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Are exposure-based cognitive behavioral therapies safe during pregnancy?

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.

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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.

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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.

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Correspondence to Joanna J. Arch.

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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

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

Keywords

  • Anxiety disorders
  • Cognitive behavioral therapy
  • Exposure
  • Pregnancy or antenatal
  • Safety