Original Research
European Journal of Forensic Sciences
www.ejfs.co.uk
DOI: 10.5455/ejfs.167903
Effectiveness of mindfulness based
cognitive therapy on anxiety, stress
and depression of pregnant youths:
A randomized clinical trial
Mohamad Narimani1, Seyed Khadijeh Seyed Musavi2
ABSTRACT
Address for correspondence:
Seyed Khadijeh Seyed
Musavi, Department of
Psychology, Islamic Azad
University of Ardebil, Iran.
E-mail: dr_mari26@yahoo.
com
Background and Aim: Pregnancy in low age ranges could be risky and planning supportive programs is
critical for pregnant youths. Therefore, this study aimed to explore the effectiveness of Teasdale cognitive
therapy (based on mindfulness) on the reduction of anxiety, stress and depression among pregnant woman
younger than 20 years of age. Methods: This study employed pre-post-test method with the control group.
The study population included all pregnant women of Ardebil who was below 20 years of age and who
reported higher than normal level scores in anxiety, stress or depression during 2013. The selected sample
comprised 30 youth pregnant females below 20 years age. They were selected by convenience method from
health care centers of Ardebil, and assigned randomly in control and experimental group. The data collected
by standard anxiety, stress and depression questionnaire and trait anxiety. The collected data were analyzed
by multiple analysis of variance (MANOVA). Results: The result of MANOVA revealed that mindfulness
based cognitive therapy (MBCT) significantly is effective on stress (F [1,29] = 57.58 P < 0.0005), anxiety
(F [1,29] = 57.58 P < 0.0005) and depression (F [1,29] = 79.52 P < 0.0005) of pregnant women who
aged below 20 years. Conclusion: According to the findings of this study and other relevant studies as
pregnancy is a very sensitive stage of every woman’s life and they need proper care. The authors suggest
to future researchers to design and explore MBCT based on pregnancy condition associated problems.
Received: August 30, 2014
Accepted: September 29, 2014
Published: October 17, 2014
KEY WORDS: Forensic sciences, forensic psychology, Teasdale cognitive therapy, anxiety, stress, depression,
pregnancy
Department of
Psychology, Mohaghegh
University of Ardebil,
Ardabil, Iran, 2Department
of Psychology, Islamic
Azad University of
Ardebil, Ardabil, Iran
1
INTRODUCTION
Pregnancy is described as a critical period of a female life.
Pregnant women are, usually, involved to some symptom such
as helplessness, anxiety, confusion, depression, psychosomatic
symptoms, anger, and sense of inefficacy, suicidal ideation,
hopelessness and restlessness [1]. According to professional
suggestions, 21-28 years old are the best ages of fertility that
human uterus has completely developed. Very young mother
who are below 2 years old, usually, have an insufficient level
of hormones, and it could lead to mortality among newborn
infants of them. Research showed that the mother’s age is
not the only explanation for infant mortality among babies
of teenage mothers rather, meanwhile majorities of pregnant
teenagers come from poor families with stress, nourishment
and health relate problems [2]. Emotional problems also could
make the situation worst. If a pregnant woman experiences
stress, anxiety and depression, the child may be affected, and
some psychological, physical, economic and social problems
could emerge consequently.
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● Jan-Mar 2015 ● Vol 2 ● Issue 1
Severe stress is associated with abortion, premature birth,
low weight, breath diseases, digestive diseases and physical
problems such as cleft lip and palate, pyloric stenosis [3].
Considering the known and unknown side effects of psychiatric
medicine for a pregnant woman, it is recommended that using
non-pharmacological methods like psychological treatments
to cure anxiety, stress and depression of pregnant women
is more safe and secure. In last decade efficacy of several
psychotherapy methods have been examined on pregnant
woman’s psychiatric problems such as cognitive behavioral
therapy, yoga, meditation, etc. [4-6].
Regarding recently the acceptance based therapies emerged with
high promising results and medium to large efficacy during short
time treatments. In this research, we used mindfulness based
cognitive therapy (MBCT) method, a combination of Beck
cognitive therapy and Kabat-Zinn’s mindfulness based stress
reduction program [7]. Mindfulness is not only a technique; it
is a method of being or a method of understanding that requires
the perception of personal feelings [8]. The therapy usually
1
Narimani and Musavi: Mindfulness based cognitive therapy for pregnant
includes a variety of medicines, stretching yoga, a primitive
education about depression, body scanning exercise and a couple
of hours practicing cognitive therapy that shows the relationship
between mood, thoughts, feelings and bodily senses [9].
reliability for state anxiety is reported to be 0.16-0.62 and for
trait anxiety 0.73-0.86 [12].
Lots of research has shown the effectiveness of this therapy.
For example, Teasdale et al., (1995) have trained 145 healed
patients with depression by MBCT method. Results showed
that the relapse rate of the patients was 40% while the rate for
the patients who did not receive the training was 66% [10]. In
another study, Teasdale (2004) examined the effectiveness of
MBCT in comparison to usual care. He reported that MBCT
reduced relapse from 78% to 36% in 55 patients with 3 or
more previous episodes; but in 18 patients with only 2 (recent)
episodes corresponding figures were 20% and 50%. MBCT
was most effective in preventing relapses not preceded by life
events [11]. There is a lack of knowledge about third view of
psychotherapies in developing countries as Iran so no study has
been examined the efficacy of mindfulness based interventions
in a pregnant woman especially in youths. Therefore, we aimed
to examine the efficacy of MBCT on depression, anxiety and
stress of under 20-year-age pregnant youths.
Lovibond and Lovibond invented this scale, 1995 and consisted
21 items, which answered through Likert scale. This tool
measures anxiety, stress and depression. Beyond investigations
of factor structure or dimensionality, studies have reported
good estimates of internal consistency reliability for the original
scale scores (range = 0.82-0.97) of the DASS-21 in clinical and
nonclinical samples [13,14].
DASS21
Intervention
The intervention included standard eight sessions of MBCT
according to the plan proposed by Kabat-Zinn (1990).
Statistical Analysis
This research was a pre-test and post-test experimental design
with experimental and control groups.
SPSS version 20 (Armonk, NY: IBM Corp ) used for analyzing
the gathered data. Descriptive analysis comprised mean,
standard deviation, percentage and frequency. As we decided to
compare two groups with more than one variable the multiple
analysis of variance (MANOVA) used to test the significance
difference of outcome between-group differences in change
from pre intervention to post intervention.
Sampling
RESULTS
Statistical population included all the of pregnant youths
younger than 20 age years old who referred to governmental
Women’s health centers of Ardebil-Iran to receive prebirth health services during Feb-May 2013. All pregnant
youth who were under 20 years old filed anxiety, stress and
depression questionnaire of Lovibond and Lovibond (1995)
and state-trait anxiety questionnaire of Spielberger (1970).
The sample size selected according previous same studies [8].
The final sample includes 30 pregnant youth females who got
high scores in depression, anxiety and stress scale (DASS21)
Lovibond and Lovibond (1995) test and signed a consent
form to participating in this study. Then they randomly
divided to the control (n = 15) and intervention (n = 15)
groups, 15 participants each group. The intervention groups
received MBCT treatment, and the control group received no
intervention during the study.
Descriptive
METHODS
Tools
State-trait anxiety questionnaire
The questionnaire was invented by Spielberger et al. (1970) and
comprised 40 items and two scales of state (explicit) and trait
(implicit) anxiety. This scale widely used in pregnant females
and showed to be predictive for higher fetal heart rate reactivity,
greater uterine artery resistance, preeclampsia and gestational
age at birth [9]. Spielberger et al. reported alpha coefficient of
0.90 and 0.92 for state and trait anxiety respectively. Test-retest
2
The results showed 47% of the participants in the experimental
group and 33% of the control group were 16-17 years old. Also,
53% of the control group and 67% of the control group were
17-19 years old.
Comparative Results
Comparing trait anxiety scores of control and experimental groups
also showed significant differences. The experiment or treatment
group had a lower trait anxiety. The results are depicted in Table 1.
Comparing mean scores and MANOVA results F (1,29) = 7.94
P < 0.0005 of the treatment and control groups showed that
state anxiety of the treatment group was significantly lower than
experiment group. The results are shown in Table 1.
The results of MANOVA showed that F (1,29) = 57.58
P < 0.0005 of the score of stress in the treatment group was
considerably lower than the control group. The results presented
in the Table 1.
As the Table 1 shows, the depression means scores and MANOVA
results (F [1,29] = 5.81 P < 0.0005) of the treatment group
were significantly lower than the scores of the control group.
Therefore, MBCT intervention decreased the stress levels of
participants in the treatment group.
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Narimani and Musavi: Mindfulness based cognitive therapy for pregnant
Table 1: Results of MANOVA analysis to compare depression,
stress and anxiety levels of the groups
Sum of
squares
Depression
Model
47485.49
Control-experiment
789.98
Pre-test and post-test 2586.21
Control*
4558.42
Stress
Model
30656.45
Control-experiment
92.45
Pre-test and post-test
125
Control*
80
Anxiety
Model
116926.61
Control-experiment
6122.64
Pre-test and post-test 1955.05
Control*
1934.98
Df
Mean of
squares
F
P
1
1
1
1
47485.49
789.98
2586.21
4558.42
828.41
137.69
45.11
79.52
0.001
0.001
0.001
0.001
1
1
1
1
30654.45
92.45
125
80
2227.07
6.71
9.08
5.81
0.001
0.001
0.001
0.001
1
1
1
1
116926.61
6122.64
1955.05
1934.98
480.16
25.14
8.02
7.94
0.001
0.001
0.001
0.001
*Control experiment with pre-test and post-test, MANOVA: Multiple
analysis of variance
As the Table 1 shows, the depression means scores and MANOVA
results (F [1,29] = 79.52 P < 0.0005) of the treatment group
were significantly lower than the scores of the control group.
Therefore, MBCT intervention decreased the depression levels
of participants in the treatment group.
worry or fear from thoughts. This detachment helps them to
let the thoughts go without ruminating or magnification of
unhelpful thoughts.
A variety of researches Brown and Rayan, 2003; Kabat-Zinn,
2003; Evans et al., 2008; [16-18] showed that depression
symptoms could be alleviated through MBCT. The MBCT
model includes different meditations, Yoga, an introductive
training to depression, body scanning exercises, and some
cognitive exercises that show relationships between mood,
thoughts, feelings and bodily senses. The exercises make it
possible to pay attention to ongoing bodily and environmental
situations so that reduces the depress genic automatic
processes.
Totally, research showed that MBCT psychotherapy could
significantly decrease state and trait anxiety, stress, anxiety
and depression symptoms of under 20-year-old mothers. So the
method could be efficiently applicable in health centers related
to pregnancy health care. This suggested to future studies to
conduct an intervention in the greater sample size and compare
the individual with group sessions.
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It appears that a MBCT is a feasible and acceptable treatment
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the work is properly cited.
Source of Support: Nil, Conflict of Interest: None declared.
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