Cardiff and Vale University Health Board, Perinatal Community Mental Health Service, Wales, UK.
School of Psychology, Cardiff University, Wales, UK.
Br J Clin Psychol. 2020 Nov;59(4):461-479. doi: 10.1111/bjc.12261. Epub 2020 Jul 26.
The aim of the current study was to assess the feasibility, safety, and effectiveness of a newly developed Acceptance and Commitment Therapy (ACT) intervention developed specifically to address the unique context of pregnancy and parenthood. The intervention was delivered to women accessing a specialist Perinatal Community Mental Health Service (PCMHS).
An open-label pilot study was conducted of an 8-week, group-delivered ACT intervention targeting women with moderate-to-severe mood and/or anxiety disorders during pregnancy and/or postpartum.
Outcomes included session attendance rates, dropout rates, crisis/inpatient service use, and standardized symptom scales. Participant's responses to open-ended questions contained in an end of therapy questionnaire were analysed using thematic analysis.
Seventy-four women were referred to the intervention with 65 (88%) completing treatment. The median number of sessions attended was 7. No women required input from crisis/inpatient services. All reported finding the intervention helpful. The implementation of ACT in daily life, therapist support, and group processes were cited as helpful aspects of the intervention. At post-treatment, there was a significant reduction in global distress (d = 0.99) and depressive symptoms (d = 1.05), and an increase in psychological flexibility (d = 0.93). On the secondary outcome of global distress, 38% of women were classified as recovered, 31% had reliably improved, 27% remained the same, and 4% had reliably deteriorated.
The delivery of ACT in a routine practice setting is feasible, safe, and effective. A randomized control trial (RCT) is needed to establish the efficacy and cost-effectiveness of this group-delivered ACT intervention.
Group-delivered Acceptance and Commitment Therapy (ACT) is acceptable for women with moderate-to-severe perinatal mood and/or anxiety disorders and can be feasibly delivered in a routine practice setting. The trans-diagnostic nature of ACT enables the concurrent treatment of depressive and anxiety symptoms within the same intervention which is particularly helpful in the perinatal context given the comorbidity of mood and anxiety disorders. With training and supervision, mental health practitioners without extensive education in the delivery of psychological therapies can facilitate the ACT group programme. As this was a feasibility study, there was no control group, adherence to the manual was not assessed, and the absence of a follow-up period limits our knowledge of the longer-term benefits of the ACT group programme.
本研究旨在评估一项新开发的接受与承诺疗法（ACT）干预措施的可行性、安全性和有效性，该措施是专门针对妊娠和育儿的独特背景而制定的。该干预措施提供给了专门的围产期社区心理健康服务（PCMHS）的女性。
对一项为期 8 周的、以小组形式进行的 ACT 干预措施进行了开放性试点研究，该干预措施针对的是妊娠和产后有中度至重度情绪和/或焦虑障碍的女性。
结果包括出席率、退出率、危机/住院服务使用和标准化症状量表。通过对治疗结束时问卷中包含的开放性问题的参与者回答进行主题分析。
74 名女性被转介到该干预措施，其中 65 名（88%）完成了治疗。参加的平均疗程数为 7 次。没有女性需要危机/住院服务的帮助。所有人都表示该干预措施对他们有帮助。ACT 在日常生活中的实施、治疗师的支持和小组过程被认为是干预措施的有益方面。在治疗后，整体困扰程度显著降低（d=0.99），抑郁症状减轻（d=1.05），心理灵活性增加（d=0.93）。在次要结果的整体困扰方面，38%的女性被归类为恢复，31%有可靠的改善，27%保持不变，4%有可靠的恶化。
在常规实践环境中提供 ACT 是可行、安全且有效的。需要进行随机对照试验（RCT）来确定这种小组形式的 ACT 干预措施的疗效和成本效益。
小组形式的接受与承诺疗法（ACT）对有中度至重度围产期情绪和/或焦虑障碍的女性是可以接受的，并且可以在常规实践环境中可行地进行。ACT 的跨诊断性质使抑郁和焦虑症状能够在同一干预措施中同时得到治疗，这在围产期背景下尤其有帮助，因为情绪和焦虑障碍的共病率很高。经过培训和监督，没有接受过广泛心理治疗方法培训的心理健康从业者可以促进 ACT 小组项目的实施。由于这是一项可行性研究，没有对照组，没有评估对方案的遵守情况，并且没有随访期限制了我们对 ACT 小组项目的长期获益的了解。
