| Objective:Because pregnant women are in the special physiological period of pregnancy,their emotions are very fragile,their psychological endurance is poor,and they often have negative emotions such as anxiety and depression.Especially for pregnant women who have pregnancy complications or certain pregnancy risk factors during pregnancy,it is easier Fear of childbirth,anxiety,depression and other negative emotions.Cognitive behavior therapy is the most influential method of psychotherapy because of its simple operation,time saving,and quick results.At present,a relatively mature online cognitive behavioral intervention model for pregnant women’s negative emotions has been formed abroad.Domestic scholars pay more attention to the therapeutic effect of cognitive behavioral therapy on improving the negative emotions of normal pregnant women,and the intervention forms are mostly face-to-face recognition.Knowledge-based behavior therapy is the main focus,but face-to-face therapy is often limited in clinical practice due to factors such as inconvenience,time constraints,and stigma.With the rise of the "Internet + medical and health" service model,psychotherapy based on online media has become the current research direction.This study is guided by literature analysis and theoretical guidance manuals as a reference to construct an online cognitive behavioral intervention program,and verify its therapeutic effects on the fear,anxiety,and depression of pregnancy in high-risk pregnancies,which will be scientifically effective and targeted at high-risk pregnancies in the future.The network cognitive behavioral intervention model of pregnant women’s psychological needs lays the foundation.Methods:1.Research on the construction of intervention plan(1)Analysis of literature and theoretical works: The uniformly trained researchers will search the well-known domestic and foreign databases based on the established search strategy for the related literatures of pregnant and lying-in women’s online cognitive behavior intervention,and at the same time search for theoretical works of the school library resources as supplements,and include them according to the literature.The exclusion criteria independently screened the literature,extracted the general characteristics of the included literature and the intervention plan,and used content analysis to extract and summarize the intervention strategies mentioned in the literature and theoretical works to form the first draft of the intervention plan.(2)Expert meeting method: After the first draft of the intervention plan is formulated,the researcher takes the initiative to contact experts in the relevant professional field to determine the meeting time,and send the meeting schedule and the first draft of the intervention plan to the experts by email.At the beginning of the meeting,the experts are asked to fill in the expert general information questionnaire,and the expert’s authority is self-determined.At the same time,the researcher reported on the purpose of the meeting and the main content of the intervention plan.Experts discussed the specific content of the intervention plan and made suggestions.The team members made live recordings and photographs.After the meeting,the researchers took back the meeting materials and Summarize the content of the meeting.2.Empirical research on intervention programs(1)Single-blind randomized controlled trial study: Convenience sampling was used to select high-risk pregnant women who had regular obstetrics in the perinatal care clinic of a tertiary-level A specialty hospital in Shanxi Province from January to July 2020 and met the inclusion and exclusion criteria of this study as the target population,and the final determination was made according to the sample size 170 For example,a computer-generated random number table was used to divide the research objects into an intervention group and a control group.The intervention group used Ding Talk video conference combined with We Chat group form of cognitive behavior intervention.The control group received routine outpatient psychological consultation.Wijma Delivery Expectation and Experience Questionnaire(WDEQ),Pregnancy-specific Anxiety Scale(PAQ),Edinburgh Postpartum Depression Scale(EPDS)were used to evaluate pregnancy fear,anxiety,and depression before and after the intervention,immediately after the intervention,and 3 days after delivery.(2)Qualitative research: Adopt purpose sampling method to select pregnant women with different high-risk factors and different sociodemographic characteristics from the research subjects who participated in the whole process of online cognitive behavioral therapy as interview subjects,and use the pre-set interview outline to conduct interviews on the subjects.One-on-one,semi-structured in-depth interviews,using the Colaizzi analysis method when analyzing the interview data.Results:1.The result of plan construction(1)Analysis of literature and theoretical works: In the literature retrieved so far,all researches on online cognitive behavior intervention for pregnant women’s negative emotions are foreign literatures,and finally 9 RCT studies and 2 theoretical works are included.By summarizing the literature and theoretical works,it can be seen that the timing of intervention mentioned in the literature starts from the second trimester of pregnancy to within 1 year after delivery;the forms of intervention are mostly through websites and mobile phone applications,and text messages and emails are used as auxiliary intervention forms;In terms of intervention strategies,systemic desensitization training is often used for childbirth fears,psychological education,cognitive correction,cognitive reconstruction,behavioral experiments,social skills training,relaxation training, etc.are used for anxiety and depression,and corresponding homework is assigned as consolidation exercises.The frequency of intervention is mostly 1 time/week,ranging from3-11 times in total,and the duration of each intervention is about 20-50 minutes;the evaluation of outcome indicators is mostly evaluated by the internationally accepted negative emotion scale;the time of outcome evaluation starts after the intervention Follow-up for 1 week to 4 years after intervention.(2)Expert meeting method: A total of 10 experts were invited to participate in the meeting,and the collective authority coefficient of the experts was 0.855.Experts put forward the following suggestions:(1)In terms of the form of intervention,the intervention through online video interaction is more effective than the treatment on the We Chat official account.It is recommended to add video,animation,music,etc.,and supervise the completion through telephone or text messages.The form of homework was changed from writing to writing,video,and voice;(2)In the intervention content,case videos were inserted into the content of each course,and consolidation treatment was added after 6treatments.The content of consolidation treatment was mainly for pregnant women to share their actual psychology Difficulties are the main reason;(3)In the intervention frequency and timing,increase the intervention frequency during the treatment period or increase the consolidation treatment after the treatment period,30-45 minutes each time,choose the intervention time every Saturday and Sunday,and the intervention period needs to be extended to the postpartum period.4 weeks;(4)For the intervention objects,the pregnant women and their spouses were treated as the intervention objects at the same time,to investigate the influence of the spouse’s psychological intervention on the negative emotions of pregnant and lying-in women;(5)In the outcome evaluation index,the questionnaire evaluation is more subjective,and it is recommended to add objective biological indicators,Outcome evaluation time needs to be followed up to postpartum at least,and at least two evaluations are required after intervention.According to expert suggestions,the intervention plan is revised as follows: change the form of We Chat public account intervention to Dingding video conference combined with We Chat group,supplemented by telephone and SMS intervention,and change the form of homework from writing to writing or video,Voice format;in the intervention strategy,taking into account the diversity of high-risk pregnancy diseases,the case topic "sugar mother’s story" was changed to "the psychological distress of expectant mothers",and 3 different cases were played at the same time.After 6 treatments Increasing the consolidation period;the timing of intervention was changed from an unfixed weekly time to 19:00 every Saturday night;the outcome evaluation time was selected at three time points: baseline,immediately after intervention(after consolidation treatment),and 3 days postpartum.2.Empirical research on intervention(1)Single-blind randomized controlled trial study:(1)Comparison of the two groups before intervention: The general data of the two groups of study subjects before the intervention were balanced and comparable(p>0.05).During the treatment period,19 cases were dropped from the intervention group and 17 cases from the control group.(2)Comparison between the two groups after intervention: The two groups of subjects were compared immediately after intervention.The results of ITT analysis and PP analysis were basically the same.The results showed that the scores of childbirth fear and pregnancy-related anxiety scales were significantly different(both p<0.001),and the amount of depression There was no significant difference in the scores of the two groups immediately after the intervention(p>0.05);the comparison between the two groups of subjects 3 days after delivery,the results of ITT analysis and PP analysis were basically the same,both showed that the two groups of subjects were childbirth fear,pregnancy-related anxiety,and depression scales The difference in scores was statistically significant(all p<0.005);(3)Multiple comparisons between the two groups before and after intervention:comparison of the scores on the Fear of Childbirth,Anxiety,and Depression Scales before the intervention,immediately after the intervention,and 3d postpartum.Time factors,inter-group factors,and time-interaction factors were significantly different(p<0.001).The scores of the depression scale for pregnant women between the two groups were significantly different in time factors and time-interaction factors(p<0.005),but there were differences in factors between groups Not significant(p>0.05).(4)The compliance rate of the intervention group was 77.7%,and that of the control group was 75.3%.There were 51 pregnant women with a total score of 25 points or more in the satisfaction questionnaire of the intervention group,and the satisfaction rate was 77.27%.(2)Qualitative research: A total of 12 subjects were interviewed in this study.From the real feelings of the subjects participating in the treatment and their deficiencies and suggestions for the treatment,it can be concluded that the subjects agreed with the treatment and believed that this treatment The treatment improves the negative emotions and behaviors during pregnancy in a convenient,practical,flexible and diverse form,which can meet the needs of home psychotherapy,but the effect of online psychotherapy is affected by subjective factors such as individual self-control,treatment interest,and family environment.The influence of objective factors.Future research needs to consider the individual differences of pregnant women and environmental factors when formulating online cognitive behavioral intervention programs,and increase the content of postpartum self-care.Conclusion:In this study,an online cognitive behavior intervention program was constructed through the analysis of literature and theoretical works,and the expert meeting method.The program was divided into two phases: the treatment period(6 online videos)and the consolidation period(3 online exchanges).A single-blind randomized controlled experimental study was used to verify the therapeutic effect of the program on negative emotions in high-risk pregnant women.Practice has proved that Internet cognitive behavioral therapy has significant therapeutic effects on the fear of childbirth and anxiety in high-risk pregnant women,but it has no short-term effect on depression.Obviously,the long-term treatment effect needs to be continuously tracked.At the same time,the research subjects are more subjectively accepting this treatment,and believe that this intervention adopts convenient,practical,flexible and diverse methods to improve their negative emotions during pregnancy.However,this treatment is affected by the subjective factors of the research subjects and family environment factors.Future research It is necessary to further improve the network cognitive behavior intervention program on the basis of fully considering the individual differences and environmental factors of pregnant women,so as to lay the foundation for the formation of a systematic and standardized network cognitive behavior intervention model in the future. |
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