Intolerance of Uncertainty and Perfectionistic Beliefs About Parenting as Cognitive Mechanisms of Symptom Change During Cognitive Behavior Therapy for Perinatal Anxiety☆
Section snippets
participants and procedures
Participants were women seeking treatment for anxiety disorders in pregnancy or the postpartum. The trial took place at a university-affiliated teaching hospital clinic specializing in the treatment of women’s mental health difficulties during reproductive milestones. The study protocol was approved by the hospital’s research ethics board. All participants provided written informed consent before study entry (see Green et al., 2020, for detailed study procedures, participant flowchart, and main
baseline characteristics
Sociodemographic variables collected at baseline included age, ethnicity, education, marital status, maternal status (pregnant, postpartum), and psychotropic medication use.
diagnostic interview
The Structured Clinical Interview for DSM-IV (SCID; First et al., 1994) is a semistructured interview for determining DSM-IV diagnoses (American Psychiatric Association, 2000). As noted, diagnoses were checked against DSM-5 (APA, 2013) diagnostic criteria.
symptom measures
The State-Trait Inventory for Cognitive and Somatic Anxiety, Trait
participant characteristics at baseline
Of the sample of 75 women (Mage = 31.99, SD = 3.57, Range = 22–41 years), one third were pregnant (n = 28, 37.3%) and two-thirds were within 6 months postpartum (n = 47, 62.7%). In terms of clinical characteristics, the mean score on the STICSA (M = 47.81, SD = 11.16) was above the clinical cutoff for anxiety. All participants met DSM-5 diagnostic criteria for at least one anxiety disorder at baseline. Principal anxiety disorders were generalized anxiety disorder (n = 65, 86.7%), social anxiety
Discussion
A small but growing number of studies have demonstrated that cognitive behavioral therapy can be effective in the treatment of anxiety as a principal problem for women in pregnancy or the postpartum period (Loughnan et al., 2018). Although most research on perinatal mental health has focused on postpartum depression, anxiety is now known to be at least as common among women during this time (Goodman et al, 2016). As a result, the growing empirical support for CBT for perinatal anxiety is in
Conclusions
This study is one of the first to examine specific cognitive mechanisms of symptom reduction during an effective cognitive behavioral protocol for women with a principal difficulty of an anxiety disorder in pregnancy or the postpartum. The findings are consistent with a mediating role played by negative beliefs about uncertainty and parenting-specific perfectionistic beliefs in symptom reduction during CBT. The identification of mechanisms of symptom change during CBT for perinatal anxiety may
Conflict of Interest Statement
The authors declare that there are no conflicts of interest.
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No financial disclosures were reported by any author. This research was funded by a grant from the 2016 Teresa Cascioli Charitable Foundation Research Award in Women’s Health, Research Institute of St. Joseph’s Healthcare, awarded to Dr. Sheryl Green (PI).The funding source had no role in the design, analysis, interpretation, or publication of this study.The authors would like to extend our sincere gratitude to the students and staff members who helped with this project, including Arela Agako (graduate student), Peggy Carter-Arrowsmith (RN), Dan-Bi Cho (RN), and Christelle Tshilenge (RSW), and our team of psychology research assistants, residents and practicum students at the Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton.