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The high comorbidity of major depressive disorder (MDD), anxiety disorders (ANX), and post-traumatic stress disorder (PTSD) complicates the study of their structural neural correlates, particularly in white matter (WM) alterations. Using fractional anisotropy (FA), this meta-analysis aimed to identify both unique and shared WM characteristics for these disorders by comparing them with healthy controls (HC). The aggregated sample size across studies includes 3,661 individuals diagnosed with MDD, ANX, or PTSD and 3,140 HC participants. The whole-brain analysis revealed significant FA reductions in the corpus callosum (CC) across MDD, ANX, and PTSD, suggesting a common neurostructural alteration underlying these disorders. Further pairwise comparisons highlighted disorder-specific differences: MDD patients showed reduced FA in the middle cerebellar peduncles and bilateral superior longitudinal fasciculus II relative to ANX patients and decreased FA in the CC extending to the left anterior thalamic projections (ATPs) when compared with PTSD. In contrast, PTSD patients exhibited reduced FA in the right ATPs compared to HC. No significant FA differences were observed between ANX and PTSD or between ANX and HC. These findings provide evidence for both shared and unique WM alterations in MDD, ANX, and PTSD, reflecting the neural underpinnings of the clinical characteristics that distinguish these disorders.
Threat sensitivity, an individual difference construct reflecting variation in responsiveness to threats of various types, predicts physiological reactivity to aversive stimuli and shares heritable variance with anxiety disorders in adults. However, no research has been conducted yet with youth to examine the heritability of threat sensitivity or evaluate the role of genetic versus environmental influences in its relations with mental health problems. The current study addressed this gap by evaluating the psychometric properties of a measure of this construct, the 20-item Trait Fear scale (TF-20), and examining its phenotypic and genotypic correlations with different forms of psychopathology in a sample of 346 twin pairs (121 monozygotic), aged 9–14 years. Analyses revealed high internal consistency and test-retest reliability for the TF-20. Evidence was also found for its convergent and discriminant validity in terms of phenotypic and genotypic correlations with measures of fear-related psychopathology. By contrast, the TF-20’s associations with depressive conditions were largely attributable to environmental influences. Extending prior work with adults, current study findings provide support for threat sensitivity as a genetically-influenced liability for phobic fear disorders in youth.
This study presents the most recent data on the incidence, prevalence, and years lived with disability (YLDs) due to anxiety disorders across the Middle East and North Africa (MENA) region from 1990-2021, analysed by sex, age, and sociodemographic index (SDI).
Methods:
We assessed the burden of anxiety disorders using data sourced from the Global Burden of Disease 2021 study. The estimates of prevalence, DALYs, and YLDs are provided as numbers and age-standardised rates, accompanied by their 95% uncertainty intervals (UIs).
Results:
In 2021, the age-standardised point prevalence of anxiety disorders in the region was 5.95 thousand, with an incidence rate of 883.4 per 100,000. The number of YLDs in 2021 reached 4.5 million. From 1990 to 2021, the burden of anxiety disorders increased significantly. Lebanon had the highest burden in 2021. Among both sexes, the 10–14 age group had the highest incidence rate, while the 15–19 age group had the highest prevalence and YLD rates. In 2021, most age groups in the MENA region had YLD rates that were higher than the global average.
Conclusion:
This study highlights the urgent need for a multidisciplinary approach to prevent and manage anxiety disorders. Ensuring accessible and affordable treatment options for all affected individuals is crucial. Governments should prioritise supporting programmes to effectively address mental health issues, given the unique socioeconomic and geopolitical challenges in the MENA region. By including effective preventive methods alongside treatment in healthcare strategies, the burden of anxiety disorders can be significantly reduced.
Low-income, publicly insured youth face numerous barriers to adequate mental health care, which may be compounded for those with multiple marginalized identities. However, no research has examined how identity and diagnosis may interact to shape the treatment experiences of under-resourced youth with psychiatric conditions. Applying an intersectional lens to treatment disparities is essential for developing targeted interventions to promote equitable care.
Methods
Analyses included youth ages 7–18 with eating disorders (EDs; n = 3,311), mood/anxiety disorders (n = 3,219), or psychotic disorders (n = 3,035) enrolled in California Medicaid. Using state billing records, we examined sex- and race and ethnicity-based disparities in receipt of core services – outpatient therapy, outpatient medical care, and inpatient treatment – in the first year after diagnosis and potential differences across diagnostic groups.
Results
Many youth (50.7% across diagnoses) received no outpatient therapy, and youth with EDs were least likely to receive these services. Youth of color received fewer days of outpatient therapy than White youth, and Latinx youth received fewer therapy and medical services across outpatient and inpatient contexts. Sex- and race and ethnicity-based disparities were especially pronounced for youth with EDs, with particularly low levels of service receipt among boys and Latinx youth with EDs.
Conclusions
Results raise concerns for unmet treatment needs among publicly insured youth, which are exacerbated for youth with multiple marginalized identities and those who do not conform to historical stereotypes of affected individuals (e.g., low-income boys of color with EDs). Targeted efforts are needed to ensure equitable care.
Anxiety disorders, characterized by excessive fear and behavioral disturbances, are among the most prevalent psychiatric conditions, yet treatment options remain suboptimal for many patients. Clonidine, an alpha-2 adrenergic receptor agonist, has shown potential anxiolytic effects and may address treatment-resistant cases. This review explores the efficacy, safety, and mechanism of clonidine as a pharmacological option for anxiety disorders, with emphasis on its role in modulating noradrenergic dysfunction and its potential synergistic effects with existing therapies. A literature review was conducted to evaluate clinical studies, case reports, and comparative trials on clonidine’s use in anxiety disorders, focusing on its pharmacological profile, efficacy, and tolerability. Evidence suggests clonidine may reduce anxiety symptoms, particularly in treatment-resistant cases and specific populations, such as pediatric patients and those with comorbid psychiatric disorders. Its mechanism involves modulating norepinephrine release and glutamatergic pathways. Case studies and small trials highlight its potential in reducing cognitive symptoms of anxiety, but inconsistencies in efficacy and side effects, including sedation and hypotension, were noted. Comparative studies suggest clonidine may have similar efficacy to SSRIs in some cases but lack large-scale validation. Clonidine presents as a promising pharmacotherapeutic option for anxiety disorders, particularly in cases resistant to conventional treatments or in patients with contraindications to other typical medications. Its mechanism of action, tolerability, and potential synergistic effects with existing therapies underscore the need for continued exploration and clinical trials to establish its optimal role in anxiety disorder management.
Functional Somatic Disorders (FSD) and Internalizing Psychiatric Disorders (IPD) are frequently comorbid and likely share familial/genetic risk factors.
Methods
We performed a Common Factor Multivariate Analysis of 2 FSDs, Fibromyalgia (FM) and Irritable Bowel Syndrome (IBS), and two IPDs, Major Depression (MD) and Anxiety Disorders (AD), in five kinds of Swedish female–female relative pairs: monozygotic (n = 8,052) dizygotic (n = 7216), full siblings (n = 712,762), half-siblings reared together (n = 23,623), and half-siblings reared apart (n = 53,873). Model fitting was by full information maximum likelihood using OpenMx.
Results
The best-fit model included genetic, shared environmental, and unique environmental factors. The common factor, ~50% heritable with a small shared environmental effect, loaded more strongly on the two IPDs (~0.80) than the 2 FSDs (0.40). Disorder-specific genetic effects were larger for the 2 FSDs (~0.30) than the 2 IPDs (~0.03). Estimated genetic correlations were high for MD and AD (+0.91), moderate between IBS and IPDs (+0.62), and intermediate between FM and MD (+0.54), FM and AD (+0.28), and FM and IBS (+0.38). Shared environmental influences on all disorders were present but small.
Conclusions
In women, FSDs and IPDs shared a moderate proportion of their genetic risk factors, greater for IBS than for FM. However, the genetic sharing between IBS and FM was less than between MD and AD, suggesting that FSDs do not form a highly genetically coherent group of disorders. The shared environment made a modest contribution to the familial aggregation of FSDs and IPDs.
Myocardial bridge contributes to chest pain, often accompanied by non-specific complaints.
Aims
Our study aims to determine somatic symptom disorder (SSD) prevalence in patients with myocardial bridge, investigating associated clinical and psychological features.
Method
In this prospective cross-sectional study, we enrolled 1357 participants (337 with and 1020 without myocardial bridge) from Shanghai Renji Hospital. The Somatic Symptom Scale-China questionnaire was used to assess SSD. Depressive and anxiety disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7).
Results
The prevalence of SSD in the myocardial bridge group was 63.2%, higher than the group without myocardial bridge (53.8%). Patients with myocardial bridge were at an increased risk of SSD (odds ratio 1.362, 95% CI 1.026–1.809; P = 0.033). There were no differences in the mean PHQ-9 scores (3.2 ± 3.4 v. 3.2 ± 4.1; P = 0.751) or GAD-7 scores (2.5 ± 3.0 v. 2.3 ± 3.7; P = 0.143) between the two groups. Among patients with myocardial bridge, gender was the only independent risk factor for SSD. Women were 3.119 times more likely to experience SSD compared with men (95% CI 1.537–6.329; P = 0.002).
Conclusions
Our findings emphasise the high prevalence and severity of SSD among patients with myocardial bridge. The screening for SSD should be of particular concern, especially among female patients.
The Personalized Advantage Index (PAI) shows promise as a method for identifying the most effective treatment for individual patients. Previous studies have demonstrated its utility in retrospective evaluations across various settings. In this study, we explored the effect of different methodological choices in predictive modelling underlying the PAI.
Methods
Our approach involved a two-step procedure. First, we conducted a review of prior studies utilizing the PAI, evaluating each study using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). We specifically assessed whether the studies adhered to two standards of predictive modeling: refraining from using leave-one-out cross-validation (LOO CV) and preventing data leakage. Second, we examined the impact of deviating from these methodological standards in real data. We employed both a traditional approach violating these standards and an advanced approach implementing them in two large-scale datasets, PANIC-net (n = 261) and Protect-AD (n = 614).
Results
The PROBAST-rating revealed a substantial risk of bias across studies, primarily due to inappropriate methodological choices. Most studies did not adhere to the examined prediction modeling standards, employing LOO CV and allowing data leakage. The comparison between the traditional and advanced approach revealed that ignoring these standards could systematically overestimate the utility of the PAI.
Conclusion
Our study cautions that violating standards in predictive modeling may strongly influence the evaluation of the PAI's utility, possibly leading to false positive results. To support an unbiased evaluation, crucial for potential clinical application, we provide a low-bias, openly accessible, and meticulously annotated script implementing the PAI.
Observational studies consistently report associations between tobacco use, cannabis use and mental illness. However, the extent to which this association reflects an increased risk of new-onset mental illness is unclear and may be biased by unmeasured confounding.
Methods
A systematic review and meta-analysis (CRD42021243903). Electronic databases were searched until November 2022. Longitudinal studies in general population samples assessing tobacco and/or cannabis use and reporting the association (e.g. risk ratio [RR]) with incident anxiety, mood, or psychotic disorders were included. Estimates were combined using random-effects meta-analyses. Bias was explored using a modified Newcastle–Ottawa Scale, confounder matrix, E-values, and Doi plots.
Results
Seventy-five studies were included. Tobacco use was associated with mood disorders (K = 43; RR: 1.39, 95% confidence interval [CI] 1.30–1.47), but not anxiety disorders (K = 7; RR: 1.21, 95% CI 0.87–1.68) and evidence for psychotic disorders was influenced by treatment of outliers (K = 4, RR: 3.45, 95% CI 2.63–4.53; K = 5, RR: 2.06, 95% CI 0.98–4.29). Cannabis use was associated with psychotic disorders (K = 4; RR: 3.19, 95% CI 2.07–4.90), but not mood (K = 7; RR: 1.31, 95% CI 0.92–1.86) or anxiety disorders (K = 7; RR: 1.10, 95% CI 0.99–1.22). Confounder matrices and E-values suggested potential overestimation of effects. Only 27% of studies were rated as high quality.
Conclusions
Both substances were associated with psychotic disorders and tobacco use was associated with mood disorders. There was no clear evidence of an association between cannabis use and mood or anxiety disorders. Limited high-quality studies underscore the need for future research using robust causal inference approaches (e.g. evidence triangulation).
Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders.
Methods
We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference.
Results
The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment.
Conclusions
Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.
Although there is now substantial evidence on the acute impacts of the COVID-19 pandemic on anxiety disorders, the long-term population impact of the pandemic remains largely unexplored.
Aims
To quantify a possible longitudinal population-level impact of the pandemic by projecting the prevalence of anxiety disorders through 2030 among men and women aged up to 95 years in Germany under scenarios with varying impacts of the pandemic on the incidence of anxiety disorders.
Method
We used a three-state illness–death model and data from the Global Burden of Disease Study to model historical trends of the prevalence and incidence of anxiety disorders. The German population projections determined the initial values for projections. The COVID-19 incidence rate data informed an additional incidence model, which was parameterised with a wash-in period, delay, wash-out period, incidence increase level and decay constant.
Results
When no additional increase in the incidence during the pandemic waves during 2020–2022 was assumed, it was estimated that 3.86 million women (9.96%) and 2.13 million men (5.40%) would have anxiety disorders in 2030. When increases in incidence following pandemic waves were assumed, the most extreme scenario projected 5.67 million (14.02%) women and 3.30 million (8.14%) men with the mental disorder in 2030.
Conclusions
Any increased incidence during the pandemic resulted in elevated prevalence over the projection period. Projection of anxiety disorder prevalence based on the illness–death model enables simulations with varying assumptions and provides insight for public health planning. These findings should be refined as trend data accumulate and become available.
Mood and anxiety disorders are heterogeneous conditions with variable course. Knowledge on latent classes and transitions between these classes over time based on longitudinal disorder status information provides insight into clustering of meaningful groups with different disease prognosis.
Methods
Data of all four waves of the Netherlands Mental Health Survey and Incidence Study-2 were used, a representative population-based study of adults (mean duration between two successive waves = 3 years; N at T0 = 6646; T1 = 5303; T2 = 4618; T3 = 4007; this results in a total number of data points: 20 574). Presence of eight mood and anxiety DSM-IV disorders was assessed with the Composite International Diagnostic Interview. Latent class analysis and latent Markov modelling were used.
Results
The best fitting model identified four classes: a healthy class (prevalence: 94.1%), depressed-worried class (3.6%; moderate-to-high proportions of mood disorders and generalized anxiety disorder (GAD)), fear class (1.8%; moderate-to-high proportions of panic and phobia disorders) and high comorbidity class (0.6%). In longitudinal analyses over a three-year period, the minority of those in the depressed-worried and high comorbidity class persisted in their class over time (36.5% and 38.4%, respectively), whereas the majority in the fear class did (67.3%). Suggestive of recovery is switching to the healthy class, this was 39.7% in the depressed-worried class, 12.5% in the fear class and 7.0% in the high comorbidity class.
Conclusions
People with panic or phobia disorders have a considerably more persistent and chronic disease course than those with depressive disorders including GAD. Consequently, they could especially benefit from longer-term monitoring and disease management.
Anxiety related school avoidance can affect up to 5% of a country’s students each year. VRET (Virtual Reality Exposure Therapy) is a novel therapy proven to be as effective as conventional approaches for treating many anxiety disorders. The aim of this research is to co-design and evaluate a VRET intervention for students experiencing school related anxiety.
Method:
Eighteen adolescents participated in design thinking workshops where they developed a script and storyboard for the VRET. Using an iterative approach, a VRET prototype was developed based on this work. Eighteen teenagers were subsequently recruited to engage with the VRET for one session each and provide feedback on their experience via a structured questionnaire (supervised by a study coordinator) particularly focusing on the ability of the VR experience to reduce school related anxiety.
Results:
Exposure therapy needs to produce an anxiety response to be effective. The VRET was effective in producing an anxiety response in 89% of participants. Results demonstrated that 93% of participants found the simulations immersive, 94% found the scenarios believable, and 83% could relate to ‘Dala’, the avatar in the videos. 100% of participants believed that VRET would help with school anxiety.
Conclusion:
This proof-of-concept study demonstrates favourable face validity indicating promise for this mode of intervention for delivering targeted support to anxious students. VRET could be used as a scalable, cost effective early intervention to reduce the severity of anxiety associated with school avoidance.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
Anxiety symptoms and anxiety disorders are common in community settings and primary and secondary medical care. Anxiety symptoms are often mild and only transient, but many people are troubled by severe symptoms that cause both considerable personal distress and a marked impairment in social and occupational function. The principal anxiety disorders are currently considered to comprise panic disorder, generalised anxiety disorder, social anxiety disorder, agoraphobia, specific phobias, separation anxiety disorder and selective mutism. Additional conditions (not considered further here) include substance/medication-induced anxiety disorder, anxiety disorder due to another medical condition, other specified anxiety disorder and unspecified anxiety disorder. Together, anxiety disorders constitute the most frequent mental disorders, with an estimated 12-month prevalence of approximately 10–14 per cent.
Although the societal impact of anxiety disorders is substantial, many of those who could benefit from psychological or pharmacological treatment are neither recognised nor treated. Recognition relies on maintaining a keen awareness of the psychological and physical symptoms of anxiety disorders, and accurate diagnosis rests on identifying the pathognomonic features of specific conditions.
The influence of baseline severity on the efficacy of Silexan, a proprietary essential oil from Lavandula angustifolia, in anxiety disorders has not been investigated in a pooled dataset. We report on an individual patient data analysis of all five double-blind, randomized, placebo-controlled trials with Silexan in anxiety disorders. Eligible participants received Silexan 80 mg/d or placebo for 10 weeks. Analyses were based on the Hamilton Anxiety Rating Scale (HAMA), its psychic and somatic anxiety subscores, and the Clinical Global Impressions (CGI) scale. To correlate baseline severity with outcome, patients were segregated into mild, moderate, and severe cases. Altogether 1,172 patients (Silexan, n = 587; placebo, n = 585) were analyzed. For the HAMA total score, we found a significant association between the score at baseline and the treatment effect of Silexan versus placebo at week 10 (p < 0.001). HAMA items from the somatic domain scored lower at baseline and showed less improvement than items from the psychic domain, particularly in patients with mild or moderate baseline symptoms. For CGI item 2 (global improvement), significant efficacy favoring Silexan were observed in mild, moderate, and severe baseline symptom severity. Although significant improvements were found for all subsets, the more severe the initial symptoms, the greater the treatment effects documented by the HAMA. Overall this analysis confirms that Silexan is an effective treatment option in early or mild stages of anxiety disorder. Given its favorable safety profile, Silexan can thus fill a therapeutic gap in the treatment of (subsyndromal) anxiety disorders.
Depressive symptoms may be the observable features of several different mental conditions, which require different treatments. It is particularly important to identify bipolar vulnerability. Alcohol and other recreational drugs can cause or worsen depression and anxiety. Eating disorders can be manifestations of depression or anxiety, but can also bring about these conditions. People with autism may be particularly vulnerable to anxiety disorders. Students suffer from depression and anxiety disorders at around the same rate as the rest of their age group but have unique difficulties accessing treatment. They can benefit from access to psychotherapies alongside medication to enhance benefits. There is a wide range of anxiety disorders, and anxiety is very often present alongside depression. In such cases higher doses of the so-called ‘antidepressant’ drugs are required. Students and staff may have both genetic and environment predispositions to mental disorders. Treatments which have helped a family member may prove most effective. Prescribing for female students and staff should consider safety during any future pregnancy. Students with more severe depression or anxiety disorders require longer therapies than university counselling routinely offers. Discussions with local NHS clinics are needed. Arrangements for treatment during vacations are essential.
Edited by
Andrea Fiorillo, University of Campania “L. Vanvitelli”, Naples,Peter Falkai, Ludwig-Maximilians-Universität München,Philip Gorwood, Sainte-Anne Hospital, Paris
Anxiety Disorders (ADs) are the most prevalent mental disorders worldwide and are characterized by a wide variety of psychological and somatic symptoms, which are often misinterpreted as symptoms of a medical condition. ADs carry a large disease burden that impacts negatively on patients’ health-related quality of life and global life satisfaction and disrupts important activities of daily living. In this chapter we analyze the epidemiology and clinical presentation of ADs, highlighting recent innovations and changes in the classification of anxiety disorders in DSM-5 and ICD-11. Main available pharmacological and nonpharmacological therapies for the treatment of ADs, based on the most recent clinical evidence and updated literature, are presented as well. Lastly, we focus the attention on future perspectives about ADs, examining clinical correlations of peripheral biomarkers, neuroimaging, genetics, epigenetics, and microbiota data. These features may be useful to achieve further insight in terms of physiopathology, to support early diagnosis, and to facilitate the prediction of illness susceptibility and treatment response, in order to support clinicians’ practice and to develop personalized treatment strategies.
This paper explores the relationship between globalisation and mental health by using the global dataset of high-, middle-, and low-income countries for the period 1970–2020. Although the consequences of globalisation on general health have been extensively studied, limited attention has been paid to investigating the implications on mental health. To show robustness, globalisation has been divided into three main dimensions such as economic globalisation, political globalisation, and social globalisation while, mental health has been classified through various indicators, i.e., mental disorder, anxiety disorder, and depressive disorder. The study used panel fixed effect techniques to demonstrate the quadratic effects of globalisation on mental health. A U-shaped curve relationship between globalisation (including economic, political, and political globalisation) and mental disorders, anxiety disorders, and depressive disorders was identified. However, findings also indicate an inverted U-shaped curve relationship between globalisation and mental health for high-income countries and a U-shaped curve relationship for middle- and low-income countries. Prioritizing mental health is crucial for overall well-being and productivity. Furthermore, a comprehensive policy implementation is strongly recommended to protect societies from mental distress when a country plans to expand globalisation worldwide.
This chapter provides the rationale and background of interoceptive exposure exercises, the body investigations parents and children (and possibly healthcare providers) will perform in each session. The origins of these exercises in the treatment of panic disorder will be reviewed, while introducing key developmental considerations and explaining the importance of an acceptance-based framework. In brief, in the context of panic disorder, interoceptive exposure exercises were intended to provoke a sensation that was feared and to provide new learning that this experience is not dangerous - new learning that competes with prior beliefs of harm or threat. One of the strengths of the FBI approach is that it uses sensations rather than cognitions as a framework for learning. This is essential for children who often do not have access to the content and meaning of their thoughts, or the language to articulate them with insight. As children do not have well-formed beliefs about threats, body exposure investigations are designed to help children learn how smart and trustworthy their bodies are –experiences that may directly contrast with their prior ones of weakness and vulnerability.
Approximately 15% of pregnant women experience anxiety disorders. Effective treatments exist but their acceptability during pregnancy, particularly exposure therapy, is not known.
Aims
To understand patient and therapist experiences of time-intensive and weekly exposure-based therapy for anxiety disorders delivered during pregnancy. Trial registration: ISRCTN81203286.
Method
In-depth interviews were conducted with patients and therapists who had taken part in a feasibility trial of predominantly online time-intensive versus weekly cognitive–behavioural therapy in pregnancy in a primary care setting in the UK. Data were analysed using reflexive thematic analysis.
Results
In total, 45 women participating in the trial and 6 therapists who had delivered the treatments were interviewed. Five themes were developed from the data that showed convergence from therapist and patient perspectives: ‘Acquiring tools to navigate the perinatal period’; ‘Motivated yet constrained by pregnancy’; ‘Having the confidence to face fears and tolerate uncertainty’; ‘Momentum with the need for flexibility’; ‘Being removed from the face-to-face world’.
Conclusions
Exposure therapy is acceptable and helpful in pregnancy and can lead to lasting gains. Exposure is a key element of treatment and needs to be confidently conducted by therapists with perinatal knowledge and expertise. Treatments need to consider the unfolding context of pregnancy. The momentum of intensive therapy can lead to rapid improvements, but is demanding for both patients and therapists, especially fitting round other commitments. Online treatments can work well and are a good fit for perinatal women, but this needs to be balanced with the need for social connection, suggesting a hybrid model is the ideal.