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Challacombe FL, Sabin K, Jacobson S, Tinch-Taylor R, Potts L, Carter B, Lawrence V. Patient and therapist experiences of exposure therapy for anxiety-related disorders in pregnancy: qualitative analysis of a feasibility trial of intensive versus weekly CBT. BJPsych Open 2023; 9:e189. [PMID: 37822231 PMCID: PMC10594159 DOI: 10.1192/bjo.2023.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Approximately 15% of pregnant women experience anxiety disorders. Effective treatments exist but their acceptability during pregnancy, particularly exposure therapy, is not known. AIMS To understand patient and therapist experiences of time-intensive and weekly exposure-based therapy for anxiety disorders delivered during pregnancy. Trial registration: ISRCTN81203286. METHOD In-depth interviews were conducted with patients and therapists who had taken part in a feasibility trial of predominantly online time-intensive versus weekly cognitive-behavioural therapy in pregnancy in a primary care setting in the UK. Data were analysed using reflexive thematic analysis. RESULTS In total, 45 women participating in the trial and 6 therapists who had delivered the treatments were interviewed. Five themes were developed from the data that showed convergence from therapist and patient perspectives: 'Acquiring tools to navigate the perinatal period'; 'Motivated yet constrained by pregnancy'; 'Having the confidence to face fears and tolerate uncertainty'; 'Momentum with the need for flexibility'; 'Being removed from the face-to-face world'. CONCLUSIONS Exposure therapy is acceptable and helpful in pregnancy and can lead to lasting gains. Exposure is a key element of treatment and needs to be confidently conducted by therapists with perinatal knowledge and expertise. Treatments need to consider the unfolding context of pregnancy. The momentum of intensive therapy can lead to rapid improvements, but is demanding for both patients and therapists, especially fitting round other commitments. Online treatments can work well and are a good fit for perinatal women, but this needs to be balanced with the need for social connection, suggesting a hybrid model is the ideal.
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Affiliation(s)
- Fiona L. Challacombe
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Sabin
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samantha Jacobson
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rose Tinch-Taylor
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura Potts
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and King's Clinical Trials Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Rahmani N, Araj-Khodaei M, Mohammad-Alizadeh-Charandabi S, Esmaeilpour K, Montazeri M, Mirghafourvand M. The effect of cognitive-behavioral counseling with or without Citrus aurantium essential oil on sleep quality in pregnant women: a randomized controlled trial. Sleep Biol Rhythms 2023; 21:337–346. [PMID: 36778981 PMCID: PMC9899505 DOI: 10.1007/s41105-023-00451-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/25/2023] [Indexed: 02/07/2023]
Abstract
Sleep disorder is very common during pregnancy. Non-pharmacological treatments are a priority to improve the sleep pattern. This study aimed to determine the effect of cognitive-behavioral counseling with or without Citrus aurantium essential oil on sleep quality (primary outcome) and anxiety and quality of life (secondary outcomes). This randomized controlled trial was performed on 75 pregnant women in Tabriz, Iran. Participants were randomly assigned to the intervention and control groups. The first intervention group received 8 sessions of cognitive-behavioral counseling and aromatherapy with Citrus aurantium essential oil 15-20 min before bedtime. The second intervention group received cognitive-behavioral counseling and aromatherapy with placebo and the control group received only routine prenatal care. Pittsburgh Sleep Quality Index, Pregnancy-Specific Quality of life Questionnaire, and Pregnancy-Specific Anxiety Scale were completed before and after intervention. After the intervention based on ANCOVA test and by adjusting the baseline score, the mean score of anxiety in the intervention group 1 (AMD: - 4.54; 95% CI - 6.79 to - 2.28) and intervention group 2 (AMD: - 3.30; 95% CI - 5.60 to - 0.97) was significantly lower than the control group. Also, the mean score of quality of life in intervention group 1 (AMD: 2.55; 95% CI 0.45-4.65) and intervention group 2 (AMD: 2.72; 95% CI 0.60-4.83) was significantly higher than the control group, but there was no statistically significant difference between the study groups in terms of sleep quality (P > 0.05). Also, there was no statistically significant difference between the two intervention groups after the intervention in terms of anxiety (P = 0.379) and quality of life (P = 0.996). Cognitive-behavioral counseling reduced anxiety and improved quality of life. However, further trials are required to reach a definitive conclusion. Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N63. Date of registration: 4/10/2020. URL: https://en.irct.ir/user/trial/54986/view; Date of first registration: 18/10/2020.
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Affiliation(s)
- Narges Rahmani
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Araj-Khodaei
- Department of Persian Medicine, Faculty of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Khalil Esmaeilpour
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Tabriz, Tabriz, Iran
| | - Maryam Montazeri
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati Street, P.O. Box: 51745-347, Tabriz, 513897977 Iran
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Hendrix YMGA, Sier MAT, Baas MAM, van Pampus MG. Therapist perceptions of treating posttraumatic stress disorder in pregnancy: The VIP Study. J Trauma Stress 2022; 35:1420-1431. [PMID: 35535472 DOI: 10.1002/jts.22842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
There is no consensus on the treatment of posttraumatic stress disorder (PTSD) during pregnancy, and therapists' views on the matter are largely unknown. This cross-sectional study aimed to explore therapist beliefs and experiences regarding PTSD treatment during pregnancy. Participants were therapists (N = 301) with experience treating PTSD who completed an online survey. The primary outcome measure was the percentage of therapists who were experienced in treating PTSD symptoms during pregnancy; secondary outcome measures assessed preferred treatments for the general and pregnant populations, perceived reluctance to treat PTSD in pregnancy, and perceived effects and adverse events attributed to treatment for pregnant women and fetuses. The majority of participants (n = 246, 81.7%) had experience with treating PTSD during pregnancy. Eye movement desensitization and reprocessing was the preferred treatment for both the general and the pregnant populations. Almost half of the sample (48.8%) reported hearing that PTSD treatment in pregnancy could be harmful; 30.5% of therapists were reluctant to treat pregnant women with PTSD. Most therapists observed a clinically relevant posttreatment reduction of PTSD symptoms in pregnant women. Perceived adverse maternal and fetal events attributed to treatment were reported by 8.4% and 1.4% of therapists, respectively. Despite reluctance, most therapists reported treating PTSD during pregnancy. The results show that although therapists often reported hearing that treating PTSD during pregnancy was harmful, only a small percentage reported perceived adverse events, and treatment was often viewed as effective. These findings implicate a more positive view on the treatment of PTSD in pregnancy.
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Affiliation(s)
| | - Misha A T Sier
- Department of Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Melanie A M Baas
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
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5
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Walker AL, Witteveen AB, Otten RHJ, Verhoeven CJ, Henrichs J, de Jonge A. Resilience-enhancing interventions for antepartum depressive symptoms: systematic review. BJPsych Open 2022; 8:e89. [PMID: 35514260 PMCID: PMC9169502 DOI: 10.1192/bjo.2022.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antepartum depressive symptoms (ADS) are highly prevalent and may affect the mother and child. Cognitive-behavioural therapy and interpersonal therapy are effective psychological interventions for depression. However, low adherence and high attrition rates in studies of prevention and treatment of antepartum depression suggest that these approaches might not be entirely suitable for women with mild/moderate ADS. Considering the protective association between resilience and ADS, women with ADS might benefit more from interventions focusing on promotion of mental well-being and resilience. AIMS We aimed to provide an overview of studies evaluating the effectiveness of antepartum resilience-enhancing interventions targeting the improvement of ante- and postpartum depressive symptoms. We also investigated whether these interventions improve resilience and resilience factors in the peripartum period. METHOD We conducted a systematic review, using PRISMA guidelines. Studies were eligible for inclusion when they utilised a randomised controlled trial or quasi-experimental design, studied pregnant women with ADS, and implemented psychological interventions that (a) aimed to reduce maternal ADS and/or prevent peripartum major depression, and (b) addressed one or more psychological resilience factors. RESULTS Five of the six included cognitive-behavioural therapy interventions and all four mindfulness-based interventions were effective in reducing peripartum depressive symptoms and/or the incidence of depression. However, the methodological quality of most of the included studies was low to moderate. Only three studies assessed change in resilience factors. CONCLUSIONS Resilience-enhancing interventions might be beneficial for mental well-being of pregnant women with ADS, although more rigorously designed intervention studies are needed.
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Affiliation(s)
- Annika L Walker
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Anke B Witteveen
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - René H J Otten
- Medical Library, Vrije Universiteit Amsterdam, The Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Jens Henrichs
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
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6
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Dual-Session Tokophobia Intervention, a Novel Ultrashort Cognitive Behavioral Therapy Protocol for Women Suffering From Tokophobia in the Third Term of Pregnancy. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Effects of maternal psychological stress during pregnancy on offspring brain development: Considering the role of inflammation and potential for preventive intervention. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 7:461-470. [PMID: 34718150 PMCID: PMC9043032 DOI: 10.1016/j.bpsc.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/04/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
Heightened psychological stress during pregnancy has repeatedly been associated with increased risk for offspring development of behavior problems and psychiatric disorders. This review covers a rapidly growing body of research with the potential to advance a mechanistic understanding of these associations grounded in knowledge about maternal-placental-fetal stress biology and fetal brain development. Specifically, we highlight research employing magnetic resonance imaging to examine the infant brain soon after birth in relation to maternal psychological stress during pregnancy to increase capacity to identify specific alterations in brain structure and function and to differentiate between effects of pre- versus postnatal exposures. We then focus on heightened maternal inflammation during pregnancy as a mechanism through which maternal stress influences the developing fetal brain based on extensive preclinical literature and emerging research in humans. We place these findings in the context of recent work identifying psychotherapeutic interventions found to be effective for reducing psychological stress among pregnant individuals, which also show promise for reducing inflammation. We argue that a focus on inflammation, among other mechanistic pathways, has the potential to lead to a productive and necessary integration of research focused on the effects of maternal psychological stress on offspring brain development and prevention and intervention studies aimed at reducing maternal psychological stress during pregnancy. In addition to increasing capacity for common measurements and understanding potential mechanisms of action relevant to maternal mental health and fetal neurodevelopment, this focus can inform and broaden thinking about prevention and intervention strategies.
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8
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Stevens NR, Miller ML, Puetz AK, Padin AC, Adams N, Meyer DJ. Psychological Intervention and Treatment for Posttraumatic Stress Disorder During Pregnancy: A Systematic Review and Call to Action. J Trauma Stress 2021; 34:575-585. [PMID: 33340151 DOI: 10.1002/jts.22641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/07/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
Posttraumatic stress disorder (PTSD) during pregnancy is a significant global mental health concern that affects up to 1 in 5 trauma-exposed pregnant women and is associated with an increased risk of adverse maternal and infant complications and health outcomes. This systematic literature review, conducted in accordance with PRISMA guidelines, examined findings from studies of psychological interventions and treatments for prenatal PTSD to inform recommendations for future research. Relevant evidence was identified from reference reviews and electronic databases (i.e., PubMed, Google Scholar, PsychInfo, and Scopus). Included studies reported on the effect of nonpharmacological intervention or treatment of PTSD symptomatology delivered during pregnancy, with at least one postintervention follow-up collected during pregnancy to assess prenatal treatment outcomes. The systematic review was augmented with a discussion of lower-level evidence. Of the 954 articles screened, six peer-reviewed, quantitative reports met the inclusion criteria and featured three empirically based interventions, including two randomized controlled trials: Two psychoeducation interventions for PTSD and one treatment study of interpersonal psychotherapy in trauma-exposed pregnant women. Effect sizes for PTSD symptom change ranged from small to large, Cohen's d/ηp 2 = 0.16-0.78. No studies examined evidence-based PTSD treatments (e.g., exposure therapy, cognitive processing therapy). A risk of bias assessment indicated variability in study quality. This review demonstrates that research on prenatal PTSD symptoms, diagnosis, and treatment is extremely limited despite a clear link between prenatal PTSD and perinatal complications. Early evidence supports further scientific inquiry into psychoeducation, psychotherapy treatments (e.g., exposure therapy), integrated prenatal care approaches, and community-based approaches.
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Affiliation(s)
- Natalie R Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Michelle L Miller
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Ann-Kathrin Puetz
- Department of Clinical and Neuropsychology, University of Konstanz, Konstanz, Germany
| | - Avelina C Padin
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Natasia Adams
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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9
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Evans K, Spiby H, Morrell CJ. Developing a complex intervention to support pregnant women with mild to moderate anxiety: application of the Medical Research Council framework. BMC Pregnancy Childbirth 2020; 20:777. [PMID: 33317463 PMCID: PMC7734709 DOI: 10.1186/s12884-020-03469-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022] Open
Abstract
Background To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy. Methods The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Results The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care. Conclusion The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
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Affiliation(s)
- Kerry Evans
- University of Nottingham, 12th Floor Tower Building, Nottingham, NG7 2RD, UK.
| | - Helen Spiby
- University of Nottingham, 12th Floor Tower Building, Nottingham, NG7 2RD, UK.,School of Nursing and Midwifery, University of Queensland, Brisbane, Australia
| | - C Jane Morrell
- University of Nottingham, 12th Floor Tower Building, Nottingham, NG7 2RD, UK
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10
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Esfandiari M, Faramarzi M, Nasiri-Amiri F, Parsian H, Chehrazi M, Pasha H, Omidvar S, Gholinia H. Effect of supportive counseling on pregnancy-specific stress, general stress, and prenatal health behaviors: A multicenter randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:2297-2304. [PMID: 32439135 DOI: 10.1016/j.pec.2020.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 04/18/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of group supportive counseling (SC) on pregnancy-specific stress, general stress, and healthy behavior of pregnant women. METHODS This randomized controlled trial study was conducted on 80 pregnant women in two groups; SC for six sessions, once a week for two hours (n = 40), and antenatal usual care (AUC) (n = 40). All Participants completed questionnaires measuring pregnancy-specific stress, state anxiety, prenatal health behaviors, perceived stress, and provided a saliva sample for measurement of cortisol at pre-intervention and 6-week post-intervention. RESULTS The post-intervention results indicated that the outcome scores decreased more significantly in group SC than in the AUC for total NuPDQ, for state-anxiety, for PSS-14, and for unhealthy behaviors with a large effect size. Also, healthy behaviors were promoted more significantly in SC group than in AUC. However, salivary cortisol levels did not differ between group SC and AUC groups. CONCLUSION Group supportive counselling can promote pregnancy stress and healthy behaviors. PRACTICE IMPLICATIONS Addition of supportive counseling to prenatal usual care may be suggested for pregnant women with any gestational age who seek methods for improving pregnancy stress and healthy behaviors.
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Affiliation(s)
- Maria Esfandiari
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.
| | - Mahbobeh Faramarzi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Fatemeh Nasiri-Amiri
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran.
| | - Hadi Parsian
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran.
| | - Hajar Pasha
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Shabnam Omidvar
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | - Hemmat Gholinia
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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11
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Han Q, Guo M, Ren F, Duan D, Xu X. Role of midwife-supported psychotherapy on antenatal depression, anxiety and maternal health: A meta-analysis and literature review. Exp Ther Med 2020; 20:2599-2610. [PMID: 32765754 PMCID: PMC7401497 DOI: 10.3892/etm.2020.9011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
The onset of depression and anxiety during the antenatal stage of pregnancy is common. Despite the conception of numerous interventions in the past decades, studies show no signs of decline in the prevalence of antenatal depression and anxiety. Recently, the use of midwife-supported psychotherapy to treat these psychosomatic disorders has garnered a lot of attention. However, no attempt to date has been made to synthesize the evidence evaluating the influence of midwife-supported psychotherapy on antenatal depression, anxiety, and overall maternal health-status. The aim of the present meta-analysis was to demonstrate the effectiveness of midwife-supported psychotherapy on depression, anxiety, and maternal health-status outcome during the antenatal stage of pregnancy. A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis evaluated the influence of midwife-supported psychotherapy on depression, anxiety, and maternal health-status outcome as compared to conventional obstetric care. Of the 1,011 records, 17 articles, including 6,193 pregnant women (mean age: 28.9±2.2 years) were included in this meta-analysis. Eleven studies compared the effects of midwife-supported therapy on depression, 14 compared its effects on anxiety and 2 compared its effects on maternal health-status outcome. The meta-analysis reveals the beneficial effects of midwife-supported psychotherapy for reducing depression (Hedge's g: -0.9), anxiety (-0.8) and enhancing maternal health-status outcome (0.1), as compared to conventional obstetric care. The current systematic review and meta-analysis recommend the use of midwife-supported psychotherapy for the reduction of depression, anxiety and enhancing maternal health-status during the antenatal stage of pregnancy.
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Affiliation(s)
- Qing Han
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Min Guo
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Fenfen Ren
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Dongyun Duan
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Xiufeng Xu
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
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Li C, Sun X, Li Q, Sun Q, Wu B, Duan D. Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis. Medicine (Baltimore) 2020; 99:e20947. [PMID: 32629701 PMCID: PMC7337511 DOI: 10.1097/md.0000000000020947] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression and anxiety are common psychological manifestations encountered during the antenatal stage of pregnancy. Treatments by pharmacological interventions have been reported to impart negative implications on maternal and fetal health outcomes. Therefore, the use of psychotherapeutic interventions to bypass these side-effects and manage depression, anxiety has received a lot of attention. A meta-statistical consensus regarding the intervention is available, but with several limitations. In this study, we attempt to address these limitations and provide the current state of evidence evaluating the influence of psychotherapy on antenatal depression, anxiety, and maternal quality of life. OBJECTIVE To demonstrate the effects of psychotherapy on depression, anxiety, and maternal quality of life during the antenatal stage of pregnancy. METHODS A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE, and CENTRAL. A meta-analysis evaluated the influence of psychotherapy on depression, anxiety, and maternal quality of life as compared to conventional obstetric care. RESULTS Out of 1146 records, 22 articles including 2146 pregnant women (mean age: 28.6 ± 2.8 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of psychotherapy for reducing depression, anxiety and enhancing maternal quality of life. The meta-analysis reveals the beneficial effects of psychotherapy for reducing depression (Hedge g: -0.48), anxiety (-0.47) and enhancing maternal quality of life (0.19) as compared to conventional obstetric care. CONCLUSIONS The current systematic review and meta-analysis recommend the use of psychotherapy as for reducing depression, anxiety and enhancing maternal quality of life during the antenatal stage of pregnancy.
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Burger H, Verbeek T, Aris-Meijer JL, Beijers C, Mol BW, Hollon SD, Ormel J, van Pampus MG, Bockting CLH. Effects of psychological treatment of mental health problems in pregnant women to protect their offspring: randomised controlled trial. Br J Psychiatry 2020; 216:182-188. [PMID: 31806071 DOI: 10.1192/bjp.2019.260] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Perinatal depression and anxiety are associated with unfavourable child outcomes. AIMS To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive-behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242. METHOD Pregnant women (n = 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n = 140) or CAU (n = 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother-infant bonding and child cognitive and motor development at age 18 months. RESULTS In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI -1.82 to 4.57); t = 0.85, P = 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. A post hoc analysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group. CONCLUSIONS Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking.
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Affiliation(s)
- Huibert Burger
- Associate Professor of Clinical Epidemiology, Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen; and Department of Epidemiology, University Medical Centre Groningen, The Netherlands
| | - Tjitte Verbeek
- Researcher, Department of General Practice and Elderly Care Medicine, University Medical Centre Groningen; and Department of Epidemiology, University Medical Centre Groningen, The Netherlands
| | - Judith L Aris-Meijer
- Researcher, Department of Epidemiology, University Medical Centre Groningen, The Netherlands
| | - Chantal Beijers
- Researcher, Department of Psychiatry, University Medical Centre Groningen, The Netherlands
| | - Ben W Mol
- Professor of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Steven D Hollon
- Professor of Psychology, Department of Psychology, Vanderbilt University, Tennessee, USA
| | - Johan Ormel
- Professor of Social Psychiatry and Psychiatric Epidemiology, Department of Psychiatry, University Medical Centre Groningen, The Netherlands
| | - Mariëlle G van Pampus
- Gynaecologist, Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, The Netherlands
| | - Claudi L H Bockting
- Professor of Clinical Psychology, Department of Psychiatry, Amsterdam University Medical Centre; and Institute for Advanced Study, University of Amsterdam, The Netherlands
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de Bruijn L, Stramrood CA, Lambregtse-van den Berg MP, Rius Ottenheim N. Treatment of posttraumatic stress disorder following childbirth. J Psychosom Obstet Gynaecol 2020; 41:5-14. [PMID: 31164035 DOI: 10.1080/0167482x.2019.1593961] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Aim: The aim of this systematic review is to give an overview of the literature on treatment options for posttraumatic stress disorder (PTSD) following childbirth and to assess their efficacy.Method: PubMed, Embase, Web of Science, Cochrane and PsycINFO were searched using "PTSD", "childbirth" and "therapy" as terms for studies in English language published between 2000 and 2017. Additional studies were identified by checking reference lists. Studies were included when presence of PTSD was confirmed prior to treatment and childbirth was the traumatic event focused on. All studies were reviewed on sample size, study design, used instruments, sample characteristics, type of treatment and the result of treatment regarding PTSD (symptoms).Results: Six studies met the inclusion criteria. One study on debriefing, three studies on cognitive behavioral therapy (CBT) and two studies on eye movement desensitization and reprocessing (EMDR) were identified. Both EMDR and CBT appear to be promising therapies for PTSD following childbirth. Debriefing seems to be beneficial when women request it themselves.Conclusions: EMDR and CBT seem to be effective as therapy for PTSD following childbirth. However, evidence is still limited and more controlled trials are needed to draw conclusive results.
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Affiliation(s)
- Lisa de Bruijn
- Department of Psychiatry and Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Claire A Stramrood
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Mijke P Lambregtse-van den Berg
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.,Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
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Stephenson LA, Beck K, Busuulwa P, Rosan C, Pariante CM, Pawlby S, Sethna V. Perinatal interventions for mothers and fathers who are survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2018; 80:9-31. [PMID: 29558671 DOI: 10.1016/j.chiabu.2018.03.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/04/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Childhood sexual abuse (CSA) is a worldwide problem with severe long-term consequences. A history of CSA can impact the childbearing experience of mothers and fathers; affecting their mental health, parenting skills and compromising infant development. Nonetheless, the perinatal period offers huge opportunity for intervention and hope. This literature review collates evidence for perinatal psychosocial interventions targeting both mothers and fathers who are survivors of CSA. Publications dating from 1970 to June 2016 were searched using Medline, Maternity and Infant Health, PsychINFO, PsychArticles, PubMed and the International Bibliography of the Social Sciences (IBSS). There were no perinatal interventions that considered the needs of survivor fathers. Sixteen publications on 9 psychosocial perinatal interventions for CSA survivors were identified. However, no sub-analyses specific to CSA survivors were reported. Trauma-specific perinatal interventions drew from a range of theoretical models and varied widely in format. Generally interventions were associated with improvements in maternal mental health, parenting competence, infant attachment security and positive public health outcomes. They were safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocols with adequate fidelity. Yet current data is hampered by small sample size, inconsistent reporting of CSA rates and outcome measures, scarcity of observational data and longer-term follow-up. Intervention modifications are proposed for CSA survivors in view of their unique childbearing experiences.
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Affiliation(s)
- Lucy A Stephenson
- South London and the Maudsley NHS Foundation Trust/Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Katherine Beck
- Department of Psychosis Studies, Institute Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Paula Busuulwa
- GKT School of Medical Education, King's College London, UK
| | - Camilla Rosan
- National Society for the Prevention of Cruelty to Children, UK
| | - Carmine M Pariante
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Susan Pawlby
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vaheshta Sethna
- Stress, Psychiatry and Immunology Lab. & Perinatal Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Sackler Institute for Translational Neurodevelopment, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
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Sockol LE. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord 2018; 232:316-328. [PMID: 29501991 DOI: 10.1016/j.jad.2018.01.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/05/2018] [Accepted: 01/29/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Interpersonal psychotherapy (IPT) has demonstrated efficacy for the prevention and treatment of perinatal depression. Previous systematic reviews have not evaluated the effects of IPT on other outcomes, most notably symptoms of anxiety and interpersonal functioning, or assessed moderators of treatment efficacy specific to IPT. METHOD A systematic review identified 28 studies assessing the efficacy of IPT during pregnancy or the first year postpartum. Random effects meta-analyses assessed the average change in outcomes (depression, anxiety, relationship quality, social adjustment, and social support) from pre- to post-treatment, the difference in the change in outcomes between treatment and comparison conditions, and the difference in prevalence of depressive episodes between treatment and comparison conditions. Study, intervention, and sample characteristics were evaluated as potential moderators of effect sizes. RESULTS In prevention studies, IPT was effective for reducing depressive symptoms and the prevalence of depressive episodes. In treatment studies, IPT reduced symptoms of depression and anxiety and improved relationship quality, social adjustment and social support. Few significant moderators were identified, and results of moderation analyses were inconsistent across outcomes. LIMITATIONS There are insufficient studies to evaluate the effects of preventive IPT on anxiety and interpersonal outcomes. Analyses of potential moderators were limited by the number of studies available for subgroup comparisons. CONCLUSIONS IPT is an effective preventive intervention for perinatal depression. IPT is clearly effective for treating depressive symptoms and promising as a treatment for anxiety and improving interpersonal functioning. Further research is necessary to assess whether adaptations to IPT enhance its efficacy.
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Affiliation(s)
- Laura E Sockol
- Department of Psychology, Davidson College, Davidson, NC 28035, USA.
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Demirkol ME, Şimşek L, Yılmaz H, Tamam L. Gebelik ve Postpartum Dönemde Obsesif Kompulsif Bozukluk. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2018. [DOI: 10.18863/pgy.336626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lang AJ, Gartstein MA. Intergenerational transmission of traumatization: Theoretical framework and implications for prevention. J Trauma Dissociation 2018; 19:162-175. [PMID: 28509617 DOI: 10.1080/15299732.2017.1329773] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intergenerational transmission of traumatization (ITT) occurs when traumatized parents have offspring with increased risk for emotional and behavioral problems. Although fetal exposure to the maternal biological milieu is known to be one factor in ITT, PTSD-driven parent-child interactions represent an additional important and potentially modifiable contributor. The Perinatal Interactional Model of ITT presented herein proposes that PTSD leads to social learning and suboptimal parent-child interactions, which undermine child regulatory capacity and increase distress, largely explaining poor social-emotional outcomes for offspring of parents with PTSD. Psychosocial intervention, particularly when delivered early in pregnancy, holds the possibility of disrupting ITT.
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Affiliation(s)
- Ariel J Lang
- a VA San Diego Center of Excellence for Stress and Mental Health (CESAMH) , University of California San Diego , San Diego , California , USA
| | - Maria A Gartstein
- b Department of Psychology , Washington State University , Pullman , Washington , USA
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Blakey SM, Abramowitz JS. Interoceptive Exposure: An Overlooked Modality in the Cognitive-Behavioral Treatment of OCD. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Dworkin ER, Zambrano-Vazquez L, Cunningham SR, Pittenger SL, Schumacher JA, Stasiewicz PR, Coffey SF. Treating PTSD in Pregnant and Postpartum Rural Women with Substance Use Disorders. ACTA ACUST UNITED AC 2017; 41:136-151. [PMID: 28983389 DOI: 10.1037/rmh0000057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The co-occurrence of posttraumatic stress disorder and substance use disorder (PTSD-SUD) can pose significant problems for rural pregnant and postpartum women (PPW) and the well-being of their children. Although effective treatments exist, PPW experience limitations in their ability to access and engage in treatment that may be compounded by various aspects of rural settings, so providers must be attentive to these barriers in order to address this pressing public health need. In addition, as part of increasing rural access to care, it is important to consider the costs and benefits to PPW of selecting exposure-based techniques (e.g., prolonged exposure) to disseminate. The current article discusses the treatment of PTSD-SUD in rural PPW in the context of the authors' experiences providing an exposure-based cognitive behavioral treatment for PTSD in this population. Barriers to treatment access and engagement are discussed and recommendations are provided.
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Affiliation(s)
- Emily R Dworkin
- University of Mississippi Medical Center, Jackson MS.,G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS
| | - Laura Zambrano-Vazquez
- University of Mississippi Medical Center, Jackson MS.,G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS
| | - Sarah R Cunningham
- University of Mississippi Medical Center, Jackson MS.,G.V. (Sonny) Montgomery Veteran Affairs Medical Center, Jackson MS
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Tomfohr-Madsen LM, Clayborne ZM, Rouleau CR, Campbell TS. Sleeping for Two: An Open-Pilot Study of Cognitive Behavioral Therapy for Insomnia in Pregnancy. Behav Sleep Med 2017; 15:377-393. [PMID: 27124405 DOI: 10.1080/15402002.2016.1141769] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Insomnia and disturbed sleep are common during pregnancy. This study investigated the effectiveness of group cognitive-behavioral therapy for insomnia (CBT-I) delivered in pregnancy. Thirteen pregnant women with insomnia participated in five weekly CBT-I group sessions. All participants completed the study and provided baseline and follow-up data. Significant reductions in insomnia symptoms and increases in subjective sleep quality were observed over the course of the study. Diary and actigraphy assessments of sleep also changed, such that participants reported less time in bed (TIB), shorter sleep onset latency (SOL), increased sleep efficiency (SE), and increased subjective total sleep time (TST). Additionally, symptoms of depression, pregnancy-specific anxiety, and fatigue all decreased over the course of treatment. Effect sizes ranged from medium to large. CBT-I delivered during pregnancy was associated with significant improvements in sleep and mood. The next step in this area of inquiry is to better establish effectiveness via a randomized controlled trial.
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Affiliation(s)
- Lianne M Tomfohr-Madsen
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada.,b Alberta Children's Hospital Research Institute for Child and Maternal Health , Calgary , Alberta , Canada.,c Department of Pediatrics , Alberta Children's Hospital , Calgary , Alberta , Canada
| | - Zahra M Clayborne
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada
| | - Codie R Rouleau
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada
| | - Tavis S Campbell
- a Department of Psychology , University of Calgary , Calgary , Alberta , Canada
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Khanzadeh AAH, Rostampour A, Nedaee N, Khosrojavid M. Effectiveness of cognitive-behavioral education on anxiety during pregnancy and delivery method in primiparous women. J Nurs Educ 2017. [DOI: 10.21859/jne-05064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Asghari E, Faramarzi M, Mohammmadi AK. The Effect of Cognitive Behavioural Therapy on Anxiety, Depression and Stress in Women with Preeclampsia. J Clin Diagn Res 2016; 10:QC04-QC07. [PMID: 28050449 PMCID: PMC5198402 DOI: 10.7860/jcdr/2016/21245.8879] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/22/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Stress induced by preeclampsia in pregnancy may have a detrimental effect on both the mother and child. Risk of anxiety, depression and stress during pregnancy is, therefore, commonly associated with preeclampsia. AIM To determine the effect of Cognitive Behavioural Therapy (CBT) on anxiety, depression and stress in pregnant women with preeclampsia. MATERIALS AND METHODS In a clinical trial, 60 women with preeclampsia were selected by the convenience sampling method from the Imam-Ali Hospital of Amol city (North of Iran). The subjects were randomly divided into two groups; the study group (n=30) and the control (n=30). All participants completed the Hospital Anxiety and Depression Scale (HADS) and a Pregnancy Distress Questionnaire (PDQ) at the beginning and end of the study. The intervention group received 12 CBT sessions lasting for 90 minutes over 4 weeks (3 sessions in a week) and the control group received no treatment. RESULTS A MANCOVA test showed that CBT significantly reduced the mean scores of anxiety (5.5 ± 3.2 vs. 9.7 ± 3.8) and depression (6.4±2.6 vs 9.3±4.0) in preeclamptic women (F: 19.933, p-value <0.01). In addition, ANCOVA also revealed that CBT significantly improved the mean scores of specific-stress pregnancy (15.9 ± 6.3 vs 22.2 ± 6.8) in women with preeclampsia (F: 10.214, p-value <0.01). CONCLUSION Psychotherapy was effective in reducing anxiety, depression and specific-stress pregnancy in pregnant women with preeclampsia.
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Affiliation(s)
- Elahe Asghari
- Student, Department of Psychology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Mazadreran, Iran
| | - Mahbobeh Faramarzi
- Assistant Professor, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Arsalan Khan Mohammmadi
- Assistant Professor, Department of Psychology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Mazadreran, Iran
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Christiansen DM. Posttraumatic stress disorder in parents following infant death: A systematic review. Clin Psychol Rev 2016; 51:60-74. [PMID: 27838460 DOI: 10.1016/j.cpr.2016.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/19/2022]
Abstract
Parents who have lost an infant prior to, during, or following birth often interpret the event as highly traumatic. The present systematic review included 46 articles based on 31 different studies of posttraumatic stress disorder (PTSD) in parents bereaved by infant death. The PTSD prevalence in mothers differed widely across studies with estimated rates at 0.6-39%. PTSD in fathers following infant loss has been less extensively studied but PTSD levels were generally much lower than in mothers with reported prevalence rates at 0-15.6% across studies. PTSD symptoms were not found to differ much depending on whether the death occurred prior to, during, or following birth and nor was gestational age consistently associated with PTSD severity. A number of risk and protective factors have been found to be associated with PTSD severity. Relevant focus areas for future research are presented along with considerations for future pregnancies and children. The suffering associated with PTSD following infant loss is overwhelming because of the rates at which such losses occur around the world. For this reason, it is problematic that not all types of infant loss resulting in sufficient symptoms of re-experiencing, avoidance, and arousal can elicit a DSM-5 PTSD diagnosis.
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Affiliation(s)
- Dorte M Christiansen
- Institute of Psychology, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark; National Center for Psychotraumatology, Institute of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
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Tomfohr-Madsen LM, Campbell TS, Giesbrecht GF, Letourneau NL, Carlson LE, Madsen JW, Dimidjian S. Mindfulness-based cognitive therapy for psychological distress in pregnancy: study protocol for a randomized controlled trial. Trials 2016; 17:498. [PMID: 27737714 PMCID: PMC5064936 DOI: 10.1186/s13063-016-1601-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/14/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinically significant psychological distress in pregnancy is common, with epidemiological research suggesting that between 15 and 25 % of pregnant women experience elevated symptoms of stress, anxiety, and depression. Untreated psychological distress in pregnancy is associated with poor obstetrical outcomes, changes in maternal physiology, elevated incidence of child physical and psychological disorders, and is predictive of maternal postpartum mood disorders. Despite the wide-ranging impact of antenatal psychological distress on mothers and their children, there is a gap in our knowledge about the most effective treatments that are available for psychological distress experienced in pregnancy. Additionally, no trials have focused on potential physiological changes that may occur as a result of receiving mindfulness training in pregnancy. The proposed trial will determine the effectiveness of an 8-week modified Mindfulness-based Cognitive Therapy (MBCT) intervention delivered during pregnancy. METHODS A randomized controlled trial (RCT) design with repeated measures will be used to evaluate the effectiveness of MBCT to treat psychological distress in pregnancy. A sample of 60 consenting pregnant women aged 18 years and above will be enrolled and randomized to the experimental (MBCT) or control (treatment as usual) condition. Primary (e.g., symptoms of stress, depression, and anxiety), secondary (cortisol, blood pressure (BP), heart rate variability (HRV), and sleep) and other outcome data (e.g., psychological diagnoses) will be collected via a combination of laboratory visits and at-home assessments from both groups at baseline (T1), immediately following the intervention (T2), and at 3 months postpartum (T3). Descriptive statistics will be used to describe sample characteristics. Data will be analyzed using an intention-to-treat approach. Hierarchical linear models will be used to test intervention effects on primary and secondary outcomes. DISCUSSION The trial is expected to improve knowledge about evidence-based treatments for psychological distress experienced in pregnancy and to evaluate the potential impact of mindfulness-based interventions on maternal physiology. TRIAL REGISTRATION ClinicalTrials.gov: NCT02214732 , registered on 7 August 2014. Protocol Version 2.0., 5 September 2016.
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Affiliation(s)
- Lianne M. Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB Canada
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Department of Oncology, University of Calgary, Calgary, AB Canada
| | - Gerald F. Giesbrecht
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Nicole L. Letourneau
- Faculties of Nursing and Medicine (Pediatrics), University of Calgary, Calgary, AB Canada
- Alberta Children’s Hospital Research Foundation, Calgary, AB Canada
| | - Linda E. Carlson
- Department of Psychology, University of Calgary, Calgary, AB Canada
- Department of Oncology, University of Calgary, Calgary, AB Canada
| | - Joshua W. Madsen
- Department of Psychology, University of Calgary, Calgary, AB Canada
| | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado, Boulder, CO USA
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Kittel-Schneider S, Reif A. [Treatment of psychiatric disorders during pregnancy and the breast feeding : Psychotherapy and other nondrug therapies]. DER NERVENARZT 2016; 87:967-73. [PMID: 27448177 DOI: 10.1007/s00115-016-0177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The majority of women suffering from psychiatric disorders in pregnancy and the breast feeding prefer psychotherapy and other nonpharmacological treatment over psychopharmacological treatment although the risk of malformations and postnatal complications in children exposed to psychopharmacological drugs must be regarded as acceptable in moderate to severely ill patients. Data are lacking, but several psychotherapeutic and biological treatments as well as noninvasive brain stimulation procedures have been investigated to treat depressive episodes and anxiety disorders in pregnancy and the breast feeding. In mild to moderate depressive episodes different psychotherapy treatments and counseling are significantly more effective in reducing depressive symptoms than no treatment.The same seems to be true for anxiety disorders; however, studies on this are sparse. Treatment by telephone and internet also seems to improve symptoms, which is of interest especially in the less flexible group of breast feeding women and for the development of future health care structures. Noninvasive stimulation treatment has been shown to be an effective nonpharmacological therapeutic option. Data for other recent noninvasive brain stimulation treatments and biological treatments as well as exercise therapy are sparse. In severe and delusional cases as well as treatment-resistant depressive episodes, electroconvulsive therapy should be considered in pregnant women. Because several patients prefer nonpharmacological therapy during this period, those should be applied if available and feasible. Regarding nonpharmacological treatment of obsessive-compulsive disorder, bipolar disorder and schizophrenia during pregnancy and the breast feeding, no recommendation can currently be given.
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Affiliation(s)
- S Kittel-Schneider
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Frankfurt am Main, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Deutschland.
| | - A Reif
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Frankfurt am Main, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Deutschland
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Faramarzi M, Yazdani S, Barat S. A RCT of psychotherapy in women with nausea and vomiting of pregnancy. Hum Reprod 2015; 30:2764-73. [PMID: 26466913 DOI: 10.1093/humrep/dev248] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 08/27/2015] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does adding psychological intervention to medical therapy improve nausea/vomiting, psychological symptoms, and pregnancy distress in women with moderate nausea and vomiting of pregnancy (NVP)? SUMMARY ANSWER Three weeks of medical therapy plus psychotherapy yielded statistically and clinically significant improvements in NVP-specific symptoms, anxiety/depression symptoms, and pregnancy distress, compared with medical therapy alone. WHAT IS KNOWN ALREADY Pregnancy with nausea/vomiting is associated with psychiatric morbidity. Evidence supports the exploration of psychosocial reactions in addition to biochemical markers related to NVP. STUDY DESIGN, SIZE, DURATION This prospective, open-label, randomized, controlled, parallel-group study was performed at two obstetrics clinics in Iran. A total of 86 women, aged 18-40 years, between 6 and 12 weeks pregnant with moderate NVP, more than 5 years of education, and not currently practicing any relaxation techniques or undergoing any psychotherapy, were enrolled from June 2013 to November 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 86 moderate NVP women were randomly allocated to either a control (medical therapy alone) or experimental (medical therapy plus psychotherapy) group. Block randomization was achieved using a paper list prepared by an investigator with no clinical involvement in the trial. The experimental group was given pyridoxine hydrochloride (40 mg daily) for 3 weeks, and also received intensive mindfulness-based cognitive therapy (MBCT) in eight individual sessions (50 min each) over 3 weeks. The control group was given pyridoxine hydrochloride (40 mg daily tablet) for 3 weeks alone. All participants completed the Rhodes index of nausea, vomiting and retching (RINVR), the hospital anxiety and depression scale (HADS), and the prenatal distress questionnaire (PDQ) at baseline, 3 weeks after baseline at the end of the study, and at a 1 month post-treatment follow-up. Linear mixed-effects models were used, in an intention-to-treat analysis. MAIN RESULTS AND ROLE OF CHANCE In the psychotherapy plus medical therapy group, the mean relative difference between baseline and post-treatment decreased for RINVR; nausea 8.2 (95% confidence interval (CI) 4.1, 10.2), vomiting 3.5 (95% CI 1.5, 5.8), and total RINVR 11.7 (95% CI 6.5, 16.5), for HADS; anxiety 5.1 (95% CI 3.2, 9.2), depression 3.5 (95% CI 2.4, 7.3), total HADS 7.2 (95% CI 4.4, 12.1), for PDQ; birth concerns 3.3 (95% CI 1.3, 9.1), body concerns 1.5 (95% CI 0.9, 5.1), relationship concerns 2.1 (95% CI 1.2, 5.9), and total PDQ 5.9 (95% CI 3.5, 10.6). At 1 month after treatment, the statistically significant improvement in RINVR, HADS and PDQ, as well as clinical improvement in severity of symptoms, persisted. Medical therapy plus psychotherapy also improved nausea/vomiting symptoms, psychological symptoms, and reduced pregnancy distress more than medical therapy alone, with an effect size of 0.42-0.72 over the trial period. LIMITATIONS, REASONS FOR CAUTION The conclusions were limited to a small number of women with moderate NVP. It is unclear whether the difference between the outcomes in the different groups was related to MBCT alone, or to the extra time and attention paid to patients in the medical therapy plus psychotherapy. The participants in the study did not remain blind to the treatment and the outcome may only be representative of women with moderate NVP who have been referred to obstetrics clinics. WIDER IMPLICATIONS OF THE FINDINGS These findings show that adding 3 weeks of psychological intervention to medical therapy may appear to produce positive therapeutic outcomes upon conclusion of treatment, and 1 month after treatment. This suggests that psychotherapy should be considered as an adjunctive treatment option for women with moderate NVP. In future studies, however, a group of patients who are receiving placebo psychotherapy along with medical treatment should be included. Furthermore, an economic evaluation of the addition of psychological intervention to standard medical therapy would be useful.
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Affiliation(s)
- Mahbobeh Faramarzi
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shala Yazdani
- Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics & Gynecology Department, Babol University of Medical Science, Babol, Iran
| | - Shahnaz Barat
- Infertility and Reproductive Health Research Center, Health Research Institute, Obstetrics & Gynecology Department, Babol University of Medical Science, Babol, Iran
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Treatment of anxiety during pregnancy: room to grow. Arch Womens Ment Health 2015; 18:569-70. [PMID: 25694354 DOI: 10.1007/s00737-015-0514-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 02/08/2015] [Indexed: 10/24/2022]
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Williams CHJ. Improving access to psychological therapies (IAPT) and treatment outcomes: epistemological assumptions and controversies. J Psychiatr Ment Health Nurs 2015; 22:344-51. [PMID: 26014832 DOI: 10.1111/jpm.12181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 11/26/2022]
Abstract
Cognitive behaviour therapy (CBT) is recommended as a primary treatment choice in England, for anxiety and depression, by the National Institute for Health and Care Excellence (NICE). It has been argued that CBT has enjoyed political and cultural dominance and this has arguably led to maintained government investment in England for the cognitive and behavioural treatment of mental health problems. The government programme 'Improving Access to Psychological Therapies' (IAPT) aims to improve the availability of CBT. The criticism of the NICE evidence-based guidelines supporting the IAPT programme, has been the dominance of the gold standard randomized controlled trial methodology, with a focus on numerical outcome data, rather than a focus on a recovery narrative. RCT-based research is influenced by a philosophical paradigm called positivism. The IAPT culture is arguably influenced by one research paradigm and such an influence can skew services only towards numerical outcome data as the only truth of 'recovery'. An interpretative paradigm could assist in shaping service-based cultures, alter how services are evaluated and improve the richness of CBT research. This paper explores the theory of knowledge (epistemology) that underpins the evidence-based perspective of CBT and how this influences service delivery. The paper argues that the inclusion of service user narrative (qualitative data) can assist the evaluation of CBT from the user's perspective and can understand the context in which people live and how they access services. A qualitative perspective is discussed as a research strategy, capturing the lived experience of under-represented groups, such as sexual, gender and ethnic minorities. Cognitive behaviour therapy (CBT) has enjoyed political and cultural dominance within mental healthcare, with renewed government investment in England for the'Improving Access to Psychological Therapies' (IAPT) programme. The criticism of the evidence-based guidelines, published by the National Institute for Health and Care Excellence (NICE), which supports the IAPT programme has been the dominance of the gold standard randomized controlled trial methodology. The definition of 'recovery' used by IAPT is based on a positivist position, with a focus on numerical outcome data garnered through psychometric measures. An interpretative perspective of recovery, which would include a subjective individual patient/service user narrative and would include a collaborative qualitative dialogue, is arguably absent from the IAPT programme. The challenge inherent in the IAPT programme is the high demand/high turnover culture, and psychometric measures are quick to administer; however, this culture is driven from one research paradigm. An interpretative paradigm may assist in shaping service-based cultures, alter how services are evaluated, and improve the richness of CBT research.
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Affiliation(s)
- C H J Williams
- Mental Health Access Team - IAPT, South West Yorkshire Partnership NHS Trust, Barnsley, UK
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Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Höfler M, Wittchen HU. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord 2015; 175:385-95. [PMID: 25678171 DOI: 10.1016/j.jad.2015.01.012] [Citation(s) in RCA: 212] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Peripartum anxiety and depressive disorders are associated with adverse consequences for mother and child. Thus, it is important to examine risk factors, correlates and course patterns of anxiety and depressive disorders during pregnancy and after delivery. METHODS In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) Study, n=306 expectant mothers were recruited from gynaecological outpatient settings in Germany and completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Anxiety and depressive disorders and potential risk factors/correlates were assessed with the Composite International Diagnostic Interview for Women (CIDI-V), medical records and additional questionnaires. RESULTS Although peripartum anxiety and depressive disorders appeared to be persistent in some women, others reported major changes with heterogeneous courses and shifts between diagnoses and contents. There was a considerable amount of incident disorders. Strongest predictors for peripartum anxiety and depressive disorders were anxiety and depressive disorders prior to pregnancy, but psychosocial (e.g. maternal education), individual (e.g. low self-esteem), and interpersonal (e.g. partnership satisfaction, social support) factors were also related. LIMITATION Knowing the aims of the study, some participants may have been more encouraged to report particular symptoms, but if so, this points to the importance of a comprehensive assessment in perinatal care. CONCLUSION Peripartum time is a sensitive period for a considerable incidence or persistence/recurrence of anxiety and depressive disorders albeit the course may be rather heterogeneous. Interventional studies are needed to examine whether an alteration of associated factors could help to prevent peripartum anxiety and depressive disorders.
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Affiliation(s)
- Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Gera, Germany.
| | - Johanna Petzoldt
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Gera, Germany
| | - Franziska Einsle
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Gera, Germany; SRH Fachhochschule für Gesundheit Gera, Gera, Germany
| | - Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Gera, Germany; Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
| | - Michael Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Gera, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Gera, Germany
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Goodman DJ, Milliken CU, Theiler RN, Nordstrom BR, Akerman SC. A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report. J Dual Diagn 2015; 11:248-57. [PMID: 26457976 PMCID: PMC4762276 DOI: 10.1080/15504263.2015.1104484] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for co-occurring posttraumatic stress disorder in pregnant women who use substances in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.
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Affiliation(s)
- Daisy J Goodman
- a Department of Obstetrics and Gynecology , Dartmouth-Hitchcock Medical Center and Geisel School of Medicine , Lebanon , New Hampshire , USA
| | - Catherine U Milliken
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Regan N Theiler
- a Department of Obstetrics and Gynecology , Dartmouth-Hitchcock Medical Center and Geisel School of Medicine , Lebanon , New Hampshire , USA
| | - Benjamin R Nordstrom
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
| | - Sarah C Akerman
- b Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Abstract
A combination of exposure therapy techniques and Acceptance and Commitment Therapy (ACT) strategies were used to treat a 23-year-old pregnant female who was housebound due to symptoms of agoraphobia. The client in this case study had not left her family home in 10 months when she sought treatment for her anxiety. The client was successfully treated over a year, such that she was able to receive prenatal care at an obstetrician’s office and to deliver her infant at a hospital. Neither the client nor her fetus suffered any complications due to treatment. Post-treatment and 1-year follow-up data indicated that the client continued to show significant functional improvements following the birth of her child. Recommendations for integrating ACT strategies into exposure therapy for severe agoraphobia and for anxious pregnant women are provided.
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Rowe H, Sperlich M, Cameron H, Seng J. A Quasi-experimental outcomes analysis of a psychoeducation intervention for pregnant women with abuse-related posttraumatic stress. J Obstet Gynecol Neonatal Nurs 2014; 43:282-93. [PMID: 24754455 DOI: 10.1111/1552-6909.12312] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To test the effectiveness of a trauma-specific, psychoeducational intervention for pregnant women with a history of childhood maltreatment on six intrapartum and postpartum psychological outcomes. DESIGN Quasi-experimental study comparing women from a single-group, pretest-posttest pilot intervention study with women matched from a prospective observational study. SETTING Rural and university-based prenatal clinics. PARTICIPANTS Pregnant women entered the study by responding to an advertisement or by referral from a maternity care provider. Women could take part whether or not they met posttraumatic stress disorder diagnostic criteria. Outcomes data exist for 17 pilot intervention study participants and 43 matched observational study participants. INTERVENTIONS Participants in the observational study received usual care. Participants in the pilot intervention study received usual care plus the intervention, a fully manualized, self-study program supported by weekly phone tutoring sessions with a health professional. MAIN OUTCOME MEASURES The National Women's Study PTSD Module, the Peritraumatic Dissociation Experience Questionnaire, the Perception of Care Questionnaire, the Postpartum Depression Screening Scale, the Postpartum Bonding Questionnaire, and a semantic differential appraisal of the labor experience. RESULTS Participants in the intervention study had better scores on all measures. Differences in means between participants in the intervention study and participants in the observational study equated to medium effect sized for dissociation during labor, rating of labor experience, and perception of care in labor and small effect sizes for postpartum posttraumatic stress disorder (PTSD) symptoms, postpartum depression symptoms, and motherinfant bonding. CONCLUSION This trauma-specific intervention reaches and benefits pregnant women with a history of childhood maltreatment.
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O'Connor TG, Monk C, Fitelson EM. Practitioner review: maternal mood in pregnancy and child development--implications for child psychology and psychiatry. J Child Psychol Psychiatry 2014; 55:99-111. [PMID: 24127722 PMCID: PMC3982916 DOI: 10.1111/jcpp.12153] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The empirical base suggesting a link between prenatal maternal anxiety, stress or depression and cognitive, behavioral, and biological outcomes in the infant and child has increased dramatically in the past 10 years. METHODS In this review, we consider the relevance of prenatal maternal mood for child mental health practitioners; the empirical base for a likely causal impact of the link between prenatal anxiety, depression, or stress and child outcomes; the degree to which the available evidence is sufficient for informing or altering clinical practice; and the possible role of prenatal interventions for promoting child health and development. A selective review of PubMed, Cochrane Library and other sources was undertaken. FINDINGS Clinically significant links between maternal prenatal distress and child behavioral and cognitive outcomes have been reported; predictions to stress physiology, immunology, and neurodevelopment have been reported but the effect sizes and clinical significance is less clear. Several candidate mechanisms have been proposed, with some supporting evidence. Many behavioral treatments for prenatal maternal distress exist, but their application to promoting child health is largely unknown. CONCLUSIONS Research on maternal prenatal distress is a good example of translational research and offers a strong paradigm for promoting interdisciplinary clinical research on child health and development.
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Arch JJ. Cognitive behavioral therapy and pharmacotherapy for anxiety: treatment preferences and credibility among pregnant and non-pregnant women. Behav Res Ther 2013; 52:53-60. [PMID: 24326075 DOI: 10.1016/j.brat.2013.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/16/2013] [Accepted: 11/13/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Relatively little is known about women's anxiety-related treatment preferences and no studies have examined potential differences between pregnant versus non-pregnant women. Treatment credibility and willingness are particularly important to understand regarding exposure-based cognitive behavioral therapy (CBT) and pharmacotherapy, the leading evidence-based treatments. METHODS A large U.S. sample of pregnant (n = 377) and matched non-pregnant (n = 399) women (total N = 776) rated overall treatment preferences and treatment credibility, concerns, and willingness to have CBT and pharmacotherapy if suffering from anxiety. RESULTS Women preferred anxiety-related treatment that included psychotherapy. Preference for psychotherapy alone was stronger among pregnant (74%) than non-pregnant (47%) women, p < .001. In response to treatment descriptions, both groups rated CBT more favorably than pharmacotherapy on treatment willingness, credibility, and concerns, ps < .001, with the magnitude of this preference significantly greater among pregnant than non-pregnant women, ps < .001. Pregnancy status was unrelated to CBT ratings. Treatment credibility and to a lesser extent total concerns mediated the relationship between pregnancy status and pharmacotherapy willingness. CONCLUSIONS Non-pregnant and especially pregnant women rated exposure-based CBT for anxiety more favorably than pharmacotherapy. Pregnancy status predicted general treatment preferences and pharmacotherapy, but not CBT, ratings.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado, 345 UCB Muenzinger, Boulder, CO 80309-0345, USA.
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