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Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth : Randomized controlled trial

Rondung, Elisabet; Ternström, Elin; Hildingsson, Ingegerd; Haines, Helen M.; Sundin, Örjan; Ekdahl, Johanna; Karlström, Annika; Larsson, Birgitta; Segeblad, Birgitta and Baylis, Rebecca, et al. (2018) In Journal of Medical Internet Research 20(8).
Abstract

Background: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. Objective: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. Methods: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the... (More)

Background: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. Objective: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. Methods: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. Results: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). Conclusions: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.

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published
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keywords
Anxiety, Cognitive behavioral therapy, Fear of birth, Internet-based, Pregnancy
in
Journal of Medical Internet Research
volume
20
issue
8
publisher
Journal of Medical Internet Research
external identifiers
  • scopus:85052907128
ISSN
1438-8871
DOI
10.2196/10420
language
English
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yes
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3c2697e7-4aaa-4b90-870b-09d1ae3aacdb
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2018-10-18 11:00:19
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2019-03-19 04:01:10
@article{3c2697e7-4aaa-4b90-870b-09d1ae3aacdb,
  abstract     = {<p>Background: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. Objective: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. Methods: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. Results: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=−1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F<sub>1,192.538</sub>=4.96, P=.03). Conclusions: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.</p>},
  articleno    = {e10420},
  author       = {Rondung, Elisabet and Ternström, Elin and Hildingsson, Ingegerd and Haines, Helen M. and Sundin, Örjan and Ekdahl, Johanna and Karlström, Annika and Larsson, Birgitta and Segeblad, Birgitta and Baylis, Rebecca and Rubertsson, Christine},
  issn         = {1438-8871},
  keyword      = {Anxiety,Cognitive behavioral therapy,Fear of birth,Internet-based,Pregnancy},
  language     = {eng},
  number       = {8},
  publisher    = {Journal of Medical Internet Research},
  series       = {Journal of Medical Internet Research},
  title        = {Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth : Randomized controlled trial},
  url          = {http://dx.doi.org/10.2196/10420},
  volume       = {20},
  year         = {2018},
}