Accepted for/Published in: JMIR Formative Research
Date Submitted: Feb 11, 2022
Date Accepted: Aug 10, 2022
Transdiagnostic Internet-Delivered Cognitive Behaviour Therapy for Symptoms of Postpartum Anxiety and Depression: A Pilot Trial
ABSTRACT
Background:
Postpartum depression (PPD) and postpartum anxiety (PPA) are often comorbid and associated with significant personal and economic costs. Fewer than half of mothers experiencing PPD or PPA receive face-to-face treatment, suggesting a need for alternative delivery formats such as internet-delivered cognitive behaviour therapy (ICBT).
Objective:
The goal of the pilot study was to examine the impact of a therapist-assisted, transdiagnostic ICBT program on PPD and PPA, as there is only one previous study on transdiagnostic ICBT with this population and the study did notinclude therapist assistance.
Methods:
Clients endorsing symptoms of PPD/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 at pre-treatment, post-treatment, and 1-month follow-up, as well as measures of treatment satisfaction and therapeutic alliance. Outcome measures were also completed at 6-month follow-up for clients who completed ICBT.
Results:
Both the ICBT and TAU groups experienced statistically significant improvements over time. The ICBT group experienced larger improvements at post-treatment and 1-month follow-up on more measures than TAU, with medium between-group Cohen’s d effects on primary outcome measures for anxiety (Cohen’s d = 0.65, 95% CI: 0.13, 1.17), postpartum depression (Cohen’s d = 0.52, 95% CI: 0.01, 1.04), and depression (Cohen’s d = 0.56, 95% CI: 0.05, 1.08), and on secondary outcome measures of overall distress (Cohen’s d = 0.69, 95% CI: 0.17, 1.21), anxiety (Cohen’s d = 0.59, 95% CI: 0.07, 1.11), and stress (Cohen’s d = 0.76, 95% CI: 0.23, 1.28). Time-by-group interactions for proportional reductions between groups over time were only significant at post-treatment and 1-month follow-up for the primary anxiety measure (p = .006). The study was underpowered for detecting small or medium effects. Overall, clients perceived the treatment as credible and 95% of clients (21/22) were satisfied with treatment content and therapist support.
Conclusions:
Findings from this pilot study provide preliminary support for transdiagnostic ICBT in treating PPD/PPA to improve access to psychological treatments. Clinical Trial: ClinicalTrials.gov NCT04012580
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