Comparison of the Effects of Lecture and Cognitive Behavioral Therapy with a Consulting Advisory Approach on the Anxiety Level of Women with High-risk Pregnancy in Comprehensive Health Centers of Sanandaj, Iran

Document Type : Original article

Authors

1 MSc student in Midwifery, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 MSc in Psychiatric Nursing Education, Instructor, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran

3 PhD in Statistics, Associate Professor, Department of Statistics and Epidemiology, Kurdistan University of Medical Sciences, Sanandaj, Iran

4 PhD in Community Health, Assistant Professor, Department of Midwifery, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

Introduction: High-risk pregnancy is a kind of pregnancy that causes anxiety and compromises the health of the mother and fetus. The current study aimed to compare the effect of lecture and cognitive behavioral methods on the anxiety level in women with high-risk pregnancy in Sanandaj, Iran.
Materials and Methods: The present interventional study was a randomized clinical trial performed on 144 women with high-risk pregnancy of 24-35 weeks referring to comprehensive health centers in Sanandaj, within 2018. To select samples, the city was divided into five districts and then the subjects were randomly selected from 6 centers with the highest number of women with high-risk pregnancy. In each center, the sampling units were selected by the available sampling method. Before the intervention, the Spielberger questionnaire was completed to assess the anxiety score. Then the samples were divided into three groups of cognitive behavioral (n =48), lecture (n=48), and control (n=48). The cognitive behavioral group was divided into four groups of 12 participants and the lecture group into two groups of 24 people, each. The intervention was performed twice a week in a 90-120 minute sessions for each cognitive behavioral group and once a week for each lecture group for a period of 4 weeks. The control group also received routine pregnancy care. Four weeks after the intervention, the Spielberger questionnaire was completed again by the researcher for all groups. Data analysis was performed using SPSS software (version 21) and the collected data were analyzed by Kruskal-Wallis, Chi-square, paired t-test, Tukey, covariance analysis, and one-way ANOVA. 
Results: The results of the current study showed that before intervention there was no significant difference in the level of anxiety in the three groups of lecture, cognitive behavioral, and control groups (P<0.05). In addition, no significant difference was observed in the anxiety level of the control group (P>0.05). However, there was a significant difference in the lecture group (P<0.05) and the cognitive behavioral group (P<0.05) and the anxiety in the cognitive behavioral group decreased significantly (P<0.05), compared to the control and lecture groups.
Conclusion: The results of the current study showed that educating with the cognitive behavioral approach and lecture style reduced pregnancy anxiety. Moreover, cognitive behavioral training had a more effective impact on reducing anxiety during pregnancy. Therefore, it was concluded that in lecture and cognitive behavioral methods, mothers gain a higher ability to manage their anxiety and avoid thoughts or behaviors that lead to increased anxiety.

Keywords


  1. Yuksel F, Akin S, Durna Z. Prenatal distress in Turkish pregnant women and factors associated with maternal prenatal distress. J Clin Nurs. 2014; 23(1-2):54-64.
  2. Din ZU, Ambreen S, Iqbal Z, Iqbal M, Ahmad S. Determinants of antenatal psychological distress in Pakistani women. Noro Psikiyatr Ars. 2016; 53(2):
    152-7.
  3. Ghazavi H, Ahadi M, Aghasi Yazdi Z, Behzadmehr A. Anxiety in pregnancy. J Raze Behzistan. 2008; 17(35):19-21. [in Persian]
  4. John T, Spong Catherine Y. Management of high-risk pregnancy: an evidence-based approach. 5th ed. New Jersey: Blackwell Publishing; 2007.
  5. Cunningham F. Williams obstetrics. Trans: Ghazi Jahani B, Ghotbi R. Tehran: Golban; 2014. [in Persian]
  6. Field T, Diego M, Hernandez-Reif M, Figueiredo B, Deeds O, Ascencio A, et al. Comorbid depression and anxiety effects on pregnancy and neonatal outcome. Infant Behav Dev. 2010; 33(1):23-9.
  7. Chuang LL, Lin LC, Cheng PJ, Chen CH, Wu SC, Chang CL. The effectiveness of arelaxation training program for women with preterm labour on pregnancy outcomes. Int J Nurs Stud. 2012; 49(3):257-64.
  8. Babanazari L, Kafi M. Relationship of pregnancy anxiety to its different periods, sexual satisfaction and demographic factors. Iran J Psychiatry Clin Psychol. 2008; 14(2) 206-13. [in Persian]
  9. Lee AM, Lam SK, Sze Mun Lau SM, Chong CS. Prevalence, course, and risk factors for antenatal anxiety and depression. Obstet Gynecol. 2007; 110(5):
    1102-12.
  10. Hernandez-Martinez C, Val VA, Murphy M, Busquets PC, Sans JC. Relation between positive and negative maternal emotional states and obstetrical outcomes. Women Health. 2011; 51(2):124-35.
  11. Rico MA, Rodríguez AJ, Díez SM, Real MC. Análisis de la relación entre riesgo gestacional y ansiedad materna. Progresos Obstetr Ginecol. 2010; 53(7):273-9.
  12. James DK, Steer PJ, Weiner CP, Gonik B, Robson SC. High-risk pregnancy: management options. Cambridge: Cambridge University Press; 2017.
  13. Bayrampour H, McDonald S, Tough S. Risk factors of transient and persistent anxiety during pregnancy. Midwifery. 2015; 31(6):582-9.
  14. Martini J, Petzoldt J, Einsle F, Beesdo-Baum K, Hofler M, Wittchen HU. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery. J Affect Disord. 2015; 175:385-95.
  15. 15.Waqas A, Raza N, Lodhi HW, Muhammad Z, Jamal M, Rehman A. Psychosocial factors of antenatal anxiety and depression in Pakistan: is social support a mediator. PloS One. 2015; 10(1):e0116510.
  16. Rezaee R, Framarzi M. Predictors of mental health during pregnancy. Iran J Nurs Midwifery Res. 2014; 19(7):45-50. [in Persian]
  17. Biaggi A, Conroy S, Pawlby S, Pariante C. Identifying the women at risk of antenatal anxiety and depression. J Affect Disord. 2016; 191:62-77.
  18. Helbig A, Kaasen A, Malt UF, Haugen G. Maternal psychological distress and placental circulation in pregnancies after a previous offspring with congenital malformation. PLoS One. 2014; 9(1):e86597.
  19. Bandelow B, Sher L, Bunevicius R, Hollander E, Kasper S, Zohar J, et al. Guidelines for the pharmacological treatment of anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder in primary care. Int J Psychiatry Clin Pract. 2012; 16(2):77-84.
  20. Li AW, Goldsmith C. The effects of yoga on anxiety and stress. Altern Med Rev. 2012; 17(1):21-35.
  21. Gleeson PB, Pauls JA. Obstetrical physical therapy review of the literature. Phys Ther. 1988; 68(11):1699-702.
  22. Escribano B, Quero I, Feijoo M, Tasset I, Montilla P, Tunez I. Role of noise and music as anxiety modulators: Relationship with ovarian hormones in the rat. Appl Animal Behav Sci. 2014; 152:73-82.
  23. Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014; 28(1):25-35.
  24. Shabani H. Educational and developmental skills (methods and techniques of teaching). 3th ed. Tehran: Center for Human Sciences Research and Development; 2011. [in Persian]
  25. Adib-Hajbaghery M, Afazel MR. A comparison of the effects of instructional methods on satisfaction, anxiety and learning of nursing students. Future Med Educ J. 2011; 4(3):11-5. [in Persian]
  26. Martin-Gronert MS, Ozanne SE. Maternal nutrition during pregnancy and health of the offspring. Biochem Soc Trans. 2006; 34(Pt 5):779-82. 
  27. Solati M, Javadi R, Hosseini Teshnizi S, Asghari N. Desirability of two participatory methods of teaching, based on students' view point. Hormozgan Med J. 2010; 14(3):191-7. [in Persian]
  28. Figueiredo B, Conde A. Anxiety and depression symptoms in women and men from early pregnancy to 3 months postpartum: parity differences and effects. J Affect Disord. 2011; 132(1-2):146-57.
  29. Arch JJ, Dimidjian S, Chessick C. Are exposure-based cognitive behavioral therapies safe during pregnancy? Arch Womens Ment Health. 2012; 15(6):445-57.
  30. Saisto T, Halmesmaki E. Fear of childbirth: a neglected dilemma. Acta Obstet Gynecol Scand. 2003; 82(3):201-8.
  31. 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. 2016; 95(43):e5224.
  32. Rapee RM, Schniering CA, Hudson JL. Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol. 2009; 5:311-41.
  33. Shayeghian Z, Tabatabaey SK, Seddighi Looye E. Effect of maternal anxiety during third trimester on pregnancy outcomes and infants' mental health. J Hayat. 2008; 14(4):57-65. [in Persian]
  34. Mighty HE, Fahey AJ. Obesity and pregnancy complications. Curr Diab Rep. 2007; 7(4):289-94.
  35. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001; 25(8):1175-82.
  36. Mohaddesi H, Bahadory F, Khalkhali H, Baghi P. Comparison of quality of life in low risk pregnant with high risk pregnant women in perinatology clinic of Kowsar ward Shahid Motahari Hospital in Urmia. Sci J Hamadan Nurs Midwifery Facul. 2013; 21(4):69-95. [in Persian]
  37. Jabbari Z, Hashemi H, Haghayegh SA. Survey
    on effectiveness of cognitive behavioral stress management on the stress, anxiety and depression of pregnant women. Health Syst Res. 2013; 8(7):1342-8. [in Persian]
  38. Aslami E, Alipour A, Aghayusefi A, Najib F. Assessing the effectiveness of mindfulness-based Islamic–spiritual schemas on anxiety of mothers pregnancy and infants physiological health. Quart J Health Psychol. 2016; 4(14):129-40. [in Persian]