(PS5-50) Prevention of Postpartum Anxiety in High-risk Women: A Proof-of-concept Randomized Clinical Trial

Introduction: Anxiety disorders are the leading mental health concern during the perinatal period (pregnancy and postpartum), and are associated with negative effects for the mother, infant, and their family. Intolerance of uncertainty (IU) during pregnancy has been identified as a significant risk factor for developing postpartum anxiety. Within non-perinatal populations, therapies targeting IU have demonstrated positive improvements in reducing anxiety symptoms, however it is unknown whether these therapies are helpful for pregnant individuals in preventing postpartum anxiety. The primary objective of this study is to assess whether a brief Cognitive Behavioural Therapy program targeting IU (CBT-IU) is effective in preventing postpartum anxiety disorders compared to treatment-as-usual (TAU).

Methods: Twelve pregnant (n = 12) participants exhibiting IU [defined as a score of ≥64 on the Intolerance of Uncertainty Scale (IUS; Furtado et al., 2021)] and without any current anxiety disorders were randomized to six sessions of individual CBT-IU (n = 7) or TAU (n = 5). Prevention of postpartum anxiety was defined as the absence of a DSM-5 anxiety disorder diagnosis at the postpartum time point. Given the length of symptom duration criteria for some anxiety disorders (e.g., 6-months for Generalized Anxiety Disorder), we utilized provisional diagnostic criteria (i.e., participants had to fulfil all other DSM-5 criteria to meet for a provisional postpartum diagnosis). Participants completed measures assessing IU (IUS), anxiety (Hamilton Anxiety Rating Scale, Generalized Anxiety Disorder 7-Item Scale), and worry (Penn State Worry Questionnaire) at baseline, post-treatment/6-weeks post-baseline, and 6-12 weeks postpartum. Participants in the treatment group also completed the Client Satisfaction Questionnaire at post-treatment.

Preliminary

Results: One participant in the TAU group discontinued participation following randomization. There were no significant differences between groups on all baseline measures. Two participants in the TAU group met criteria for a provisional diagnosis of Generalized Anxiety Disorder, while one participant in the CBT-IU group met criteria for Major Depressive Disorder, in partial remission postpartum. When compared with the TAU condition, participants in CBT-IU reported significantly greater reductions in anxiety and worry symptoms from baseline to postpartum. No time by group interactions were observed for IU symptoms specifically. All CBT-IU participants indicated that they were very satisfied with the services they received, that it helped them cope with their symptoms effectively, and that they would recommend it to a friend in similar need. Outcomes from an additional ~10-15 participants will be reported at the time of presentation.

Discussion: Although time by group interactions did not exist for IU specifically, it appears that participants engaging in CBT-IU developed skills to better manage anxiety and worry in the postpartum. This skill set may have contributed to the prevention of postpartum anxiety disorders in the CBT-IU group, however, preliminary results should be interpreted with caution due to the small sample size.