CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety

“1990) or ≥10 on the GAD-7 (Spitzer et al. 2006), (e) no greater than moderate level of depression as determined by a score of <15 on the Patient Health Questionnaire-9 (PHQ-9; Kroenke et al.”

“Anxiety disorders are the most common of all psychiatric conditions (Kessler et al. 2005) and are up to twice as common among women as men (Kessler et al.”

“The Mindfulness Attention Awareness Scale (MAAS; Brown and Ryan 2003) is a 15-item scale purported to measure dispositional mindfulness, with higher scores indicating higher mindfulness levels.”

“Nearly one in three women will experience an anxiety disorder during her lifetime, often with a chronic or recurrent course (Kessler et al. 1994).”

“Clinical significance at post-intervention was operationalized by the recommended reliable change index and cut-off points (Jacobson and Truax 1991; Vollestad et al. 2011) for the BAI, BDI-II, and PSWQ (see Table 1).”

“…suggesting that self-compassion may be a particularly important component in mindfulness-based treatments and that it is significantly correlated with less anxiety and depression and overall greater psychological health (Davis and Hayes 2011; Neff 2003; Kuyken et al. 2010; van Dam et al. 2011).”

“The Penn StateWorryQuestionnaire (PSWQ;Meyer et al. 1990) is a widely used 16-item self-report questionnaire Recruitment and”

“2011); however, anxiety also occurs without depression, and many women may experience more than one anxiety disorder concurrently (Kroenke et al. 2007).”

“…symptoms in patients with anxiety disorders (Arch et al. 2013; Kabat-Zinn et al. 1992; Miller et al. 1995; Vollestad et al. 2011) and a meta-analytic review indicated that MBIs were associated with large effect sizes for improving anxiety in patients with anxiety disorders (Hofmann et al. 2010).”

“The MINI has demonstrated concurrent validity with the much longer Structured Clinical Interview for DSM Diagnoses (Sheehan et al. 1997) as well as with the Composite International Diagnostic Interview for ICD-10 (Lecrubier et al. 1997).”

“Mindfulness-based interventions (MBIs) offer a promising development for the treatment of anxiety, with numerous studies demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Gr…”

“…symptoms and/or PSWQ ≥45 indicating elevated worry symptoms and/or met criteria for GAD as determined by the MINI International Neuropsychiatric Interview (MINI; Sheehan et al. 1997), and (b) willing and able to participate in at least seven of the eight CALM Pregnancy intervention sessions.”

“Mindfulness-based interventions (MBIs) offer a promising development for the treatment of anxiety, with numerous studies demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Gr…”

“Intensive training in mindfulness meditation via MBSR or MBCT may reduce anxiety and associated symptoms in patients with anxiety disorders (Arch et al. 2013; Kabat-Zinn et al. 1992; Miller et al. 1995; Vollestad et al. 2011) and a meta-analytic review indicated that MBIs were associated with large effect sizes for im…”

“…demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Grossman et al. 2004; Hofmann et al. 2010; Keng et al. 2011; Khoury et al. 2013; Toneatto and…”

“Mindfulness-based interventions (MBIs) offer a promising development for the treatment of anxiety, with numerous studies demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Gr…”

“Several studies indicate rates of anxiety symptomsmay be higher during pregnancy than in the postpartum period (Evans et al. 2001; Goodman and TyerViola 2010; Heron et al. 2004; Lee et al. 2007) and may be more common during pregnancy than depression (Lee et al. 2007).”

“Maternal anxiety during pregnancy is associated with negative consequences for mothers and children, including increased pregnancy-related symptoms (e.g., nausea and vomiting), higher alcohol and tobacco use, greater number of medical visits, obstetric complications, shorter fetal gestation, compromised fetal neurodev…”

“…Forget MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA 02129, USA e-mail: jgoodman@mghihp.edu M. Freeman Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (Andersson et al. 2006; Faisal-Cury and Menezes 2007; Lee et al. 2007; Heron et al. 2004).”

“…meditation via MBSR or MBCT may reduce anxiety and associated symptoms in patients with anxiety disorders (Arch et al. 2013; Kabat-Zinn et al. 1992; Miller et al. 1995; Vollestad et al. 2011) and a meta-analytic review indicated that MBIs were associated with large effect sizes for improving…”

“2005) and are up to twice as common among women as men (Kessler et al. 1994, 2005; Somers et al. 2006).”

“As women move from pregnancy into the postpartum stage and beyond, consolidation and adaptation ofmindfulness practices in the context of mothering is important (Bogels et al. 2010; Duncan et al. 2009), and may well benefit from continued support and further learning.”

“(4) Individuals with GAD have difficulty in regulating their emotions, as shown by greater negative reactivity to and poorer understanding of emotions (Mennin et al. 2005; Tull et al. 2009).”

“…medical visits, obstetric complications, shorter fetal gestation, compromised fetal neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley…”

“The PHQ has been validated for use in pregnant populations (Spitzer et al. 2000).”

“…suggesting that self-compassion may be a particularly important component in mindfulness-based treatments and that it is significantly correlated with less anxiety and depression and overall greater psychological health (Davis and Hayes 2011; Neff 2003; Kuyken et al. 2010; van Dam et al. 2011).”

“The PSWQ has been reported to discriminate patients with GAD from community controls and patients with other anxiety disorders (Brown et al. 1992) and has demonstrated sensitivity to change across both 6-week and 12-week therapeutic interventions for GAD (Borkovec and Costello 1993).”

“Mindfulness-based interventions (MBIs) offer a promising development for the treatment of anxiety, with numerous studies demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Gr…”

“The PSWQ has been reported to discriminate patients with GAD from community controls and patients with other anxiety disorders (Brown et al. 1992) and has demonstrated sensitivity to change across both 6-week and 12-week therapeutic interventions for GAD (Borkovec and Costello 1993).”

“Transdiagnostic treatments for anxiety and other emotional disorders have gained increased attention and empirical study in recent years (Farchione et al. 2012; Norton and Barrera 2012; Wilamowska et al. 2010).”

“…Forget MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA 02129, USA e-mail: jgoodman@mghihp.edu M. Freeman Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (Andersson et al. 2006; Faisal-Cury and Menezes 2007; Lee et al. 2007; Heron et al. 2004).”

“…demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Grossman et al. 2004; Hofmann et al. 2010; Keng et al. 2011; Khoury et al. 2013; Toneatto and…”

“It is not surprising therefore that anxiety disorders are common during pregnancy (Ross and McLean 2006).”

“…suggesting that self-compassion may be a particularly important component in mindfulness-based treatments and that it is significantly correlated with less anxiety and depression and overall greater psychological health (Davis and Hayes 2011; Neff 2003; Kuyken et al. 2010; van Dam et al. 2011).”

“2009), GAD (Craigie et al. 2008; Evans et al. 2008; Hoge et al. 2013; Majid et al. 2010), and in social anxiety disorder (Koszycki et al.”

“(3) The nature of worry in GAD is future directed and therefore training in presentfocused mindful awareness may provide a useful alternative way of responding for individuals with GAD (Roemer and Orsillo 2002).”

“Notably, pregnant women are reluctant to take medication due to potential risks to the developing fetus (Goodman 2009).”

“2009), GAD (Craigie et al. 2008; Evans et al. 2008; Hoge et al. 2013; Majid et al. 2010), and in social anxiety disorder (Koszycki et al.”

“The intervention is further informed by the general literature regarding conceptualizations of GAD (e.g., Behar et al. 2009; Garfinkle and Behar 2012; Roemer and Orsillo 2002) and from consultation with experts in the areas of MBIs, CBT, and interventions with pregnant women.”

“…and Germer (2012) regarding self-compassion, Roemer and Orsillo’s mindfulness/acceptance-based approach to the treatment of GAD (Hayes-Skelton et al. 2013; Roemer et al. 2008; Treanor et al. 2011; Orsillo and Roemer 2011), and Bardacke’s (2012) application of MBSR to preparation for childbirth.”

“Three small studies have demonstrated that MBIs are effective in reducing stress, anxiety, depressive symptoms, and emotional distress during pregnancy in healthy, non-clinical populations (Duncan and Bardacke 2010; Dunn et al. 2012; Vieten and Astin 2008a, b).”

“…shorter fetal gestation, compromised fetal neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley et al. 2005; Swallow et al. 2004;…”

“Clinical significance at post-intervention was operationalized by the recommended reliable change index and cut-off points (Jacobson and Truax 1991; Vollestad et al. 2011) for the BAI, BDI-II, and PSWQ (see Table 1).”

“Three small studies have demonstrated that MBIs are effective in reducing stress, anxiety, depressive symptoms, and emotional distress during pregnancy in healthy, non-clinical populations (Duncan and Bardacke 2010; Dunn et al. 2012; Vieten and Astin 2008a, b).”

“…Forget MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA 02129, USA e-mail: jgoodman@mghihp.edu M. Freeman Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (Andersson et al. 2006; Faisal-Cury and Menezes 2007; Lee et al. 2007; Heron et al. 2004).”

“As women move from pregnancy into the postpartum stage and beyond, consolidation and adaptation ofmindfulness practices in the context of mothering is important (Bogels et al. 2010; Duncan et al. 2009), and may well benefit from continued support and further learning.”

“2010), and in social anxiety disorder (Koszycki et al. 2007).”

“…Forget MGH Institute of Health Professions, School of Nursing, 36 1st Ave, Boston, MA 02129, USA e-mail: jgoodman@mghihp.edu M. Freeman Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (Andersson et al. 2006; Faisal-Cury and Menezes 2007; Lee et al. 2007; Heron et al. 2004).”

“Transdiagnostic treatments for anxiety and other emotional disorders have gained increased attention and empirical study in recent years (Farchione et al. 2012; Norton and Barrera 2012; Wilamowska et al. 2010).”

“Mindfulness-based interventions (MBIs) offer a promising development for the treatment of anxiety, with numerous studies demonstrating the effectiveness of MBIs in reducing anxiety, depression, and stress in clinical and non-clinical populations (for reviews see Chiesa and Serretti 2009, 2011; Fjorback et al. 2011; Gr…”

“Psychological therapies, particularly cognitive behavioral therapy (CBT), effectively reduce anxiety in patients with anxiety disorders (Otte 2011), yet such therapies have not been tested for treatment of anxiety in pregnant women.”

“Although originally designed for the prevention of relapse in patients in remission from depression, early studies suggest that MBCT may be helpful for a broad range of mental health problems (Sipe and Eisendrath 2012).”

“interventions in which mindfulness training is an integral component of treatment have also shown favorable results as a clinical intervention for GAD (Hayes-Skelton et al. 2013; Roemer et al. 2008; Roemer and Orsillo 2007).”

“…widely, with reported rates of women meeting diagnostic criteria for one or more specific anxiety disorders during pregnancy ranging from 12.2 to 39% (Adewuya et al. 2006; Borri et al. 2008; Giardinelli et al. 2012; Mota et al. 2008; Sutter-Dallay et al. 2004; Uguz et al. 2010; Zar et al. 2002).”

“…widely, with reported rates of women meeting diagnostic criteria for one or more specific anxiety disorders during pregnancy ranging from 12.2 to 39% (Adewuya et al. 2006; Borri et al. 2008; Giardinelli et al. 2012; Mota et al. 2008; Sutter-Dallay et al. 2004; Uguz et al. 2010; Zar et al. 2002).”

“Nevertheless, anxiety during pregnancy is frequently undetected and untreated (Alder et al. 2007; Coleman et al. 2008; Goodman and Tyer-Viola 2010).”

“MBCT has shown positive effects in panic (Kim et al. 2009), GAD (Craigie et al.”

“Transdiagnostic treatments for anxiety and other emotional disorders have gained increased attention and empirical study in recent years (Farchione et al. 2012; Norton and Barrera 2012; Wilamowska et al. 2010).”

“MBCT has been shown to reduce maladaptive rumination (Heeren and Philippot 2011; Michalak et al. 2011).”

“Three small studies have demonstrated that MBIs are effective in reducing stress, anxiety, depressive symptoms, and emotional distress during pregnancy in healthy, non-clinical populations (Duncan and Bardacke 2010; Dunn et al. 2012; Vieten and Astin 2008a, b).”

“Furthermore, elevated anxiety during pregnancy is a major risk factor for postpartum depression (e.g., Britton 2008; Heron et al. 2004; Lee et al. 2007; Sutter-Dallay et al. 2004), independent of antenatal depression (Coelho et al. 2011; Heron et al. 2004; Mauri et al. 2010; Sutter-Dallay et al.…”

“Intensive training in mindfulness meditation via MBSR or MBCT may reduce anxiety and associated symptoms in patients with anxiety disorders (Arch et al. 2013; Kabat-Zinn et al. 1992; Miller et al. 1995; Vollestad et al. 2011) and a meta-analytic review indicated that MBIs were associated with large…”

“…work of Neff (2012) and Germer (2012) regarding self-compassion, Roemer and Orsillo’s mindfulness/acceptance-based approach to the treatment of GAD (Hayes-Skelton et al. 2013; Roemer et al. 2008; Treanor et al. 2011; Orsillo and Roemer 2011), and Bardacke’s (2012) application of MBSR to…”

“…neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley et al. 2005; Swallow et al. 2004; Teixeira et al. 1999; Van den Bergh et al. 2007).”

“Psychotropic medications such as antidepressants and benzodiazepines are often used to treat anxiety; however, the potential risks of fetal exposure make the development of efficacious non-pharmacologic approaches particularly urgent in this context (e.g., Hayes et al. 2012; Udechuku et al. 2010).”

“MBCT has been shown to reduce maladaptive rumination (Heeren and Philippot 2011; Michalak et al. 2011).”

“…neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley et al. 2005; Swallow et al. 2004; Teixeira et al. 1999; Van den Bergh et al. 2007).”

“…neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley et al. 2005; Swallow et al. 2004; Teixeira et al. 1999; Van den Bergh et al. 2007).”

“…complications, shorter fetal gestation, compromised fetal neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley et al. 2005;…”

“…widely, with reported rates of women meeting diagnostic criteria for one or more specific anxiety disorders during pregnancy ranging from 12.2 to 39% (Adewuya et al. 2006; Borri et al. 2008; Giardinelli et al. 2012; Mota et al. 2008; Sutter-Dallay et al. 2004; Uguz et al. 2010; Zar et al. 2002).”

“Psychotropic medications such as antidepressants and benzodiazepines are often used to treat anxiety; however, the potential risks of fetal exposure make the development of efficacious non-pharmacologic approaches particularly urgent in this context (e.g., Hayes et al. 2012; Udechuku et al. 2010).”

“2009), GAD (Craigie et al. 2008; Evans et al. 2008; Hoge et al. 2013; Majid et al. 2010), and in social anxiety disorder (Koszycki et al.”

“2004), independent of antenatal depression (Coelho et al. 2011; Heron et al. 2004; Mauri et al. 2010; Sutter-Dallay et al. 2004), conferring further risks for mother and child.”

“(4) Individuals with GAD have difficulty in regulating their emotions, as shown by greater negative reactivity to and poorer understanding of emotions (Mennin et al. 2005; Tull et al. 2009).”

“…widely, with reported rates of women meeting diagnostic criteria for one or more specific anxiety disorders during pregnancy ranging from 12.2 to 39% (Adewuya et al. 2006; Borri et al. 2008; Giardinelli et al. 2012; Mota et al. 2008; Sutter-Dallay et al. 2004; Uguz et al. 2010; Zar et al. 2002).”

“…and Germer (2012) regarding self-compassion, Roemer and Orsillo’s mindfulness/acceptance-based approach to the treatment of GAD (Hayes-Skelton et al. 2013; Roemer et al. 2008; Treanor et al. 2011; Orsillo and Roemer 2011), and Bardacke’s (2012) application of MBSR to preparation for childbirth.”

“Comorbidity between perinatal anxiety and depression is high (Grigoriadis et al. 2011); however, anxiety also occurs without depression, and many women may experience more than one anxiety disorder concurrently (Kroenke et al. 2007).”

“There are many reasons why pregnancy may contribute to vulnerability to increased anxiety; these include physiological and hormonal changes, physical discomfort, increased stress, uncertainty, fear regarding the possibility of pregnancy and birth complications, concerns for health of self and baby, significant life ch…”

“…widely, with reported rates of women meeting diagnostic criteria for one or more specific anxiety disorders during pregnancy ranging from 12.2 to 39% (Adewuya et al. 2006; Borri et al. 2008; Giardinelli et al. 2012; Mota et al. 2008; Sutter-Dallay et al. 2004; Uguz et al. 2010; Zar et al. 2002).”

“…widely, with reported rates of women meeting diagnostic criteria for one or more specific anxiety disorders during pregnancy ranging from 12.2 to 39% (Adewuya et al. 2006; Borri et al. 2008; Giardinelli et al. 2012; Mota et al. 2008; Sutter-Dallay et al. 2004; Uguz et al. 2010; Zar et al. 2002).”

“2004), independent of antenatal depression (Coelho et al. 2011; Heron et al. 2004; Mauri et al. 2010; Sutter-Dallay et al. 2004), conferring further risks for mother and child.”

“A cut-off score of 11 is recommended as the most appropriate cut-off for identifying clinically relevant subthreshold anxiety (Karsten et al. 2011).”

“Nevertheless, anxiety during pregnancy is frequently undetected and untreated (Alder et al. 2007; Coleman et al. 2008; Goodman and Tyer-Viola 2010).”

“…neurodevelopment, and later child behavioral–emotional problems (Alder et al. 2007; Alvik et al. 2006; Andersson et al. 2004; Dunkel Schetter and Tanner 2012; Glover and O’Connor 2006; Goodwin et al. 2007; Hurley et al. 2005; Swallow et al. 2004; Teixeira et al. 1999; Van den Bergh et al. 2007).”

“The intervention is further informed by the general literature regarding conceptualizations of GAD (e.g., Behar et al. 2009; Garfinkle and Behar 2012; Roemer and Orsillo 2002) and from consultation with experts in the areas of MBIs, CBT, and interventions with pregnant women.”

“Engagement Of the seventeen included studies, nine reported on the number of participants meeting a study defined criterion for engagement or completion (completing all fifteen steps [64]; completing the programme [36,63]; completing at least 50% of sessions [37, 56, 58, 59], attending at least three out of four sessi…”

“Goodman et al. (2014) 8 weekly 2-h group sessions following a basic MBCT session structure.”

“…base that suggests that mindfulness-based interventions are promising for pregnant women, including those with elevated anxiety symptoms (J. H. Goodman et al., 2014) and those with broadly defined concerns about depression, anxiety, or stress (Dunn, Hanieh, Roberts, & Powrie, 2012; Vieten &…”

“From the noncontrolled studies, dropout was also relatively low with a range from 4% (Goodman et al. 2014) to 45% (Woolhouse et al. 2014, sample 2).”

“An evaluation of group mindfulness-based cognitive therapy for perinatal anxiety showed statistically and clinically significant improvements in anxiety, worry, and depression, as well as a significant increase in selfcompassion and mindfulness.(104) Additionally, in this study 94% of women with GAD no longer met diag…”

“Modifications for perinatal depression and anxiety were based on clinical trials in this fields (Dimidjian et al. 2016; Goodman et al. 2014; Luberto et al. 2018) and included stronger emphasis on brief formal and informal mindfulness and meditation practices customized for the perinatal period.”

“, 2020), 16 studies in SS (Giblin et al., 1987; Stevenson et al., 1999; Macleod and Weaver, 2003; Elsenbruch et al., 2007; Rokach, 2007; Emmanuel et al., 2012; Ngai and Ngu, 2013; Gebuza et al., 2014; Goodman et al., 2014; Calou et al., 2018; Gul et al., 2018; Nakamura et al., 2018; Pakseresht et al., 2019; Yu et al.,…”

“The majority of studies reported significant reductions in anxiety following intervention use (Beddoe et al., 2009; Byrne et al., 2014; Duncan & Bardacke, 2010; Goodman et al., 2014; Vieten & Astin, 2008; Woolhouse et al., 2014).”

“Promising pilot studies indicate that self-compassion is modifiable among perinatal women participating in mindfulness interventions (e.g., Goodman and Chenausky 2014; Perez-Blasco et al. 2013).”

“However, despite the success of these evidence-based interventions at reducing depression and the emerging support for anxiety reduction during the perinatal period (e.g., Goodman et al., 2014), their efficacy with ethno-racial minority women is mixed (Nillni et al., 2018).”

“The prevalence of anxiety has been reported 12.2%–39%, depending on the type of anxiety in pregnant women two or three times higher than the general population (Goodman et al., 2014).”

“[64] developed the 8-week Coping with Anxiety through Living Mindfully (CALM) Pregnancy program, which was also an adaptation of MBCT, but specifically geared toward reducing anxiety and co-morbid symptoms in pregnant women with generalized anxiety disorder.”

“MBCT in pregnancy has been shown to reduce worry, anxiety, and comorbid symptoms of depression in pregnant women with clinically elevated symptoms of generalized anxiety disorder (GAD) [52].”

“The perinatal period seems to increase a woman‘s vulnerability to psychiatric disorders due to increased physical and mental stress as well as hormonal changes (Goodman et al., 2014).”

“An 8-week uncontrolled mindfulness-based intervention for perinatal anxiety (which included an explicit focus on self-compassion) led to significant improvements in self-compassion, worry, and anxiety (Goodman et al. 2014; for similar results in a controlled study using a non-clinical sample see; Robins et al. 2012).”

“Recent studies suggest a relationship between mindfulness and the reduction of perinatal anxiety [10–15], stress [13] and perinatal depression [10, 11, 14, 16, 17].”

“However, about 80 % of women with peripartum depression the condition remains undetected and thus only 20 % receive appropriate treatment (Goodman et al., 2014; Marcus, 2009; O ’ Connor et al., 2016; Patel and Wisner, 2011).”

“Mindfulness-based cognitive therapy (MBCT) has also been adapted for pregnant women with general anxiety disorder in an intervention called CALM Pregnancy (Goodman et al. 2014).”

“5 hours weekly): integrated MBSR and an empowerment model of childbirth education, using the benefits, risks, alternatives, intuition, nothing (BRAIN) decision-making model (Byrne, Hauck, Fisher, Bayes, & Schutze, 2014); (c) the 10-session mindfulness-based childbirth and parenting program (MBCP) consisting of nine se…”

“In the study of Goodman et al. (2014), coping with anxiety through living mindfully which is kind of mindfulnessbased cognitive therapy significantly reduces the level Tab.”

“…among such findings were that mindfulness could: (a) induce a feeling of calm (corroborating the use of MBIs to help deal with anxiety, e.g., Goodman et al., 2014); provide an insitu coping technique to help defuse feelings of anger or stress (cf. the use of MBIs as a tool to help manage…”

“Maternal distress impairs daily functioning [1,6] and increases the risk of post-partum depression and suboptimal behavioural and emotional development in an infant [6].”

“How the woman adapts to these changes determines the quality of her life and her levels of well-being [11].”

“Other mindfulness programs have been pilot tested with pregnant women with histories of mental illness, with a goal of relapse prevention rather than childbirth preparation (Dimidjian et al. 2016; Goodman et al. 2014).”

“Mindfulness interventions conducted by Goodman et al [18] also include self-compassion in the intervention process, with the consideration that self-compassion was an essential component of mindfulnessrelated interventions and was associated significantly with decreased anxiety, depression and overall psychological he…”

“0 out of 7 assignments), which is below the range reported in other behavioral interventions with mostly non-Hispanic white mothers (50% to 67%; Goodman et al., 2014; Leermakers, Anglin, & Wing, 1998).”

“39,40 Other studies have used the measure in other ways.”

“…in control (4% vs. 20%); no significant difference between groups for depression severity (BDI) or social adjustment at 3 months PN Qualitative Studies Goodman et al. 2014 (US) [58] Coping with anxiety through Living Mindfully (CALM) Pregnancy; mindfulness-based cognitive therapy adapted for…”

“Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.”

“62 One study on MBCT-PD in perinatal people with bipolar spectrum disorder reported no improvement in mood yet concluded that the applicability of the intervention remained unclear for this population.”

“The percentage of women in pregnancy who meet 1 or more diagnostic criteria for an anxiety disorder ranges from 12.2% to 39%, which is 2-3 times higher than the general population [2].”

“, 2015; Cenkseven Onder & Utkan, 2018; Chu, 2010; Kabat-Zinn, 2005; Neece, 2014), and anxiety (Goodman et al., 2014; Guardino, Dunkel Schetter, Bower, Lu, & Smalley, 2014; Vieten & Astin, 2008).”

“In recent years small trials have assessed psychosocial interventions for anxiety and depression delivered during pregnancy but with mixed results (Austin et al., 2008; Bittner et al., 2014; Goodman et al., 2014; Milgrom et al., 2011).”