Cognitive behavioral stress management effects on prenatal anxiety among low-income women.

Abstract

Objective: Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety. Method: A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; M age = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, posttreatment, and at follow-up in the postpartum using the State-Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (<7 vs. ≥7 sessions) at post-treatment and follow-up timepoints. Results: ITT results revealed no intervention Group × Time interactions for state, F(3, 356) = .51, p = .68, or pregnancyspecific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; M sessions = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition. Conclusions: While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately postintervention. What is the public health significance of this article?This study suggests that cognitive behavioral stress management as a treatment for subclinical anxiety among Latinas and Black women may be efficacious, but only if all sessions are attended. Research examining the impact of dosage and strategies to improve adherence may be a meaningful future direction to improve treatments for ethnic and racial minority women with prenatal anxiety.

The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta‐analysis

“…To investigate the potential impact of outliers, an influence analysis was also conducted. This identified four potential influential outliers (Bayat et al, 2021; Ponting et al, 2022; Shahsavan et al, 2021; Zemestani & Fazeli Nikoo, 2019). When these studies were omitted, the overall effect size was reduced ( d = −0.60) as were the confidence intervals (−0.91 to −0.29), albeit still significant, as well as reduced heterogeneity (87.4%).…”

“…To account for outliers, the above analysis was re‐run with the omission of the Zemestani and Fazeli Nikoo (2019), Shahsavan et al (2021), Bayat et al (2021) and Ponting et al (2022)studies. For group interventions, the overall effect size for the effect of intervention versus control reduced to d = −0.82 (95% CI = −1.33 to −0.23), indicating a medium effect.…”

“…Re‐running the analyses with the omission of the outlying studies (Bayat et al, 2021; Ponting et al, 2022; Shahsavan et al, 2021; Zemestani & Fazeli Nikoo, 2019) indicated that for face‐to‐face interventions, the overall effect size for the effect of face‐to‐face intervention versus control reduced to d = −0.55 (95% CI = −1.07 to −0.02). The effect for online interventions was also reduced to a medium effect size of d = −0.64 (95% CI = −1.01 to −0.28).…”

“…To account for outliers, the above analysis was re‐run, omitting Zemestani and Fazeli Nikoo (2019) as well as Shahsavan et al (2021), Bayat et al (2021) and Ponting et al (2022). For CBT interventions, the overall effect size for the effect of intervention versus control reduced to a medium effect size d = −0.57 (95% CI = −0.98 to −0.16).…”

Pregnancy school education program in mother friendly training and research hospital impact on stress and anxiety

“…Non-pharmacological and pharmacological interventions are available for this purpose. In a study by Ponting et al it was reported that the level of state anxiety was lower in women who were trained for stress management compared to those who did not complete the intervention 18 . Shen et al reported that the anxiety level of the pregnant women who were given five needs-based education programs by trained researchers was significantly lower than that of the control group 19 .…”