Hiệu quả của liệu pháp hành vi nhận thức qua internet cho cha mẹ sau khi mất trẻ trong thai kỳ: dữ liệu thử nghiệm từ một thử nghiệm ngẫu nhiên có đối chứng

Archives of Women's Mental Health - Tập 14 - Trang 465-477 - 2011
Anette Kersting1, Kristin Kroker2, Sarah Schlicht2, Katja Baust2, Birgit Wagner1
1Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany
2Department of Psychiatry, University of Muenster, Muenster, Germany

Tóm tắt

Sự mất mát của một đứa trẻ trong thời gian mang thai có thể là một sự kiện chấn thương, liên quan đến nỗi đau kéo dài và sự căng thẳng tâm lý. Nghiên cứu này đã xem xét tính hiệu quả của một chương trình liệu pháp hành vi nhận thức dựa trên internet cho các bà mẹ sau khi mất thai. Trong một thử nghiệm ngẫu nhiên có nhóm chứng chờ, 83 người tham gia đã mất trẻ trong thai kỳ được phân bổ ngẫu nhiên vào 5 tuần liệu pháp internet hoặc vào điều kiện chờ 5 tuần. Trong một chương trình điều trị hành vi nhận thức theo sách hướng dẫn, các tham gia viên đã viết mười bài luận về các chủ đề liên quan đến sự mất mát. Căng thẳng sau chấn thương, nỗi buồn, và tâm lý học tổng quát, đặc biệt là trầm cảm, đã được đánh giá trước và sau điều trị, cũng như trong lần theo dõi 3 tháng sau đó. Phân tích theo ý định điều trị và phân tích theo người hoàn thành đã được thực hiện. So với nhóm chứng, những người tham gia trong nhóm điều trị đã cho thấy sự cải thiện đáng kể về căng thẳng sau chấn thương, nỗi buồn, trầm cảm, và sức khỏe tâm thần tổng thể, nhưng không có cải thiện ở mức lo âu hay triệu chứng hóa. Kích thước hiệu ứng từ trung bình đến lớn đã được quan sát, và mức độ cải thiện đã được duy trì trong lần theo dõi 3 tháng. Chương trình liệu pháp hành vi nhận thức dựa trên internet này thể hiện một phương pháp điều trị hiệu quả với các hiệu ứng ổn định cho phụ nữ sau khi mất thai. Việc triển khai chương trình này do đó có thể giúp cải thiện cung cấp dịch vụ chăm sóc sức khỏe cho các bà mẹ trong tình huống mất mát chấn thương này.

Từ khóa

#mất trẻ trong thai kỳ #liệu pháp hành vi nhận thức #tâm lý học #căng thẳng sau chấn thương #trầm cảm

Tài liệu tham khảo

Andersson G (2009) Using the internet to provide cognitive behaviour therapy. Behav Res Ther 47:175–180 Andersson G, Cuijpers P (2009) Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther 38(4):196–205 Badenhorst W, Riches S, Turton P, Hughes P (2006) The psychological effects of stillbirth and neonatal death on fathers: systematic review. J Psychosom Obstet Gynaecol 27(4):245–256 Bergner A, Beyer R, Klapp BF, Rauchfuss M (2008) Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping. J Psychosom Obstet Gynaecol 29(2):105–113 Berth H, Puschmann AK, Dinkel A, Balck F (2008) Trauma Fehlgeburt: Einflussfaktoren auf das Angsterleben nach dem frühen Verlust eines Kindes [The trauma of miscarriage: factors influencing the experience of anxiety after early pregnancy loss]. Psychother Psychosom Med Psychol 59(8):314–320 Boelen PA, de Keijser J, van den Hout MA, van den Bout J (2007) Treatment of complicated grief: a comparison between cognitive behavioral therapy and supportive counseling. J Consult Clin Psychol 75:277–284 Bradley R, Greene J, Russ E, Dutra L, Westen D (2005) A multi-dimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 162:214–227 Brier N (2004) Anxiety after miscarriage: a review of the empirical literature and implications for clinical practice. Birth 31(2):138–142 Brier N (2008) Grief following miscarriage: a comprehensive review of the literature. J Womens Health (Larchmt) 17(3):451–464 Buchner A, Erdfelder E, Faul F (1997) How to use G*Power. http://www.psycho.uni-duesseldorf.de/aap/projects/gpower/how_to_use_gpower.html. Accessed 10 February 2010 Carter D, Misri S, Tomfohr L (2007) Psychologic aspects of early pregnancy loss. Clin Obstet Gynecol 50(1):154–165 Cohen J (1992) A power primer. Psychol Bull 112:155–159. doi:10.1037/0033-2909.112.1.155 Cougle JR, Reardon DC, Coleman PK (2003) Depression associated with abortion and childbirth: a long-term analysis of the NLSY cohort. Med Sci Monit 9(4):105–112 Derogatis LR (1993) Brief Symptom Inventory (BSI), administration, scoring, and procedures manual. National Computer Services, Minneapolis Dunlap WP, Cortina JM, Vaslo WJB, Burke MJ (1996) Meta-analysis of experiments with matched groups or repeated measures designs. Psychol Methods 1:170–177 Engelhard IM, van den Hout MA, Arntz A (2001) Posttraumatic stress disorder after pregnancy loss. Gen Hosp Psychiatry 23(2):62–66 First MB, Spitzer RL, Williams JB, Gibbon M (1997) Structured clinical interview for DSM-IV clinical version (SCID-I/CV). American Psychiatric Association, Washington DC Foa EB, Jaycox LH (1999) Cognitive-behavioral theory and treatment of posttraumatic stress disorder. In: Spiegel D (ed) Efficacy and cost effectiveness of psychotherapy. Amercian Psychiatric Press, Washington DC, pp 23–61 Geller PA, Kerns D, Klier CM (2004) Anxiety following miscarriage and the subsequent pregnancy: a review of the literature and future directions. J Psychosom Res 56(1):35–45 Geller PA, Psaros C, Kerns D (2006) Web-based resources for health care providers and women following pregnancy loss. J Obstet Gynecol Neonatal Nurs 35(4):523–532 Geller PA, Psaros C, Kornfield SL (2010) Satisfaction with pregnancy loss aftercare: are women getting what they want? Arch Womens Ment Health 13(2):111–124 Gold KJ, Dalton VK, Schwenk TL (2007) Hospital care for parents after perinatal death. Obstet Gynecol 109(5):1156–1166 Horowitz MJ, Wilner NR, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218 Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19 Johnson MP, Baker SR (2004) Implications of coping repertoire as predictors of men’s stress, anxiety and depression following pregnancy, childbirth and miscarriage: a longitudinal study. J Psychosom Obstet Gynaecol 25(2):87–98 Kersting A, Dorsch M, Kreulich C, Reutemann M, Ohrmann P, Baez E, Arolt V (2005) Trauma and grief 2–7 years after termination of pregnancy because of fetal anomalies: a pilot study. J Psychosom Obstet Gynecol 26(1):9–14 Kersting A, Kroker K, Steinhard J, Lüdorff K, Wesselmann U, Ohrmann P, Arolt V, Suslow T (2007) Complicated grief after traumatic loss: a 14-month follow up study. Eur Arch Psychiatry Clin Neurosci 257(8):437–443 Kersting A, Kroker K, Steinhard J, Hoernig-Franz I, Wesselmann U, Lüdorff K, Ohrmann P, Arolt V, Suslow T (2009a) Psychological impact on women after second and third trimester termination of pregnancy due to fetal anomalies versus women after preterm birth—a 14-month follow-up study. Arch Womens Ment Health 12(4):193–201 Kersting A, Schlicht S, Kroker K (2009b) [Internet therapy. Opportunities and boundaries]. Nervenarzt 80(7):797–804, article in German Kersting A, Kroker K, Schlicht S, Wagner B (2011) Internet-based treatment after pregnancy loss: concept and case study. J Psychosom Obstet Gynaecol 32(2):72–78 Klier CM, Geller PA, Neugebauer R (2000) Minor depressive disorder in the context of miscarriage. J Affect Disord 59(1):13–21 Klier CM, Geller PA, Ritsher JB (2002) Affective disorders in the aftermath of miscarriage: a comprehensive review. Arch Womens Ment Health 5(4):129–149 Knaevelsrud C, Maercker A (2007) Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled trial. BMC Psychiatry 7:13 Korenromp MJ, Page-Christiaens GC, van den Bout J, Mulder EJ, Hunfeld JA, Potters CM, Erwich JJ, van Binsbergen CJ, Brons JT, Beekhuis JR, Omtzigt AW, Visser GH (2007) A prospective study on parental coping 4 months after termination of pregnancy for fetal anomalies. Prenat Diagn 27(8):709–716 Korenromp MJ, Page-Christiaens GC, van den Bout J, Mulder EJ, Visser GH (2009) Adjustment to termination of pregnancy for fetal anomaly: a longitudinal study in women at 4, 8, and 16 months. Am J Obstet Gynecol 201(2):160.e1–160.e7 Kramer PRL, Jarve RK, Yaron YK (1998) Determinants of parental decision after prenatal diagnosis of Down syndrome. Am J Med Genet 79:172–174 Lange A, Schrieken B, Blankers M, van de Ven J-P, Slot M (2000a) [Construction and validation of the screening device for psychotic disorder]. Dir Ther 20:162–173, Netherlands Lange A, Schrieken B, van de Ven J, Bredeweg B, Emmelkamp PMG, van der Kolk J et al (2000b) Interapy: the effects of a short protocolled treatment of posttraumatic stress and pathological grief through the internet. Behav Cogn Psychother 28:175–192 Lange A, Rietdijk D, Hudcovicova M, van de Ven J, Schrieken B, Emmelkamp PMG (2003) Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. J Consult Clin Psychol 71:901–909 Litz B, Engel C, Bryant R, Papa A (2007) A randomized, controlled proof-of-concept trial of an internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. Am J Psychiatry 164:1676–1683 Mansfield C, Hopfer S, Mareau TM (1999) Termination rates after prenatal diagnosis of Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes: a systematic literature review. European Concerted Action: DADA (decision-making after the diagnosis of a fetal abnormality). Prenat Diagn 19:808–812 Neal LA, Walter B, Rollins J, Herepath R, Strike P, Turnbull G (1994) Convergent validity of measures of post-traumatic stress disorder in a mixed military and civilian population. J Trauma Stress 7:447–455 Neugebauer R, Kline J, Shrout P, Skodol A, O’Connor P, Geller P, Stein Z, Susser M (1997) Major depressive disorder in the 6 months after miscarriage. JAMA 277:383–388 Neugebauer R, Kline J, Bleiberg K, Baxi L, Markowitz JC, Rosing M, Levin B, Keith J (2007) Preliminary open trial of interpersonal counseling for subsyndromal depression following miscarriage. Depress Anxiety 24(3):219–222 Nijenhuis ERS, Spinhoven P, van Dyck R, van der Hart O, Vanderlinden J (1997) The development of the Somatoform Dissociation Questionnaire (SDQ-5) as a screening instrument for dissociative disorders. Acta Psychiatr Scand 96:311–318 Nikcevic AV, Kuczmierczyk AR, Nicolaides KH (2007) The influence of medical and psychological interventions on women’s distress after miscarriage. J Psychosom Res 63:283–290 Prigerson HG, Maciejewski PK, Reynolds CF, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M (1995) Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 59(1–2):65–79 Puddifoot JE, Johnson MP (1997) The legitimacy of grieving: the partner’s experience at miscarriage. Soc Sci Med 45(6):837–845 Shear K, Frank E, Houck PR, Reynolds CF III (2005) Treatment of complicated grief: a randomized controlled trial. JAMA 293:2601–2608 Sundin EC, Horowitz MJ (2002) Impact of Event Scale: psychometric properties. Br J Psychiatry 180:205–209 Swanson KM, Chen HT, Graham JC, Wojnar DM, Petras A (2009) Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions. J Womens Health (Larchmt) 18(8):1245–1257 Turton P, Hughes P, Evans CDH, Fainman D (2001) Incidents, correlates and predictors of posttraumatic stress disorder in the pregnancy after stillbirth. Br J Psychiatry 178:556–560 van der Houwen K, Schut H, van den Bout J, Stroebe M, Stroebe W (2010) The efficacy of a brief internet-based self-help intervention for the bereaved. Behav Res Ther 48(5):359–367 Vance JC, Boyle FM, Najman JM, Thearle MJ (1995) Gender differences in parental psychological distress following perinatal death of sudden infant death syndrome. Brit J Psychiatr 167:806–811 Wagner B, Maercker A (2007) A 1.5-year follow-up of an internet-based intervention for complicated grief. J Trauma Stress 20(4):625–629 Wagner B, Maercker A (2008) An internet-based preventive intervention (CBT) for complicated grief: a pilot study. Psicologia Applicata alla Medicina del Lavoro e della Riabilitazione 30:B43–B47 Wagner B, Knaevelsrud C, Maercker A (2005) Complicated grief and internet-based treatment for complicated grief: concepts and case study. J of Loss and Trauma 10:1–24 Wagner B, Knaevelsrud C, Maercker A (2006) Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Stud 30(5):429–453 Wittouck C, Van Autreve S, De Jaegere E, Portzky G, van Heeringen K (2011) The prevention and treatment of complicated grief: a meta-analysis. Clin Psychol Rev 1:69–78