Volume 28, Issue 4 (Fall 2020)                   Avicenna J Nurs Midwifery Care 2020, 28(4): 32-44 | Back to browse issues page

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Ghorbani S, Jourabchi Z, Sarichloo M E, Olfati F. The Effect of Group Counseling Based on Cognitive Behavioral Therapy on Anxiety of Pregnant Women with Constipation: Clinical Trial. Avicenna J Nurs Midwifery Care 2020; 28 (4) :32-44
URL: http://nmj.umsha.ac.ir/article-1-2123-en.html
1- MSc. Master Student, Department of Midwifery Counseling, Student Research Committee of Qazvin University of Medical Sciences, Qazvin, Iran
2- Assistant Professor, Social Determinants of Health Research and Department of Midwifery, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
3- PhD Student, Department of Psychiatry, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
4- Assistant Professor, Metabolic Diseases Research Center and Department of Midwifery, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran , papoy6olfati@yahoo.com
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✅ The present study indicated the beneficial effect of cognitive and behavioral therapy model on the anxiety of pregnant women with constipation, and it is recommended as a non-pharmacological approach to reduce their anxiety.

Extended Abstract:   (682 Views)

Anxiety during pregnancy is a special emotional state related with different concerns during pregnancy including infant health and parturition, which is associated with an increased risk of a range of negative consequences for both mother and child. Therefore, the aim of this study was to investigate the effect of cognitive and behavioral therapy on the anxiety of mothers with pregnancy constipation.


Materials and Methods

The present randomized clinical trial, which included 60 pregnant women with gestational age of 10 to 20 weeks referred to two comprehensive urban health services in Takestan during 2019. Subjects were randomly divided into intervention (n=30) and control (n=30) groups. Study tools included the short form of pregnancy-related anxiety questionnaire (PRAQ-17) and a constipation assessment scale in pregnancy. Intervention included 6-week 90-minute consultation sessions (one session each week) for five groups of 6 persons. Follow-up included immediately and one and two months after session completion.
SPSS software version 23 (SPSS Inc., Chicago, Ill., USA) was used for data analysis. Descriptive statistical methods were used to provide general information, to compare the two experimental and control groups before the intervention, to compare the intervention and control groups after the intervention, repeated measures test (Chi-square test) was used to compare qualitative variables. Significance level was determined to be less than 0.05.
This study was approved in the Clinical Trial Registration Center of Iran obtaining the code IRCT20181205041852N1 and by ethics committee of Qazvin University of Medical Sciences with the code IR.QUMS.REC.1397.267.



The mean of pregnancy anxiety scale, immediately, one month and two months after the intervention was significant (P<0.001). In terms of time and group interaction significant difference was observed (P<0.001; F=29.776), In other words, there was a significant difference between the two groups in terms of pregnancy anxiety over time.
Table 1. Demographic characteristics of the two groups of intervention and control
Variable Intervention Control x2 P
Frequency % Frequency %
Mother age (years)
16-20 7 11.7 6 10.0 1.0142 0.780
21-25 6 10.0 8 13.3
26-30 10 16.7 7 11.7
31-35 7 11.7 9 15.0
Duration of marriage (years)
0-5 15 25.0 16 26.7 0.906 0.181
6-10 11 18.3 8 13.3
11-15 2 3.3 3 5.0
16-20 2 3.3 3 5.0
Mother's education
Illiterate 0 0.0 1 1.7 1.273 0.889
High school 12 20.0 10 16.7
Diploma 13 21.7 13 21.7
BS 5 8.3 6 10.0
Income (million Tomans)
1-2 10 16.7 12 20.0 4.649 0.113
2-3 18 30.0 11 18.3
3-4 2 3.3 7 11.7
Insurance with 22 36.7 27 45.0 2.783 0.181
without 8 13.3 3 5.0
Marital Satisfaction Very satisfied 10 16.7 9 15.0 0.077 0.781
Satisfied 20 33.3 21 35.0
History of abortion history has 9 15.0 5 8.3 1.491 0.360
does not have 21 35.0 25 41.7
Type of previous delivery normal 7 11.7 8 13.3 0.113 0.936
Cesarean section 8 13.3 7 11.7
No history of childbirth 15 25.0 15 25.0
Wanting to get pregnant willingly 23 38.3 21 35.0 0.344 0.771
Unwillingly 7 11.7 9 15.0
Physical activity rate
Low 12 20.0 14 23.3 1.669 0.434
medium 10 16.7 12 20.0
Much 8 13.3 4 6.7
Take iron supplements Yes 21 35.0 22 36.7 1.273 0.771
No 9 15.0 8 12.4
Vegetable and fruit consumption share (share) 1-2 12 20.0 14 23.3 2.064 0.598
2-3 9 15.0 11 18.3
3-4 8 13.3 5 8.3
Other 1 1.7 0 0.0
Vegetable and fruit consumption share (share 2-4 22 36.7 15 25.5 3.486 0.226
4-6 7 1.71 12 20.0
6-8 1 1.7 3 5.0
Night sleep (hours) >4 1 1.7 1 1.7 5.784 0.195
6-4 3 5.0 6 10.0
6-8 13 21.7 7 11.7
8-10 8 13.3 14 23.3
<10 5 8.3 2 3.3
Table 2. Comparison of mean and standard deviation of pregnancy anxiety in test and control groups before and immediately, 1 and 2 months after intervention
Before intervention Immediately after the intervention One month after the intervention Two months after the intervention F (P)
Pregnancy Anxiety Index
control group M 84.200 83.300 75.633 87.200 <0.001
SD 8.433 7.278 12.438 10.340
Intervention group M 79.366 58.633 52.600 59.966 <0.001
SD 6.365 6.376 9.922 9.600
T(P) 0.015 <0.001 <0.001 <0.001  


In a study conducted by Karamouzian et al. in 2013, showed that cognitive-behavioral stress management training has been effective in reducing anxiety and depression during pregnancy, which can be said to be consistent with the present study [29]. In a study conducted by Safaralinezhad et al. to investigate the effect of group cognitive-behavioral counseling on depression during pregnancy showed that this counseling model has a significant effect on reducing depression during pregnancy [30]. Although in this study the dependent variable was depression during pregnancy, but since many studies showed that there is a significant relationship between anxiety and depression, it can be said that it was consistent with the present study [31].
Because interventions during pregnancy are always associated with concerns, there were concerns that the use of cognitive-behavioral interventions for the mother was associated with complications until Goodman et al. to perform other psychotherapeutic methods such as cognitive-behavioral therapy. In this study, they concluded that mindfulness as a non-pharmacological method is effective on pregnancy anxiety [33]. Therefore, in the present study, the effect of group counseling based on cognitive-behavioral therapy on anxiety and constipation in pregnant women was investigated.
In their study, Arch et al. found that pregnant women preferred cognitive-behavioral therapy more than non-pregnant women, and that pregnancy status influenced this preference. This may be due to the limited use of medication to treat anxiety in pregnancy [34]. To increase the effectiveness of this intervention, examining cognitive errors and negative automatic thoughts is not enough and it is necessary to pay special attention to irrational and false assumptions and the main beliefs of pregnant women and correct them, as well as their coping skills in dealing with anxiety.
One of the limitations of this study was the fatigue of the samples to participate in counseling sessions, which caused the samples to fall. Also, due to the consultative nature of the intervention, a single-sided blind study was performed.



The present study indicated the beneficial effect of cognitive and behavioral therapy model on the anxiety of pregnant women with constipation, and it is recommended as a non-pharmacological approach to reduce their anxiety.



This study is part of the approved master's thesis in the field of counseling in midwifery with the ID number IR.QUMS.REC.1397.267. We would like to thank the staff of Takestan County Health Network who helped us in this research.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Original Research | Subject: Midwifery
Received: 2020/01/7 | Accepted: 2020/04/26 | Published: 2020/10/1

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