Suchan Victoria, Peynenburg Vanessa, Thiessen David, Nugent Marcie, Dear Blake, Titov Nickolai, Hadjistavropoulos Heather
Department of Psychology, University of Regina, Regina, SK, Canada.
Department of Mathematics and Statistics, University of Regina, Regina, SK, Canada.
JMIR Form Res. 2022 Sep 6;6(9):e37216. doi: 10.2196/37216.
Postpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and are associated with significant personal and economic costs. Fewer than half of the mothers experiencing PPD or PPA symptoms receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behavioral therapy (ICBT).
This pilot study aimed to examine the impact of a therapist-assisted, transdiagnostic ICBT program on symptoms of PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population, which did not include therapist assistance.
Clients endorsing the symptoms of PPD or PPA (N=63) were randomized to an 8-week transdiagnostic ICBT course (Wellbeing Course for New Moms) or to treatment as usual (TAU). Clients completed measures of depression, anxiety, stress, postnatal bonding, and relationship satisfaction, as well as measures of treatment satisfaction and therapeutic alliance, before treatment, after treatment, and at the 1-month follow-up. Outcome measures were also completed at the 6-month follow-up for clients who completed the ICBT course.
Both the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements after treatment and at the 1-month follow-up on more measures than the TAU group, with medium between-group Cohen d effects on primary outcome measures for anxiety (Cohen d=0.65, 95% CI 0.13-1.17), PPD (Cohen d=0.52, 95% CI 0.01-1.04), and depression (Cohen d=0.56, 95% CI 0.05-1.08), and on secondary outcome measures of overall distress (Cohen d=0.69, 95% CI 0.17-1.21), anxiety (Cohen d=0.59, 95% CI 0.07-1.11), and stress (Cohen d=0.76, 95% CI 0.23-1.28). Time-by-group interactions for proportional reductions between groups over time were only significant after treatment and at the 1-month follow-up for the primary anxiety measure (P=.006). This study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible, and 95% (21/22) of the clients were satisfied with the treatment content and therapist support.
Findings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD and PPA symptoms to improve access to psychological treatments.
ClinicalTrials.gov NCT04012580; https://clinicaltrials.gov/ct2/show/NCT04012580.
产后抑郁症（PPD）和产后焦虑症（PPA）常常并发，且会带来巨大的个人和经济成本。出现PPD或PPA症状的母亲中，接受面对面治疗的不到一半，这表明需要诸如互联网认知行为疗法（ICBT）等替代治疗方式。
本试点研究旨在检验由治疗师辅助的跨诊断ICBT项目对PPD和PPA症状的影响，因为此前仅有一项针对该人群的跨诊断ICBT研究，且未包含治疗师的协助。
认可PPD或PPA症状的患者（N = 63）被随机分为8周的跨诊断ICBT课程（新妈妈幸福课程）组或常规治疗（TAU）组。患者在治疗前、治疗后及1个月随访时完成抑郁、焦虑、压力、产后情感联结及关系满意度的测量，以及治疗满意度和治疗联盟的测量。完成ICBT课程的患者在6个月随访时也完成了结果测量。
随着时间推移，ICBT组和TAU组均有统计学上的显著改善。与TAU组相比，ICBT组在治疗后及1个月随访时在更多测量指标上有更大改善，在焦虑（Cohen d = 0.65，95% CI 0.13 - 1.17）、PPD（Cohen d = 0.52，95% CI 0.01 - 1.04）和抑郁（Cohen d = 0.56，95% CI 0.05 - 1.08）的主要结果测量指标上，以及在总体痛苦（Cohen d = 0.69，95% CI 0.17 - 1.21）、焦虑（Cohen d = 0.59，95% CI 0.07 - 1.11）和压力（Cohen d = 0.76，95% CI 0.23 - 1.28）的次要结果测量指标上，组间Cohen d效应为中等。随着时间推移，两组间比例降低的时间×组间交互作用仅在治疗后及1个月随访时对主要焦虑测量指标有显著意义（P = 0.006）。本研究检测小或中等效应的效能不足。总体而言，患者认为该治疗可信，95%（21/22）的患者对治疗内容和治疗师支持感到满意。
本试点研究结果为跨诊断ICBT治疗PPD和PPA症状以改善心理治疗的可及性提供了初步支持。
ClinicalTrials.gov NCT04012580；https://clinicaltrials.gov/ct2/show/NCT04012580
