Summary of Evidence on the Impact of Mindfulness Training on Anxiety Levels of Pregnant Women

Abstract

Background: Mental health during pregnancy is a global health problem, the percentage of pregnant women with antenatal anxiety or mood disorders ranges from 15% and 25%, with generalized anxiety disorder as the most common factor in the illness. Most of the research findings show a relationship between mothers’ psychological distress and poor prognosis for either the mother or the infant. Low well-being during pregnancy has significant adverse impacts on both mother and infant. Therefore, it is important to focus on antenatal anxiety and psychological stress in pregnant women. Mindfulness training, defined as an intentional and non-judgmental awareness of experience in the present moment, it is the most common intervention for antenatal education. Although the impact of positive thinking interventions on antenatal maternal well-being has been increasingly examined, the results still have not been systematically evaluated. Aim: This paper aims to systematically evaluate the effects of positive thinking interventions on evidence of antenatal anxiety in pregnant women and current research methods with a population of pregnant women by evaluating five studies of Randomized Controlled Trials (RCTs) using the CASP checklist tool. Summarize the implications of the evaluation results for future studies, and finally provide practical insights and research recommendations. Methods: Firstly, the research topic is identified: patient/problem: pregnancy anxiety; intervention: intervention in positive thinking; comparison: usual care. A complete internet-based search of five databases was conducted through Academic Search Complete, Medical Line, CINAHL, Health Source: Nursing/Academic Edition and Google Scholar to identify randomized controlled trials assessing positive thinking training versus postnatal depression controls. To select higher quality and relevant articles, the author rechecked titles and abstracts exclusion criteria and manually searched five peer-reviewed RCT articles from the last five years by further evaluating reference lists, while focusing on assessing interventions, measurement scale outcomes, study sample results, strengths and limitations. Secondly, randomized controlled trials were assessed using the CASP Randomized Controlled Trial Criteria Checklist. This version has now been updated to the 2020 Access Guide. Results: This paper provides a specific review of five RCT studies by using the CASP assessment tool, and concludes that positive thinking training shows potential benefits in terms of prenatal depression, anxiety and negative affect levels. From a comparison of the five intervention modalities of the positive thinking intervention, Mindfulness-integrated Cognitive Behavior Therapy (MICBT) had the broadest range of interventions and the most comprehensive curriculum. Most of the studies had small sample sizes of participants and an increase in sample size and longer follow-up time through comparative analysis would be beneficial to generalizability, therefore a sample size of 50 people on average between the intervention and control groups was chosen as appropriate, with a follow-up time of at least one month and three months. Also, the presence of potential bias was mentioned in these studies, by comparing randomized classification methods it was found that the smaller the base difference present through computer allocation and single-blind allocation, the less systematic bias there was. The choice of measurement instruments did not conflict with the sample size, the cultural background of the population and the findings. However, positive effects on anxiety and stress during pregnancy were less consistent with the assessment tool for the intervention group. Self-report instruments are highly sensitive and idiosyncratic, coupled with the tendency of participants to interact with researchers to produce bias. Therefore, when selecting a measurement tool, the best approach is to combine a self-report instrument with a researcher’s assessment. The literature highlights the increased interest in this area in recent years. Coupled with the prevalence of methodological issues and variation between studies, the current review is timely and necessary to determine intervention effects and best practice for future research. Findings: Mindfulness training is a useful intervention for improving anxiety and stress during pregnancy, but future research recommendations must follow robust methodological criteria with expanded sample sizes and longer follow-ups to examine the effects of positive thinking interventions during pregnancy.