Skip to main content

Advertisement

SpringerLink
Log in

Are exposure-based cognitive behavioral therapies safe during pregnancy?

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Anxiety disorders during pregnancy are highly prevalent and associated with serious and enduring consequences for both mother and child. Exposure-based cognitive behavioral (CBT) and behavioral therapies (BT) represent the most empirically supported psychosocial treatments for anxiety disorders in general adult samples. Pregnant women, however, generally have been excluded from this body of research. Evidence that pregnant women inhabit a unique biological context combined with untested assumptions that exposure would unduly stress or harm the fetus have likely prohibited inquiry. This paper seeks to remedy this gap by integrating findings from obstetric, psychiatric, and psychological research to inform central questions regarding exposure-based treatment of anxiety disorders during pregnancy. Based on available evidence, we consider the potential risks and benefits of CBT/BT for anxiety disorders during pregnancy relative to other currently available treatment options. From a multidisciplinary research perspective, we argue that exposure-based therapies are likely to be safe during pregnancy, particularly relative to the alternatives. However, we also highlight critical questions for future research to directly test the biopsychological impact of exposure-based therapies among pregnant women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The term “antenatal anxiety disorders” is used as shorthand throughout to indicate “anxiety disorders that occur during antenatal periods”. This non-technical term is not meant to imply that anxiety disorders that occur during antenatal periods differ (except in timing) from anxiety disorders that occur outside of antenatal periods.

References

  • Arch JJ, Eifert GH, Davies C, Plumb JC, Rose RD and Craske MG (2012) Randomized clinical trial of cognitive behavioral therapy versus acceptance and commitment therapy for the treatment of mixed anxiety disorders. Journal of Consulting and Clinical Psychology. doi:10.1037/a0028310

  • Banhidy F, Acs N, Puho E, Czeizel AE (2006) Association between maternal panic disorders and pregnancy complications and delivery outcomes. Eur J Obstet Gynecol Reprod Biol 124:47–52

    Article  PubMed  Google Scholar 

  • Barlow DH (2002) Anxiety and its disorders: The nature and treatment of anxiety and panic, 2nd edn. Guilford, New York

    Google Scholar 

  • Barlow DH, Craske MG (2007) Mastery of your anxiety and panic workbook, 4th edn. Oxford University Press, New York

    Google Scholar 

  • Barlow DH, Gorman JM, Shear MK, Woods SW (2000) Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: a randomized controlled trial. JAMA 283(19):2529–2536

    Article  PubMed  CAS  Google Scholar 

  • Beckham JC, Vrana SR, May JG, Gustafson DJ, Smith GR (1990) Emotion processing and fear measurement synchrony as indicators of treatment outcome in fear of flying. J Behav Ther Exp Psychiatry 21(3):153–162

    Article  PubMed  CAS  Google Scholar 

  • Berntson GG, Quiqley DS, Lozano D (2007) Cardivascular psychophysiology. In: Cacioppo JT, Tassinary LG, Berntson GG (eds) Handbook of psychophysiology, 3rd edn. Cambridge University Press, New York

    Google Scholar 

  • Blanco C, Heimberg RG, Schneier FR, Fresco DM, Chen H, Turk CL, Liebowitz MR (2010) A placebo-controlled trial of phenelzine, cognitive behavioral group therapy, and their combination for social anxiety disorder. Arch Gen Psychiatry 67(3):286–295

    Article  PubMed  CAS  Google Scholar 

  • Bruce SE, Yonkers KA, Otto MW, Eisen JL, Weisberg RB, Pagano M, Keller MB (2005) Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 162(6):1179–1187

    Article  PubMed  Google Scholar 

  • Buss C, Davis EP, Muftuler LT, Head K, Sandman CA (2010) High pregnancy anxiety during mid-gestation is associated with decreased gray matter density in 6-9 year-old children. Psychoneuroendocrinology 35(1):141–153. doi:10.1016/j.psyneuen.2009.07.010

    Article  PubMed  Google Scholar 

  • Butler AC, Chapman JE, Forman EM, Beck AT (2006) The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 26:17–31

    Article  PubMed  Google Scholar 

  • Chen Y-H, Lin H-C, Lee H-C (2010) Pregnancy outcomes among women with panic disorder: do panic attacks during pregnancy matter? J Affect Disord 120(1–3):258–262. doi:10.1016/j.jad.2009.04.025

    Article  PubMed  Google Scholar 

  • Clark DM, Salkovskis PM, Hackmann A, Middleton H, Anastasiades P, Gelder M (1994) A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Br J Psychiatry 164(6):759–769

    Article  PubMed  CAS  Google Scholar 

  • Clark DM, Ehlers A, McManus F, Hackmann A, Fennell M, Campbell H, Louis B (2003) Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. J Consult Clin Psychol 71(6):1058–1067. doi:10.1037/0022-006x.71.6.1058

    Article  PubMed  Google Scholar 

  • Conde A, Figueiredo B, Tendais I, Teixeira C, Costa R, Pacheco A, Nogueira R (2010) Mother's anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20 weeks of gestation. J Psychosom Obstet Gynecol 31(2):70–82. doi:10.3109/01674821003681464

    Article  Google Scholar 

  • Craske MG (1999) Anxiety disorders: Psychological approaches to theory and treatment. Westview, Boulder

    Google Scholar 

  • Craske MG (2003) Origins of phobias and anxiety disorders: Why more women than men? Elsevier Ltd., Oxford

    Google Scholar 

  • Craske MG, Barlow DH (2007) Mastery of your anxiety and panic: Therapist guide, 4th edn. Oxford University Press, New York

    Google Scholar 

  • Craske MG, Maidenberg E, Bystritsky A (1995) Brief cognitive-behavioral versus nondirective therapy for panic disorder. J Behav Ther Exp Psychiatry 26(2):113–120

    Article  PubMed  CAS  Google Scholar 

  • Craske MG, Roy-Byrne P, Stein MB, Sullivan G, Hazlett-Stevens H, Bystritsky A, Sherbourne C (2006a) CBT intensity and outcome for panic disorder in a primary care setting. Behav Ther 37(2):112–119. doi:10.1016/j.beth.2005.05.003

    Article  PubMed  Google Scholar 

  • Craske MG, Roy-Byrne P, Stein MB, Sullivan G, Hazlett-Stevens H, Bystritsky A, Sherbourne C (2006b) CBT intensity and outcome for panic disorder in a primary care setting. Behav Ther 37:112–119

    Article  PubMed  Google Scholar 

  • Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A (2008) Optimizing inhibitory learning during exposure therapy. Behav Res Ther 46(1):5–27. doi:10.1016/j.brat.2007.10.003

    Article  PubMed  Google Scholar 

  • Craske MG, Stein MB, Sullivan G, Sherbourne C, Bystritsky A, Rose RD, Roy-Byrne P (2011) Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Arch Gen Psychiatry 68(4):378–387. doi:10.1001/archgenpsychiatry.2011.25

    Article  PubMed  Google Scholar 

  • Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V (2011) Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry 68(11):1104–12. doi:10.1001/archgenpsychiatry.2011.73

    Article  PubMed  Google Scholar 

  • de Beurs E, van Balkom AJLM, Van Dyck R, Lange A (1999) Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: a 1-year naturalistic follow-up. Acta Psychiatr Scand 99(1):59–67. doi:10.1111/j.1600-0447.1999.tb05385.x

    Article  PubMed  Google Scholar 

  • de Weerth, C., & Buitelaar, J. K. (2005). Physiological stress reactivity in human pregnancy—a review. Neuroscience and Biobehavioral Reviews. Special Issue: Prenatal Programming of Behavior, Physiology And Cognition, 29(2), 295-312. doi:10.1016/j.neubiorev.2004.10.005

  • DeSilva P, Rachman S (1984) Does escape behaviour strengthen agoraphic avoidance—a preliminary study. Behav Res Ther 22(87–91)

    Google Scholar 

  • Dietz PM, Williams SB, Callaghan WM, Bachman DJ, Whitlock EP, Hornbrook MC (2007) Clinically identified maternal depression before, during, and after pregnancies ending in live births. Am J Psychiatry 164(10):1515–1520. doi:10.1176/appi.ajp.2007.06111893

    Article  PubMed  Google Scholar 

  • Dolovich LR, Addis A, Vaillancourt JM, Power JD, Koren G, Einarson TR (1998) Benzodiazepine use in pregnancy and major malformations or oral cleft: meta-analysis of cohort and case-control studies. BMJ 317(7162):839–843

    Article  PubMed  CAS  Google Scholar 

  • Dunkel Schetter C (2009) Stress processes in pregnancy and pretern birth. Curr Dir Psychol Sci 18(4):205–209

    Article  Google Scholar 

  • Entringer S, Buss C, Shirtcliff EA, Cammack AL, Yim IS, Chicz-DeMet A, Wadhwa PD (2010) Attenuation of maternal psychophysiological stress responses and the maternal cortisol awakening response over the course of human pregnancy. Stress: Int J Biol Stress 13(3):258–268. doi:10.3109/10253890903349501

    Article  CAS  Google Scholar 

  • Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, Barlow DH (2012) Unified protocol for transdiagnostic treatment of emotional disorders: a randomized controlled trial. Behav Ther 43(3):666–678

    Article  PubMed  Google Scholar 

  • Feske U, Chambless DL (1995) Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behav Ther 26:695–720

    Article  Google Scholar 

  • Foa EB, Kozak MJ (1986) Emotional processing of fear: exposure to corrective information. Psychol Bull 99:20–35

    Article  PubMed  CAS  Google Scholar 

  • Foa EB, Zoellner LA, Feeny NC, Hembree EA, Alvarez-Conrad J (2002) Does imaginal exposure exacerbate PTSD symptoms? J Consult Clin Psychol 70(4):1022–1028. doi:10.1037/0022-006x.70.4.1022

    Article  PubMed  Google Scholar 

  • Foa EB, Huppert JD, Cahill SP (2006) Emotional processing theory: An update. In: Rothbaum BO (ed) Pathological anxiety: Emotional processing in etiology and treatment. Guilford, New York, pp 3–24

    Google Scholar 

  • Gloster AT, Wittchen H-U, Einsle F, Lang T, Helbig-Lang S, Fydrich T, Arolt V (2011) Psychological treatment for panic disorder with agoraphobia: a randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT. J Consult Clin Psychol 79(3):406–420. doi:10.1037/a0023584

    Article  PubMed  Google Scholar 

  • Grayson JB, Foa EB, Steketee G (1982) Habituation during exposure treatment: distraction vs attention-focusing. Behav Res Ther 20:323–328

    Article  PubMed  CAS  Google Scholar 

  • Grey S, Sartory G, Rachman S (1979) Synchronous and desynchronous changes during fear reduction. Behav Res Ther 17(2):137–147. doi:10.1016/0005-7967(79)90022-6

    Article  PubMed  CAS  Google Scholar 

  • Grey S, Rachman S, Sartory G (1981) Return of fear: the role of inhibition. Behav Res Ther 19(2):135–143. doi:10.1016/0005-7967(81)90037-1

    Article  PubMed  CAS  Google Scholar 

  • Haug TT, Blomhoff S, Hellstrom K, Holme I, Humble M, Madsbu HP, Wold JE (2003) Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial. Br J Psychiatry 182:312–318

    Article  PubMed  Google Scholar 

  • Hemels ME, Einarson A, Koren G, Lanctot KL, Einarson TR (2005) Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother 39(5):803–809. doi:10.1345/aph.1E547

    Article  PubMed  Google Scholar 

  • Hofmann SG (2008) Common misconceptions about cognitive mediation of treatment change: a commentary to Longmore and Worrell (2007). Clin Psychol Rev 28:67–70

    Article  PubMed  Google Scholar 

  • Hofmann SG, Smits JAJ (2008) Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry 69(4):621–632

    Article  PubMed  Google Scholar 

  • Hunter S, Robson SC (1992) Adaptation of the maternal heart in pregnancy. Br Hear J 68:540–543

    Article  CAS  Google Scholar 

  • Jaycox LH, Foa EB, Morral AR (1998) Influence of emotional engagement and habituation on exposure therapy for PTSD. J Consult Clin Psychol 66(1):185–192. doi:10.1037/0022-006x.66.1.185

    Article  PubMed  CAS  Google Scholar 

  • Kallen B, Olausson PO (2008) Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf 17(8):801–806. doi:10.1002/pds.1570

    Article  PubMed  Google Scholar 

  • Kammerer M, Adams D, Castelberg BB, Glover V (2002) Pregnant women become insensitive to cold stress. BMC Pregnancy Childbirth 2(1):8

    Article  PubMed  Google Scholar 

  • Kessler RC, Berglund P, Demler O, Jin R, Walters EE (2005a) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Arch Gen Psychiatry 62(6):593–602

    Article  PubMed  Google Scholar 

  • Kessler RC, Chiu WT, Demler O, Walters EE (2005b) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey replication. Arch Gen Psychiatry 62(6):617–627

    Article  PubMed  Google Scholar 

  • Kinsella MT, Monk C (2009) Impact of maternal stress, depression and anxiety on fetal neurobehavioral development. Clin Obstet Gynecol 52(3):425–440

    Article  PubMed  Google Scholar 

  • Klosko JS, Barlow DH, Tassinari R, Cerny JA (1990) A comparison of alprazolam and behavior therapy in treatment of panic disorder. J Consult Clin Psychol 58(1):77–84. doi:10.1037/0022-006x.58.1.77

    Article  PubMed  CAS  Google Scholar 

  • Lang AJ, Craske MG (2000) Manipulations of exposure-based therapy to reduce return of fear: a replication. Behav Res Ther 38(1):1–12

    Article  PubMed  CAS  Google Scholar 

  • Lang PJ, Melamed BG, Hart J (1970) A psychophysiological analysis of fear modification using an automated desensitization procedure. J Abnorm Psychol 76(2):220–234. doi:10.1037/h0029875

    Article  PubMed  CAS  Google Scholar 

  • Lattimore KA, Donn SM, Kaciroti N, Kempber AR, Neal CR, Vazquez DM (2005) Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol 25:595–604

    Article  PubMed  CAS  Google Scholar 

  • Lilliecreutz C, Josefsson A, Sydsjo G (2010) An open trial with cognitive behavioral therapy for blood- and injection phobia in pregnant women—a group intervention program. Arch Women's Mental Health 13:259–265

    Article  Google Scholar 

  • Longmore RJ, Worrell M (2007) Do we need to challenge thoughts in cognitive behavioral therapy? Clin Psychol Rev 27:173–187

    Article  PubMed  Google Scholar 

  • Magiakou MA, Mastorakos G, Rabin D, Margioris AN, Dubbert B, Calogero AE, Chrousos GP (1996) The maternal hypothalamic-pituitary-adrenal axis in the third trimester of human pregnancy. Clin Endocrinol 44(4):419–428

    Article  CAS  Google Scholar 

  • Magiakou MA, Mastorakos G, Webster E, Chrousos GP (1997) The hypothalamic-pituitary-adrenal axis and the female reproductive system. Annals NY Acad Sci 816:42–56

    Article  CAS  Google Scholar 

  • Maric NP, Dunjic B, Stojiljkovic DJ, Britvic D, Jasovic-Gasic M (2010) Prenatal stress during the 1999 bombing associated with lower birth weight: a study of 3,815 births from Belgrade. Arch Women's Mental Health 13(1):83–89. doi:10.1007/s00737-009-0099-9

    Article  Google Scholar 

  • Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen H-U (2010) Anxiety disorders before birth and self-perceived distress during pregnancy: associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Human Dev 86(5):305–310. doi:10.1016/j.earlhumdev.2010.04.004

    Article  Google Scholar 

  • Mastorakos G, Ilias I (2003) Maternal and fetal hypothalamic-pituitary-adrenal axes during pregnancy and postpartum. Ann N Y Acad Sci 997:136–149

    Article  PubMed  CAS  Google Scholar 

  • Matthews KA, Rodin J (1992) Pregnancy alters blood pressure responses to psychological and physical challenge. Psychophysiology 29:232–240

    Article  PubMed  CAS  Google Scholar 

  • McAdrle WD, Katch FI, Katch VL (eds) (1991) Exercise physiology: Energy, nutrition, and human performance, 3rd edn. Lea & Febiger, Malvern

    Google Scholar 

  • Mintzes, B., & Jureidini, J. (2008). Should paroxetine be used to treat depression during pregnancy? The American Journal of Psychiatry 165(11): doi:10.1176/appi.ajp.2008.08040573

  • Misri S, Kendrick K (2007) Treatment of perinatal mood and anxiety disorders: a review. Canadian J Psychiatry/La Revue canadienne de psychiatrie 52(8):489–498

    Google Scholar 

  • Mitte K (2005) Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychol Bull 131(5):785–795

    Article  PubMed  Google Scholar 

  • Morland L, Goebert D, Onoye J, Frattarelli L, Derauf C, Herbst M, Friedman M (2007) Posttraumatic stress disorder and pregnancy health: preliminary update and implications. Psychosom: J Consultation Liaison Psychiatry 48(4):304–308. doi:10.1176/appi.psy.48.4.304

    Article  Google Scholar 

  • Moser JS, Cahill SP, Foa EB (2010) Evidence for poorer outcome in patients with severe negative trauma-related cognitions receiving prolonged exposure plus cognitive restructuring: implications for treatment matching in posttraumatic stress disorder. J Nerv Ment Dis 198(1):72–75

    Article  PubMed  Google Scholar 

  • Neuner F, Schauer M, Klaschik C (2004) A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating post-traumatic stress disorder in an African refugee settlement. J Consult Clin Psychol 72(579–587)

    Google Scholar 

  • Nishith P, Resick PA, Griffin MG (2002) Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. J Consult Clin Psychol 70(4):880–886. doi:10.1037/0022-006x.70.4.880

    Article  PubMed  Google Scholar 

  • Norton PJ, Price EC (2007) A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. J Nerv Ment Dis 195:521–531

    Article  PubMed  Google Scholar 

  • Norton PJ, Hayes-Skelton SA, Klenck SC (2011) What happens in session does not stay in session: changes within exposures predict subsequent improvement and dropout. J Anxiety Disord 25(5):654–660. doi:10.1016/j.janxdis.2011.02.006

    Article  PubMed  Google Scholar 

  • Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C (2006) Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 63(8):898–906. doi:10.1001/archpsyc.63.8.898

    Article  PubMed  Google Scholar 

  • Oberlander TF, Warburton W, Misri S, Riggs W, Aghajanian J, Hertzman C (2008) Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data. Birth Defects Res B Dev Reprod Toxicol 83(1):68–76. doi:10.1002/bdrb.20144

    Article  PubMed  CAS  Google Scholar 

  • O'Connor TG, Heron J, Glover V (2002a) Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. [Peer Reviewed]. J Am Acad Child Adolesc Psychiatr 41(12):1470–1477. doi:10.1097/00004583-200212000-00019

    Article  Google Scholar 

  • O'Connor TG, Heron J, Golding J, Beveridge M, Glover V (2002b) Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years: report from the Avon Longitudinal Study of Parents and Children. Br J Psychiatry 180(6):502–508. doi:10.1192/bjp.180.6.502

    Article  PubMed  Google Scholar 

  • O'Connor TG, Heron J, Golding J, Glover V (2003) Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. J Child Psychol Psychiatry 44(7):1025–1036. doi:10.1111/1469-7610.00187

    Article  PubMed  Google Scholar 

  • Olatunji BO, Deacon BJ, Abramowitz JS (2009) The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cogn Behav Pract 16:172–180

    Article  Google Scholar 

  • Oliver NS, Page AC (2003) Fear reduction during in vivo exposure to blood-injection stimuli: distraction vs. attentional focus. Br J Clin Psychol 42(1):13–25. doi:10.1348/014466503762841986

    Article  PubMed  Google Scholar 

  • Ost LG (1989) One-session treatment for specific phobias. Behav Res Ther 27(1):1–7

    Article  PubMed  CAS  Google Scholar 

  • Otto MW, Pollack MH, Sabatino SA (1996) Maintenance of remission following cognitive behavior therapy for panic disorder: possible deleterious effects of concurrent medication treatment. Behav Ther 27(3):473–482. doi:10.1016/s0005-7894(96)80028-1

    Article  Google Scholar 

  • Otto MW, Smits AJJ, Reese HE (2005) Combined psychotherapy and pharmacotherapy for mood and anxiety disorders in adults: review and analysis. Clin Psychol Sci Pract 12:72–86

    Article  Google Scholar 

  • Rachman S, Lopatka C (1988) Return of fear: underlearning and overlearning. Behav Res Ther 26(2):99–104

    Article  PubMed  CAS  Google Scholar 

  • Rachman S, Craske M, Tallman K, Solyom C (1986) Does escape behavior strengthen agoraphobic avoidance? A replication. Behav Ther 17(4):366–384. doi:10.1016/s0005-7894(86)80069-7

    Article  Google Scholar 

  • Roshanaei-Moghaddam B, Pauly MC, Atkins DC, Baldwin SA, Stein MB, Roy-Byrne P (2011) Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety? Depress Anxiety 28:560–567

    Article  PubMed  Google Scholar 

  • Ross LE, McLean LM (2006) Anxiety disorders during pregnancy and the postpartum period: a systematic review. J Clin Psychiatry 67(8):1285–1298

    Article  PubMed  Google Scholar 

  • Rowe MK, Craske MG (1998a) Effects of an expanding-spaced vs massed exposure schedule on fear reduction and return of fear. Behav Res Ther 36(7–8):701–717

    Article  PubMed  CAS  Google Scholar 

  • Rowe MK, Craske MG (1998b) Effects of varied-stimulus exposure training on fear reduction and return of fear. Behav Res Ther 36(7–8):719–734

    Article  PubMed  CAS  Google Scholar 

  • Roy-Byrne PP, Craske MG, Sullivan G, Rose RD, Edlund MJ, Lang A, Stein MB (2010) Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA 19(303):1921–1928

    Article  Google Scholar 

  • Sarkar P, Bergman K, O'Connor TG, Glover V (2008) Maternal antenatal anxiety and amniotic fluid cortisol and testosterone: possible implications for foetal programming. J Neuroendocrinol 20(4):489–496. doi:10.1111/j.1365-2826.2008.01659.x

    Article  PubMed  CAS  Google Scholar 

  • Schmidt LG, Grohmann R, Muller-Oerlinghausen B, Otto MW, Ruther E, Wolf B (1989) Prevalence of benzodiazepine abuse and dependence in psychiatric in-patients with different nosology. An assessment of hospital-based drug surveillance data. Br J Psychiatry 154:839–843

    Article  PubMed  CAS  Google Scholar 

  • Schweizer E, Rickels K (1998) Benzodiazepine dependence and withdrawal: a review of the syndrome and its clinical management. Acta Psychiatr Scand 393:95–101

    Article  CAS  Google Scholar 

  • Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, Roy-Byrne PP (2004) Quality of care for primary care patients with anxiety disorders. Am J Psychiatry 161(12):2230–2237

    Article  PubMed  Google Scholar 

  • Teixeira JM, Fisk NM, Glover V (1999) Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 318(7177):153–157

    Article  PubMed  CAS  Google Scholar 

  • Tuerk PW, Grubaugh AL, Hamner MB, Foa EB (2009) Diagnosis and treatment of PTSD-related compulsive checking behaviors in veterans of the Iraq War: the influence of military context on the expression of PTSD symptom. Am J Psychiatry 166:762–767

    Article  PubMed  Google Scholar 

  • van den Bergh BR, Marcoen A (2004) High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Dev 75(4):1085–1097. doi:10.1111/j.1467-8624.2004.00727.x

    Article  PubMed  Google Scholar 

  • van den Bergh BR, Mennes M, Oosterlaan J, Stevens V, Stiers P, Marcoen A, Lagae L (2005a) High antenatal maternal anxiety is related to impulsivity during performance on cognitive tasks in 14- and 15-year-olds. Neurosci Biobehav Rev 29(2):259–269. doi:10.1016/j.neubiorev.2004.10.010

    Article  PubMed  Google Scholar 

  • van den Bergh BR, Mulder EJH, Mennes M, Glover V (2005b) Antenatal maternal anxiety and stress and the neurobiological development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev 29(2):237–258

    Article  PubMed  Google Scholar 

  • van den Bergh BR, Mennes M, Stevens V, van der Meere J, Borger N, Stiers P, Lagae L (2006) ADHD deficit as measured in adolescent boys with a continuous performance task is related to antenatal maternal anxiety. Pediatr Res 59(1):78–82. doi:10.1203/01.pdr.0000191143.75673.52

    Article  PubMed  Google Scholar 

  • van den Bergh BR, Van Calster B, Smits T, Van Huffel S, Lagae L (2008) Antenatal maternal anxiety is related to HPA-axis dysregulation and self-reported depressive symptoms in adolescence: a prospective study on the fetal origins of depressed mood. Neuropsychopharmacology 33(3):536–545. doi:10.1038/sj.npp.1301450

    Article  PubMed  Google Scholar 

  • Watson JP, Gaind R, Marks IM (1972) Physiological habituation to continuous phobic stimulation. Behav Res Ther 10(3):269–278. doi:10.1016/0005-7967(72)90043-5

    Article  PubMed  CAS  Google Scholar 

  • Wikner BN, Stiller CO, Bergman U, Asker C, Kallen B (2007) Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: neonatal outcome and congenital malformations. Pharmacoepidemiol Drug Saf 16(11):1203–1210. doi:10.1002/pds.1457

    Article  PubMed  Google Scholar 

  • Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, Singer LT (2009) Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry 166(5):557–566. doi:10.1176/appi.ajp.2008.08081170

    Article  PubMed  Google Scholar 

  • Yonkers KA, Bruce SE, Dyck IR, Keller MB (2003) Chronicity, relapse, and illness—course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Depress Anxiety 17(3):173–179

    Article  PubMed  Google Scholar 

  • Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL, Stotland N, Lockwood C (2009) The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Gen Hosp Psychiatry 31(5):403–413. doi:10.1016/j.genhosppsych.2009.04.003

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the University of Colorado Boulder startup funds to the first author (J.J.A.). We thank Jenn Leiferman, Ph.D., for her helpful suggestions on heart rate exercise safety guidelines during pregnancy.

Author information

Authors and Affiliations

  1. Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA

    Joanna J. Arch & Sona Dimidjian

  2. Department of Psychiatry, School of Medicine, Depression Center, University of Colorado Denver, Aurora, CO, 80045, USA

    Cheryl Chessick

Authors
  1. Joanna J. Arch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sona Dimidjian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheryl Chessick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joanna J. Arch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arch, J.J., Dimidjian, S. & Chessick, C. Are exposure-based cognitive behavioral therapies safe during pregnancy?. Arch Womens Ment Health 15, 445–457 (2012). https://doi.org/10.1007/s00737-012-0308-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-012-0308-9

Keywords

Search

Navigation