Background: There is a notable lack of empirical validation regarding the use of internet-based emotion-focused cognitive behavioral therapy (IECBT) for counseling pregnant women. Objectives: This study examines the feasibility, acceptability, and effectiveness of IECBT in counseling women with suspected fetal anomalies. Methods: In a quasi-experimental study, 130 pregnant women diagnosed with anxiety disorders were randomly assigned to either IECBT with spousal participation (65 participants) or IECBT alone (65 participants). All participants completed three pregnancy-specific stress questionnaires—the NuPDQ, Spielberger State Anxiety Inventory, and Edinburgh Depression Scale—both before and immediately after the intervention. Results: Within-group analyses indicated that both counseling methods, with and without spousal involvement, led to significant reductions in pregnancy-specific stress, depression, and anxiety symptoms by the end of the intervention (P < 0.001). Between-group comparisons revealed that IECBT with spousal participation significantly reduced pregnancy-specific stress (effect size = 0.055, P = 0.007) and depressive symptoms (effect size = 0.480, P < 0.001) compared to IECBT without spousal involvement. However, neither intervention produced a significant reduction in anxiety symptoms (effect size = 0.001, P = 0.787). Conclusions: Both IECBT approaches (with and without spousal participation) are feasible, reliable, and effective methods for alleviating depression and stress symptoms in pregnant women with suspected fetal anomalies.