Mindfulness-Based Cognitive Therapy Postpartum Mothers Stress, Postpartum Blues, Mother-Baby Attachment and Breastfeeding
Condition: Mindfulness-based Cognitive Therapy
Study type: Interventional

Summary: 
      Objectives: Research on the effect of mindfulness-based cognitive therapy (MBCT) applied to
      postpartum mothers on the mother's mood and mother-infant interaction is a new and promising
      feld of research. However, the evidence on whether MBCT reduces stress and postpartum blues
      and improves mother-infant attachment and breastfeeding is inconclusive. The present study
      addresses this research question.

      Design: A two-arm randomized controlled trial was conducted in 90 postpartum mothers.
    

Detailed description: 
      This two-arm randomized controlled trial (RCT) was conducted in the postpartum mothers
      located in Edirne, between April and December 2022. During the intake, postpartum mothers
      were informed about the goals and setup of the study and intervention, and assessed for
      eligibility by a brief standardized interview. Postpartum mothers who fulfilled our criteria
      received an information letter and informed consent form, as well as the baseline
      questionnaire. Those postpartum mothers that provided written informed consent for
      participation were included in the study. Assessments in both groups were performed before
      randomization (i.e., baseline) and directly after the intervention period (i.e.,
      post-measurement, approximately 2 months after baseline).

      Randomization: Postpartum mothers were randomly assigned to an 8-week MBCT or control
      condition. A research assistant not actively involved in the design and data analysis of the
      study created a random distribution sequence and assigned participants to one of the two
      conditions (1:1 ratio).

      Intervention: Mindfulness-Based Cognitive Therapy (MBCT) is a structured group intervention
      developed. The intervention consisted of eight weekly 2.5-hr sessions and one 3-hr silent
      session. The main aspects of the program; It included group meditation, cognitive-behavioral
      exercises, psycho-education, and daily homework. The intervention in our study closely
      followed the original manual, with several adaptations for the study group and purpose.
      First, psycho-education focused on the importance of recognizing personal feelings and the
      relationship between stress, postpartum blues, mother-infant attachment and breastfeeding
      symptoms, and stress management, stress, postpartum blues, mother-infant attachment and
      breastfeeding.

      Control Condition: Postpartum mothers in the control condition were informed that they would
      receive MBCT after a waiting period of 2 months. Meanwhile, no psychological intervention was
      ofered.

      Measures: The baseline questionnaire included questions about demographic, socioeconomic,
      obstetric, mood, and breastfeeding-specific information. Outcomes related to all stress,
      postpartum blues, mother-infant attachment, and breastfeeding were assessed at baseline and
      after therapy (on average, 2 months after baseline assessment).

      Sample size calculation for the primary research question was performed based on a pilot
      study, which assessed pre- and post-measurement stres and depression levels in postpartum
      participating in a mindfulness program similar to MBCT, specifcally CALM Pregnancy as focused
      on training in formal mindfulness and informal mindfulness practices. The CALM Pregnancy
      program both involve eight weekly 2.5-hr sessions. Sessions included didactic presentations,
      group exercises, formal meditation practices, and leader-facilitated group inquiry and
      discussion. Formal practices included the body scan, mindful yoga, and sitting meditation.
      Informal mindfulness practices included mindfulness of everyday activities such as mindful
      eating and mindful walking. The intervention also incorporated the 3-min breathing space and
      cognitive approaches for developing alternative ways of responding to stress and anxiety
      symptoms. Given the similarities in the content, structure, and intensity of the two
      programs, the investigators used this pilot study for the sample size calculation. With a
      statistical power of 0.95 and an alpha of 0.05, 45 postpartum mothers patients were required
      per group (90 in total) to be able to detect diferences with an effect size of at least 0.50.
    

Intervention name(s): Mindfulness-Based Cognitive Therapy
Intervention type(s): Other
Intervention description(s): Mindfulness-Based Cognitive Therapy (MBCT) is a structured group intervention developed by Segal et al. (2002). The intervention consisted of eight weekly 2.5-hr sessions and one 3-hr silent session. First, psycho-education focused on the importance of recognizing personal feelings and the relationship between stress, postpartum blues, mother-infant attachment and breastfeeding symptoms, and stress management, stress, postpartum blues, mother-infant attachment and breastfeeding. Additionally, postpartum mothers' experiences of stress, postpartum blues, mother-infant attachment, and breastfeeding were central during the study and were a recurring topic for the purpose of the study in general. Postpartum mothers were given homework assignments, including audio CDs with formal exercises, and were asked to practice for 30 min per day.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Postpartum; Stress; Postpartum blues; Mother-infant attachment; Breastfeeding