Carrie Cornsweet Barber and Bridgette Masters-Awatere
Perinatal Mental Health Research Group
University of Waikato, School of Psychology
Life presents all of us with changes and challenges. Some of these are ordinary stresses—moving house, changing jobs—while others may be more momentous—losing a loved one, facing a serious illness, becoming a parent. There is a large body of research, developed over the last half century, about the effects of stress and change on health and wellbeing (Aldwin, 2007). It is clear that the impact of changes and stressful events, and the extent to which those events cause distress, varies across people and situations—some cope well and are resilient even in difficult circumstances, and others are more vulnerable and struggle with high levels of distress.
One of the most challenging transitions in the lives of many people is becoming a parent. This involves physical, psychological, social, economic, and practical changes for both parents, and these changes often amount to a pile-up of stressors. In a previous New Zealand study of women during pregnancy, for example, 42% of them moved house during pregnancy, 55% said they had unusual financial pressures, 33% reported serious arguments with someone, and they reported an average of four events on a standard ‘life events stressors’ inventory. Over the last two decades, extensive research has been conducted on the impact of stress in pregnancy, and studies have found that high levels of stress are associated with negative outcomes for both the mother and the developing child (Charil et al., 2010; Glover, 2014). A few studies have looked at the effects of strategies such as exercise, meditation, music, and relaxation training in pregnancy, and these results are promising, but preliminary (Barber, 2012; Barber et al., 2013).
It is important, then, to develop strategies for supporting families during pregnancy and early parenting, including enhancement of well-being and healthy coping as well as early interventions for anxiety and depression. Formal perinatal mental health services provide treatment for serious emotional disorders, but these services are not staffed or designed to provide support for mild to moderate depression and anxiety, and many parents who are struggling are reluctant to engage with mental health services. Often, it is difficult for the new parent, as well as for the whanau and professionals around the parent, to know whether distress is part of the normal process of adapting to parenting, or more worrisome and enduring. Ideally, the parent can be supported and provided with strategies that anticipate and prevent more serious difficulties. If significant depression, anxiety, or other psychological disorder is contributing to the struggle, then identifying the problem and connecting with appropriate services is important to preventing further impairment in personal and parental functioning.
The CCCC model is a framework for helping parents to identify their challenges, make choices that promote healthy development for themselves and their children, focus on aspects of their lives they can control, accept and manage those aspects they cannot, evaluate their coping strategies, and develop a menu of options for managing stress that they can use as they meet the challenges of pregnancy and early parenting. The model is based on psychological theory and research, and guides the user to develop an individualised plan for managing stress and maintaining wellbeing.
One of the underlying principles of the CCCC model is that people differ in their preferences and styles, so no single strategy or solution is likely to be effective for all people. What makes sense for each family will emerge from reflection and conversation, given appropriate information and resources.
Positively Pregnant is a mobile phone app, developed by clinical and community psychologists in collaboration with midwives, antenatal educators, and computer scientists in New Zealand. This interactive app uses the CCCC model and principles of positive psychology to offer information, activities, and structures for reflection for pregnant women to promote resilience and wellbeing.
The app consists of four types of components:
- Know Yourself: Interactive assessments to take stock of one’s own strengths, resources, stressors, coping strategies, support systems, health behaviours, cognitive style, and emotions
- Conversations: Structure and prompts for conversations with the partner, whanau, LMC, or for individual reflection on topics such as birth planning, household chores, financial challenges, and childrearing beliefs, traditions, hopes and plans
- Do Something: Activities that promote healthy stress management and are tailored to the interests and experiences of the user
- Find out: Brief information about 30 topics having to do with the psychological aspects of transition to parenting, with links to online resources for services and more information
The user is guided through these components with daily tips and notifications, and can tailor additional notifications and reminders to prompt use of their preferred activities. The activities included have been developed based on research on resilience and behaviour change, as well as the particular cultural and social features of New Zealand families. Links are provided to local and international resources for information and services.
We have recently completed a pilot study in which 88 women used Positively Pregnant and gave feedback on the initial version. As we expected, these women varied in which parts of the app they used most, and found helpful—they tried an average of 12 components, and found most of the ones they tried helpful. The women who volunteered to try the app tended to be quite healthy, emotionally and physically, so overall, we didn’t see significant change in their levels of distress after using the app. A small number, though, were struggling with depression or anxiety, and their levels of distress did decrease while they were using the app. Further study with more high-risk groups may help us to understand this better. The primary outcome of the pilot was extensive feedback and suggestions for improving the content and usability of the app; we are currently in the process of revising the app based on this feedback, for release in New Zealand in November of 2018.
References
Aldwin, C. M. (2007). Stress, Coping and Development: An integrative perspective (2nd ed). New York: Guilford.
Barber, C.C. (2012). Prelude to parenthood: The impact of anxiety and depression during pregnancy. In Perinatal Depression, Maria Graciela Rojas Castillo (ed). InTech: Rijeka, Croatia
Barber, C.C., Clark, M., Williams, S. & Isler, R. (2013). Relaxation and mindfulness to manage stress in pregnancy: initial studies of a computerized self-help programme. MIDIRS Midwifery Digest, 23, 449-454.
Charil, A., Laplante, D. P., Vaillancourt, C., & King, S. (2010). Prenatal stress and brain development. Brain Res Rev, 65(1), 56-79.
Glover, V. (2014). Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. [Review]. Best Pract Res Clin Obstet Gynaecol, 28(1), 25-35.
