Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton & Department of Psychiatry and Behavioural Neurosciences, McMaster University.
Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton & Department of Psychiatry and Behavioural Neurosciences; McMaster University; Mood Disorders Program, St. Joseph's Healthcare Hamilton.
Behav Ther. 2022 Jul;53(4):738-750. doi: 10.1016/j.beth.2022.02.005. Epub 2022 Feb 26.
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).
The sample included 75 women (M = 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.
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.
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.
最近一项群组认知行为疗法（CBGT）治疗围产期焦虑的随机对照试验表明，CBGT 可有效降低孕妇和产后女性的焦虑和抑郁。在二次分析中，研究人员考察了症状变化的潜在机制，包括无法容忍不确定性（IU）、自我导向型育儿完美主义（SOPP）和社会规定型育儿完美主义（SPPP）。
该研究样本包括 75 名女性（M=31.99，SD=3.57；37.3%处于孕期，62.7%处于产后），她们因焦虑寻求治疗，并在更大的试验中完成了为期 6 周的 CBGT 或 6 周的候补名单。在基线和 6 周后，参与者完成了焦虑量表（认知和躯体焦虑状态特质问卷；STICSA）、抑郁量表（爱丁堡产后抑郁量表；EPDS）和拟议的中介变量（IU、SOPP、SPPP）的测量。
研究评估了两个调节中介模型，以确定条件（CBGT、候补名单）对焦虑（STICSA；模型 1）或抑郁症状（EPDS；模型 2）的影响的潜在中介变量。在模型 1 中，IU 的变化部分中介了条件对焦虑（STICSA）的影响，对孕期和产后女性均如此。SOPP 和 SPPP 的变化仅为产后女性的部分中介。在该模型中，抑郁（EPDS）的变化也是孕期女性的部分中介。在模型 2 中，认知变量均未中介条件对抑郁症状（EPDS）的影响。然而，焦虑（STICSA）的变化是条件对抑郁（EPDS）影响的一个重要中介，仅在孕期女性中如此。
结果支持 IU、SOPP 和 SPPP 作为 CBGT 期间的变化机制，并确定了孕期和产后女性之间重要机制的差异。
