Elsevier

Behavior Therapy

Volume 53, Issue 4, July 2022, Pages 738-750
Behavior Therapy

Intolerance of Uncertainty and Perfectionistic Beliefs About Parenting as Cognitive Mechanisms of Symptom Change During Cognitive Behavior Therapy for Perinatal Anxiety

https://doi.org/10.1016/j.beth.2022.02.005Get rights and content

Highlights

  • Group CBT for perinatal anxiety reduced anxiety and depressive symptoms.

  • Group CBT reduced intolerance of uncertainty and perfectionistic parenting beliefs.

  • Changes in beliefs about uncertainty and perfectionism predicted symptom change.

  • Impact of beliefs on symptom change differs for pregnant and postpartum women.

Abstract

Objective

A recent randomized controlled trial of group cognitive behavior therapy (CBGT) for perinatal anxiety showed that CBGT is effective in reducing anxiety and depression in pregnant and postpartum women. In secondary analyses, the role of potential mechanisms of symptom change was examined, including intolerance of uncertainty (IU), self-oriented parenting perfectionism (SOPP) and societal-prescribed parenting perfectionism (SPPP).

Method

The sample included 75 women (Mage = 31.99, SD = 3.57; 37.3% pregnant, 62.7% postpartum) who sought treatment for anxiety and completed the 6-week CBGT or 6-week waitlist within the larger trial. Measures of anxiety (State-Trait Inventory for Cognitive and Somatic Anxiety; STICSA), depression (Edinburgh Postnatal Depression Scale; EPDS), and the proposed mediators (IU, SOPP, SPPP) were completed at baseline and 6-weeks post-baseline.

Results

Two moderated mediation models were evaluated to identify potential mediators of the effect of condition (CBGT, waitlist) on anxiety (STICSA; Model 1) or depressive symptoms (EPDS; Model 2). In Model 1, changes in IU partially mediated the effect of condition on anxiety (STICSA) for both pregnant and postpartum women. Changes in SOPP and SPPP were partial mediators for postpartum women only. Change in depression (EPDS) was also a partial mediator for pregnant women in this model. In Model 2, none of the cognitive variables mediated the effect of condition on depressive symptoms (EPDS). However, change in anxiety (STICSA) was a significant mediator of the effect of condition on depression (EPDS) and only among pregnant women.

Conclusions

The results provide support for IU, SOPP and SPPP as mechanisms of change during CBGT and identify differences in important mechanisms among pregnant and postpartum women.

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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  • Cited by (3)

    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.

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