Comparing the Effectiveness of Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy on Depression, Anxiety, and Stress in Nulliparous Pregnant Women

Pregnancy is a new and unique situation in which every pregnant mother experiences many psychological and physiologic changes. Pregnancy is somewhat stressful, which can cause mental disorders. Depression and anxiety are among the most common and important complications of pregnancy and have negative effects on the outcome of the pregnancy and the growing fetus. All humans feel depressed at some point in their lives and can usually relate the cause of depression to certain events. Anxiety is often considered a response to an unpredictable and uncertain disturbing consequence. Anxiety states include physiological (arousal) and psychological (worry) components, describing stress as a model of a person's specific and non–specific responses to the stimuli of events that disturb a person's balance as well as excessive pressure that impairs a person's ability to cope. It is necessary to help pregnant women solve pregnancy problems by identifying factors affecting depression, anxiety, and stress. This study aimed to compare the effectiveness of cognitive–behavioral therapy (CBT) and acceptance and commitment therapy (ACT) on depression, anxiety, and stress in nulliparous pregnant women.

The research method was quasi–experimental with a pretest–posttest design with a control group. The statistical population of this study included all pregnant women referred to Shahid Taleghani, Hedayat, and Amiralmomenin hospitals in Tehran City, in 2019. They included 157 pregnant women who were referred for birth control. Using the convenience sampling method, 51 women were selected and enrolled in the study. The inclusion criteria were obtaining a total score above 30 on the Depression, Anxiety and Stress Scale, gestational age at the time of entering the study 20–25 weeks, age range between 20–35 years, being nulliparous, not having psychological disorders and physical illnesses, not using antidepressants, stress and anxiety. The exclusion criteria were absence in more than two treatment sessions. The first experimental group received CBT in eight sessions of 120 minutes (for two months), and the second experimental group received ACT in eight sessions of 120 minutes (for two months). To describe the data, centrality and dispersion indices such as mean and standard deviation were used. For data analysis, analysis of variance with repeated measures and Tukey and Bonferroni post hoc tests were used. A comparison of three groups in terms of age was made by 1–way analysis of variance. The mentioned statistical analyzes were done using SPSS version 22 software. The significance level of the tests was considered 0.05.

The results showed that variance analysis of the depression variable was significant for time effect (p<0.001) and group effect (p<0.001), and the effect size of a group intervention for depression was 0.64. Variance analysis of the anxiety variable was significant for time effect (p<0.001) and group effect (p<0.001) and the effect size of a group intervention for anxiety was 0.17. Also, the variance analysis of the stress variable was significant for the effect of time (p<0.001) and the effect of the group (p=0.005), and the effect size of the group intervention for stress was 0.22. In all three variables of depression (p=0.012), anxiety (p=0.015), and stress (p=0.010), significant differences were observed in the posttest between the averages of the two treatment groups. Also, a significant difference was observed between the averages of the two treatment groups and the averages of the control group in the aforementioned variables (p<0.001). The scores of anxiety (p<0.001), stress (p<0.001), and depression (p<0.001) variables in the ACT group and the CBT group in the posttest and follow–up phases were significantly different from those in the pretest phase. However, no significant difference was observed between the two stages of posttest and follow–up in the variables of anxiety, stress and depression (p=0.105, p=0.804, p=0.847, respectively), which shows the effectiveness of the treatment based on acceptance and commitment and cognitive behavioral therapy in the follow–up stage showed for all three variables.

It can be concluded that CBT and ACT were effective in reducing depression, anxiety, and stress in nulliparous pregnant women, but ACT was more effective than CBT in decreasing depression, anxiety, and stress in nulliparous pregnant women.