Effect of cognitive behavioral therapy-based counseling on perceived stress in pregnant women with history of primary infertility

1. Cognitive behavioral therapy (CBT)-based counseling significantly improved perceived stress, anxiety, and quality of life among women with primary infertility.

2. Measures of depression suggested minimal effects of CBT-based counseling on these symptoms, based on this sample.

Evidence Rating Level: 1 (Excellent)

It is estimated that infertility impacts 11 to 51 million people worldwide. Infertility has a negative effect on quality of life, increasing stress, anxiety, and depressive symptoms both during pregnancy and after birth. This randomized, controlled clinical trial investigated the effect of group cognitive behavioral therapy (CBT)-based counseling on perceived stress, depression, anxiety, and quality of life among women with primary infertility. A total of 56 pregnant women with a history of primary infertility at a teaching hospital in Tabriz were randomly assigned to intervention (n = 28) and control (n = 28) groups. The CBT intervention included counseling after the 14th week of pregnancy, with six in-person sessions and two phone sessions weekly. Routine care was provided to the control group. Several measures were administered four weeks before and after the initiation of intervention: Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Van den Bergh’s Pregnancy-Related Anxiety Questionnaire (PRAQ), and Quality of Life in Pregnancy (Gravidarum; QOL-GRAV). Groups differed only in gestational age and husband educational attainment (ps>.05). Following CBT-based counseling, mean scores of the intervention group were significantly lower than the control group in perceived stress (M difference = -7.3, 95% CI -5.6 to -0.9, p<.001) and anxiety (M difference = -14.7, 95% CI -20.6 to -8.8, p<.001). Though depression levels were lower among the intervention group, this difference was not significant (p = .052). Lastly, quality of life was significantly higher among those in the intervention group, compared to controls (M difference = -5.4, 95% CI 3.4 to 7.4, p<.001). Overall, this clinical trial demonstrated that CBT-based counseling is effective for improving perceived stress, anxiety, and quality of life in pregnant women with a history of primary infertility. Effects on depression are relatively minimal, based on the current sample.

Click to read the study in BMC Psychiatry

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