The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review.

BACKGROUND: The Fear of Childbirth (FOC) is regarded as a general problem, which affects women's health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies. OBJECTIVE: This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers. METHODS: In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021. RESULTS: After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly. CONCLUSION: According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth.

Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials.

BACKGROUND: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. METHODS: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. FINDINGS: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. INTERPRETATION: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. FUNDING: Swiss National Science Foundation.

Investigating the Efficacy of Theta Binaural Beat on the Absolute Power of Theta Activity in Primary Insomniacs.

Introduction: The brain waves pattern in primary insomniacs is different from healthy subjects. Studies have shown that binaural beats can alter the pattern of brain waves in healthy individuals; however, the efficacy of binaural beats in altering the pattern of brain waves in primary insomniacs has not yet been investigated. This study aims to evaluate the efficacy of theta binaural beat on the absolute power of theta activity in primary insomniacs. Methods: This study was a randomized clinical trial with experimental and control groups. The primary insomniacs received theta binaural beats in the experimental group while the control group received white noise. Their brain waves were recorded by electroencephalogram for 25 min; the first 5 min was without stimulus (first block), the next was followed by 15 min of receiving stimulus (binaural beat or white noise), and the last 5 min without stimulus (fifth block). The Matlab software, version R2019a, EEGLAB toolbox, and SPSS software, version 24 were used to analyze the data. Results: The absolute power of theta activity in the experimental group was significantly higher in the last block compared to the first block in all brain lobes (P<0.05). The largest changes in theta activity were in the temporal and parietal lobes, and the last one was in the prefrontal lobe. In the control group, none of the brain lobes showed significant differences in the last block compared to the first block. Conclusion: Theta binaural beat can alter the absolute power of theta activity in primary insomniacs. The implications of the study are discussed. Highlights: Theta binaural beat can be effective in changing the brain wave pattern of primary insomniacs.The amount of changes in the absolute power of theta wave activity in different brain regions of primary insomniacs under the influence of theta binaural beat was not the same.The effect of theta binaural beat on temporal and parietal was higher than other brain areas, whereas the prefrontal and occipital had the least significant changes in the absolute power of theta activity. Plain Language Summary: Different people experience different brain waves based on the type of activity they do in their life at the same time. This brain wave pattern can change especially after a person decides to go to bed and experience an ideal sleep. Theta brain wave, which plays a role in important activities such as memory, deep relaxation, and day-dreaming, helps a person to change from wakefulness to sleep faster. Research literature has shown that people with insomnia have different brain waves than healthy people, especially in the theta brain wave. Accordingly, many interventions have been carried out to improve the sleep quality of these people and change their brain waves. It has been shown that binaural beat as a low-cost method based on sound waves, can change the brain waves of healthy people, but so far, no study has been done to investigate the effect of these sound waves (especially theta waves) on the brain waves of people with insomnia. The current study was conducted with the aim of investigating a non-invasive method (theta binaural beat) to improve the brain wave pattern of people suffering from insomnia. The findings of this study showed that theta binaural beat can be effective in changing the brain wave pattern of people suffering from insomnia.

Investigating the Relationship between Self-Compassion and Body Image with Postpartum Depression in Women Referring to Health Centres in Iran.

Background: Depression is the most important postpartum mental disorder that can lead to irreversible damage to family health if not addressed, including inability to provide maternal care, impaired mother-child relationship, impaired growth, and development of the child, to marital problems, and sometimes the risk of suicide and infant death. The aim of this study was to investigate the relationship between self-compassion and body image with postpartum depression. Material and Method: In this study, 150 pregnant women in the third trimester and 6 weeks postpartum completed the Short Form Self-Compassion Questionnaire (SCS-SF), Multidimensional Self-Body Relationships (MBSRQ), and Edinburgh Postpartum Depression Inventory (EPDS). Depending on the type of study, descriptive statistics such as mean, median, and standard deviation were calculated for quantitative, frequency, and relative frequency variables. Kolmogorov-Smirnov test was used to evaluate the normality of the distribution of scores in each questionnaire. Data were analyzed using parametric proportional statistical tests (paired t-test, Pearson correlation, and linear regression) at the level of significance less than 0.05. Results: Based on the findings, the relationship between self-compassion and postpartum depression was not significant. Self-kindness had a significant positive relationship, and self-judgement had a significant negative relationship with depression (p < 0.01). Body image had a significant predictive effect on postpartum depression (p < 0.05). Conclusions: Negative body image as a risk factor for postpartum depression should be considered by healthcare providers and used in the prevention and treatment of postpartum depression.

Effectiveness of acceptance and commitment therapy upon distress, emotion regulation, and self-compassion in patients with cardiovascular disease: a randomized clinical trial.

INTRODUCTION: Cardiovascular patients experience various psychological problems due to the conditions caused by their disease, which make it worse if left untreated. OBJECTIVE: The purpose of the current study was to evaluate the effects of acceptance and commitment therapy on distress, emotion regulation, and self-compassion in patients with cardiovascular disease. METHODS: This study was a randomized clinical trial with pre-test, post-test and two-month and four-month follow-up periods accompanying a control group. At four stages, patients filled out questionnaires on depression, anxiety, stress (DASS-21), emotion regulation (ERQ), and self-compassion (SCS). The experimental group underwent a treatment protocol based on acceptance and commitment therapy. Data were then analyzed using SPSS-25 with repeated measures analysis of variance. RESULTS: Act significantly reduced depression, anxiety, and stress, enhanced self-compassion, and improved emotion regulation in cardiac patients. Between-subjects (Group) partial etas for depression, anxiety, stress, reappraisal, suppression, and self-compassion were 0.61, 0.64, 0.66, 0.62, 0.66, and 0.65, respectively. Treatment efficacy was maintained during the 2- and 6-month follow-up visits. CONCLUSION: The results of this study suggest that treating cardiac patients' psychological problems in a way focused on acceptance and commitment therapy may have an impact on how well they respond to their treatment.

Qualitative Exploration of the Needs of Pregnant Women to Manage the Fear of Childbirth.

Background: Some women experience the Fear of Childbirth (FOC) during pregnancy, labor, and birth which can have consequences for their health and well-being. To provide the right conditions for having a positive experience of childbirth, the needs of pregnant women must be correctly recognized. The present study was conducted with the aim of investigating the needs of women in managing the FOC with a qualitative design. Materials and Methods: This qualitative study was conducted using conventional content analysis from January to November 2021. To this aim, 15 pregnant women, 21 healthcare providers, and four maternal health policymakers were purposefully selected from Kermanshah health centers, with maximum diversity. Data were collected through in-depth semi-structured interviews. Data accuracy was guaranteed using Lincoln and Guba criteria. The MAXQDA software was used for data analysis. Results: From the analysis of the data obtained from the interviews, three main categories emerged concerning the needs of mothers to properly manage the FOC: "need to provide awareness and empowerment of mother and family," and "the need to pay attention to the mental health of pregnant women," and "supporting needs (seeking support)." Conclusions: Identifying and paying attention to woman's needs in the areas of education, mental health, and support can help them manage crisis-ridden situations, including the FOC. In response to the needs of mothers to empower them in managing the FOC, it is recommended to formulate special guidelines in this field.

Social Capital of Parents of Children and Adolescents and Its Relation to Psychiatric Disorders; A Population-Based Study.

Social capital is a complex concept that is considered an effective factor in the development of societies. Considering the importance of burdens of psychiatric disorders in Iran, we studied the relationship between various dimensions of social capital of parents of children and adolescents and psychiatric disorders among them. In this cross-sectional study, 18,940 parents of children and adolescents aged 6 to 18 years old were randomly selected from all provinces of Iran and were evaluated by the Millon clinical multiaxial inventory-III (MCMI-III) and a modified version of Nahapiet and Ghoshal questionnaire. MCMI-III was designed as a self-report tool for investigating psychiatric clinical disorders and personality traits in the general population. Modified Nahapiet and ghoshal questionnaire has 20 items and measures four components of social capital included trust, values, communication, and collaboration. Validity and reliability of both questionnaires have been approved in Iran. In the regression model, the relationship between social capital components and clinical and sever clinical syndromes, in the form of regression weight and standard weight for trust was - 0.558 and - 0.062 with p value less than 0.0001, and for values was - 0.466 and - 0.057, respectively, with p value less than 0.0001. There was a reverse correlation between social capital components of parents of children and adolescents and psychiatric disorders in Iran. In regression statistical models, the two components of values and trust were negative predictors of psychiatric disorders. Considering the high prevalence of psychiatric disorders in Iran, it seems that the strengthening of cognitive and structural aspects of social capital of parents of children and adolescents is one of the effective factors in reducing the prevalence of these disorders among them.

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents.

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p= 5.4, 95% CI = 5.1-5.7) and encopresis (p= 0.13, 95% CI = 0.09-0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95% CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95% CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders.

The Effect of Cognitive-Behavioral Counseling on Lifestyle in Pregnant Women: A Randomized Controlled Clinical Trial.

The lifestyle of pregnant women has a close relationship with maternal and fetal health. In pregnant women, health-promoting behaviors lead to the promotion of quality of life and improvement of pregnancy outcomes. Therefore, the present study aimed to determine the effect of cognitive-behavioral counseling on pregnant women's lifestyle. This randomized controlled clinical trial study was performed in the health centers of Sanandaj, Iran. Seventy pregnant women were randomly assigned to intervention (n = 35) and control (n = 35) groups. The study was completed with 33 pregnant women in each group. In addition to routine pregnancy care, the control group received, the intervention group received 8 consecutive 60-90-minute counseling sessions with a cognitive-behavioral approach weekly. The Walker Health Promotion Lifestyle Questionnaire was completed before, immediately, and one month after the intervention by the participants of control and intervention groups. Data were collected from February until June 2017. Data were analyzed using SPSS version 16. The mean score of lifestyle in the intervention and control group was 139.78 ± 21.71 and 142.63 ± 19.12 before the intervention, which reached 151 ± 17.72 and 159.14 ± 14.77, respectively, after the intervention. The difference was significant in the intervention group (P = 0.001) but not in the control group (P = 0.619). Also, the mean scores of the two groups were not significantly different before intervention (P = 0.574), but this difference was statistically significant after the intervention (P = 0.029) and one month after the intervention (P = 0.001). Based on the results of this study, cognitive-behavioral counseling improves the lifestyle of pregnant women. Therefore, it is suggested that this type of counseling be used along with other services to improve the lifestyle of pregnant women in health care centers.

The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial.

OBJECTIVE: Acceptance and commitment therapy has been used to treat anxiety disorders recently. The purpose of this study was to investigate the effectiveness of acceptance and commitment therapy for psychological symptoms in students with social anxiety disorder, including difficulty in emotion regulation, psychological flexibility based on experiential avoidance, self-compassion, and external shame. METHODS: This study was a semi-experimental clinical trial. Twenty four students with social anxiety disorder were randomly divided into two groups after initial evaluations: an experimental group (12 subjects) and a control group (12 subjects). The experimental group received 12 treatment sessions based on a protocol of acceptance and commitment therapy for anxiety disorders, and the control group was put on a waiting list. Self-Compassion (SCS), Difficulty in Emotion Regulation (DERS), External Shame (ESS), Social Anxiety (SPIN), and Acceptance and Action (AAQ-II) questionnaires were used to assess participants. Data were analyzed using SPSS. RESULTS: Acceptance and commitment therapy was shown to be effective at the post-test and follow up stages for reducing external shame, social anxiety, and difficulty in emotion regulation and its components, and for increasing psychological flexibility and self-compassion (p < 0.05). The largest effect size of treatment was for increase of psychological flexibility and the lowest efficacy was for the components "difficulty in impulse control" and "limited access to emotional strategies" at the post-test and follow-up stages, respectively. CONCLUSION: Acceptance and commitment therapy may be an appropriate psychological intervention for reducing the symptoms of students with social anxiety disorder and helping them to improve psychological flexibility. Emotion and related problems can be identified as one of the main targets of this treatment. CLINICAL TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT20180421039369N1.

The effectiveness of acceptance and commitment therapy for social anxiety disorder: a randomized clinical trial

Abstract Objective Acceptance and commitment therapy has been used to treat anxiety disorders recently. The purpose of this study was to investigate the effectiveness of acceptance and commitment therapy for psychological symptoms in students with social anxiety disorder, including difficulty in emotion regulation, psychological flexibility based on experiential avoidance, self-compassion, and external shame. Methods This study was a semi-experimental clinical trial. Twenty four students with social anxiety disorder were randomly divided into two groups after initial evaluations: an experimental group (12 subjects) and a control group (12 subjects). The experimental group received 12 treatment sessions based on a protocol of acceptance and commitment therapy for anxiety disorders, and the control group was put on a waiting list. Self-Compassion (SCS), Difficulty in Emotion Regulation (DERS), External Shame (ESS), Social Anxiety (SPIN), and Acceptance and Action (AAQ-II) questionnaires were used to assess participants. Data were analyzed using SPSS. Results Acceptance and commitment therapy was shown to be effective at the post-test and follow up stages for reducing external shame, social anxiety, and difficulty in emotion regulation and its components, and for increasing psychological flexibility and self-compassion (p < 0.05). The largest effect size of treatment was for increase of psychological flexibility and the lowest efficacy was for the components "difficulty in impulse control" and "limited access to emotional strategies" at the post-test and follow-up stages, respectively. Conclusion Acceptance and commitment therapy may be an appropriate psychological intervention for reducing the symptoms of students with social anxiety disorder and helping them to improve psychological flexibility. Emotion and related problems can be identified as one of the main targets of this treatment. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT20180421039369N1.

Factorial Structure and Construct Validity of an Iranian Version of the Fear of Compassion Scale: A Study in Nurses.

BACKGROUNDS: Fear of compassion is one of the psychological variables in the nursing profession that can be a barrier to providing appropriate services to patients. This research was done in order to assess psychometric properties, construct validity, reliability of fear of compassion scales and to introduce suitable measures for experts and researchers in the healthcare-related fields. MATERIALS AND METHODS: In this study, 216 nurses (117 males and 99 females) were chosen with a multistage cluster sampling method between June 2016 and Feb 2017. Lisrel-8 and SSPS-18 were used for data analysis. The construct validity of the fear of compassion scales was assessed using confirmatory factor analysis. To assess the divergent and convergent validity of the fear of compassion scales, the compassion for others, depression, anxiety, stress, burnout, and cognitive emotion regulation questionnaires were used. RESULTS: The results of confirmatory factor analysis showed that the single-factor model of fear of compassion scales (for others, from others, and for self) is a better fit to the data. Furthermore, these three scales had a positive and significant correlation with anxiety, depression, stress, burnout, and unhealthy cognitive-emotion regulation strategies, and negative and significant correlation with compassion for others and healthy cognitive-emotion regulation strategies. In addition, the Cronbach's alpha coefficient for fear of expressing compassion to others was 0.85, and 0.95 and 0.96 for fear of responding to compassion from others and fear of self-compassion, respectively. CONCLUSIONS: This study provides additional evidence for the psychometric properties of fear of compassion scales in Iranian nurses.

Effectiveness of Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing in Child Victims of Domestic Violence.

Objective: This study was conducted to examine and compare the effectiveness of cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) in child victims of domestic violence (child physical abuse and/or witnessing parents' conflicts). Method : A total of 139 girls and boys, aged 8-12 years, were randomly assigned into CBT (n = 40), EMDR (n = 40), or control groups (n=59). All children received up to 12 individual treatment sessions over 4-12 weeks. Blind assessment was done before and 2 weeks after the treatment and on a variety of teacher-parent-rated and self-report measures of posttraumatic symptomatology, depression, anxiety, and behavior problems. Results: CBT and EMDR were effective in ameliorating psychological sequelae of victims of domestic violence on the measured variables (p =.001). Comparison of the treatment and control groups suggested moderate to high practical significance in treatment groups vs controls. Conclusion: Both CBT and EMDR can help children to greatly recover from the outcomes of domestic violence in comparison with control group. Moreover, structured trauma treatments are strongly recommended and can be used for children.

The prevalence, comorbidity and socio-demographic factors of depressive disorder among Iranian children and adolescents: To identify the main predictors of depression.

BACKGROUND: Depressive disorders are a major public health problem in developed and developing countries. Recently, several risk factors have been described for depressive disorders in children and adolescents. The aim of the present study was to identify the main risk factors that can affect the incidence of depression in Iranian children and adolescents. METHODS: A total of 30,546 children and adolescents (between 6 and 18 years of age) participated in a cross-sectional study to identify the predictors of depressive disorders. Depressive disorders were assessed using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). In addition, a demographic characteristics questionnaire was completed by parents of the participants. The data was analyzed using the SPSS22 software via performing the descriptive analysis and the multiple logistic regression analysis methods. P-values less than 0.05 were considered statistically significant. RESULTS: Results showed that a higher age (15-18), being female, and the father's unemployment were associated with an increased odds ratio for depressive disorders. The age of 10-14 (OR = 2.1; 95% CI, 1.57-2.81), the age of 15-18 (OR = 4.44; 95% CI, 3.38-5.83), female gender (OR = 1.44; 95% CI, 1.2-1.73) and the father's unemployment (OR = 1.59; 95% CI, 1.01-2.5) were significant positive predictors, whereas, the mother's job (as a housewife) (OR = 0.66; 95% CI, 0.45-0.96) and a history of psychiatric hospitalization of the father and mother (OR = 0.34; 95% CI, 0.15-0.78 and OR = 0.34; 95% CI, 0.14-0.84) were negative predictors for depressive symptoms. CONCLUSION: Depressive symptoms are common in children and adolescents and are correlated with age and gender. The assessment of the prevalence of psychiatric disorders, especially the depressive disorders and their comorbidities, may help to prevent mood disorders in children and adolescents.