At a glance
- Opposite action is a DBT skill: when an emotion doesn't fit the moment, or acting on it would make things worse, you do the opposite of its urge.
- In PMS and PMDD, hormone drops before your period can make urges like yelling or withdrawing stronger and faster to arrive.
- Examples: lowering your voice instead of yelling, going out briefly instead of canceling plans, waiting before sending an angry text.
- Opposite action helps in the moment. It isn't a treatment; guidelines for PMDD point to SSRIs, certain hormonal contraceptives or CBT, decided by a doctor.
Strength of evidence
Limited evidence
No trial has tested opposite action in PMS or PMDD specifically. It's drawn from the general DBT research base on emotion regulation. Treatments with trial evidence in PMDD include SSRIs and certain hormonal contraceptives (1, 2, 3).
What is opposite action?
Opposite action is a skill from dialectical behavior therapy (DBT), developed by psychologist Marsha Linehan. The idea: when an emotion doesn't fit the facts of a situation, or acting on it would make things worse, you deliberately do the opposite of what it's telling you to do.
A few examples:
- Urge to snap at someone: soften your voice or step away, instead of raising it.
- Urge to cancel plans when sadness hits: go anyway, even for a short while.
- Urge to avoid a hard conversation: have it anyway, in a steady voice.
You don't have to pretend you feel fine to use this skill. You can feel furious and still choose not to slam the door. The feeling stays. The action that follows it can change.
How does opposite action relate to PMS and PMDD?
In the days before your period, estrogen and progesterone drop. In PMDD, the brain reacts to that normal drop more strongly than in PMS alone, which can make anger, sadness or anxiety louder and faster to show up during the luteal phase.
The urge behind each feeling gets stronger too: to yell, to go silent, to send the text you'll regret later. Opposite action doesn't erase the feeling or the real reason behind it. A fight that keeps showing up on a cycle pattern doesn't mean it wasn't a real problem. It just gives you a second option before you act on the first urge.
A few examples:
- Urge to pick a fight over something small: name what's actually bothering you instead.
What does the research say?
There's no trial testing opposite action specifically in PMS or PMDD. It comes from the general DBT research base on emotion regulation, not from premenstrual studies.
What's been tested in PMDD is medical treatment, which works differently from a coping skill. A randomized trial found that paroxetine, taken only from ovulation to the start of a period, reduced irritability within days (2), and fluoxetine produced marked improvement across mood and physical symptoms in another trial (1).
| Approach | What it does | Evidence for PMDD |
|---|---|---|
| Opposite action (DBT skill) | Changes the action that follows a feeling | Not tested in PMDD trials; used broadly for emotion regulation |
| SSRIs, luteal-phase dosing | Reduces irritability and mood symptoms | Randomized trials, effects within days (1, 2) |
| Certain hormonal contraceptives | Aim to steady the hormone swings of a cycle | Mixed results depending on the formulation (3) |
Opposite action can sit alongside treatment, as something to do in the moment, not instead of it.
Why this matters, and related terms
Opposite action helps with what you do right now. It doesn't change the hormone drop behind the feeling, and it isn't a treatment for PMDD on its own.
Guidelines for PMDD point to SSRIs (sometimes taken only in the luteal phase), certain hormonal contraceptives, or CBT, with a doctor deciding what fits. If this pattern takes up a week of every month, or you have thoughts of hurting yourself, see a GP or gynecologist and bring two months of daily notes.
If you want somewhere to use a skill like this in the moment, Niyora is a PMS and PMDD support app. Its Moon feature lets you write down what happened, see it from another angle, calm down, and draft a reply you can hold onto before sending anything, which pairs well with opposite action.
- Corpus luteum: the structure behind the progesterone drop before your period.
- Menstrual cycle hormones, phase by phase: how estrogen and progesterone move across your cycle.
- PMS and PMDD research, summarised: where the studies behind this page come from.
From the research library
Research on mood swings
117 studies in the library look at mood swings in PMS and PMDD. They were published from 1971 to 2026, and each one has a short summary of what was tested and found.
117
studies, 1971 to 2026
How strong the studies are
- Strong study design
- 6
- Moderate study design
- 41
- Early or limited evidence
- 70
Study, 2026
How do women with PMDD process emotions differently in their brains?
Women with PMDD show increased activity in emotion-processing brain networks, especially during the luteal phase, and this baseline difference even appears in the follicular phase and relates to symptom severity.
Strong study design
Case-control study, 2026
Do women with PMS handle emotions differently at different times of the cycle?
Yes. Women with PMS tend to use emotion coping strategies that make symptoms worse (like dwelling on negative thoughts) and fewer strategies that help (like accepting difficult thoughts). These patterns change across the menstrual cycle.
Strong study design
Systematic review, 2025
Do people with PMDD and severe PMS have difficulties with emotion regulation?
People with PMDD and severe PMS may have difficulties identifying emotions and choosing how to handle them, particularly using rumination (replaying upset thoughts) in the late-luteal phase. Evidence remains limited.
Strong study design
Systematic review, 2025
Does teaching adolescent girls about their menstrual cycle and health help reduce period pain and PMS?
Yes. A systematic review of five good-quality studies shows that psychoeducation (structured teaching) significantly reduced period pain and PMS symptoms and improved emotional wellbeing in adolescent girls.
Strong study design
Randomised trial, 2007
Does paroxetine work better if taken daily or just during your luteal phase for PMDD?
Daily paroxetine had an 85% response rate and was most effective overall, while luteal-phase-only paroxetine worked equally well for irritability and mood swings but was weaker for depression and physical symptoms. This well-designed study provides reliable results.
Strong study design
Survey study, 1994
How many different ways do researchers measure PMS in clinical trials?
Researchers use many different measurement tools across studies. 65 different questionnaires were found in 350 trials of PMS drugs, making it hard to compare whether treatments actually work.
Strong study design
Questions people ask
What is opposite action in DBT?+
Opposite action is a dialectical behavior therapy (DBT) skill where you do the opposite of what a strong emotion urges you to do, such as softening your voice instead of yelling. It doesn't deny the feeling, it just changes what happens next, while the feeling and the facts behind it stay real.
Does opposite action treat PMDD?+
Opposite action doesn't treat PMDD. It's a coping skill for the moment, not a medical treatment. Guidelines for PMDD point to SSRIs (sometimes taken only in the luteal phase), certain hormonal contraceptives, or CBT, with a doctor deciding what fits your symptoms.
When should you use opposite action before your period?+
Opposite action can help when an urge, like yelling or going silent, would make a hard moment worse before your period. It's most useful in the minutes right after a strong feeling shows up, before you've acted on it. It won't change the hormone drop behind the feeling.
Is opposite action the same as suppressing feelings?+
No. Opposite action isn't about suppressing feelings before your period. You still feel angry or sad. You just choose a different action, like leaving the room for 20 minutes instead of yelling, so the feeling doesn't decide what happens next.
Sources
- 1.Fluoxetine's spectrum of action in premenstrual syndrome, International clinical psychopharmacology, 1993
- 2.Short onset of action of a serotonin reuptake inhibitor when used to reduce premenstrual irritability, Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 2009
- 3.Safety, efficacy, actions, and patient acceptability of drospirenone/ethinyl estradiol contraceptive pills in the treatment of premenstrual dysphoric disorder, International journal of women's health, 2010