Comparing the Effectiveness of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy on Depression, Anxiety, and Stress in Nulliparous Pregnant Women

Hosseinian, Soheila; Lotfi Kashani, Farah; Peyman, Akram

Volume 12 - Articles-1401 MEJDS (2022) 12: 149 | Back to browse issues page

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Hosseinian S, Lotfi Kashani F, Peyman A. Comparing the Effectiveness of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy on Depression, Anxiety, and Stress in Nulliparous Pregnant Women. MEJDS 2022; 12 :149-149
URL: http://jdisabilstud.org/article-1-2239-en.html

Comparing the Effectiveness of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy on Depression, Anxiety, and Stress in Nulliparous Pregnant Women

Soheila Hosseinian¹

, Farah Lotfi Kashani ^*²

, Akram Peyman³

1- Department of Psychology, Roudehen Branch, Islamic Azad University
2- Department of Psychology, Roodehen Branch, Islamic Azad University
3- School of Nursing and Midwifery, Research Sciences Branch, Islamic Azad University

Abstract: (1134 Views)

Background & Objectives: Pregnancy is a new and unique situation in which every pregnant mother experiences many psychological and physiologic changes. Pregnancy is somewhat stressful, which can cause mental disorders. Depression and anxiety are among the most common and important complications of pregnancy and have negative effects on the outcome of the pregnancy and the growing fetus. All humans feel depressed at some point in their lives and can usually relate the cause of depression to certain events. Anxiety is often considered a response to an unpredictable and uncertain disturbing consequence. Anxiety states include physiological (arousal) and psychological (worry) components, describing stress as a model of a person's specific and non–specific responses to the stimuli of events that disturb a person's balance as well as excessive pressure that impairs a person's ability to cope. It is necessary to help pregnant women solve pregnancy problems by identifying factors affecting depression, anxiety, and stress. This study aimed to compare the effectiveness of cognitive–behavioral therapy (CBT) and acceptance and commitment therapy (ACT) on depression, anxiety, and stress in nulliparous pregnant women.
Methods: The research method was quasi–experimental with a pretest–posttest design with a control group. The statistical population of this study included all pregnant women referred to Shahid Taleghani, Hedayat, and Amiralmomenin hospitals in Tehran City, in 2019. They included 157 pregnant women who were referred for birth control. Using the convenience sampling method, 51 women were selected and enrolled in the study. The inclusion criteria were obtaining a total score above 30 on the Depression, Anxiety and Stress Scale, gestational age at the time of entering the study 20–25 weeks, age range between 20–35 years, being nulliparous, not having psychological disorders and physical illnesses, not using antidepressants, stress and anxiety. The exclusion criteria were absence in more than two treatment sessions. The first experimental group received CBT in eight sessions of 120 minutes (for two months), and the second experimental group received ACT in eight sessions of 120 minutes (for two months). To describe the data, centrality and dispersion indices such as mean and standard deviation were used. For data analysis, analysis of variance with repeated measures and Tukey and Bonferroni post hoc tests were used. A comparison of three groups in terms of age was made by 1–way analysis of variance. The mentioned statistical analyzes were done using SPSS version 22 software. The significance level of the tests was considered 0.05.
Results: The results showed that variance analysis of the depression variable was significant for time effect (p<0.001) and group effect (p<0.001), and the effect size of a group intervention for depression was 0.64. Variance analysis of the anxiety variable was significant for time effect (p<0.001) and group effect (p<0.001) and the effect size of a group intervention for anxiety was 0.17. Also, the variance analysis of the stress variable was significant for the effect of time (p<0.001) and the effect of the group (p=0.005), and the effect size of the group intervention for stress was 0.22. In all three variables of depression (p=0.012), anxiety (p=0.015), and stress (p=0.010), significant differences were observed in the posttest between the averages of the two treatment groups. Also, a significant difference was observed between the averages of the two treatment groups and the averages of the control group in the aforementioned variables (p<0.001). The scores of anxiety (p<0.001), stress (p<0.001), and depression (p<0.001) variables in the ACT group and the CBT group in the posttest and follow–up phases were significantly different from those in the pretest phase. However, no significant difference was observed between the two stages of posttest and follow–up in the variables of anxiety, stress and depression (p=0.105, p=0.804, p=0.847, respectively), which shows the effectiveness of the treatment based on acceptance and commitment and cognitive behavioral therapy in the follow–up stage showed for all three variables.
Conclusion: It can be concluded that CBT and ACT were effective in reducing depression, anxiety, and stress in nulliparous pregnant women, but ACT was more effective than CBT in decreasing depression, anxiety, and stress in nulliparous pregnant women.

Keywords: Nulliparous pregnant women, Stress, Anxiety, Depression, Acceptance and commitment therapy, Cognitive–Behavioral therapy

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Type of Study: Original Research Article | Subject: Psychology

References

1. Babanazari L. The study of effectiveness of spiritual intelligence training on psychological well-being, marital satisfaction and pregnancy anxiety of pregnant women in Shiraz. Journal of Clinical Nursing and Midwifery. 2017;6(1):51–63. [Persian] [Article]

2. Pearlstein T. Depression during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2015;29(5):754–64. [DOI]

3. Guardino CM, Schetter CD. Understanding pregnancy anxiety: concepts, correlates, and consequences. Zero to Three. 2014;34(4):12–21.

4. Vitasari P, Wahab MNA, Herawan T, Sinnadurai SK, Othman A, Awang MG. Assessing of physiological arousal and cognitive anxiety toward academic performance: the application of catastrophe model. Procedia-Social and Behavioral Sciences. 2011;30:615–9. [DOI]

5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013.

6. Veisani Y, Delpisheh A, Sayehmiri K, Rezaeian S. Trends of postpartum depression in Iran: a systematic review and meta-analysis. Depress Res Treat. 2013;2013:291029. [DOI]

7. Polo-Kantola P, Aukia L, Karlsson H, Karlsson L, Paavonen EJ. Sleep quality during pregnancy: associations with depressive and anxiety symptoms. Acta Obstet Gynecol Scand. 2017;96(2):198–206. [DOI]

8. Mansell T, Novakovic B, Meyer B, Rzehak P, Vuillermin P, Ponsonby AL, et al. The effects of maternal anxiety during pregnancy on IGF2/H19 methylation in cord blood. Transl Psychiatry. 2016;6:e765. [DOI]

9. Huizink AC, Delforterie MJ, Scheinin NM, Tolvanen M, Karlsson L, Karlsson H. Adaption of Pregnancy Anxiety Questionnaire-Revised for all pregnant women regardless of parity: PRAQ-R2. Arch Womens Ment Health. 2016;19(1):125–32. [DOI]

10. Stuart S, Koleva H. Psychological treatments for perinatal depression. Best Pract Res Clin Obstet Gynaecol. 2014;28(1):61–70. [DOI]

11. Salehi F, Pourasghar M, Khalilian A, Shahhosseini Z. Comparison of group cognitive behavioral therapy and interactive lectures in reducing anxiety during pregnancy: A quasi experimental trial. Medicine (Baltimore). 2016;95(43):e5224. [DOI]

12. Jha S, Salve HR, Goswami K, Sagar R, Kant S. Burden of common mental disorders among pregnant women: a systematic review. Asian J Psychiatr. 2018;36:46–53. [DOI]

13. Ahmadi A, Mousavi Sahebol Zamani SS, Fathi Ashtiyani A, Motiee S. Identification and early intervention of reducing postnatal depression and increasing self-esteem and marital satisfaction of Pregnant Women. Thoughts and Behavior in Clinical Psychology. 2014;9(32):47–56. [Persian] [Article]

14. Shamsabadi N, Khajevand A, Hasanzadeh R. Effect of cognitive-behavioral based stress management on anxiety reduction of pregnant women. Journal of Research Development in Nursing and Midwifery. 2016;12(3):19–29. [Persian] [Article]

15. Jalali A, Heydarpour S, Tohidinejad F, Salari N. Cognitive-behavioral counseling and mental health of pregnant women. Heliyon. 2020;6(2):e03463. [DOI]

16. Hrynyschyn R, Dockweiler C. Effectiveness of smartphone-based cognitive behavioral therapy among patients with major depression: systematic review of health implications. JMIR Mhealth Uhealth. 2021;9(2):e24703. [DOI]

17. Twohig MP, Levin ME. Acceptance and commitment therapy as a treatment for anxiety and depression: a review. Psychiatr Clin North Am. 2017;40(4):751–70. [DOI]

18. Levin ME, Haeger JA, Pierce BG, Twohig MP. Web-based acceptance and commitment therapy for mental health problems in college students: a randomized controlled trial. Behav Modif. 2017;41(1):141–62. [DOI]

19. Bonacquisti A, Cohen MJ, Schiller CE. Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention. Arch Womens Ment Health. 2017;20(5):645–54. [DOI]

20. Feyzi Z, Moradi A, Khaje Dalouee M, Khadem N. The efficacy of Acceptance and Commitment Therapy(ACT) on anxiety and depression in infertile women who undergoing In Virto Fertilization (IVF). Clinical Psychology Studies. 2017;7(27):1–21. [Persian] [DOI]

21. Karami A, Omrani R, Danaei N. Comparison of the effectiveness of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) on anxiety and depression in premature infants mothers. Clinical Psychology Studies. 2018;8(31):139–56. [Persian] [DOI]

22. Azizi S, Rasool Zade Tabatabaie K, Janbozorgi M. Comparing the efficacy of Acceptance and Commitment Therapy (ACT) with Cognitive-Behavioral Therapy (CBT) on depression taking into account the level of psycho-spiritual development (case study). Clinical Psychology Studies. 2019;9(35):147–72. [Persian] [DOI]

23. Hancock KM, Swain J, Hainsworth CJ, Dixon AL, Koo S, Munro K. Acceptance and commitment therapy versus cognitive behavior therapy for children with anxiety: outcomes of a randomized controlled trial. J Clin Child Adolesc Psychol. 2018;47(2):296–311. [DOI]

24. Losada A, Márquez-González M, Romero-Moreno R, Mausbach BT, López J, Fernández-Fernández V, et al. Cognitive-behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for dementia family caregivers with significant depressive symptoms: results of a randomized clinical trial. J Consult Clin Psychol. 2015;83(4):760–72. [DOI]

25. Loughnan SA, Newby JM, Haskelberg H, Mahoney A, Kladnitski N, Smith J, et al. Internet-based cognitive behavioural therapy (iCBT) for perinatal anxiety and depression versus treatment as usual: study protocol for two randomised controlled trials. Trials. 2018;19(1):56. [DOI]

26. Wersebe H, Lieb R, Meyer AH, Hofer P, Gloster AT. The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. International Journal of Clinical and Health Psychology. 2018;18(1):60–8. [DOI]

27. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995;33(3):335–43. [DOI]

28. Salehpoor G, Rezaei S, Hosseininezhad M. Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: a bicenter study from north of Iran. Iran J Nurs Midwifery Res. 2014;19(6):593–9.

29. Hayes SC. Climbing our hills: a beginning conversation on the comparison of acceptance and commitment therapy and traditional cognitive behavioral therapy. Clinical Psychology: Science and Practice. 2008;15(4):286–95. [DOI]

30. Sperry L. Treatment of chronic medical conditions: cognitive-behavioral therapy strategies and integrative treatment protocols. 1st ed. Washington, DC: American Psychological Association; 2009.