Skip to main content
Top
Published in: Archives of Women's Mental Health 2/2020

01-04-2020 | Mood Disorders | Original Article

Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: a randomized controlled trial

Authors: Mehdi Zemestani, Zahra Fazeli Nikoo

Published in: Archives of Women's Mental Health | Issue 2/2020

Login to get access

Abstract

Pregnant women are at high risk of mood and anxiety disorders, and options for non-pharmacological treatment are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among people with mood and anxiety disorders, but limited studies reported the effectiveness of MBCT on perinatal comorbid conditions. This study aimed to examine the effects of an 8-week MBCT intervention on pregnant women with comorbid depression and anxiety. In this randomized controlled study, 38 pregnant women with a diagnosis of depression and varying levels of comorbid anxiety disorders were randomly assigned to either MBCT or a control group. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, Emotion Regulation Questionnaire, and Scales of Psychological Wellbeing were used as outcome measures at baseline, after MBCT, and through 1-month follow-up. Intent to treat analyses provided preliminary evidence that MBCT can be effective in reducing depressive and anxiety symptoms and in enhancing the use of adaptive emotion regulation strategies and psychological well-being. Improvements in outcomes were maintained 1 month. Results provide cross-cultural support for MBCT as a treatment for depression and anxiety in pregnant women. This brief and non-pharmacological treatment can be used to improve maternal psychological health.
Literature
go back to reference Alloy LB, Abramson LY, Whitehouse WG, Hogan ME, Panzarella C, Rose DT (2006) Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression. J Abnorm Psychol 115(1):145–156PubMed Alloy LB, Abramson LY, Whitehouse WG, Hogan ME, Panzarella C, Rose DT (2006) Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression. J Abnorm Psychol 115(1):145–156PubMed
go back to reference American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Author, Washington, DC American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5th ed.). Author, Washington, DC
go back to reference Arch JJ, Craske MG (2006) Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther 44(12):1849–1858PubMed Arch JJ, Craske MG (2006) Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther 44(12):1849–1858PubMed
go back to reference Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 5(6):893–897 Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 5(6):893–897
go back to reference Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. San Antonio 78(2):490–498 Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. San Antonio 78(2):490–498
go back to reference Bonacquisti A, Cohen MJ, Schiller CE (2017) Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention. Arch Women's Ment Health 20(5):645–654 Bonacquisti A, Cohen MJ, Schiller CE (2017) Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention. Arch Women's Ment Health 20(5):645–654
go back to reference Brown KW, Ryan RM (2003) The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 84(4):822–848PubMed Brown KW, Ryan RM (2003) The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol 84(4):822–848PubMed
go back to reference Brummelte S (2018) Treating maternal depression: considerations for the well-being of the mother and child. Policy Insights Behav Brain Sci 5(1):110–117 Brummelte S (2018) Treating maternal depression: considerations for the well-being of the mother and child. Policy Insights Behav Brain Sci 5(1):110–117
go back to reference Dhillon A, Sparkes E, Duarte RV (2017) Mindfulness-based interventions during pregnancy: a systematic review and meta-analysis. Mindfulness 8(6):1421–1437PubMedPubMedCentral Dhillon A, Sparkes E, Duarte RV (2017) Mindfulness-based interventions during pregnancy: a systematic review and meta-analysis. Mindfulness 8(6):1421–1437PubMedPubMedCentral
go back to reference Dimidjian S, Goodman S (2009) Nonpharmacological intervention and prevention strategies for depression during pregnancy and the postpartum. Clin Obstet Gynecol 52(3):498–515PubMedPubMedCentral Dimidjian S, Goodman S (2009) Nonpharmacological intervention and prevention strategies for depression during pregnancy and the postpartum. Clin Obstet Gynecol 52(3):498–515PubMedPubMedCentral
go back to reference Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A (2015) An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Arch Women's Ment Health 18(1):85–94 Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A (2015) An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence. Arch Women's Ment Health 18(1):85–94
go back to reference Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A (2016) Staying well during pregnancy and the postpartum: a pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. J Consult Clin Psychol 84(2):134–145PubMed Dimidjian S, Goodman SH, Felder JN, Gallop R, Brown AP, Beck A (2016) Staying well during pregnancy and the postpartum: a pilot randomized trial of mindfulness-based cognitive therapy for the prevention of depressive relapse/recurrence. J Consult Clin Psychol 84(2):134–145PubMed
go back to reference Dunn C, Hanieh E, Roberts R, Powrie R (2012) Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Arch Women's Ment Health 15(2):139–143 Dunn C, Hanieh E, Roberts R, Powrie R (2012) Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women’s psychological distress and well-being in the perinatal period. Arch Women's Ment Health 15(2):139–143
go back to reference Fairbrother N, Young AH, Janssen P, Antony MM, Tucker E (2015) Depression and anxiety during the perinatal period. BMC psychiatry 15(1):206PubMedPubMedCentral Fairbrother N, Young AH, Janssen P, Antony MM, Tucker E (2015) Depression and anxiety during the perinatal period. BMC psychiatry 15(1):206PubMedPubMedCentral
go back to reference First MB, Williams JB (2016) SCID-5-CV: Structured Clinical Interview for DSM-5 Disorders: Clinician Version. American Psychiatric Association Publishing, Philadelphia First MB, Williams JB (2016) SCID-5-CV: Structured Clinical Interview for DSM-5 Disorders: Clinician Version. American Psychiatric Association Publishing, Philadelphia
go back to reference Ghorbani N, Watson P, Salimian M, Chen Z (2013) Shame and guilt: relationships of test of self-conscious affect measures with psychological adjustment and gender differences in Iran. Interpersona: Int J Pers Relat 7(1):97–109 Ghorbani N, Watson P, Salimian M, Chen Z (2013) Shame and guilt: relationships of test of self-conscious affect measures with psychological adjustment and gender differences in Iran. Interpersona: Int J Pers Relat 7(1):97–109
go back to reference Goldin PR, Gross JJ (2010) Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion 10(1):83–91PubMedPubMedCentral Goldin PR, Gross JJ (2010) Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion 10(1):83–91PubMedPubMedCentral
go back to reference Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27PubMed Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27PubMed
go back to reference Goodman JH, Guarino A, Chenausky K, Klein L, Prager J, Petersen R, Forget A, Freeman M (2014) CALM pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Women's Ment Health 17(5):373–387 Goodman JH, Guarino A, Chenausky K, Klein L, Prager J, Petersen R, Forget A, Freeman M (2014) CALM pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Women's Ment Health 17(5):373–387
go back to reference Grabovac AD, Lau MA, Willett BR (2011) Mechanisms of mindfulness: a Buddhist psychological model. Mindfulness 2(3):154–166 Grabovac AD, Lau MA, Willett BR (2011) Mechanisms of mindfulness: a Buddhist psychological model. Mindfulness 2(3):154–166
go back to reference Gross JJ, John OP (2003) Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol 85(2):348–362PubMed Gross JJ, John OP (2003) Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol 85(2):348–362PubMed
go back to reference Hayes CS, Strosahl DK, Wilson GK (2011) Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press, New York City Hayes CS, Strosahl DK, Wilson GK (2011) Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press, New York City
go back to reference Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U (2011) How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 6(6):537–559PubMed Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U (2011) How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci 6(6):537–559PubMed
go back to reference Krusche A, Dymond M, Murphy SE, Crane C (2018) Mindfulness for pregnancy: a randomised controlled study of online mindfulness during pregnancy. Midwifery 65:51–57PubMed Krusche A, Dymond M, Murphy SE, Crane C (2018) Mindfulness for pregnancy: a randomised controlled study of online mindfulness during pregnancy. Midwifery 65:51–57PubMed
go back to reference Kumar S, Feldman G, Hayes A (2008) Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cogn Ther Res 32(6):734–744 Kumar S, Feldman G, Hayes A (2008) Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cogn Ther Res 32(6):734–744
go back to reference Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14PubMedPubMedCentral Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14PubMedPubMedCentral
go back to reference Lin P-Z, Xue J-M, Yang B, Li M, Cao F-L (2018) Effectiveness of self-help psychological interventions for treating and preventing postpartum depression: a meta-analysis. Arch women's Ment Health 21(5):491–503 Lin P-Z, Xue J-M, Yang B, Li M, Cao F-L (2018) Effectiveness of self-help psychological interventions for treating and preventing postpartum depression: a meta-analysis. Arch women's Ment Health 21(5):491–503
go back to reference Loughnan SA, Wallace M, Joubert AE, Haskelberg H, Andrews G, Newby JM (2018) A systematic review of psychological treatments for clinical anxiety during the perinatal period. Arch Women's Ment Health 21(5):481–490 Loughnan SA, Wallace M, Joubert AE, Haskelberg H, Andrews G, Newby JM (2018) A systematic review of psychological treatments for clinical anxiety during the perinatal period. Arch Women's Ment Health 21(5):481–490
go back to reference Luberto CM, Park ER, Goodman JH (2018) Postpartum outcomes and formal mindfulness practice in mindfulness-based cognitive therapy for perinatal women. Mindfulness 9(3):850–859PubMed Luberto CM, Park ER, Goodman JH (2018) Postpartum outcomes and formal mindfulness practice in mindfulness-based cognitive therapy for perinatal women. Mindfulness 9(3):850–859PubMed
go back to reference Madigan S, Oatley H, Racine N, Fearon RP, Schumacher L, Akbari E, Cooke J, Tarabulsy GM, Tarabulsy GM (2018) A meta-analysis of maternal prenatal depression and anxiety on child socio-emotional development. J Am Acad Child Adolesc Psychiatry 57(9):645–657PubMed Madigan S, Oatley H, Racine N, Fearon RP, Schumacher L, Akbari E, Cooke J, Tarabulsy GM, Tarabulsy GM (2018) A meta-analysis of maternal prenatal depression and anxiety on child socio-emotional development. J Am Acad Child Adolesc Psychiatry 57(9):645–657PubMed
go back to reference Novick D, Flynn H (2013) Psychiatric symptoms and pregnancy. Women’s health psychology. Wiley, New York Novick D, Flynn H (2013) Psychiatric symptoms and pregnancy. Women’s health psychology. Wiley, New York
go back to reference Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, O'Conner TG, Stein A (2013) Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 70(12):1312–1319PubMedPubMedCentral Pearson RM, Evans J, Kounali D, Lewis G, Heron J, Ramchandani PG, O'Conner TG, Stein A (2013) Maternal depression during pregnancy and the postnatal period: risks and possible mechanisms for offspring depression at age 18 years. JAMA Psychiatry 70(12):1312–1319PubMedPubMedCentral
go back to reference Prady SL, Hanlon I, Fraser LK, Mikocka-Walus A (2018) A systematic review of maternal antidepressant use in pregnancy and short-and long-term offspring’s outcomes. Arch Women's Ment Health 21(2):127–140 Prady SL, Hanlon I, Fraser LK, Mikocka-Walus A (2018) A systematic review of maternal antidepressant use in pregnancy and short-and long-term offspring’s outcomes. Arch Women's Ment Health 21(2):127–140
go back to reference Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(8):1285–1298PubMed Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(8):1285–1298PubMed
go back to reference Ryff CD (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 57(6):1069–1083 Ryff CD (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Pers Soc Psychol 57(6):1069–1083
go back to reference Schetter CD, Tanner L (2012) Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 25(2):141–148 Schetter CD, Tanner L (2012) Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Curr Opin Psychiatry 25(2):141–148
go back to reference Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8(1):18PubMedPubMedCentral Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8(1):18PubMedPubMedCentral
go back to reference Segal Z, Williams M, Teasdale J (2018) Mindfulness-based cognitive therapy for depression. Guilford Publications, New York City Segal Z, Williams M, Teasdale J (2018) Mindfulness-based cognitive therapy for depression. Guilford Publications, New York City
go back to reference Shallcross AJ, Willroth EC, Fisher A, Dimidjian S, Gross JJ, Visvanathan PD, Mauss IB (2018) Relapse/recurrence prevention in major depressive disorder: 26-month follow-up of mindfulness-based cognitive therapy versus an active control. Behav Ther 49(5):836–849PubMedPubMedCentral Shallcross AJ, Willroth EC, Fisher A, Dimidjian S, Gross JJ, Visvanathan PD, Mauss IB (2018) Relapse/recurrence prevention in major depressive disorder: 26-month follow-up of mindfulness-based cognitive therapy versus an active control. Behav Ther 49(5):836–849PubMedPubMedCentral
go back to reference Shapero BG, McClung G, Bangasser DA, Abramson LY, Alloy AB (2017) Interaction of biological stress recovery and cognitive vulnerability for depression in adolescence. J Youth Adolesc 46(1):91–103PubMed Shapero BG, McClung G, Bangasser DA, Abramson LY, Alloy AB (2017) Interaction of biological stress recovery and cognitive vulnerability for depression in adolescence. J Youth Adolesc 46(1):91–103PubMed
go back to reference Shapero BG, Greenberg J, Pedrelli P, Desbordes G, Lazar SW (2019) Mindfulness-based cognitive therapy. In: The Massachusetts General Hospital Guide to Depression. Springer, Berlin, pp 167–177 Shapero BG, Greenberg J, Pedrelli P, Desbordes G, Lazar SW (2019) Mindfulness-based cognitive therapy. In: The Massachusetts General Hospital Guide to Depression. Springer, Berlin, pp 167–177
go back to reference Shi Z, MacBeth A (2017) The effectiveness of mindfulness-based interventions on maternal perinatal mental health outcomes: a systematic review. Mindfulness 8(4):823–847PubMedPubMedCentral Shi Z, MacBeth A (2017) The effectiveness of mindfulness-based interventions on maternal perinatal mental health outcomes: a systematic review. Mindfulness 8(4):823–847PubMedPubMedCentral
go back to reference Shulman B, Dueck R, Ryan D, Breau G, Sadowski I, Misri S (2018) Feasibility of a mindfulness-based cognitive therapy group intervention as an adjunctive treatment for postpartum depression and anxiety. J Affect Disord 235:61–67PubMed Shulman B, Dueck R, Ryan D, Breau G, Sadowski I, Misri S (2018) Feasibility of a mindfulness-based cognitive therapy group intervention as an adjunctive treatment for postpartum depression and anxiety. J Affect Disord 235:61–67PubMed
go back to reference Smith CA, Shewamene Z, Galbally M, Schmied V, Dahlen H (2018) The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: a systematic review and meta-analysis. J Affect Disord 245(15):428–439PubMed Smith CA, Shewamene Z, Galbally M, Schmied V, Dahlen H (2018) The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: a systematic review and meta-analysis. J Affect Disord 245(15):428–439PubMed
go back to reference Stevenson JC, Millings A, Emerson L-M (2018) Psychological well-being and coping: the predictive value of adult attachment, dispositional mindfulness, and emotion regulation. Mindfulness 10(2):256–271 Stevenson JC, Millings A, Emerson L-M (2018) Psychological well-being and coping: the predictive value of adult attachment, dispositional mindfulness, and emotion regulation. Mindfulness 10(2):256–271
go back to reference Sun M, Lau AS (2018) Exploring cultural differences in expressive suppression and emotion recognition. J Cross-Cult Psychol 49(4):664–672PubMedPubMedCentral Sun M, Lau AS (2018) Exploring cultural differences in expressive suppression and emotion recognition. J Cross-Cult Psychol 49(4):664–672PubMedPubMedCentral
go back to reference Taylor BL, Cavanagh K, Strauss C (2016) The effectiveness of mindfulness-based interventions in the perinatal period: a systematic review and meta-analysis. PLoS One 11(5):e0155720 Taylor BL, Cavanagh K, Strauss C (2016) The effectiveness of mindfulness-based interventions in the perinatal period: a systematic review and meta-analysis. PLoS One 11(5):e0155720
go back to reference Udechuku A, Nguyen T, Hill R, Szego K (2010) Antidepressants in pregnancy: a systematic review. Aust N Z J Psychiatry 44(11):978–996PubMed Udechuku A, Nguyen T, Hill R, Szego K (2010) Antidepressants in pregnancy: a systematic review. Aust N Z J Psychiatry 44(11):978–996PubMed
go back to reference van der Velden AM, Kuyken W, Wattar U, Crane C, Pallesen KJ, Dahlgaard J, Fjorback LO, Piet J (2015) A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clin Psychol Rev 37:26–39PubMed van der Velden AM, Kuyken W, Wattar U, Crane C, Pallesen KJ, Dahlgaard J, Fjorback LO, Piet J (2015) A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clin Psychol Rev 37:26–39PubMed
go back to reference Vieten C, Astin J (2008) Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Arch Women's Ment Health 11(1):67–74 Vieten C, Astin J (2008) Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Arch Women's Ment Health 11(1):67–74
go back to reference Yonkers KA, Blackwell KA, Glover J, Forray A (2014) Antidepressant use in pregnant and postpartum women. Annu Rev Clin Psychol 10(1):369–392PubMed Yonkers KA, Blackwell KA, Glover J, Forray A (2014) Antidepressant use in pregnant and postpartum women. Annu Rev Clin Psychol 10(1):369–392PubMed
go back to reference Zemestani M, Ottaviani C (2016) Effectiveness of mindfulness-based relapse prevention for co-occurring substance use and depression disorders. Mindfulness 7(6):1347–1355 Zemestani M, Ottaviani C (2016) Effectiveness of mindfulness-based relapse prevention for co-occurring substance use and depression disorders. Mindfulness 7(6):1347–1355
go back to reference Zemestani M, Imani M, Ottaviani C (2017) A preliminary investigation on the effectiveness of unified and Transdiagnostic cognitive behavior therapy for patients with comorbid depression and anxiety. Int J Cogn Ther 10(2):175–185 Zemestani M, Imani M, Ottaviani C (2017) A preliminary investigation on the effectiveness of unified and Transdiagnostic cognitive behavior therapy for patients with comorbid depression and anxiety. Int J Cogn Ther 10(2):175–185
Metadata
Title
Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: a randomized controlled trial
Authors
Mehdi Zemestani
Zahra Fazeli Nikoo
Publication date
01-04-2020
Publisher
Springer Vienna
Published in
Archives of Women's Mental Health / Issue 2/2020
Print ISSN: 1434-1816
Electronic ISSN: 1435-1102
DOI
https://doi.org/10.1007/s00737-019-00962-8

Other articles of this Issue 2/2020

Archives of Women's Mental Health 2/2020 Go to the issue

Letter to the Editor

Letter to the editor