Objectives: To understand patient and therapist experiences of time-intensive and weekly exposure-based therapy for anxiety disorders delivered during pregnancy.Design: A qualitative study using semi-structured interviews with patients and therapists who had taken part in a feasibility trial of predominantly online time-intensive versus weekly CBT in pregnancy. Setting UK therapists and patients in a primary care setting Participants In-depth interviews were conducted with 45 women who had participated in the trial and 6 therapists who had delivered the treatments. Analysis: Data were analysed using reflexive thematic analysis. Results: Five themes were developed from the data that showed convergence from therapist and patient perspectives. These were: ‘Acquiring tools to navigate the perinatal period’; ‘Motivated yet constrained by pregnancy’; ‘Having the confidence to face fears and tolerate uncertainty’; ‘Momentum with the need for flexibility’; ‘Being isolated from the face-to-face world’.Conclusions: Exposure therapy is acceptable and helpful in pregnancy and can lead to lasting gains. Exposure is a key element of treatment and needs to be confidently conducted by therapists with perinatal knowledge and expertise. Treatments need to consider the unfolding context of pregnancy. The momentum of intensive therapy can lead to rapid improvements, but can be demanding for both patients and therapists, especially fitting round other commitments. Online treatments can work well and are a good fit for perinatal women, but this needs to be balanced with the need for connection, suggesting a hybrid model of delivery is the ideal.
BackgroundExposure-based cognitive-behaviour therapies (CBT) are effective but their acceptability in pregnancy is untested, despite affecting 15% of women. Time-intensive delivery of CBT (INT-CBT) may accelerate treatment response. AimsTo test the acceptability and feasibility of a trial of INT-CBT for antenatal anxiety disordersMethodThis multi-centre parallel-group trial recruited pregnant women with anxiety disorders from maternity and mental health settings and randomised (1:1) to INT-CBT or standard weekly CBT (WCBT). Participants received 12 hours of individual therapy using remote delivery (95%). Outcomes were assessed: at baseline; during treatment at week 2 and 6, and at 1 month and 3 months postpartum (by blinded assessors), alongside a qualitative interview. Pre-specified primary feasibility outcomes were evaluated and adjusted mean difference estimated for the proposed study primary outcome.ResultsAll feasibility outcomes were met. Of 135 screened, 59 women were recruited and randomised into the trial (29 INT-CBT :30 WCBT). 93% completed treatment and 81% provided data at 3m postpartum. No adverse effects were attributable to treatment. Women randomised to INT-CBT showed a reduction in anxiety (GAD-7) after two weeks of treatment (aMD=-4.17, 95%CI -6.03 to -2.31). There were differences in late pregnancy aMD=-1.72 (95%CI -3.99, 0.56), 1-month postpartum aMD=-2.13 (95%CI -5.14, 0.89), 3-month postpartum aMD=-0.11 (95%CI -3.23, 3.00). Women described the momentum of INT-CBT as helpful to drive change.ConclusionsExposure-based therapies are acceptable to pregnant women. INT-CBT may reduce anxiety quickly and should be tested in a confirmatory trial examining longer term outcomes.
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