Cognitive Behavioral Stress Management Effects on Prenatal Anxiety Among Low-Income Women

Objective: Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety. Method: A sample of 100 primarily ethnic and racial minority pregnant women with subclinical anxiety (74% Latina, 18% Black; M (age) = 26.5) were randomized to an 8-week cognitive behavioral stress management (CBSM) intervention (n = 55), or to an attentional control condition (n = 45). Two forms of anxiety (state and pregnancy-specific) were measured at baseline, post-treatment, and at follow-up in the postpartum using the State-Trait Personality Inventory-State and the Pregnancy Related Anxiety scale, respectively. Intent-to-treat (ITT) and completer analyses were conducted using linear mixed models to test mean differences in both forms of anxiety by group assignment and by intervention completion (<7 vs. >= 7 sessions) at post-treatment and follow-up timepoints. Results: ITT results revealed no intervention Group x Time interactions for state, F(3, 356) = .51, p = .68, or pregnancy-specific anxiety, F(2, 184.39) = .75, p = .47, indicating no intervention effect post-treatment or at follow-up. Completer analyses showed that women who received all intervention content (34.5%) had significantly less state anxiety at post-treatment compared to women who had not completed the intervention, (65.5%; M (sessions) = 3.62); F(6, 270.67) = 2.35, p = .03, and those in the control condition. Conclusions: While we did not find support for the use of CBSM to treat prenatal anxiety among low-income women, those who received a full dose benefited in state anxiety immediately postintervention. What is the public health significance of this article? This study suggests that cognitive behavioral stress management as a treatment for subclinical anxiety among Latinas and Black women may be efficacious, but only if all sessions are attended. Research examining the impact of dosage and strategies to improve adherence may be a meaningful future direction to improve treatments for ethnic and racial minority women with prenatal anxiety.