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Hellberg SN, Bruening AB, Thompson KA, Hopkins TA. Applications of dialectical behavioural therapy in the perinatal period: A scoping review. Clin Psychol Psychother 2023. [PMID: 38116846 DOI: 10.1002/cpp.2937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
Psychological distress is the most common complication of pregnancy. High-risk concerns can include severe emotion dysregulation, suicidality and self-injury, and health risk behaviours, which bear substantial consequences for caregivers and families. Yet, effective, comprehensive interventions for high-risk caregivers have received limited attention. Dialectical behaviour therapy (DBT) is a frontline treatment for such concerns. Accordingly, we conducted a scoping review on the implementation of DBT in the perinatal period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Seven studies were identified; study designs included case studies and single-arm pilot trials. Most studies used DBT-informed protocols with significant adaptations, few included multiple components of DBT (i.e. skills group, individual therapy, phone coaching and consultation team), and none met criteria for adherent delivery of all four modes of DBT treatment. Findings suggest DBT-informed interventions may be successfully implemented to treat a range of perinatal mental health symptoms, including borderline personality disorder, depression, anxiety, and post-traumatic stress, and to promote emotion regulation and positive parenting behaviours. While results provide preliminary support for perinatal DBT, this literature is scant and empirical rigour considerably lacking. Clinical implications and future directions are outlined to aid researchers and providers in addressing the ongoing perinatal mental health crisis and developing sorely needed interventions to address the needs of high-risk caregivers.
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Affiliation(s)
- Samantha N Hellberg
- Department of Psychology and Neuroscience, UNC Chapel Hill, Chapel Hill, North Carolina, USA
| | - Amanda B Bruening
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katherine A Thompson
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Tiffany A Hopkins
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, North Carolina, USA
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Richter M, Fehringer K, Smith J, Pineda R. Parent-infant interaction in the NICU: Challenges in measurement. Early Hum Dev 2022; 170:105609. [PMID: 35752043 PMCID: PMC10072234 DOI: 10.1016/j.earlhumdev.2022.105609] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/04/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues. AIM To improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues. METHOD Twenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34-48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS. RESULTS Seventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01). CONCLUSION It remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.
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Affiliation(s)
- M Richter
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar St, Los Angeles, CA 90089, United States of America
| | - K Fehringer
- Self-employed, Ridgeway, CO 81432, United States of America
| | - J Smith
- Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St Louis, MO, United States of America
| | - R Pineda
- University of Southern California, Chan Division of Occupational Science and Occupational Therapy, 1540 Alcazar St, Los Angeles, CA 90089, United States of America; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States of America; Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, United States of America; Center for the Changing Family, University of Southern California, Los Angeles, CA, United States of America.
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Ahmad SI, Shih EW, LeWinn KZ, Rivera L, Graff JC, Mason WA, Karr CJ, Sathyanarayana S, Tylavsky FA, Bush NR. Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting. Front Psychiatry 2022; 13:838535. [PMID: 35546925 PMCID: PMC9085155 DOI: 10.3389/fpsyt.2022.838535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 12/22/2022] Open
Abstract
Objective Experiences of stress and adversity, such as intimate partner violence, confer risk for psychiatric problems across the life span. The effects of these risks are disproportionately borne by women and their offspring-particularly those from communities of color. The prenatal period is an especially vulnerable period of fetal development, during which time women's experiences of stress can have long-lasting implications for offspring mental health. Importantly, there is a lack of focus on women's capacity for resilience and potential postnatal protective factors that might mitigate these intergenerational risks and inform intervention efforts. The present study examined intergenerational associations between women's prenatal stressors and child executive functioning and externalizing problems, testing maternal parenting quality and child sex as moderators, using a large, prospective, sociodemographically diverse cohort. Methods We used data from 1,034 mother-child dyads (64% Black, 30% White) from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) pregnancy cohort within the ECHO PATHWAYS consortium. Women's prenatal stressors included stressful life events (pSLE) and intimate partner violence (pIPV). Measures of child psychopathology at age 4-6 included executive functioning and externalizing problems. Parenting behaviors were assessed by trained observers, averaged across two sessions of mother-child interactions. Linear regression models were used to estimate associations between women's prenatal stressors and child psychopathology, adjusting for confounders and assessing moderation effects by maternal parenting quality and child sex. Results Women's exposures to pSLE and pIPV were independently associated with child executive functioning problems and externalizing problems in fully-adjusted models. Maternal parenting quality moderated associations between pSLE and both outcomes, such that higher parenting quality was protective for the associations between women's pSLE and child executive functioning and externalizing problems. No moderation by child sex was found. Discussion Findings from this large, sociodemographically diverse cohort suggest women's exposures to interpersonal violence and major stressful events-common for women during pregnancy-may prenatally program her child's executive functioning and externalizing problems. Women's capacity to provide high quality parenting can buffer this intergenerational risk. Implications for universal and targeted prevention and early intervention efforts to support women's and children's wellbeing are discussed.
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Affiliation(s)
- Shaikh I. Ahmad
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Emily W. Shih
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - J. Carolyn Graff
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, United States
- Center on Developmental Disabilities, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - W. Alex Mason
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Catherine J. Karr
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Frances A. Tylavsky
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
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Sved Williams A, Osborn A, Yelland C, Hollamby S. Changing intergenerational patterns of emotional dysregulation in families with perinatal borderline personality disorder. Arch Womens Ment Health 2021; 24:641-648. [PMID: 33742283 DOI: 10.1007/s00737-021-01119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/03/2021] [Indexed: 11/24/2022]
Abstract
A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers' mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother's perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant's social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.
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Affiliation(s)
- Anne Sved Williams
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia. .,The University of Adelaide, Adelaide, South Australia.
| | - Amanda Osborn
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia.,The University of Adelaide, Adelaide, South Australia
| | - Chris Yelland
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia
| | - Sharron Hollamby
- Perinatal and Infant Mental Health Services, Women's and Children's Hospital, North Adelaide, South Australia
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