Prevention of Postpartum Traumatic Stress in Mothers with Preterm Infants: Manual Development and Evaluation

Abstract

Premature birth has been associated with multiple adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who are premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. The current study aimed to both develop and evaluate a treatment that integrates, for the first time, effective interventions for both reducing symptoms of posttraumatic stress disorder (PTSD) as well as enhancing maternal-infant interactions. Conclusions from the study indicate that the intervention is feasible, able to be implemented with a high level of fidelity, and is rated as highly satisfactory by participants. Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.

Prevention of Traumatic Stress in Mothers With Preterm Infants: A Randomized Controlled Trial

“…The entire intervention is manualized; it can be easily taught to individuals without specialized training in psychological treatments; and treatment fidelity, as measured by the therapists' adherence to the written manual, was high both across sessions and across therapists. 28 Data from other settings have suggested a relationship between disturbances of attachment and traumatic stress reactions in mothers with a history of interpersonal violence. Schechter and Willheim 51 found that greater severity of maternal PTSD was associated with lower maternal baseline salivary cortisol levels and greater likelihood of distorted, inflexible, and negative mental representations of the child.…”

“…Treatment fidelity to all components of the intervention, as measured by the therapists' adherence to the written manual, was high both across sessions and across therapists. 28 The intraclass correlation between raters varied between 0.78 and 0.80 (P , .001), which is considered a high level of reliability. 31 …”

“…28 Principles of traumafocused CBT 29 were incorporated with the expectation that reducing traumarelated symptoms would help mothers enhance their coping ability, feel more bonded to their infants, and improve their parenting ability. Sessions included: (1) psychoeducation to educate mothers about PTSD and common feelings and thoughts of NICU parents; (2) cognitive restructuring to help mothers recognize and challenge erroneous and maladaptive cognitions; (3) progressive muscle relaxation to reduce anxiety; and (4) development and processing of the mother' s trauma narrative.…”

Prevention of Traumatic Stress in Mothers of Preterms: 6-Month Outcomes

“…19 An additional 3 sessions were developed for a subset of the intervention group, with content directed at identifying triggers associated with the development of parental trauma symptoms as well as education about parenting patterns associated with the aspects of the vulnerable child syndrome. 29 Participants in the information/usual-care comparison group received one 45-minute information session on the policy, procedures, and environment of the NICU, with education about parenting the premature infant.…”

“…The intervention, which incorporated components of trauma-focused cognitive behavior therapy (CBT), was found to be feasible and easily delivered in the NICU environment and received high ratings of maternal satisfaction. 19 However, whether these symptomatic benefits continue after the infants return home is unknown. In this report, we describe the 6-month follow-up outcome data of our study participants and hypothesize that mothers in the intervention group will continue to show statistically significant reductions in symptoms of trauma, anxiety, and depression compared with mothers in the comparison group.…”