Pregnancy is one of the most stressful stages in Women's life. The purpose was to determine the effectiveness of Dialectical Behavior Therapy Techniques Training lavender aromatherapy on depression and maternal competence of Primiparous women with Insecure Attachment to Spouse.
 
 

This clinical trial study was performed in 2021 on 60 pregnant women in Birjand, Iran. Insecure attached expectant mothers were selected by purposive sampling method and randomly divided between three intervention groups 1 (Dialectical behavior therapy techniques training and aromatherapy), intervention group 2 (aromatherapy with lavender), and control group. Dialectical behavioral therapy techniques were performed in the last three months of pregnancy, aromatherapy in the active phase of labor, and the follow-up period one month after the baby's birth. The attachment to spouse Questionnaire, depression Beck, postpartum depression, and maternal competency were used. Data were analyzed in SPSS 25 (SPSS Inc., Chicago, IL., USA).

The results showed that dialectical behavioral therapy training in the last trimester of pregnancy combined with the active aromatherapy phase of labor effectively reduced depression over time (third trimester of pregnancy and one month after birth). In addition, training dialectical behavioral therapy techniques combined with aromatherapy compared to the aromatherapy group, significantly reduced depression, which indicated the effectiveness of teaching dialectical behavior therapy techniques. Supporting the present finding, several studies have confirmed the efficacy of dialectical behavior therapy on reducing pregnancy and postpartum depression [28, 26]. It can be stated that dialectical behavior therapy at all stages tries to show clients two different poles of action, how emotion, thought, or behavior can lead to the improvement or destruction of a process. Dialectical behavioral therapy shows these two poles with their implications for clients [24], and as a supportive therapy that requires strong communication between the client and the therapist, can develop skills such as tolerance, mindfulness, emotional self-regulation, and effective communication in clients [33]. Also, dialectical behavior therapy training improves the general orientation of individuals, a sense of trust, and continuous and pervasive dynamism in life and around [24]. Because depressed people have negative emotions such as sadness, anger, restlessness, and fatigue, this treatment helps pregnant mothers to identify their emotions more accurately and to examine any emotions without feeling helpless. In other words, dialectical behavior therapy enables pregnant women to perceive life as understandable and controllable while understanding emotions and feelings and accepting problems and inefficiencies, thus reducing their depression. In the present study, despite the effectiveness of the combination of dialectical behavioral therapy techniques with aromatherapy on reducing depression, the effectiveness of aromatherapy compared to the control group on reducing depression was not significant. However, some studies have confirmed the effectiveness of lavender aromatherapy as an effective treatment option for relieving depressive symptoms in a wide range of individuals [3], such as reducing depression [34].
On the other hand, as the present study showed, teaching dialectical behavior therapy techniques with aromatherapy was able to reduce depression over time in a decreasing trend, and on the other hand, studies also showed a negative relationship between postpartum depression and maternal role adequacy [14]. Therefore, it seems that dialectical behavior therapy skills, reducing the feeling of depression, increase the sense of competence in the mother role, i.e., the mother's belief in her ability to affect the child's behavior and growth and development positively. Because mothers with postpartum depression, feel less skillful and satisfied with the mother role [37]. Contrary to the results of some studies [38], the effectiveness of educating pregnant women in increasing the competency of the role of parenthood has been confirmed. Wider skills have been taught in dealing with anxiety and emotion regulation, mindfulness development, and interpersonal relationship management, which are meta-diagnostic factors in dealing with stressful situations, and have gone beyond merely discussing the role of motherhood. However, positive emotion regulation creates the ability to cope with emotions in people and enables them to recognize emotions in themselves and others and to be able to respond appropriately to stressful and anxious situations. Therefore, it can be said that the effect it has on improving the mother's efficiency contributes to the satisfaction of the mother role. In addition, given that insecure attachment mothers were targeted in this study, it seems likely that depression has increased in these mothers due to insecure attachment to their spouse and lack of social support [10].
In general, the present study was conducted considering several new angles; the target population of the present study was pregnant women vulnerable to depression (primiparous women of the third period of pregnancy with insecure attachment to their husbands). Another point is the evaluation of depression in three time periods; Pregnancy (Dialectical Behavior Therapy Techniques) took place during childbirth (aromatherapy) and one month after delivery. Researchers found no study in this regard. This study was associated with limitations, and the point to consider is the short follow-up period and the use of self-report questionnaires. It is also noteworthy that this study was conducted on women without high-risk pregnancies.
 
 

Dialectical behavioral therapy techniques and aromatherapy are effective interventions to reduce depression and increase maternal competence. They can be used for pregnant women with insecure attachment to their husbands in health centers.
 
 

This article was taken from the doctoral dissertation of Psychology carried out in Birjand and was conducted obtaining the code of ethics from Birjand University of Medical Sciences (IR.BUMS.REC.1399.115) and the clinical trial number (IRCT20200604047655N1). The authors consider it necessary to express their sincere gratitude for the cooperation of Vali-e asr Health Centers and Hospital and the pregnant women who participated in this study.
 
 

The authors declared no conflict of interest.