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

Document Type : Original Article

Authors

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

2 Department of Psychology, Roodehen Branch, Islamic Azad University, Roodehen, 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


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 
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 
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 
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 
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 
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 
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 
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 
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 
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 
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 
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 
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 
14. Levin ME, Haeger JA, Pierce BG, Twohig MP. Webbased 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 
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 
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/10.1080/07399
332.2020.1836643 
66
Hosseinian S. et al..
Razavi Int J Med. 2021; 9(3):e1049
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 
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 
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 
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