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Lindqvist K, Mechler J, Midgley N, Carlbring P, Carstorp K, Neikter HK, Strid F, Von Below C, Philips B. "I didn't have to look her in the eyes"-participants' experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression. Psychother Res 2024; 34:648-662. [PMID: 36473231 DOI: 10.1080/10503307.2022.2150583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: To explore young people's perceptions of the relationship with the therapist in internet-based psychodynamic treatment for adolescent depression.Method: As a part of a randomized controlled trial, 18 adolescents aged 15-19 were interviewed after participating in treatment. Interviews followed a semi-structured interview schedule and were analyzed using thematic analysis.Results: The findings are reported around four main themes: "a meaningful and significant relationship with someone who cared", "a helping relationship with someone who guided and motivated me through therapy"; "a relationship made safer and more open by the fact that we didn't have to meet" and "a nonsignificant relationship with someone I didn't really know and who didn't know me".Conclusion: Even when contact is entirely text-based, it is possible to form a close and significant relationship with a therapist in internet-based psychodynamic treatment. Clinicians need to monitor the relationship and seek to repair ruptures when they emerge.Trial registration: ISRCTN.org identifier: ISRCTN16206254..
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Affiliation(s)
- Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud Centre / University College London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | | | - Fredrik Strid
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Abdolalipour S, Charandabi SMA, Mashayekh-Amiri S, Mirghafourvand M. The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth in pregnant women: A systematic review and meta-analyses. J Affect Disord 2023; 333:257-270. [PMID: 37084975 DOI: 10.1016/j.jad.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/19/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Mindfulness-based interventions are a relatively new and potentially useful psychological approach in prenatal care. This study aimed to determine the effect of mindfulness-based programs on pregnant women's fear of childbirth FOC and self-efficacy. METHODS The systematic search of PubMed, Scopus, Web of Science, Cochrane Library, Google Scholar, SID, and Magiran databases began on 11 November 2021 and ended on 17 December 2021 to obtain studies published in English and Persian without date constraints. Another search was conducted in March 2023. The Cochrane handbook tool was used to evaluate selected studies and their risk of bias. RESULTS From a total of 316 records obtained, after removing duplicate items, 16 full texts were evaluated for eligibility; and finally, 10 studies were included in the study and meta-analysis. Based on the results of meta-analyses, mindfulness-based exercises may improve childbirth self-efficacy (SMD = 1.34, 95 % CI: 0.39 to 2.30; P < 0.00001; 5 studies, 304 women; low-certainty evidence) and probably reduce the level of FOC (SMD = -0.71, 95 % CI: -1.14 to -0.27; P = 0.001; 5 studies, 424 women; moderate-certainty evidence) in the intervention group compared to the control group. LIMITATIONS Different duration of interventions across studies, different gestational ages at the time of enrollment, and large heterogeneity in the meta-analysis of results were the limitations of this study. CONCLUSION Mindfulness-based interventions probably reduce FOC and may promote self-efficacy. More randomized controlled trials with stronger designs and adequate power samples are required to verify the effectiveness of mindfulness-based interventions, especially on self-efficacy in pregnant women. PROSPERO ID CRD42021294056.
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Affiliation(s)
- Somayeh Abdolalipour
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | | | - Sepideh Mashayekh-Amiri
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran.
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Exploring experiences and needs of perinatal women in digital healthcare: A meta-ethnography of qualitative evidence. Int J Med Inform 2023; 169:104929. [PMID: 36435014 DOI: 10.1016/j.ijmedinf.2022.104929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this review is to identify, appraise, and synthesize the available qualitative evidence on the experiences and needs of perinatal women by using digital technologies in healthcare. METHODS This review was consolidated following the eMERGe meta-ethnography reporting guidance. We conducted a comprehensive search in eight databases from inception to 12 October 2021. Published and unpublished qualitative and mixed-method studies published in English were included. The methodological quality was assessed using the critical appraisal skill program checklist. A meta-ethnographic synthesis was used according to Noblit and Hare's seven-step iterative process. RESULTS A total of 3,843 articles were retrieved, and 27 qualitative studies pertaining to 3,775 perinatal women from 13 countries across different ethnicities were included. Four overarching themes emerged for the aspect of experiences: (1) normalization of experience, (2) attainment of valuable knowledge, (3) empowerment and self-confidence boosting, and (4) beneficial features of digital platforms. For the aspect of needs, the derived themes included the following: (1) necessity of credible resources, (2) importance of personalization, (3) concern about cybersecurity, and (4) urging additional support. Our line-of-argument for interpreting the perinatal women's experiences can offer a much greater engagement in digital healthcare, while the findings on the perinatal women's needs can add value for improving the design of digital healthcare in the future. CONCLUSION This review offers a deeper understanding of the perinatal women's experiences and needs when using digital technologies in healthcare. Our findings provide meaningful recommendations for clinical practice and future research.
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Li L, Yue SW, Xu J, Qiao J, Redding SR, Ouyang YQ. Effectiveness of Internet-based psychological interventions for treating perinatal depression: A systematic review and meta-analysis. J Clin Nurs 2022. [PMID: 35697972 DOI: 10.1111/jocn.16399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/18/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perinatal depression can result in short- and long-term adverse effects for women and their children if untreated. Psychological interventions, the preferred treatment for most women with perinatal depression, can also be provided online. AIMS This study aimed to provide a comprehensive and systematic review of Internet-based psychological interventions and to evaluate their effectiveness in the treatment of perinatal depression. DESIGN Systematic review and meta-analysis. METHODS A systematic literature search was conducted of six databases, including CINAHL, PubMed, Embase, Web of Science, the Cochrane Library and PsycINFO. Depression and anxiety, which were the primary and secondary results of this search, were presented as standardised mean differences (SMD) and 95% confidence intervals (CIs). This review was conducted according to the PRISMA checklist. RESULTS Thirteen studies involving 2158 perinatal women were included. Content, method, duration and frequency of Internet-based psychological interventions were varied. Participants indicated a high rate of satisfaction with these interventions; participants' dropout rates ranged from 2.6% to 60.8%. Meta-analysis demonstrated that Internet-based psychological interventions improved perinatal depression (SMD = -0.72, CI = [-1.02, -0.42], p < .01) and anxiety symptoms (SMD = -0.52, CI = [-0.73, -0.30], p < .01), with heterogeneity of 86% and 59%, respectively. CONCLUSIONS Internet-based psychological interventions are considered as convenient and effective alternative treatment for perinatal depression and anxiety. In the future, additional studies are needed to investigate the long-term effects of these interventions on the mental health of perinatal women and the effects on the growth and development of infants while controlling for the dropout rate. RELEVANCE TO CLINICAL PRACTICE Internet-based psychological interventions are innovative approaches to improving perinatal depressive symptoms that can leverage mental health resources and improve accessibility while promoting multidisciplinary integration. The approach, content, frequency and duration of intervention should be considered comprehensively to achieve the objectives of the intervention while maintaining compliance of women with perinatal depression.
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Affiliation(s)
- Lu Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Shu-Wen Yue
- School of Nursing, Wuhan University, Wuhan, China
| | - Jing Xu
- School of Nursing, Wuhan University, Wuhan, China
| | - Jia Qiao
- School of Nursing, Wuhan University, Wuhan, China
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Evans K, Rennick-Egglestone S, Cox S, Kuipers Y, Spiby H. Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e28093. [PMID: 35166688 PMCID: PMC8889484 DOI: 10.2196/28093] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/03/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. OBJECTIVE This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. METHODS This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women's views, and opinions were included. RESULTS Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference -0.49, 95% CI -0.75 to -0.22; standardized mean difference -0.48, 95% CI -0.75 to -0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.
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Affiliation(s)
- Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Serena Cox
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Yvonne Kuipers
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Dadkhahtehrani T, Khalili M, Torabi F, Heidari Z. The effect of expressive writing on fear of childbirth among nulliparous pregnant women: A randomized controlled trial. Nurs Midwifery Stud 2022. [DOI: 10.4103/nms.nms_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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O'Connell MA, Khashan AS, Leahy-Warren P, Stewart F, O'Neill SM. Interventions for fear of childbirth including tocophobia. Cochrane Database Syst Rev 2021; 7:CD013321. [PMID: 34231203 PMCID: PMC8261458 DOI: 10.1002/14651858.cd013321.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia. OBJECTIVES To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. SEARCH METHODS In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. SELECTION CRITERIA We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. DATA COLLECTION AND ANALYSIS We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. MAIN RESULTS We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence). AUTHORS' CONCLUSIONS The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.
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Affiliation(s)
- Maeve Anne O'Connell
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Fiona Stewart
- Cochrane Children and Families Network, c/o Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Sinéad M O'Neill
- School of Epidemiology and Public Health Alumna, University College Cork, Cork, Ireland
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Abstract
Background Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC. Methods Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations. Results After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90). Conclusions Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made.
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Samios C, Townsend M, Newton T. Self-compassion predicts less fear of childbirth in childless women: the mediating role of birth beliefs. Psychol Health 2020; 36:1336-1351. [PMID: 33185123 DOI: 10.1080/08870446.2020.1846737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Women can have fear of childbirth (FOC) in advance of their first pregnancy and such fear can have implications for reproductive and eventual childbirth choices. This study aims to further our understanding of the role of self-compassion in FOC in young childless women, including possible pathways through which self-compassion might relate to less FOC: through natural and medical birth beliefs. DESIGN AND MAIN OUTCOME MEASURES In this correlational study, 316 young childless Australian women completed measures of self-compassion, natural and medical birth beliefs, and FOC. RESULTS Self-compassion predicted less FOC, and although self-compassion as a total score did not relate to natural birth beliefs, it did relate to lower scores on medical birth beliefs. The indirect effect through medical birth beliefs was supported; greater self-compassion predicted lower scores on medical birth beliefs, which in turn predicted less FOC. CONCLUSIONS The findings, although cross-sectional, support the study of self-compassion in FOC, which is in part because self-compassion predicts less medical birth beliefs. With further research, self-compassion training might be incorporated into public health initiatives targeting FOC in young childless women.
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Affiliation(s)
- Christina Samios
- School of Psychology, Bond University, Gold Coast, Australia.,Faculty of Health and Human Sciences, Southern Cross University, Bilinga, Australia
| | | | - Tracy Newton
- School of Psychology, Bond University, Gold Coast, Australia
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