Efficacy of internet-based emotion-focused cognitive behavior therapy (IECBT) in improving stress and anxiety of women with suspected fetal malformation: A randomized controlled trial

Abstract

Background and objectives

Anxiety is prevalent among pregnant women with suspected fetal malformation. Hence, this study aimed to assess the effectiveness of IECBT in alleviating pregnancy-specific stress and anxiety in anxious women with suspected fetal malformation.

Methods

A randomized four-arm parallel-group controlled trial was conducted involving 140 pregnant women displaying anxiety symptoms before 20 weeks of gestation and suspected fetal malformation. Participants were randomly allocated into four groups, each consisting of 35 women: IECBT alone, IECBT with booster sessions, IECBT with spouse participation, and IECBT combined with spouse participation and booster sessions. The IECBT intervention comprised six 50-min therapist-led sessions for women, with an additional 20-min session for men in the IECBT with spouse participation group. Those in the IECBT with booster sessions groups received six monthly 50-min sessions post-intervention until delivery. Five questionnaires—Spielberger's State Anxiety, Pregnancy-Specific Stress, Uncertainty Intolerance, and Emotion Regulation—were administered before the trial, upon completion of the 6-week intervention, and at 3-month and 6-month post-trial follow-ups.

Results

The IECBT interventions led to significant improvements in anxiety symptoms, pregnancy-specific stress, uncertainty intolerance, and emotional regulation after therapy, with these improvements sustained at the 3-month and 6-month post-treatment assessments. However, no superiority was observed among the four IECBT models across the three measurement intervals—post-trial, 3-month, and 6-month follow-ups regarding outcome improvement. Additionally, participants expressed high satisfaction levels with all IECBT approaches, with no significant differences noted among the four groups.

Limitation

IECBT with spouse participation and IECBT with booster sessions were not therapist-guided, results might stem from the masculism culture of the population and their low responsibility and assistance in solving pregnant women's problems, especially during pregnancy, the lack of long-term follow-up of treatment effectiveness and postnatal psychological outcomes with or without fetal malformation.

Conclusions

The findings suggest that the four models of IECBT improved anxiety, stress, uncertainty, and dysregulated emotions in women with suspected fetal malformation, and such improvements remained stable up to six months after the intervention.