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Reproductive Health
Published in: Reproductive Health 1/2024

Open Access 01-12-2024 | Infertility | Research

Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program

Authors: Ashley A. Balsom, Bridget Klest, Bethany Sander, Jennifer L. Gordon

Published in: Reproductive Health | Issue 1/2024

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Abstract

Background

Approximately one in six couples are currently infertile, defined as unable to achieve pregnancy despite 12 or more months of active attempts to conceive. Experiencing infertility has been disproportionately associated with an array of psychological difficulties, particularly in women. However, currently available psychological interventions have had minimal benefits for distress, anxiety, or depression related to infertility.

Methods

A one-arm pilot study was conducted to test the acceptability of a newly created acceptance and commitment therapy-based self-guided program—Infertility ACTion. Twenty women, located in Canada, completed the program and completed measures assessing expectancy of improvement, treatment credibility, participant satisfaction, treatment completion and retention, psychological flexibility, fertility quality of life, depression, and anxiety. Participants were also asked to provide feedback on how the researchers could improve the intervention. Paired sample t-tests were conducted to compare pre- and post-intervention outcomes.

Results

Sixteen out of 20 participants completed the entire intervention. Reported treatment expectancy, credibility and satisfaction were favorable. Eighty-one percent of participants reported that they would recommend the program to a friend and 88% thought the program was worth their time. Medium increases in psychological flexibility and fertility quality of life were observed. Improvements in anxious and depressive symptoms were in the small to medium range but were not significant. Participants had several recommendations for program improvement.

Conclusions

This acceptance and commitment therapy-based self-guided program proved to be an acceptable treatment for infertility-related distress. Participant feedback will be used to adjust the current intervention in preparation for a more rigorous randomized-controlled trial testing this program.
Appendix
Available only for authorised users
Footnotes
1
Throughout this manuscript women will be used to refer to individuals attempting to conceive and possessing a uterus. It is important to consider that not all individuals matching this description will identify as women and may have unique experiences of distress.
 
Literature
1.
American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99:63–63.CrossRef
2.
Mascarenhas MN, Cheung H, Mathers CD, Stevens GA. Measuring infertility in populations: constructing a standard definition for use with demographic and reproductive health surveys. Popul Health Metr. 2012;10:1–1.CrossRef
3.
El Kissi Y, Romdhane AB, Hidar S, Bannour S, Ayoubi Idrissi K, Khairi H, et al. General psychopathology, anxiety, depression and self-esteem in couples undergoing infertility treatment: a comparative study between men and women. Eur J Obstet Gynecol Reprod Biol. 2013;167:185–9.CrossRefPubMed
4.
Bunting L, Tsibulsky I, Boivin J. Fertility knowledge and beliefs about fertility treatment: findings from the International fertility decision-making study. Hum Reprod. 2013;28:385–97.CrossRefPubMed
5.
Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni LJ. Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril. 1985;43:48–53.CrossRefPubMed
6.
Chen T-H, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19:2313–8.CrossRefPubMed
7.
Volgsten H, Skoog SA, Ekselius L, Lundkvist Ö, Sundström PI. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23:2056–63.CrossRefPubMedPubMedCentral
8.
Balsom AA, Gordon JL. The relationship between psychological coping and mood across the menstrual cycle among distressed women struggling to conceive. J Psychosom Res. 2021;145:e110465–e110465.CrossRef
9.
10.
11.
Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25.CrossRefPubMed
12.
13.
Cunha M, Galhardo A, Pinto-Gouveia J. Experiential avoidance, self-compassion, self-judgment and coping styles in infertility. Sex Reprod Healthc. 2016;10:41–7.CrossRefPubMed
14.
Hosseinpanahi M, Mirghafourvand M, Farshbaf-Khalili A, Esmaeilpour K, Rezaei M, Malakouti J. The effect of counseling based on acceptance and commitment therapy on mental health and quality of life among infertile couples: a randomized controlled trial. J Educ Health Promot. 2020;9:251.CrossRefPubMedPubMedCentral
15.
Peterson BD, Eifert GH. Using acceptance and commitment therapy to treat infertility stress. Cogn Behav Pract. 2011;18(4):577–87.CrossRef
16.
Rahimi E, Attarha M, Majidi A. Effect of acceptance and commitment therapy on the quality of life in infertile women during treatment: a randomized control trial. Int J Womens Health Reprod Sci. 2019;7:483–9.CrossRef
17.
Peterson B, Eifert G. Treating infertility stress in patients undergoing in vitro fertilization (IVF) using acceptance and commitment therapy (ACT). Fertil Steril. 2009;91:S18–S18.CrossRef
18.
Taylor H, Strauss C, Cavanagh K. Can a little bit of mindfulness do you good? A systematic review and meta-analyses of unguided mindfulness-based self-help interventions. Clin Psychol Rev. 2021;89: 102078.CrossRefPubMed
19.
Harris R. ACT made simple: an easy-to-read primer on acceptance and commitment therapy. Oakland: New Harbinger Publications; 2019.
20.
Hayes SC. Get out of your mind and into your life: The new acceptance and commitment therapy. Oakland: New Harbinger Publications; 2005.
21.
Koert E, Takefman J, Boivin J. Fertility quality of life tool: update on research and practice considerations. Hum Fertil. 2021;24:236–48.CrossRef
22.
Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The suicidal behaviors questionnaire-revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2001;8:443–54.CrossRefPubMed
23.
24.
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092–7.CrossRefPubMed
25.
Boivin J, Takefman J, Braverman A. The fertility quality of life (FertiQoL) tool: development and general psychometric properties. Hum Reprod. 2011;26:2084–91.CrossRefPubMedPubMedCentral
26.
Russell Crane D, Middleton KC, Bean RA. Establishing criterion scores for the kansas marital satisfaction scale and the revised dyadic adjustment scale. Am J Fam Ther. 2000;28:53–60.CrossRef
27.
Busby DM, Christensen C, Crane DR, Larson JH. A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales. J Marital Fam Ther. 1995;21:289–308.CrossRef
28.
Rolffs JL, Rogge RD, Wilson KG. Disentangling components of flexibility via the hexaflex model: development and validation of the multidimensional psychological flexibility inventory (MPFI). Assessment. 2018;25:458–82.CrossRefPubMed
29.
Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31:73–86.CrossRefPubMed
30.
Dear BF, Titov N, Schwencke G, Andrews G, Johnston L, Craske MG, et al. An open trial of a brief transdiagnostic internet treatment for anxiety and depression. Behav Res Ther. 2011;49:830–7.CrossRefPubMed
31.
Rozental A, Kottorp A, Forsström D, Månsson K, Boettcher J, Andersson G, et al. The Negative Effects Questionnaire: psychometric properties of an instrument for assessing negative effects in psychological treatments. Behav Cogn Psychother. 2019;47:559–72.CrossRefPubMed
32.
Torous J, Lipschitz J, Ng M, Firth J. Dropout rates in clinical trials of smartphone apps for depressive symptoms: a systematic review and meta-analysis. J Affect Disord. 2020;263:413–9.CrossRefPubMed
33.
Carvalho SA, Skvarc D, Barbosa R, Tavares T, Santos D, Trindade IA. A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion-focused therapy for chronic illness. Clin Psychol Psychother. 2022;29:524–41.CrossRefPubMed
34.
Barrett K, Stewart I. A preliminary comparison of the efficacy of online acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT) stress management interventions for social and healthcare workers. Health Soc Care Commun. 2021;29:113–26.CrossRef
35.
36.
37.
38.
Bernstein EE, Weingarden H, Greenberg JL, Williams J, Hoeppner SS, Snorrason I, et al. Credibility and expectancy of smartphone-based cognitive behavioral therapy among adults with body dysmorphic disorder. J Obses Compuls Relat Disord. 2023;36:100781.CrossRef
39.
Scott W, Guildford BJ, Badenoch J, Driscoll E, Chilcot J, Norton S, et al. Feasibility randomized-controlled trial of online acceptance and commitment therapy for painful peripheral neuropathy in people living with HIV: the OPEN study. Eur J Pain. 2021;25:1493–507.CrossRefPubMed
40.
Smeets RJ, Beelen S, Goossens ME, Schouten EG, Knottnerus JA, Vlaeyen JW. Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Clin J Pain. 2008;24:305–15.CrossRefPubMed
41.
42.
43.
44.
Parsons CE, Crane C, Parsons LJ, Fjorback LO, Kuyken W. Home practice in mindfulness-based cognitive therapy and mindfulness-based stress reduction: a systematic review and meta-analysis of participants’ mindfulness practice and its association with outcomes. Behav Res Ther. 2017;95:29–41.CrossRefPubMedPubMedCentral
45.
Cammin-Nowak S, Helbig-Lang S, Lang T, Gloster AT, Fehm L, Gerlach AL, et al. Specificity of homework compliance effects on treatment outcome in CBT: evidence from a controlled trial on panic disorder and agoraphobia. J Clin Psychol. 2013;69:616–29.CrossRefPubMed
46.
Kazantzis N, Whittington C, Zelencich L, Kyrios M, Norton PJ, Hofmann SG. Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behav Ther. 2016;47:755–72.CrossRefPubMed
47.
LeBeau RT, Davies CD, Culver NC, Craske MG. Homework compliance counts in cognitive-behavioral therapy. Cogn Behav Ther. 2013;42:171–9.CrossRefPubMed
48.
Metadata
Title
Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program
Authors
Ashley A. Balsom
Bridget Klest
Bethany Sander
Jennifer L. Gordon
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2024
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-024-01766-5

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