The Effectiveness of Acceptance and Commitment Therapy on Depression, Anxiety, and Stress in Nulliparous Pregnant Women

Document Type : Original Article

Authors

1 Ph.D. student, Department of Psychology, Roudehen Branch, Islamic Azad University, Roudehen, Iran.

2 Associate Professor, Department of Psychology, Roudehen Branch, Islamic Azad University, Roudehen, Iran.

3 Department of Midwifery , Faculty of Nursing and Midwifery , Tehran Medical Sciences, Islamic Azad University ,Tehran,Iran.

Abstract

Background: It is necessary to help pregnant women to solve pregnancy problems by identifying the factors affecting depression, anxiety, and stress.

Objective: The aim of this study was to determine the effectiveness of acceptance and commitment therapy on depression, anxiety, and stress in nulliparous pregnant women.

Methods: The research method was semi-experimental with a pretest-posttest design with a control group. The statistical population of this study included all pregnant women referred to hospitals in Tehran in 2019, among whom 34 eligible volunteers were selected by convenience sampling method and randomly assigned to two groups of acceptance and commitment and control group. The experimental group received acceptance and commitment therapy in 9 sessions of 120 minutes. Data were collected using a depression, anxiety, and stress questionnaire (Lovibond and Lovibond, 1995). Data were analyzed using repeated-measures ANOVA and SPSS.22 software. The significance level in this study was considered to be 0.05.

Results: The results showed that acceptance and commitment therapy intervention significantly decreased depression (p <0.001), anxiety (p <0.001), and stress (p <0.001) in nulliparous pregnant women.

Conclusion: It can be concluded that acceptance and commitment therapy was effective in reducing depression, anxiety, and stress in nulliparous pregnant women, and it can be used to improve the psychological problems of pregnant women.

Keywords


Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Van Der Pol LM, Tromeur C, Bistervels IM, Ni Ainle F, Van Bemmel T, Bertoletti L, Couturaud F, van Dooren YP, Elias A, Faber LM, Hofstee HM. Pregnancy-adapted YEARS algorithm for diagnosis of suspected pulmonary embolism. New England Journal of Medicine. 2019;380(12):1139-49.
https://doi.org/10.1056/NEJMoa1813865
PMid:30893534
 
2. Bjørk MH, Veiby G, Engelsen BA, Gilhus NE. Depression and anxiety during pregnancy and the postpartum period in women with epilepsy: A review of frequency, risks and recommendations for treatment. Seizure. 2015;28:39-45.
https://doi.org/10.1016/j.seizure.2015.02.016
PMid:25777784
 
3. Pearlstein T. Depression during pregnancy. Best Practice & Research Clinical Obstetrics & Gynaecology. 2015;29(5):754-64.
https://doi.org/10.1016/j.bpobgyn.2015.04.004
PMid:25976080
 
4. Huizink AC, Delforterie MJ, Scheinin NM, Tolvanen M, Karlsson L, Karlsson H. Adaption of pregnancy anxiety questionnaire-revised for all pregnant women regardless of parity: PRAQ-R2. Archives of Women's Mental Health. 2016;19(1):125-32.
https://doi.org/10.1007/s00737-015-0531-2
PMid:25971851 PMCid:PMC4728175
 
5. Cameron EE, Sedov ID, Tomfohr-Madsen LM. Prevalence of paternal depression in pregnancy and the postpartum: an updated meta-analysis. Journal of affective disorders. 2016;206:189-203.
https://doi.org/10.1016/j.jad.2016.07.044
PMid:27475890
 
6. Reck C, Zimmer K, Dubber S, Zipser B, Schlehe B, Gawlik S. The influence of general anxiety and childbirth-specific anxiety on birth outcome. Archives of women's mental health. 2013;16(5):363-9.
https://doi.org/10.1007/s00737-013-0344-0
PMid:23558948
 
7. Hasanjanzadeh P, Faramarzi M. Relationship between maternal general and specific-pregnancy stress, anxiety, and depression symptoms and pregnancy outcome. Journal of clinical and diagnostic research: JCDR. 2017;11(4):14-21.
https://doi.org/10.7860/JCDR/2017/24352.9616
PMid:28571243 PMCid:PMC5449889
 
8. Polo‐Kantola P, Aukia L, Karlsson H, Karlsson L, Paavonen EJ. Sleep quality during pregnancy: associations with depressive and anxiety symptoms. Acta obstetricia et gynecologica Scandinavica. 2017;96(2):198-206.
https://doi.org/10.1111/aogs.13056
PMid:27861713
 
9. Mansell T, Novakovic B, Meyer B, Rzehak P, Vuillermin P, Ponsonby AL, Collier F, Burgner D, Saffery R, Ryan J. The effects of maternal anxiety during pregnancy on IGF2/H19 methylation in cord blood. Translational psychiatry. 2016;6(3):765-777.
https://doi.org/10.1038/tp.2016.32
PMid:27023171 PMCid:PMC4872456
 
10. Condon JT. Altered cognitive functioning in pregnant women: a shift towards primary process thinking. British journal of medical psychology. 1987;60(4):329-34.
https://doi.org/10.1111/j.2044-8341.1987.tb02751.x
PMid:3426970
 
11. Stuart S, Koleva H. Psychological treatments for perinatal depression. Best practice & research Clinical obstetrics & gynaecology. 2014;28(1):61-70.
https://doi.org/10.1016/j.bpobgyn.2013.09.004
PMid:24269903
 
12. Salehi F, Pourasghar M, Khalilian A, Shahhosseini Z. Comparison of group cognitive behavioral therapy and interactive lectures in reducing anxiety during pregnancy: A quasi experimental trial. Medicine. 2016;95(43).
https://doi.org/10.1097/MD.0000000000005224
PMid:27787386 PMCid:PMC5089115
 
13. Twohig MP, Levin ME. Acceptance and commitment therapy as a treatment for anxiety and depression: A review. Psychiatric Clinics. 2017;40(4):751-70.
https://doi.org/10.1016/j.psc.2017.08.009
PMid:29080598
 
14. Levin ME, Haeger JA, Pierce BG, Twohig MP. Web-based acceptance and commitment therapy for mental health problems in college students: A randomized controlled trial. Behavior Modification. 2017;41(1):141-62.
https://doi.org/10.1177/0145445516659645
PMid:27440189
 
15. Shamsabadi N, Khajevand A, Hasanzadeh R. Effect of Cognitive-Behavioral based Stress Management on Anxiety Reduction of Pregnant Women. J Res Dev Nurs Midw. 2016; 12(3):19-29.
 
16. Jalali A, Heydarpour S, Tohidinejad F, Salari N. Cognitive-behavioral counseling and mental health of pregnant women. Heliyon. 2020;6(2):46-53.
https://doi.org/10.1016/j.heliyon.2020.e03463
PMid:32140586 PMCid:PMC7049634
 
17. Beck R, Fernandez E. Cognitive-behavioral therapy in the treatment of anger: A meta-analysis. Cognitive therapy and research. 1998;22(1):63-74.
https://doi.org/10.1023/A:1018763902991
 
18. Hayes SC. Climbing our hills: A beginning conversation on the comparison of acceptance and commitment therapy and traditional cognitive behavioral therapy. Clinical Psychology: Science and Practice. 2008;15(4):286-95.
https://doi.org/10.1111/j.1468-2850.2008.00139.x
 
19. Sanaeinasab H, Saffari M, Sheykh-Oliya Z, Khalaji K, Laluie A, Al Zaben F, et al. A spiritual intervention to reduce stress, anxiety and depression in pregnant women: Randomized controlled trial. Health Care for Women International. 2020;2(4):1-8.
https://doi.org/10.1080/07399332.2020.1836643
PMid:33180001
 
20. Bonacquisti A, Cohen MJ, Schiller CE. Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention. Archives of Women's Mental Health. 2017;20(5):645-54.
https://doi.org/10.1007/s00737-017-0735-8
PMid:28600645
 
21. Feyzi Z, Moradi A, Khaje Dalouee M, Khadem N. The Efficacy of Acceptance and Commitment Therapy (ACT) on Anxiety and Depression in Infertile Women who Undergoing In Virto Fertilization (IVF). Clinical Psychology Studies. 2017;7(27):1-21.
 
22. Brown FL, Whittingham K, Boyd RN, McKinlay L, Sofronoff K. Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial. Behaviour research and therapy. 2015;73:58-66.
https://doi.org/10.1016/j.brat.2015.07.001
PMid:26255172
 
23. Ghavami BA, Ghanbari Hashem Abad BA, Saffarian MR, Khakpour M. Effect of Group Cognitive Behavioral Therapy on Inefficient Beliefs and Marital Satisfaction in Pregnant Women with the Fear of First Childbirth. Journal of Research and Health. 2020;10(1):11-8.
https://doi.org/10.32598/JRH.10.1.11
 
24. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 1995;33(3):335-43.
https://doi.org/10.1016/0005-7967(94)00075-U
PMid:7726811
 
25. Salehpoor G, Rezaei S, Hosseininezhad M. Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: A bicenter study from north of Iran. Iranian journal of nursing and midwifery research. 2014;19(6):593.
 
26. Hayes SC. Acceptance, mindfulness, and science. Clinical Psychology: Science and Practice. 2002;9(1):101-6.
https://doi.org/10.1093/clipsy.9.1.101
 
27. Stewart RE, Chambless DL. Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of consulting and clinical psychology. 2009;77(4):595-610.
https://doi.org/10.1037/a0016032
PMid:19634954 PMCid:PMC8022196