Targeting Intolerance of Uncertainty During Pregnancy: A Randomized Controlled Trial to Prevent Postpartum Anxiety...

Area of Science:

• Perinatal mental health
• Anxiety disorders
• Preventative mental health strategies

Background:

• Postpartum anxiety is prevalent and linked to adverse outcomes for parent and infant.
• Preventative strategies for postpartum anxiety are under-researched.
• Intolerance of uncertainty (IU) is a potential risk factor for postpartum anxiety.

Purpose of the Study:

• To investigate if a 6-week cognitive behavioral therapy protocol targeting intolerance of uncertainty (CBT-IU) during pregnancy can reduce the risk of postpartum anxiety disorders.
• To assess the impact of CBT-IU on worry, depression, and emotion regulation.

Main Methods:

• A proof-of-concept randomized controlled trial (RCT) involving 37 pregnant individuals (14-32 weeks gestation) with heightened IU.
• Participants were randomized to either 6 sessions of individual CBT-IU or care as usual (CAU).
• Primary outcome was the incidence of postpartum anxiety disorder; secondary outcomes included changes in IU, worry, depression, and emotion regulation.

Main Results:

• None of the participants receiving CBT-IU developed postpartum anxiety disorder, compared to 31.6% in the CAU group (P<.001).
• CBT-IU significantly reduced IU (P=.003), worry symptoms (P<.001), emotion dysregulation (P=.018), and interviewer-rated anxiety symptoms (P<.001).
• High treatment satisfaction was reported by CBT-IU participants.

Conclusions:

• Targeting intolerance of uncertainty during pregnancy with CBT-IU appears to be an effective strategy for preventing postpartum anxiety disorder.
• This proof-of-concept study supports the need for a large-scale RCT to confirm CBT-IU's efficacy.
• CBT-IU shows promise as a preventative intervention for perinatal mental health.