Author ' s personal copy Cognitive behavioral therapy and pharmacotherapy for anxiety : Treatment preferences and credibility among pregnant and non-pregnant women

Background: Relatively little is known about women’s anxiety-related treatment preferences and no studies have examined potential differences between pregnant versus non-pregnant women. Treatment credibility and willingness are particularly important to understand regarding exposure-based cognitive behavioral therapy (CBT) and pharmacotherapy, the leading evidence-based treatments. Methods: A large U.S. sample of pregnant (n 1⁄4 377) and matched non-pregnant (n 1⁄4 399) women (total N 1⁄4 776) rated overall treatment preferences and treatment credibility, concerns, and willingness to have CBT and pharmacotherapy if suffering from anxiety. Results: Women preferred anxiety-related treatment that included psychotherapy. Preference for psychotherapy alone was stronger among pregnant (74%) than non-pregnant (47%) women, p < . 001. In response to treatment descriptions, both groups rated CBT more favorably than pharmacotherapy on treatment willingness, credibility, and concerns, ps < . 001, with the magnitude of this preference significantly greater among pregnant than non-pregnant women, ps < . 001. Pregnancy status was unrelated to CBT ratings. Treatment credibility and to a lesser extent total concerns mediated the relationship between pregnancy status and pharmacotherapy willingness. Conclusions: Non-pregnant and especially pregnant women rated exposure-based CBT for anxiety more favorably than pharmacotherapy. Pregnancy status predicted general treatment preferences and pharmacotherapy, but not CBT, ratings. 2013 Elsevier Ltd. All rights reserved. Anxiety disorders represent the most common class of mental disorders in the United States (Kessler, Berglund, Demler, Jin, & Walters, 2005), and women are twice as likely as men to suffer from an anxiety disorder over the lifespan (Seedat et al., 2009). Outside of posttraumatic stress disorder (PTSD), however, few studies have examined women’s treatment preferences for anxiety disorders or elevated anxiety. The absence of studies examining women’s preferences represents a major gap in understanding anxiety treatment preferences among the majority of the people needing such treatment. Further, given that most women will be pregnant at least once in their lives (Ventura, Abma, Mosher, & Henshaw, 2004), and that elevated anxiety during pregnancy carries risk of enduring negative consequences for both the mother and offspring (e.g., van den Bergh, Mulder, Mennes, & Glover, 2005; O’Connor, Heron & Glover, 2002), it is important to consider pregnancy status as a potential moderator of women’s anxietyrelated treatment preferences. Extensive work by Feeny, Zoellner and colleagues has demonstrated that traumaexposedwomen (Feeny, Zoellner,Mavissakalian, & Roy-Byrne, 2009) and women presented with sexual assault scenarios (e.g., Feeny, Zoellner, & Kahana, 2009), overwhelmingly preferred prolonged exposure therapy over pharmacotherapy (sertraline) for trauma symptoms. Treatment credibility and personal reactions to treatment descriptions were the strongest predictors of preference (Zoellner, Feeny, & Bittinger, 2009). These findings, however, focus largely on forced-choice preferences between prolonged exposure and sertraline for trauma/PTSD. Outside of PTSD, studies show that (male and female) mixed samples generally prefer psychosocial or combination treatment over pharmacotherapy alone. For example, Hazlett-Stevens et al. (2002) surveyed primary care patients experiencing a recent panic attack episode and found that slightly more patients (67%) indicated willingness to have a six session psychosocial treatment * Tel. : þ1 303 492 4634. E-mail address: Joanna.Arch@Colorado.edu.