About 15% of women experience either anxiety or depressive symptoms  during pregnancy.  While we have data to support the reproductive safety of various antidepressant and anxiolytic medications, our data regarding the effects of these medications are incomplete and many women and their treaters are understandably reluctant to use medications in this setting.  Therefore we need to develop effective psychotherapies which can be used in this population.

Over the last decade, we have seen a variety of psychotherapeutic approaches incorporating mindfulness training. Mindfulness-based interventions have been shown to reduce stress, to improve coping skills, and to promote feelings of well-being.  Mindfulness-Based Cognitive Therapy (MBCT) is a new psychotherapeutic treatment which has been shown to reduce depressive symptoms and to reduce the risk of depressive relapse.

At the core of mindfulness training is learning to change the way one thinks and feels about one’s experiences, especially stressful ones. By focusing on thoughts, feelings, and body sensations, mindfulness-based training teaches the individual to be more aware of his or her own experiences and better able to manage them.

Coping with Anxiety through Living Mindfully (CALM) Pregnancy is an intervention based on  MBCT which is specifically designed to address anxiety in pregnant women.  In a pilot study, researchers examined the feasibility, acceptability, and effectiveness of the CALM Pregnancy intervention in a group of 24 pregnant women with generalized anxiety disorder (GAD) or prominent symptoms of generalized anxiety.

23 of the 24 women completed the intervention with high attendance and good compliance with homework.  Completers showed statistically and clinically significant improvements in anxiety, worry, and depression, and significant increases in self-compassion and mindfulness. Of the 17 women who met GAD criteria at baseline, only one continued to meet criteria post-intervention.

Equally important is the fact that participants regarded their experience in the intervention to be overwhelmingly positive.  Future studies will test the effectiveness of the CALM Pregnancy intervention in a larger, randomized controlled trial.

Ruta Nonacs, MD PhD

Goodman JH, Guarino A, Chenausky K, Klein L, Prager J, Petersen R, Forget A, Freeman M.  CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety.  Arch Womens Ment Health. 2014 Oct;17(5):373-87.

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