Online Cognitive Behavioral Therapy Improved Pregnancy-Related Stress During COVID-19 Pandemic

Pregnant women with a psychiatric disorder or receiving psychiatric medications were recruited to test the efficacy of online cognitive behavioral therapy to manage stress during the COVID-19 pandemic.

Pregnant women who attended online cognitive behavioral therapy (o-CBT) during the COVID-19 pandemic reported lower rates of pregnancy-specific stress and perceived stress. These findings were published in the Journal of Psychiatric Research.

Pregnant women (N=207) who had a psychiatric disorder or were using psychiatric medications were recruited between September 2020 and June 2021 in Spain using local and social media advertising. Participants were randomly assigned to receive o-CBT (n=70), attend an online psychological support group (o-PS; n=69), or receive usual care (n=68). Patients in the o-CBT and o-PS interventions comprised weekly sessions for 8 weeks. Changes in Perceived Stress Scale (PSS-14), Prenatal Distress Questionnaire (PDQ), Stress Vulnerability Intervention (IVE), Connor Davidson Resilience Scale (CD-RISC), and Symptom Checklist-90-Revised (SCL-90-R) scores from baseline to week 8 were evaluated.

In the o-CBT, o-PS, and control cohorts were made up of women aged mean 35.11, 35.59, and 34.31 years, respectively; 90%, 85.5%, and 76.5% attended university, respectively; 18.6%, 17.4%, and 16.2% had a high-risk pregnancy, respectively; and 85.7%, 92.8%, and 89.7% wanted their pregnancy, respectively.

In the linear mixed model analysis, there were significant pre- and posttreatment interactions for SCL-90-R anxiety (F[2,197.34], 7.05; P ≤.001), SCL-90-R obsessive-compulsion (F[2,197.49], 8.13; P ≤.001), CD-RISC PSS-14 (F[2,192.78], 7.08; P ≤.001), PDQ (F[2,197.48], 6.27; P ≤.002), SCL-90-R depression (F[2,197.46], 6.23; P ≤.002), and PSS-14 (F[2,192.78], 5.02; P ≤.007) outcomes.

The effect sizes for the change in each of the outcomes was higher for the o-CBT cohort compared with either the o-PT or usual care groups.

The major limitation of this study was the lack of a long-term follow-up.

The study authors concluded, “Clear evidence was obtained that o-CBT intervention during the COVID-19 pandemic brings about positive results for pregnant women: improvements took place regarding pregnancy-specific stress and perceived stress, psychopathological symptomatology was reduced, and resilience increased. […] Therefore, cognitive behavioral therapy for stress management in pregnant women could prevent increased stress and psychopathological symptoms resulting from a pandemic, acting as a ‘psychological vaccine,’ or buffer, in a metaphorical sense.”


Puertas-Gonzalez JA, Mariño-Narvaez C, Romero-Gonzalez B, Sanchez-Perez GM, Peralta-Ramirez MI. Online cognitive behavioural therapy as a psychological vaccine against stress during the COVID-19 pandemic in pregnant women: a randomised controlled trial. J Psychiatr Res. 2022;152:397-405. doi:10.1016/j.jpsychires.2022.07.016