Examining the Impact of Trauma-Informed Cognitive Behavioral Therapy on Perinatal Mental Health Outcomes Among Survivors of Intimate Partner Violence (The PATH Study): Protocol for a Feasibility Study

Abstract

BackgroundIntimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV.ObjectiveWe present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial.MethodsThe Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program’s perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved maternal-infant attachment, maternal coping, and maternal quality of life. Additionally, the feasibility of the protocol and acceptability of the intervention from the women’s perspective will be examined. Inductive content analysis of all qualitative data will be used to determine common themes. Additionally, descriptive statistics, including measures of central tendency and dispersion, will be computed for all continuous variables. Alternatively, frequency tables will be constructed for all categorical variables.ResultsThe work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Participant recruitment for cohort 1 has started and we have finished data collection for cohort 2. It is anticipated that the results will be available by the end of 2018.ConclusionsFindings will assess the acceptability of the study methodology and protocol for a full-scale randomized controlled trial. Furthermore, if CBT is proven effective for pregnant survivors of IPV, this interv...

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“…To minimize the negative outcomes on the patient's quality of life, self-management skills should be enhanced. Thus, independence and self-determination sults were consistent with previous findings [41][42][43][44] and suggested the following considerations.…”

Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations

“…Most protocols ( n = 6) were RCTs proposing to test the efficacy of CBT. These protocols involved delivery of CBT face-to-face ( 38 , 40 , 41 , 43 ), online ( 42 , 45 ), or in combination with a positive parenting intervention ( 43 ). One protocol compared an enhanced Prenatal Positive Parenting Program with Mellow Bumps , an intervention focused on promoting antenatal health and mother-infant attachment ( 44 ).…”

“…One protocol compared an enhanced Prenatal Positive Parenting Program with Mellow Bumps , an intervention focused on promoting antenatal health and mother-infant attachment ( 44 ). Face-to-face interventions planned to use hospital or prenatal clinic dissemination settings ( 38 , 40 , 41 , 43 ) and delivery models reliant on prenatal nursing professionals ( 38 , 40 , 41 , 44 ). Six studies planned to deliver their interventions individually ( 38 , 41 , 42 ), and the other two planned to deliver them in a group setting ( 43 , 44 ).…”

Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma‐and‐violence‐informed care to pregnant women

“…In addition, it appears that TVICBT also led to some women feeling empowered to overcome challenges that threatened their ability to build an appropriate relationship with their infant. When considered together, these findings point to the significant potential of TVICBT to fill the existing practice gap of a lack of individualized, trauma‐informed care available to perinatal women designed to optimize health outcomes (Jackson et al, 2018; Lee King et al, 2015). However, it is necessary to validate these findings in a larger study with appropriate statistical analyses to establish significant, and meaningful impact.…”

“…Accordingly, the purpose of the Promoting Attachment Through Healing (PATH) study was to examine and evaluate the feasibility of a TVICBT program administered by perinatal clinical nurse specialists (PCNS) for pregnant women who have experienced IPV and depression, anxiety and/or PTSD symptomatology in the promotion of positive coping and formation of maternal‐infant bonding. The protocol paper preceding this intervention was published by Jackson et al (2018).…”