Volume 29, Issue 4 (Fall 2021)                   Avicenna J Nurs Midwifery Care 2021, 29(4): 314-327 | Back to browse issues page

Ethics code: IR.BUMS.REC.1399.115
Clinical trials code: IRCT20200604047655N1

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Zameni E, Shahabizadeh F, Jarahi Feriz J, Ghanbarzadeh N. The Effect of Dialectical Behavior Therapy Techniques Training with lavender Aromatherapy on Depression and Maternal Competence of Nulliparous Women with Insecure Attachment to Spouse. Avicenna J Nurs Midwifery Care 2021; 29 (4) :314-327
URL: http://nmj.umsha.ac.ir/article-1-2338-en.html
1- PhD Student in Psychology, Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran
2- Associate Professor, Department of Psychology, Birjand Branch, Islamic Azad University Birjand, Iran , F_shahabizadeh@yahoo.com
3- Assistant Professor, Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran
Persian Full-Text [PDF 603 kb]   (626 Downloads)     |   Abstract (HTML)  (2131 Views)

✅ 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.

Extended Abstract:   (546 Views)

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.

Materials and Methods

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 of repeated analysis of variance showed that teaching dialectical behavioral therapy techniques was effective in reducing depression over time (P<0.001). Covariance analysis showed that depression during pregnancy was decreased significantly after the Dialectical Behavior Therapy Techniques Training (P<0.001). The multivariate analysis of variance also showed both components of maternal competence increased significantly in intervention groups 1 (P<0.05).


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.

Conflicts of Interest

The authors declared no conflict of interest.


Type of Study: Original Research | Subject: Mental health
Received: 2021/05/29 | Accepted: 2021/08/21 | Published: 2021/12/21

1. Cunningham F, Leveno K, Bloom S, Dashe J, Hoffman, BL Spong CY Translated by Valdan M, Mohammadi Z. Williams obstetrics. 25 th ed; Arjmand publications; 2018:432-434.
2. Bianciardi E, Vito C, Betrò S, De Stefano A, Siracusano A, Niolu C. The anxious aspects of insecure attachment styles are associated with depression either in pregnancy or in the postpartum period. Annu Gen Psychiatry. 2020;19(1):1-9. [DOI:10.1186/s12991-020-00301-7]
3. Sanchez-Vidana DI, Ngai SP, He W, Chow JK, Lau BW, Tsang HW. The effectiveness of aromatherapy for depressive symptoms: A Systematic Review. Evid Based Complement Alternat Med. 2017; 4:1-21:e5869315. [DOI:10.1155/2017/5869315] [PMID] [PMCID]
4. Prelog PR, Makovec MR, Šimic MV, Sršen TP, Perat M. Individual and contextual factors of nulliparas' levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor? Zdr Varst. 2019;58(3):112-9. [DOI:10.2478/sjph-2019-0015] [PMID] [PMCID]
5. Bright KS, Mughal MK, Wajid A, Lane-Smith M, Murray L, Roy N, et al. Internet-based interpersonal psychotherapy for stress, anxiety, and depression in prenatal women: study protocol for a pilot randomized controlled trial. Trials. 2019;20(1):1-11 [DOI:10.1186/s13063-019-3897-z] [PMID] [PMCID]
6. Tokumitsu K, Sugawara N, Maruo K, Suzuki T, Shimoda K, Yasui-Furukori N. Prevalence of perinatal depression among Japanese women: a meta-analysis. Ann Gen Psychiatry. 2020; 19(1):1-18. [DOI:10.1186/s12991-020-00316-0] [PMID] [PMCID]
7. Manavipour D, Heidari S. Effectiveness of education on stress relief based on conscientiousness on resiliency, emotional regulation and attachment styles in men. J Analitical-Cogn Psychol. 2018; 9(34):55-67.
8. Sutton TE. Review of attachment theory: Familial predictors, continuity and change, and intrapersonal and relational outcomes. Marriage Fam Rev. 2019;55(1):1-22 [DOI:10.1080/01494929.2018.1458001]
9. Nilforooshan P, Navidian A. Composition of spouses' attachment dimensions on marital satisfaction. J Fund Ment Health. 2014;16(63):200-12.
10. Falgares G, Lo Gioco A, Verrocchio MC, Marchetti D. Anxiety and depression among adult amputees: the role of attachment insecurity, coping strategies and social support. Psychol Health Med. 2019;24(3):281-93. [DOI:10.1080/13548506.2018.1529324] [PMID]
11. Chae J-Y. The influence of pregnant couples' attachment representation for parents of origin on their psychological symptoms. Fam Environ Res. 2019;57(1):41-50. [DOI:10.6115/fer.2019.004]
12. Røhder K, Væver MS, Aarestrup AK, Jacobsen RK, Smith-Nielsen J, Schiøtz ML. Maternal-fetal bonding among pregnant women at psychosocial risk: The roles of adult attachment style, prenatal parental reflective functioning, and depressive symptoms. PloS one. 2020;15(9):e0239208. [DOI:10.1371/journal.pone.0239208] [PMID] [PMCID]
13. Knoche LL, Givens JE, Sheridan SM. Risk and protective factors for children of adolescents: Maternal depression and parental sense of competence. J Child Fam Stud. 2007 Oct 1;16(5):684-95. [DOI:10.1007/s10826-006-9116-z]
14. Gao L-l, Chan SW-c, Sun K. Effects of an interpersonal-psychotherapy-oriented childbirth education programme for Chinese first-time childbearing women at 3-month follow up: randomised controlled trial. Int J Nurs Stud. 2012;49(3):274-81. [DOI:10.1016/j.ijnurstu.2011.09.010] [PMID]
15. Jahdi F, Kaheh A, Haghani H. Effect of attachment behaviors training on maternal competence attainment in nulliparous adolescent women. J Babol Univ Med Sci. 2019;21(1):78-84.
16. Vakilian K, Karamat A, Mousavi A, Shariati M, Ajami E, Atarha M. The effect of Lavender essence via inhalation method on labor pain. J Shahrekord Univ Med Sci. 2012; 14:34-40. []
17. Łyczko J, Jałoszyński K, Surma M, García-Garví JM, Carbonell-Barrachina ÁA, Szumny A. Determination of various drying methods' impact on odour quality of true lavender (lavandula angustifolia Mill. Flowers. Molecules. 2019; 24(16):1-15.290. [DOI:10.3390/molecules24162900] [PMID] [PMCID]
18. Mohammadi MM, Parandin S. Effect of the combination of Benson's relaxation technique and brief psychoeducational intervention on multidimensional pain and negative psychological symptoms of pregnant women: A randomized controlled trial. J Educ Health Promot. 2019;8(1):1-7.
19. Zamanifar S, Bagheri-Saveh MI, Nezakati A, Mohammadi R, Seidi J. The effect of music therapy and aromatherapy with chamomile-lavender essential oil on the anxiety of clinical nurses: A randomized and double-blind clinical trial. J Med Life. 2020; 13(1):87-93.
20. Jafari-Koulaee A, Khenarinezhad F, Sharifi Razavi A, Bagheri-Nesami M. The effect of aromatherapy with lavender essence on depression and headache disability in migraine patients: A randomized clinical trial. J Med Plants. 2019; 18(70):162-72. [http://jmp.ir/article-1-2571-en.html] [DOI:10.29252/jmp.2.70.162]
21. Xiong M, Li Y, Tang P, Zhang Y, Cao M, Ni J, et al. Effectiveness of aromatherapy massage and inhalation on symptoms of depression in Chinese community-dwelling older adults. J Altern Complement Med. 2018; 24(7):717-24. [DOI:10.1089/acm.2017.0320] [PMID]
22. Evin A, Khojasteh F, Ansari H. The Effect of Hatha Yoga on Anxiety and Self-Efficacy of Primiparous Women in Labor. Open Complement Med J. 2019;9(1):3546-59.
23. Cannon JL, Umstead LK. Applying dialectical behavior therapy to self‐harm in college‐age men: A case study. J Coll Couns 2018; 21(1):87-96. [magiran.com/p1995119] [DOI:10.1002/jocc.12089]
24. DeCou CR, Comtois KA, Landes SJ. Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis. Behav Ther. 2019; 50(1):60-72. [DOI:10.1016/j.beth.2018.03.009] [PMID]
25. Eisner L, Eddie D, Harley R, Jacobo M, Nierenberg AA, Deckersbach T. Dialectical behavior therapy group skills training for bipolar disorder. Behav Ther. 2017; 48(4):557-66. [DOI:10.1016/j.beth.2016.12.006] [PMID] [PMCID]
26. Huang J-W, Zhou X-Y, Lu S-J, Xu Y, Hu J-B, Huang M-L, et al. Dialectical behavior therapy-based psychological intervention for woman in late pregnancy and early postpartum suffering from COVID-19: a case report. J Zhejiang Univ Sci B. 2020; 21(5):394-9. [DOI:10.1631/jzus.B2010012] [PMID] [PMCID]
27. Miri N, Nayyeri M. Comparison the effectiveness of dialectical behavior therapy, drug therapy and their combination methods on depression and Irrational Beliefs in women with postpartum depression. Iran J Psy Nurs. 2019;7(2):1-9.
28. Bahrami M, Bakhtiari N, Haji Z, Fathi Z. The effectiveness of dialectical behavioral therapy on GAD incidence and Substance Abuse. J Motor Behav Sci 2018;1(3):203-10. [http://www.jmbs.ir/article_87591_en.html?lang=fa]
29. Sarmad Z, Bazargan A, Hejazi E. Research methods in behavioral sciences. Tehran. Agah publications; 2007.
30. Safaralinezhad A, Oveisi S, Sarichlu Me, Jourabchi Z. Effect of cognitive-behavioral group therapy on gestational depression: A clinical trial. Iran J Obstet Gynecol Infertilit. 2018; 21(2):48-59. [http://ijogi.mums.ac.ir/article_10712.html]
31. Kordi M, Fasanghari M, Asgharipour N, Esmaily H. The effect of maternal role training program on role attainment and maternal role satisfaction in nulliparous women with unplanned pregnancy. J Educ Health Promot. 2017;6. 113-115. [DOI:10.4103%2Fjehp.jehp_113_15]
32. Ghanbarzadeh N, Mehrani Z, Sharifzadeh G, Nadjafi-Semnani A, Nadjafi-Semnani M. Investigation the relationship between moral intelligence, social adjustment, and postpartum depression in women referring to Birjand health centers. EBNESINA 2020; 21(4):100-4.
33. Robinson S, Lang JE, Hernandez AM, Holz T, Cameron M, Brannon B. Outcomes of dialectical behavior therapy administered by an interdisciplinary team. Arch Psychiatr Nurs 2018; 32(4):512-516. [DOI:10.1016/j.apnu.2018.02.009] [PMID]
34. Muchanga SMJ, Yasumitsu-Lovell K, Eitoku M, Mbelambela EP, Ninomiya H, Komori K, et al. Preconception gynecological risk factors of postpartum depression among Japanese women: The Japan Environment and Children's Study (JECS). J Affect Disord. 2017;217:34-41. [DOI:10.1016/j.jad.2017.03.049] [PMID]
35. Kordi M, Bakhshi M, Masoudi S, Esmaily H. Effect of prenatal psychological trainings on satisfaction with childbirth and maternal role competence in primiparous women. J Maz Uni Med Sci. 2018; 28(165):98-108.
36. Kazeminia M, Abdi A, Vaisi-Raygani A, Jalali R, Shohaimi S, Daneshkhah A, et al. The effect of lavender (Lavandula stoechas L.) on reducing labor pain: A systematic review and meta-analysis. Evid Based Complement Alternat Med. 2020;1-11:e4384350. [DOI:10.1155/2020/4384350] [PMID] [PMCID]
37. Chung F-F, Wan G-H, Kuo S-C, Lin K-C, Liu H-E. Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design. BMC Pregnancy Childbirth. 2018; 18(1):1-13. [DOI:10.1186/s12884-018-1979-7] [PMID] [PMCID]
38. Abdollahpour N, Seyedfatemi N, HakimShooshtari M, Mehran A. The effect of education on sense of competence of mothers of children with hyperactivity disorder. J Nurs Educ 2017; 5(4):19-26. [DOI:10.21859/ijpn-05043]

Add your comments about this article : Your username or Email:

Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Avicenna Journal of Nursing and Midwifery Care

Designed & Developed by : Yektaweb