalance. Um, it's definitely not a hormone imbalance. Women who, with PMDD, who go and get their hormones tested from their GPs, they will come back as perfectly normal. Nothing will show up in the blood tests. It's not a hormone imbalance, it's a hormone based condition. Um, we call it a neuroendocrinological condition, which basically means the brain is responding to hormonal fluctuations in an adverse way.

So across the menstrual cycle, whenever there's any kind of fluctuation that happens in the hormones, that is a vulnerable time for women with PMDD, but especially during the luteal phase because that is when, um, there's many hormonal fluctuations happening, um, and many significant kind of fluctuations. So during the luteal phase, estrogen drops dramatically. and then what happens is progesterone starts to kind of increase it then peaks, and then it drops off towards, um, getting close to the period.

And so there's, if you think about, you know, the kind of surfing aspect there, there's a lot of waves kind of coming that, that are hitting, um, that woman. And during the follicular phase at least. So for the first kind of week, there's not a lot of hormonal fluctuations happening, so it's pretty steady. And then as we start to approach ovulation, estrogen rises, which is a fluctuation, but estrogen is neuroprotective. So it's actually, quite a feel good hormone for women and it serves a lot of, um, really important benefits, um, for mood and things like that.

So it's a fluctuation that happens where women with PMDD they actually feel really good, um, most of the time they feel, you know, a lot of them will say, I feel like I'm floating. I feel even sometimes like a little bit manic, not in like the bipolar sense, but, yeah, just more activated and, yeah, euphoric, I suppose, because yeah, as I said, it's estrogen forms that kind of neuroprotective role.

So then when estrogen drops down, drops off after ovulation, it's like a withdrawal. Um, and, and again, this is what a, what a lot of women will say, this is why it feels like a flick, uh, like a, the flick of a switch, um, because suddenly this feel good hormone has just dramatically dropped. And yeah, a lot of women will say, I feel like a drug addict in withdrawal because it's just like something has changed in my brain quite suddenly and my brain's not liking that.

[00:27:36] Bronwyn: I'm wondering then how PMDD intersects with neurodivergence. Like I've read that ADHD and PMDD, there's a large overlap. Do you have any info on why that is? And I know it's a complicated question 'cause I've read a bit about it. My, my lay conclusion from reading about it is like brain stuff.

[00:27:54] Aimee: Yeah. Brain stuff. I love that. Yes, exactly. If I just say brain stuff, is that enough?

[00:28:00] Bronwyn: Potentially. I, I think what I've read is like there's, I, I think it's like depending on who you listen to, um, I think there's like an under activation or an overactivation of like receptors in the brain to like, say dopamine, um, and that's influenced by like progesterone and estrogen changes. But I might be making stuff up and you probably have a more informed perspective than me.

[00:28:21] Aimee: I'll do my best, but I, I'm not so good at explaining, I suppose, the science behind it, but I'll start by saying I actually see PMDD as a form of neurodivergence in its own right.

[00:28:34] Bronwyn: Interesting.

[00:28:35] Aimee: Because if you think about it, neurodivergence is the brain, you know, it's working in a different way, um, to a neurotypicals brain. So women who are neurotypical, actually, what happens to them during the luteal phase is progesterone and one of its metabolites allopregnanolone is released. For a neurotypical woman that's actually supposed to be quite calming, it's supposed to have a calming effect. Um, whereas women with PMDD, they have this adverse reaction to it and it's really quite dysregulating, so we, yeah, yes, rage and all sorts of things. Um, we don't a hundred percent know why that is. There's a lot of theories, um, and research emerging in that space. But if you think about it, the brain is working differently to what it should be, essentially. So I haven't actually come across anything talking about it as its own form of neurodivergence, but for me, it helps me to understand it, looking at it in that way.

[00:29:41] Bronwyn: I really like that conceptualization, and I just wanted to say as well that I find it really exciting that there's more research going into the causes of PMDD. It's like there's been such a gap in an absence of research into women's health overall, like Endo and PCOS, and it's just so exciting to have women's health, yeah, researched.

[00:30:00] Aimee: Absolutely. Yeah. Yes, I completely agree. Um, and so yeah, first of all, I conceptualize it in that way is, is in its own right. I, I, at least in my opinion, see it as a form of neurodivergence. And we know that often neurodivergent conditions overlap. You know, there's a lot of kind of overlapping symptoms. Um, and so yes, absolutely, um, PMDD is more common, especially in autistic and ADHD individuals. Um, so there's emerging research in that area too. We're definitely seeing that. I think the statistics, I don't know how accurate they are, the kind of earlier research that's being done, um, shows, at least for ADHD, that's 45.5% of women with ADHD report, PMDD. So that's huge. If you think about that, it's almost half.

And if you think about it, I guess from an ADHD perspective, like I was looking at this and 20 years ago there was research that showed, um, the impact of the menstrual cycle on ADHD symptoms, and yeah, so this is something that's not new. It's not like 20 years ago there was research that showed that it would be beneficial to up, um, stimulants stimulant medication during the luteal phase because it wasn't working as well for women during that time.

I think there's probably, yes, like everything that you described plays a huge role and something about the, kind of, if we think about our different systems, so we've got like our HPA access, which is our stress system, and then we've got our HPG access, I think it's called my, um, I'll have to fact check that later too, but that's our reproductive system. There's, they both impact on each other, and there's so much complex kind of biology happening in that state of the luteal phase that yes, it's absolutely gonna be impacting on like dopamine, serotonin, and things like that. During this time, I guess the easiest way to explain it is that the luteal phase is a more vulnerable time, especially for women who are neurodivergent.

[00:32:17] Bronwyn: I feel like if like... because I've seen the statistic about about 45% of women with ADHD, ADHD will also have PMDD, I therefore feel like every time we mention ADHD in women, we should also be talking about PMDD, but I rarely see the two mentioned together.

[00:32:35] Aimee: Yes.

[00:32:36] Bronwyn: Yeah.

[00:32:37] Aimee: Yes, I know. Yeah, I know. I completely agree. I think, um, and it's something that I'm trying to, I guess, be more aware of whenever I'm getting, you know, a woman come through of ADHD, I'm thinking about PMDD and vice versa because, um, yes, statistically speaking, there's a big overlap there.

 And I think another thing is, like... you, in terms of a lot of, a lot of women will talk about how most of the time, you know, if they have ADHD they can cope and they can mask and things like that, um, but then something's happening during the luteal phase, which is just impacting on their ability to do that in during that time. So their capacity, gets significantly impaired, and so those symptoms kind of take hold, if that makes sense as well.

[00:33:29] Bronwyn: Yeah.

[00:33:30] Aimee: Another thing that I think helps to explain the overlap, and there's a few different models on this, is like neurodivergence sometimes can be looked at like a neuro sensitivity. So, um, we know for PMDD, for example, women with PMDD, tend to experience a lot of sensitivities in terms of, you know, light and pain and touch, um, and rejection sensitivity, and emotional sensitivities and things like that. And we see that a lot with, um, neurodivergence in general with ADHD and autism. And so I think, um, if you look at it more from like a nervous system perspective, it makes sense why there's so much overlap because we are looking at this overall kind of neuro sensitivity, which is getting activated. During this kind of luteal phase, tolerance and capacity and all sorts of things are, are getting more limited, um, in terms of resources that that person has to cope.

[00:34:32] Bronwyn: Yeah. I guess if I'm just imagining a battery in my head as a simplistic kind of metaphor, it's just, it's draining. It's draining very quickly.

[00:34:40] Aimee: Yes, absolutely. Yeah. And so even from, a perspective of what's actually happening for women with PMDD during the luteal phase, we know that they have an increased startle response. We know that they're, um, nervous systems more on edge, so they're more in that kind of fight or flight state. Their window of tolerance is decreasing or narrowing. So, um, you know, it doesn't take as much to kind of push them over the edge. Memory and things like that can get impacted. So there's just a lot that's kind of going on that's really, um, impacting on that person during that time and-

[00:35:18] Bronwyn: It's so noticeable as well. Like for me, like I regularly do puzzles that are timed, so I might do like Sudoku pretty regularly and because I know how long I usually take to do a puzzle, during the luteal phase I'm easily like five or six minutes slower and I'm like, why is my brain so slow? And it happens. But that's like, that's the impact of like, yeah, I guess symptoms during the luteal phase, it's so noticeable. The impact on memory and attention and concentration and just yes, speed and just your brain.

[00:35:48] Aimee: Yes, absolutely. And there's like, you know, this isn't just what we're seeing. This has been shown in research as well.

[00:35:55] Bronwyn: Yeah, research supports that there's. Like, this noticeable decline in these, I guess, cognitive abilities.

[00:36:02] Aimee: And like that's such a perfect example. That's something you are doing all the time, you know, so, it's interesting as well, I suppose, 'cause we know that women are different to men in terms of, um, some men have that 24 hour cycle, and they, people often refer to like, the afternoon and nighttime is like the men's luteal phase. And you know, we see a difference in how they function during that time, versus, you know, during the day or earlier in the morning. And, um, yeah, it's, it's the same for women. Like there's that, but we have instead a 28 day se cycle or whatever, you know, timing it might be for that particular woman. It's, it's different to the 24 hour cycle that men have.

[00:36:46] Bronwyn: Thank you for explaining that . So my next question, I'm so keen to hear your answer to this question. I'm very curious. How do we bring up PMDD, a client's menstrual cycle to them, if we think that it might be a factor. Without shaming pathologizing. It's like you see, media, like movies, it's like, oh, she's, she is on a period, sort of thing. Like it can be come across as quite dismissing or invalidating. And as a clinician in this space, I'm really keen to hear from you how you bring it up with women in a, in a kind, non-pathologizing way.

[00:37:21] Aimee: I think it's such an important question. This actually comes up a lot in my, my trainings that I do.

[00:37:26] Bronwyn: Oh good. Well, I'm glad people are asking about it 'cause it says that they want to ask in a non, in a good way.

[00:37:32] Aimee: Um, I think I have a number of different ways of approaching the topic, and I will often vary that depending on who's in front of me. Um, the first thing that I would say is, I think it's important to be direct. Don't beat around the bush. I think we need to start normalizing talking about the menstrual cycle and I will often, you know, regardless of, um, what that person is presenting for, if they likely have a menstrual cycle, I'm gonna ask them. That's gonna be one of my first questions. What are your periods like? How long do they last? Do you experience a lot of pain? Does it impact on your mood? I think it's really important. It's to, to start normalizing discussions about the menstrual cycle and the impact of hormones on mental health.

And I guess what I find with women with PMDD is a lot of the time, they're actually relieved when I ask them, because for so long they have wondered themselves or they've suspected or they've noticed some kind of connection. And I think because there's this awkwardness of how do you talk about the menstrual cycle with someone or how do you talk about hormones with someone? People will often steer away from asking. So I think in, in fact, I would actually just say like, don't beat around the bush. Start asking women about their menstrual cycle.

[00:38:57] Bronwyn: What would you say to a clinician who says, that seems like quite a private topic or a personal topic, like asking somebody about their sex life straight out the gate.

[00:39:07] Aimee: I guess I see it as like it is private, I suppose, like it is, it can be, and at the same time, a lot of what we talk about in therapy is private, I suppose, you know, it's, it's a different kind of space and for something like the menstrual cycle is seen as like the sixth vital sign of health for a woman. And so I think we have, we can approach it in like a cautious way and we can say, you know, do you mind if I ask you about your menstrual cycle? You know, we can, we can be sensitive in how we approach it, but I do think, we have to, especially if we think there's a connection there.

[00:39:50] Bronwyn: And particularly what you said before about that you've noticed that clients seem relieved. It's like to, to talk about it. And I think, yes, a lot of people who have a menstrual cycle, it does sound like they would be relieved to ask about it, particularly if they've been experiencing symptoms because of it. Wouldn't it be great for them to be able to talk about it in a consultation?

[00:40:09] Aimee: I mean, I personally have never had the conversation go wrong. Yeah, I mean, I'm lucky in the sense that most people are coming to me for menstrual related conditions, but in saying that, I've, having, I've been having these conversations long before I started even working in the women's health space because, I think, women with PMDD, they off don't just struggle with mood related symptoms, more often than not, they will experience painful periods and heavy periods and a lot of menstrual discomfort in many different ways. So I, I think for them especially, yeah, as I said, there is this relief.

`Um, but I do understand it can, it can be tricky and it can be a sensitive topic, and so sometimes I, I might just start by asking someone, as I said, more generally about their periods, what are they like, and that can be a way in. Um, sometimes I just ask women, do you track your cycle? Um, you know, do you use, do you use flow or do you use any other kind of tracking systems? Um, and, and sometimes that's a way in, because usually women who track it, it's because they've noticed something, right? Or, or they're just kind of more attuned or aware or, or curious about their cycles. So that might be another thing.

Sometimes I just ask, is there a pattern to your symptoms? And women may you know of themselves say, oh yeah, you know, I have two weeks of good and two weeks of bad. Or, yes, I have noticed that my periods really knock me around, or things like that. So sometimes it's just finding the question that will help you get a kind of more sensitive opening.

I also talk about women being cyclical beings a lot. Women are not... they're not supposed to function the same way every single day. There, there is supposed to be different, I guess phases in which they have different capacities and which they have different abilities and things like that. And, um, they feel that, you know, they feel it in their bodies and so often I will just sort of talk about how, yeah, men have the 24 hour cycle, women have the 28 day cycle, their cyclical beings, um, and therefore that cycle is going to have different impacts at different times, so sometimes just that conversation can be helpful.

[00:42:36] Bronwyn: I'm imagining it helps with alleviating pressure and expectation that women might have on themselves, like, I should be able to function and produce the same amount of work every day and have the same great relationship all the time. Is that what, what, you see from having that conversation?

[00:42:50] Aimee: Hugely, yeah. And I often will use metaphors like, um, the, the menstrual cycle actually correlates really nicely to the seasons. Like there's a season metaphor that's used and you know, the same way that flowers can't be in spring all the time, it's the same for women. And I think helping them understand that, that it wouldn't be healthy to kind of be expected to keep functioning in that same way, using nature metaphors, I think can be really helpful and helps, like, as you said, alleviate pressure to feel like they should be having the same output every single day. Yeah, definitely.

[00:43:31] Bronwyn: And it sounds like you're suggesting as well that clinicians ask about the cycle in, in however of the number of ways you described, like right from the start.

[00:43:40] Aimee: Yes, absolutely. Right from the start. Like, as a clinician, you have to be tuned to the person in front of you. And you know, I'm not saying that's a blanket rule and you have to do it every single time, but I think it is helpful to start building that into your practice wherever you can.

[00:43:57] Bronwyn: I, completely agree, and I can see where you're coming from. Obviously, if you've got a client in the first session and they're talking for 50 minutes about the topic that they really need to talk about, you're not gonna end that session about, by the way, how's your cycle? Um, yeah, have some, have some sensitivity and, and read the room, I guess.

[00:44:12] Aimee: Definitely, definitely, But even just, um, some final things that I'd say is mentioning that the menstrual cycle is seen as the sixth vital sign of health, or...

[00:44:22] Bronwyn: I didn't know that. That's an awesome thing to say.

[00:44:24] Aimee: Absolutely, absolutely. It's, um, it's huge. And then also things like, you know, if there's comorbid conditions, women who have ADHD are more likely to have PMDD. Is this something that you've heard about? Um, or, uh, you know, even just education around the timing of symptoms. Um, so I will actually, I've got a graph that I often show to women just to show them about the menstrual cycle, and I'll show them that window, that two week window and say, if you are noticing symptoms specifically in this phase of the cycle and not here, you know, this might mean sometimes they even just say you have a hormonal sensitivity. Sometimes they don't jump straight into PMDD. So there's lots of different ways to approach it, and I think it's just about getting a feel for the person that's in the room with you and what's gonna resonate with them.

Finally, I would say for some of my women, I just relate it back to things that they've told me. So I'll say, oh, do you remember when you told me that you had this really bad reaction to that contraceptive pill? And when you told me, you know that you have really painful periods? And I'll start to kind of put together a picture and then I'll say like, I'm, I'm wondering if there might be an underlying, hormonal sensitivity, have you heard of anything like premenstrual dysphoric disorder before? So as you can see, lot of differents in the bag. It just depends on who you're with.

[00:45:50] Bronwyn: Yeah. So Aimee, you were mentioning that you may draw together some symptoms that people have and kind of be like, like, look, this might fit in with a hormonal sensitivity. I'm curious about how psychologists and mental people who work in mental health can support people with PMDD more broadly. I'm like, as soon as you recognize it, is it just like, go talk to your GP? Or are there things that psychs can do?

[00:46:14] Aimee: Yeah. Um, I think that's a really good question and often, I'd say there's a number of things I'd recommend. Um, so yes, having a good GP is gonna be a really important part of treating premenstrual dysphoric disorder because first of all, there can be a lot of physical conditions that look like PMDD, that aren't PMDD. Um, so you wanna make sure at very least, that they've had a good physical workup, they've had some blood tests done, they've had their thyroid checked out, they've, um, you know, looked at their iron levels and things like that. Um, that's, that's gonna be crucial. So yes, good GP is gonna be very important.

But in addition to that, there is a lot that you can do, especially in those early phases of, of the person learning about PMDD. So, um, one of the things that we talk about a lot is psychoeducation. All the things that I've just spoken about, I suppose, at the beginning of this podcast are all things that women with PMDD should understand so that they can understand what's going on for them and they can advocate for themselves and they can know what's happening in their body at different times and be able to adjust what they're doing at different times as well. So education's really important, um, and really thorough psychoeducation goes a very long way.

Validation is something else that's really important. Um, in the model that, um, my colleague and I put together, our very first phase. Yeah, um, so it's a DVT informed treatment model. It's, it's really simple to be honest. Like there's nothing super special about it, but it is the first of its kind in the sense that there's just not a lot of research on psychological interventions for PMDD.

So really what we've done is we've just kind of captured, um, different, different stages of that you might follow when you are both assessing for and treating PMDD. And our very first stage is actually, validation and psychoeducation because that's such a crucial part to treatment for women with PMDD... often women with PMDD have been misdiagnosed with a number of other conditions. They've, they've waited, I think, average of 12 years before they've received their diagnosis. They're, they're feeling, you know, like, what's going on for them is, is not being heard or not being seen. They're wondering, you know, if it's all in their head or they're questioning their reality.

And so validation is so important of being able to help and see, yes, this is real. Yes, it is debilitating. `Um, and I think that... It sound, people who kind of hear that would go, oh, wouldn't that make it worse? But I think in reality, they've already known for so long how bad it is.

[00:49:16] Bronwyn: Yeah, I'm like, I'm super grateful hearing that. I think it's so crucial, and I don't think it can be understated. Like you said, maybe an average of 12 years to obtain a diagnosis. And in that time you may have tried several different treatments. And I mean, just speaking from personal experience, it can feel like you're a bit of a bad patient as well because it's like, I want things to work and then I hate going back to the GP and it's like the 10th pill okay, this one made me depressed, this one made me want to die. Um, and it's like, you just want something to work and you just feel like a complainy complainer. Um, so it is, it is really nice to, to have that validation. I think it's crucial. So thank you so much for putting it in there.

[00:49:54] Aimee: Absolutely. So education validation, really important. I do often encourage women to track in whatever way that they can. There are lots of different methods of tracking. Some are more comprehensive than others, but in whatever way that they can, whether it's just logging when their period is, whether it's journaling, whether it's using something that's more symptom specific... um, getting somebody tracking is gonna be really important as part of their PMDD journey for a number of reasons I won't go into, but it is important.

 I think as well, just understanding that PMDD is a condition that's best treated multi-, like in a multidisciplinary team. So, um, psychological intervention can go a really long way, and I encourage clinicians to look at it like if you were treating chronic pain. So we know that pain, chronic pain is chronic, and we know that the goal might not necessarily be to cure the pain. Instead, it might be about how can we equip this person with coping mechanisms? How can we help them to understand this condition better? How can we help to reduce things like psychological distress?

So helping that person to navigate that condition and also helping to improve quality of life around it. So that's, I think that's like a helpful way of looking at as a mental health worker, what's your role when it comes to PMDD? Um, even things like, that might be impacting and making the PNDD more severe. So, for example, we know there's a huge overlap with trauma. And we know that women with PMDD during their luteal phase and much more... schemas and things like that are gonna be much more activated during that time. And so even, even trauma work, um, like processing work and things like that can reduce the severity of PMDD as well.

So there's, there is a, there is a big role that, um, mental health clinicians can play, and that's something that we really want to stress and advocate is that, yeah, you can make a big difference, and often it's around education validation, coping mechanisms, and, and finding out like what is coming up during that time and how can we help that person navigate it, whether it be improving their quality of their relationships, interpersonal effectiveness, all those kind of DBT based skills that, I really love.

[00:52:20] Bronwyn: So one scenario that I've got in my head is, particularly for early career clinicians or just any, any clinician who has not worked with PMDD much before, I can imagine a situation where they identify that the client has PMDD and then they notice themselves feeling a bit scared and they're like, oh, maybe I should refer on. But the skills you were describing, there are skills that it sounds like clinicians can put in. So my first thought was like, um, yeah, but go seek supervision with Aimee, but, but what would you say to those clinicians who are like, oh, I dunno if I can handle this.

[00:52:56] Aimee: Yeah, I, I think it's a common anxiety that comes up with something like PDD because it's often seen more as a medical condition than a psychological condition. I guess I would say like, focus on what you can do to begin with because sometimes we can do more by holding someone and creating space for them, especially if they've connected well with you and they're feeling really supported. You know, sometimes it's about focusing on what you can do and there is actually a lot we can do for someone who has PMDD. The International Association for Premenstrual Disorders has a wealth of information for clinicians and it's simple stuff that you would've learned about, like things like pacing, things like cycle thinking, lifestyle adjustments. You know, they're not gonna cure PMDD, but they can make a difference in how that person is experiencing PMDD.

So, yeah, I'd say focus on what you can do and depending on the severity, I think most people will start to realize when something's getting a bit beyond them. And sometimes it might be about like, is it that you just need to connect them with a medical professional who can handle some of that other side of things? Or is it that you need to seek supervision? Um, come along to my peer supervision groups. They're always really helpful. I get people, we have people presenting case presentations and stuff to get more advice.

[00:54:22] Bronwyn: Mm. And I'll make sure those links to Aimee's group is in the show notes listeners. So do check that out.

[00:54:27] Aimee: It's free, um, as well. So, but yeah, I think like, you know, seek supervision I suppose, on whether it is time that they need more specialized support or whether there is more that you can keep doing to hold that person. Um, but yeah, I think there is a lot that we can do. It's just about knowing what those things are more than anything.

[00:54:50] Bronwyn: Yeah, and I think, um, like you said, it's a, uh, some people see it as, as more of a medical condition, so they might feel a bit frightened, but I'll just get your opinion on this. I think if I was a client I, and, and a clinician didn't know much about PMD, I would still be okay with them if they said, look, I dunno much, but I've got some really well researched like information here. We can go through it together, or I can go away and read it and I can come back and talk about it with you a bit more... like, is that an okay approach?

[00:55:18] Aimee: Absolutely think so. Like, again, it's one of those things that I think the idea of saying, oh, I, I don't know, like scares a lot of people, but I actually think most of the time it's quite reassuring for people to be like, oh, you know, it makes sense why I don't know about this 'cause even the professionals don't, a hundred percent know.

And I think if you are saying, I don't know, and I'm willing to learn and I'm willing to help you and help you advocate, and all those sorts of things, that is really important. So few people are getting that with their professionals who are supporting them. They're just getting shipped off from one person to another.

So yeah, I think it can actually be really healing for people to say, I don't know, and I'm willing to learn and, and go on this journey with you. At the same time saying, let's just both agree, you know, if we feel like we're getting to a point where it's not enough, let's both have that conversation and call it as well. I think it's just about covering all those different basises... yeah.

[00:56:18] Bronwyn: That's really lovely. And so it's not as the clinician that you're like, oh gosh, they're gonna find out that, I dunno, it's really overting that process and, and naming it and I'm, but I'm here and I'm willing to learn. Um, and like you said, if we both feel like that there's like a bit more here, that we need more assistance, we, I, I can assist and I'm willing to discuss that with you.

[00:56:36] Aimee: Yeah. And I've had that conversation many time with my clients and I've told them here and there, hey, like, I'm actually going to take this to my peer supervision group and are you okay with me doing that? And... or sometimes there's like a medical group that I'm a part of where I will ask questions to that group to gather more information, again, with my client's permission. But I think they really like and appreciate when you acknowledge. You know that there are certain things we don't fully understand that we can explore further and keep learning about.

[00:57:12] Bronwyn: Yeah, I think that's a really nice sentiment for listeners to hear. Thank you for sharing that.

Aimee, one of the last questions that I wanted to really ask you about was if there's some common misconceptions that people who work in mental health might have about PMDD or just like hormonal, mood changes in general.

[00:57:28] Aimee: Hmm.

[00:57:29] Bronwyn: Um, yeah.

[00:57:30] Aimee: Yeah, sure. Common misconceptions... Okay, so I think the big one we already spoke about is people often think PMDD is just severe PMS, um, so we know that it's not, we know that it's... there's much more to PMDD. Um, and it's really worth knowing the differences between PMS and PMDD to really understand that.

The next one, again, um, we mentioned it's not a hormone imbalance. Um, it's a hormone sensitivity, it's a hormone based condition, but the hormones are normal, so they're, they're actually having a heightened reaction to normal hormonal fluctuations across the menstrual cycle.

[00:58:14] Bronwyn: I think that's such a important one to understand. Um, so when I was like in my early twenties, I actually. I didn't know anything about PMDD or hormones. And so I went to my doctor and I was like, I want a hormone test. And I think they explained to me like, you have hundreds of hormones in your body. Like they're fluctuating all the time. We can't really do that. And I was like, I still want one. Um, so, so I got one and then I, it came back normal and I was like, oh, I guess I must be making it up. Um, so it's like if you don't have that knowledge, that's where the investigation can end. And so it's so important to really understand that it's not a hormonal condition.

[00:58:49] Aimee: And I think it's really important to remember that even some medical professionals have this misunderstanding. So they will actually do a hormone test, they'll see it's normal, and they'll go, all right, you're fine, send me off. So I often, actually, a lot of what I do with my clients as well is helping them understand our medical system. It's androcentric in nature, it's, it works of a disease-based model, not an optimal health model. There's so much that just understanding the medical system in itself will allow clients to better advocate for themselves.

I guess coming back to that, um, what can happen sometimes is... a medical professional will do that blood test and, and that's it, that's the end of the client's journey, and they just think, okay, well my hormones are normal, so it's not hormonally related. But when you understand that a lot of the tests that we look at, I guess, in this disease based model, which is looking at, is this person dying, they're not gonna show what's really happening for something like PMDD.

Um, and so sometimes it's even about understanding that more comprehensive testing is often needed for something like PMDD, because there could be underlying conditions, as I said, like a thyroid condition or, um, you know, like endometriosis and other sorts of things that, um, that do require much more kind of comprehensive, optimal health approach to really know what's going on underneath the surface than understand why PMDD is present and why it might be quite severe for some people.

So. Um, yeah, just understanding the medical system... understanding the types of tests that are done more generally versus what might be more comprehensive and helpful, all that sort of stuff, and knowing that a lot of professionals don't know about PMDD so, uh, unfortunately a lot of clients have to educate their professionals and that seems so awkward and seems like when I, when I help clients do that, they often look at me and they're like, what? What do you mean I have to like tell them about PMDD? But it's, um, it's an unfortunate reality. And when we, when we keep kind of allowing ourselves to understand that our medical professionals not, might not know everything, but if they're willing to learn, if they're willing to listen, if they're willing to hear, um, we can create better care for everybody essentially.

[01:01:16] Bronwyn: Totally. Absolutely. Was there any other misconceptions that people who work in mental health or just in the medical field more generally, might have about PMDD?

[01:01:26] Aimee: I think those are kind of the three pet peeves that I have, the ones that I've already mentioned. Those three, I think get in the way a lot of people getting the support that they need and, and getting a diagnosis.

[01:01:38] Bronwyn: Aimeey, was there anything else that we haven't covered today that you're like, I really want early career clinicians to know about this?

[01:01:44] Aimee: I think I would just say, with something like PMDD, if you can just approach it with this open-minded, curious, willing to learn attitude, and if you just go into, you know, wanting to learn, I suppose, about the menstrual cycle, about women's hormones on a very basic level, I think it can make a really big difference.

Um, you know, I've been obviously talking about PMDD here, but we know that, um, there's so many other conditions that are impacted by the menstrual cycle and hormones. So, yes, be open-minded, be curious, be willing to learn more about those things, and I think it will take you quite far in your understanding of women's health.

And just how important awareness and advocacy is in this space. Um, and self-advocacy for clients, being able to use their voice, being able to assert themselves. Um, I think they learn a lot just on that journey alone, that that will take them much further than what you could take them if you did everything for them, essentially. So yeah, awareness, advocacy,

One simple question can change the course of treatment. The amount of times, you know, I've realized later on, oh, I haven't actually asked this person about their menstrual cycle. I asked the question and I realized there's this whole layer of suffering that that person's been experiencing that we've never discussed before, 'cause they thought it was normal. A simple question can go a very long way.

[01:03:15] Bronwyn: When I hear that, I'm like, mental health professionals can make a really big difference, and yeah, that shouldn't be underestimated and the impact can be a lot for clients.

[01:03:24] Aimee: Absolutely.

[01:03:25] Bronwyn: Aimee, it's been such a pleasure to speak with you. It's been awesome. I'm so glad that you're doing the work in this space. I'm so glad that you have this peer supervision and that you've got this training and you've got your own practice. So, if listeners wanna learn more about you, or get in touch, or join your peer supervision group, where can they find you?

[01:03:42] Aimee: Yes. Um, so my website is flourishingwomenpsychology.com.au. I also am quite active on LinkedIn for professionals who, um, wanna follow the work that I do or connect with me on there. I talk a lot about, um, the peer supervision and things on that space. But either of those two, um, should, should, you should be able to find me, I suppose.

[01:04:09] Bronwyn: Yeah, and I know I said earlier, I was like, go seek supervision with Aimee. Do you actually offer supervision or did I just like, dob you in.

[01:04:15] Aimee: No, I do offer supervision as well. Yes.

[01:04:18] Bronwyn: Yeah. Okay. So available for that as well. Um, and I'll make sure all those links in the show notes. So listeners do get in touch with Aimee if you would like to join the peer supervision or if you would like more informational supervision, um, you know, your wealth of knowledge. So it, it'd be great to connect further with you.

[01:04:36] Aimee: Thank you. I also have a professional development talk coming up with the MHPN. I don't know when this podcast will be released, but it is next Monday, so.

[01:04:46] Bronwyn: Oh yes, I've got that one booked in my calendar. It won't be released in time for next monday.

[01:04:49] Aimee: Okay, nevermind. But, I do do professional development talks too, so, um, if, if there's others upcoming, you can just follow me on LinkedIn and stuff, and hopefully you'll be able to join in on a talk as well.

[01:05:02] Bronwyn: Wonderful. Well, Aimee, thank you so much again for coming on the podcast. I think this episode will be so helpful for everyone who has listened to it.

And listeners, if you found this episode helpful, please follow Mental Work on your favorite podcast app, including Spotify. Leave a rating or review and share this episode with someone who could benefit from listening to it. It really helps more people find the podcast and make sure that this valuable information gets into people's ears.

That's a wrap. Thanks for listening to Mental Work. I'm Bronwyn Milkins. Have a good one, and catch you next time. Bye.