Category: Treatment - CBT
Background: The perinatal period (pregnancy and up to 12 months postpartum) is a time of increased vulnerability for anxiety disorders in new and expecting mothers (Lee et al., 2007). Cognitive behaviour therapy (CBT) can be effective in this population (e.g., Green et al., 2015), but empirical support has been mixed across trials and improving treatment outcomes is essential. One way to do so is to ensure that treatments target variables that are thought to play a role in symptom reduction. Two potential variables are intolerance of uncertainty and perfectionistic beliefs. Intolerance of uncertainty (IU) has been defined as a set of negative beliefs about uncertainty and its implications (Dugas et al., 2008). In samples of anxious adults, higher levels of IU are associated with higher levels of anxiety (de Bruin et al., 2006) and changes in IU mediate the effect of CBT on anxiety symptoms (Bomyea et al., 2015). However, the potential role of IU in symptom reduction during CBT for perinatal anxiety has not been examined. Perfectionistic beliefs about parenting are associated with greater reporting of anxiety symptoms among pregnant and postpartum women (Donegan, Green, & McCabe, 2016; Snell et al., 2005) and reductions in these beliefs may also play a role in symptom reduction during CBT.
Study Goals and Hypotheses: We will examine the relative associations between changes in IU, perfectionistic beliefs, and anxiety symptoms during CBT for perinatal anxiety. It is expected that, relative to a waitlist condition, CBT will be associated with (1) greater reductions in anxiety symptoms, (2) intolerance of uncertainty (IU) and (3) perfectionistic beliefs by posttreatment. Finally, it is expected (4) that changes in both perfectionistic thinking and in intolerance of uncertainty during CBT will be associated with lower levels of anxiety symptoms by posttreatment.
Results: The sample will be recruited from a larger clinical trial examining the effectiveness of CBT for perinatal anxiety at the Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, with an estimated sample of N = 30 by October 2017. Self-report measures of perfectionistic beliefs, intolerance of uncertainty, and anxiety symptoms will be completed at pre, mid, and posttreatment. A series of mixed effects ANOVA analyses and hierarchical linear regression will be used to examine the impact of CBT on outcomes as well as the relationships between change in perfectionistic beliefs and intolerance of uncertainty and perinatal anxiety symptoms.
Conclusions: Understanding the relationships between changes in IU, perfectionistic beliefs and anxiety symptoms during treatment may provide insight into how CBT for perinatal anxiety works as well as identifying factors that, if targeted more thoroughly during treatment, may help improve treatment outcomes in this vulnerable population.
St. Joseph's Healthcare Hamilton
Hamilton, Ontario, Canada