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The Effectiveness of Neurofeedback on Pregnancy Anxiety and Prenatal Depression in Pregnant Women during the COVID-19: A Single-Case Research with Multiple Baseline Design

Document Type : Scientific Research

Authors

1 Assistant Prof of clinical psychology, Faculty of Humanities and Social sciences, Golestan University, Gorgan, Iran

2 Assistant Prof, Department of Clinical Psychology, BandarGaz Branch, Islamic Azad University, BandarGaz, Iran

Abstract

Objectives: During the pandemic COVID-19, numerous studies displayed an increase in anxiety and depression in pregnant women. This present study aimed to investigate the effect of neurofeedback therapy on pregnancy anxiety and prenatal depression in pregnant women. Methods: The study was a single-case experimental study with multiple baseline design with a follow-up period. Three pregnant women were selected according to purposive sampling method and entered the study gradually in fixed intervals. The research tools included the neurofeedback therapy, Pregnancy Related Anxiety Questionnaire (PRAQ) and Beck Depression Inventory Second Edition (BDI-II). Results: The findings showed that the neurofeedback reduced the severity of pregnancy anxiety and prenatal depression symptoms in both post-treatment and follow-up stages, so that the percentage of improvement for the first, second and third participants in the symptoms of pregnancy anxiety was 72%, 74% and 71% in post-treatment and 75%, 80% and 73% in follow-up stage, respectively. The percentages of improvement for the first, second and third participants in the symptoms of prenatal depression were also 72%, 77% and 77% in post-treatment and 79%, 77% and 83% in follow-up stages, respectively. Moreover, the overall percentages of improvement in post-treatment and follow-up stage in the symptoms of pregnancy anxiety were 72% and 79% and in the symptoms of prenatal depression was 75% and 80%, respectively. In addition, at the end of the intervention sessions and at the 1-month follow-up, all the three patients scored less than 14 on BDI-II, which indicated the clinical significance of the reduction of their depression symptoms on this scale. The visual analyses and the results of inter-positional and intra-positional analyses showed a significant difference between baseline and intervention stage for all subjects (PND>70, PAND>50). The percentages of non-overlapping data (PND) as a measure of effect size for the first, second and third participants in the symptoms of pregnancy anxiety were 83%, 100% and 83% respectively. The percentages of all non-overlapping data (PAND) as the second effect size criterion for the subjects were also 87.5%, 100% and 90%, respectively, which shows the effectiveness of the intervention for all the three subjects in the symptoms of pregnancy anxiety. The percentages of non-overlapping data (PND) for the first, second and third participants in the symptoms of prenatal depression were 83%, 83% and 67% respectively. The percentages of all non-overlapping data (PAND) for the subjects were 87.5%, 89% and 800% respectively, which shows the effectiveness of the intervention for all the three subjects in the symptoms of prenatal depression.

Highlights

Results: The findings showed that the neurofeedback reduced the severity of pregnancy anxiety and prenatal depression symptoms in both post-treatment and follow-up stages, so that the percentage of improvement for the first, second and third participants in the symptoms of pregnancy anxiety was 72%, 74% and 71% in post-treatment and 75%, 80% and 73% in follow-up stage, respectively. The percentages of improvement for the first, second and third participants in the symptoms of prenatal depression were also 72%, 77% and 77% in post-treatment and 79%, 77% and 83% in follow-up stages, respectively. Moreover, the overall percentages of improvement in post-treatment and follow-up stage in the symptoms of pregnancy anxiety were 72% and 79% and in the symptoms of prenatal depression was 75% and 80%, respectively. In addition, at the end of the intervention sessions and at the 1-month follow-up, all the three patients scored less than 14 on BDI-II, which indicated the clinical significance of the reduction of their depression symptoms on this scale. The visual analyses and the results of inter-positional and intra-positional analyses showed a significant difference between baseline and intervention stage for all subjects (PND>70, PAND>50). The percentages of non-overlapping data (PND) as a measure of effect size for the first, second and third participants in the symptoms of pregnancy anxiety were 83%, 100% and 83% respectively. The percentages of all non-overlapping data (PAND) as the second effect size criterion for the subjects were also 87.5%, 100% and 90%, respectively, which shows the effectiveness of the intervention for all the three subjects in the symptoms of pregnancy anxiety. The percentages of non-overlapping data (PND) for the first, second and third participants in the symptoms of prenatal depression were 83%, 83% and 67% respectively. The percentages of all non-overlapping data (PAND) for the subjects were 87.5%, 89% and 800% respectively, which shows the effectiveness of the intervention for all the three subjects in the symptoms of prenatal depression.

Keywords

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References
Aftanas, L.I. & Pavlov, S. (2005). Trait anxiety impact on posterior activation asymmetries at rest and during evoked negative emotions: EEG investigation. International Journal of Psychophysiology, 55: 85–94.
Ayaz, R., Hocaoğlu, M., Gunay, T., Yardımcı, O.D., Turgut, A., & Karateke, A. (2020). Anxiety and depression symptoms in the same pregnant women before and during the COVID-19 pandemic. Journal of Perinatal Medicine, 48: 965-970.
Barabasz, A., & Barabasz, M. (1996). Neurotherapy and alert hypnosis in the treatment of attention deficit disorder. Chapter in S. J. Lynn, I. Kirsch, & J. W. Rhue (Eds.), Casebook of Clinical Hypnosis. Washington, D.C. American Psychological Association Press: 271– 292.
Barry, R.J., Clarke, A.R., & Johnstone, S.J. (2006). A review of electrophysiology in attention-deficit/ hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 114: 171-183.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the BDI-II. San Antonio, TX: The Psychological Corporation.
Beck, A.T., Steer, R.A., & Brown, G.K.(1996). Beck depression inventory-II. San Antonio, 78(2): 490-498.
Bloch, M., Schmidt, P. J., Danaceau, M., Murphy, J., Nieman, L., & Rubinow, D.R. (2000). Effects gonadal steroids in women with a history of postpartum depression. American Journal of Psychiatry, 157: 924-30.
Buss, C., Davis, E. P., Hobel, C. J., & Sandman, C.A. (2011). Maternal pregnancy-specific anxiety is associated with child executive function at 6-9 years age. Stress, 14: 665–76.
Byrnes, L. (2018). Perinatal mood and anxiety disorders. The Journal for Nurse Practitioners,14: 507–513.
Canadian Agency for Drugs and Technologies in Health. (2014). Neurofeedback and Biofeedback for Mood and Anxiety Disorders: A Review of the Clinical Evidence and Guidelines – An Update, Rapid Response Report: Summary with Critical Appraisal.
Cantwell, R. (2016). In: Joint Care of Parents and Infants in Perinatal Psychiatry. Sutter-Dallay A.L., Glangeaud-Freudenthal N.C., Guedeney A., Riecher-Rössler A., editors. Springer; Cham. Maternal perinatal psychopathology, overview: 13–24.
Chandra, P.S., & Nanjundaswamy, M.H. (2020). Pregnancy specific anxiety: an under-recognized problem. World Psychiatry, 19(3): 336–337.
Czeisler, M. E., Lane, R.I., Petrosky, E., Wiley, J.F., Christensen, A., Njai & et al. (2020). Mental health, substance use, and suicidal ideation during the COVID-19 pandemic – United States. MMWR Morbidity and Mortality Weekly Report, 69(32): 1049-1057.
Dadi, A. F., Miller, E. R., Bisetegn, T. A., &   Mwanri, L. (2020). Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review. BMC Public Health, 20(1): 173.
Damasio, A.R.(1994). Neuropsychology. Towards a neuropathology of emotion and mood. Nature, 386(6627):769– 770.
Da Silva, F. C. T., & Neto, M.L.R. (2020). Psychological effects caused by the COVID-19 pandemic in health professionals: a systematic review with meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry, 104, 110062.
Davidson, .R. J., & Irwin,W. (1999). The functional neuroanatomy of emotion and affective style. Trends in Cognitive Sciences, 3(1): 11–21.
Davidson, R. J., Marshall, J. R., Tomarken, A. J., &  Henriques, J. B. (2000). While a phobic waits: regional brain electrical and autonomic activity in social phobics during anticipation of public speaking. Biological Psychiatry, 47(2):85–95.
Demehri, F., Honarmand, M. M., &  Yavari, A. H.(2012). Depression and Obsessive -Compulsive as Antecedent of Guilt Feeling and Anxiety as Consequences of it in University Girl Students. Signs, 2(6): 25-36.
Egner, T., & Gruzelier, J. H.( 2003). Ecological validity of neurofeedback: modulation of slow wave EEG enhances musical performance. NeuroReport, 14(9): 1221–4.
Eismont, E.V., Lutsyu, N.V., & Pavlenko,V. B.(2001). Moderation of increased anxiety in children and teenagers with the use of neurotherapy: estimation of the efficacy. Neurophysiology, ,43(1): 53–61.
Ettman, C. K., Abdalla, S. M., Cohen, G. H,. Sampson, L., & Vivier, P.M., Galea, S. (2020). Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open, 3(9), 2019686.
Falah-Hassani, K., Shiri, R., & Dennis, C.L. (2017). The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychological Medicine, 47: 2041–53.
Fata, L., Birshak, B., Atef Vahid, M., Dobson Keith, S.(2005).Meaning structures/schemas, emotional states and cognitive processing of emotional information: comparison of two conceptual frameworks. Iranian Journal of Psychiatry and Clinical Psychology (thought and behavior), 11(3): 346-350. (in persian)
Fernandez, T., Harmony, T., Fernandez-Bouzas, A., az-Comas, L., Prado-Alcala, R. A, Valdes-Sosa, P., & Fabiola G. M. (2007). Changes in EEG current sources induced by neurofeedback in learning disabled children. An exploratory study. Applied Psychophysiology Biofeedback, 32(3-4):169–183.
Fan, S., Guan, J., Cao, L., Wang, M., Zhao, H., Chen,L., & Yan,Y.(2021). Psychological effects caused by COVID-19 pandemic on pregnant women: A systematic review with meta-analysis. Asian Journal of Psychiatry, 56: 1025-33.
Hamel, L., & Salganicoff, A. (2020). Is There a Widening Gender Gap in Coronavirus Stress? Kaiser Family Foundation.
Hammond, D. C. (2004). Treatment of the obsessional subtype of obsessive compulsive disorder with neurofeedback. Biofeedback, 32(1): 2-12.
Hammond,D. C.(2005). Neurofeedback with anxiety and affective disorders:A review. Child & Adolescent Psychiatric Clinics of North America, 14(1): 105-23.
Hammond, D. C. (2006). What is Neurofeedback? University of Utah school of medicine.
Hanington, L., Heron, J., Stein, A., &  Ramchandani, P. (2012). Parental depression and child outcomes−is marital conflict the missing link?Child: Care, Health and Development, 38(4):520–529.
Hermans, E. J., & van Honk, J. ( 2006). Toward a framework for defective emotion processing in social phobia. Cognitive Neuropsychiatry, 11(3): 307–331.
Huang-Storms, L., Bodenhamer-Davis, E., Davis, R., Janice Dunn, J. ( 2006). qEEG-guided neurofeedback for children with histories of abuse and neglect: neurodevelopmental rationale and pilot study. Journal of Neurotherapy, 10 (4): 3–16.
Hammond, D. C. (2003). QEEG-guided neurofeedback in the treatment of obsessive compulsive disorder. Journal of neurotherapy, 7(2): 25-52.
Jha, S., Salve H. R., Goswami K., Sagar, R., &  Kant, S. (2018). Burden of common mental disorders among pregnant women: a systematic review. Asian Journal of Psychiatry, 36: 46–53.
Karamouzian, M.,  Askarizadeh, Q., Behrouzi, N.(2015).  Examining the psychometric properties of pregnancy anxiety questionnaire. Journal of Nursing and Midwifery,4(3):22-34. (in persian)
Kendig, S., Keats, J. P., Hoffman, M. C., Kay, L. B., Miller, E. S.,  Simas, T. A. M., & et al.(2017). Consensus bundle on maternal mental health: perinatal depression and anxiety. Obstetrics & Gynecology, 129(3):422–30.
Kienast, T., Hariri, A. R., Schlagenhauf, F., Wrase, J., Sterzer, P., Buchholz, H. G.,  &  et al. (2008). Dopamine in amygdala gates limbic processing of aversive stimuli in humans. Nature Neuroscience, 11(12): 1381-2.
Lawrence, J. T. (2002). Neurofeedback and your brain: A beginners manual. Faculty, NYU medical center & brain research lab, New York.
Lebel, C., MacKinnon, A., Bagshawe, M., Tomfohr-Madsen, L., & Giesbrecht, G. (2020). Elevated depression and anxiety symptoms among pregnant individuals during the COVID-19 pandemic. Journal of Affective Disorders Reports, 277: 5-13.
Lenz, A. S. (2013). Calculating Effect Size in Single-Case Research: A Comparison of Nonoverlap Methods. Measurement and Evaluation in Counseling and Development, 46(1): 64–73.
Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020). The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public – a systematic review and meta-analysis. Psychiatry Research, 291, 113190.
Madigan, S., Oatley H., Racine N.,Fearon, R.M.P., Schumacher,L., Akbari, E., & et al. (2018). A meta-analysis of maternal prenatal depression and anxiety on child socioemotional development. Journal of the American Academy of Child & Adolescent Psychiatry, 57(9): 645–657.
Miskovic. V., Ashbaugh, A.R., Santesso, D.L., McCabe, R.E.,  Antony, M.M., &  Schmidt. L. A. (2010). Frontal brain oscillations and social anxiety: A cross-frequency spectral analysis during baseline and speech anticipation. Biological Psychology, 83(2): 125–132.
Meltzer-Brody, S., &   Rubinow, D. (2021). An overview of perinatal mood and anxiety disorders: epidemiology and etiology. In: Cox E, ed. Women’s mood disorders, New York, NY: Springer Nature, 5–16.
Moore, N.C., (2000). A Review of EEG Biofeedback Treatment of Anxiety Disorders. Clinical Electroencephalography, 31(1): 1-6.
Moore, N.C. (2005).The Neurotherapy of Anxiety Disorders: A review. Journal of Adult Development, 12 (2), 147-154.
Ogles, B. M., Lunnen, K. M., &  Bonesteel, K.(2001). Clinical Significance: History, Application, and Current Practice. Clinical Psychology Review, 21(3): 421-446.
Palladino, C. L., Singh, V., Campbell, J., Flynn, H., & Gold, K.J. (2012). Homicide and suicide during the perinatal period. Obstetrics & Gynecology, 119(6): 1275-1276.
Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V.G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis. Brain and Behavior, 88: 901–907.
Parker, R. I., & Vannest, K. (2009). An Improved Effect Size for Single-Case Research: Non-overlap of All Pairs. Behavior Therapy, 40(4): 357–367.
Parker, P. I., Vannest, K.J., & Davis, J. L. (2011). Effect Size in Single-Case Research: A Review of Nine Nonoverlap Techniques. Behavior Modification, 35(4): 303–322.
Pompili, M., Innamorati, M., Lamis, D. S., Erbuto, D.,Venturini,P, Ricci, F., & et al.(2014). The associations among childhood maltreatment, “male depression” and suicide risk in psychiatric patients. Psychiatry Research, 220 (1–2): 571–578.
Racine, N., Eirich, R., Cooke, J., Zhu, J., Pador,P., Dunnewold, N., & et al.(2022). When the bough breaks: a systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic. Infant Mental Health Journal, 43(1): 36–54.
Ratey, J. A. (2001). A user’s guide to the brain: Perception, attention and the four theatres the brain. New York: Vintage.
Raymond, J., Varney, C., & Gruzelier, J. H. ( 2005). The effects of alpha/theta neurofeedback on personality and mood. Cognitive Behaviour Resarch,23(2-3): 287–292.
Rossiter, T. R., & LaVaque, T. J. (1995). A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders. Journal of Neurotherapy, 1(1): 48-59.
Rossiter, T. (2004). The Effectiveness of  Neurofeedback and Stimulant Drugs in Treating AD/HD: Part I. Review of Methodological Issues. Applied Psychophysiology and Biofeedback, 29 (2): 225-235.
Salum, G. A., Desousa, D. A., do Rosário, M. C., Pine, D. S., Manfro, G. G.(2013). Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice. Revista Brasileira de Psiquiatria, 35(1): 203-221.
Scott, T., Gaynor, M. A, Susan, C., Baird, M. A., & Nelson-Gray, R.O. (1999). Application of time-series (single-subject) designs in clinical psychology. In: Kendall, P., Butcher J. N, Holmbeck, G. N. editors. Handbook of research methods in clinical psychology. New York: John Wiley & Sons, Inc: 297-329.
Segger, L. B., Lambert, m. J., & Hasen, N. B. (2002). Assessing clinical significance: Application to the Beck depression inventory. Behavior Therapy, 33(2): 253- 269.
Simkin, D. R., Thatcher,R.W., & Lubar, J. (2014). Quantitative EEG and Neurofeedback in Children and Adolescents: Anxiety Disorders, Depressive Disorders, Comorbid Addiction and Attention-deficit/Hyperactivity Disorder, and Brain Injury.Child and Adolescent Psychiatric Clinics of North America, 23(3): 427–464.
Siever D. (2004). The rediscovery of audio-visual entrainment technology. 6th ed. Alberta CA: Comptronic Devices Limited: 3-6.
Swales, D. A., Winiarski, D. A., Smith, A. K., Stowe, Z. N., Newport, D. J., & Brennan, P.A. (2018). Matenal depression and cortisol in pregnancy predict offspring emotional reactivity in the preschool period. Developmental Psychobiology, 60(5): 557-66.
Thibodeau, R., Jorgensen, R. S., & Kim, S. (2006). Depression, anxiety, and resting frontal EEG asymmetry: a meta-analytic review. Journal of Abnormal Psychology, 115(4):715-729.
Tillman, C.R., & Burns, M.K. (2009). Evaluating Educational Interventions Single-Case Design for Measuring Response to Intervention. New York & London: Guilford press.
Van den Bergh, B. (1990). The influence of maternal emotions during pregnancy on fetal and neonatal behavior. Pre-and Perinatal Psychology Journal, 5(2): 119-30.
Vehmeijer, F.O. L., Guxens, M., Duijts, L., & Marroun, H. E. l (2019). Maternal psychological distress during pregnancy and childhood health outcomes. a narrative review.Journal of Developmental Origins of Health and Disease, 10(3): 274-85.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & et al. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17 (5): 1729.
Weissman, M.M., Wickramaratne, P., Nomura, Y., Warner, V., Pilowsky, D., & Verdeli, H.(2006). Offspring of depressed parents: 20 years later. American Journal of Psychiatry, 163 (6): 1001–1008.
Wilson, V. E., Peper, E., & Moss, D. (2006). Professional issue ‘‘The mind room’’ in Italian soccer training: the use of biofeedback and neurofeedback for optimum performance. Biofeedback, 34(3): 79–81.
Woody, C.A., Ferrari, A.J., Siskind, D.J., Whiteford, H.A., Harris, M.G. (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders, 219, 86-92.
Wu, P., Fang, Y., Guan, Z., Fan, B., Kong, J., Yao, Z., &  et al. (2009). The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk.The Canadian Journal of Psychiatry, 54(5):302–311.
Wu, Y., Zhang, C., Liu, H.,  Duan, C., Li, C.,  Fan, J., & et al. (2020). Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. American Journal of Obstetrics and Gynecology, 223 (2): 240–241.
Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H.,  Phan, L., & et al.(2020). Impact of COVID-19 pandemic on mental health in the general population: a systematic review. Journal of Affective Disorders, 277: 55–64.
Yan, H., Ding, Y., & Guo, W. (2020). Mental health of pregnant and postpartum women during the coronavirus disease 2019 pandemic: A systematic review and meta-analysis. Frontiers in Psychology, 11: 617001.
Zhang, J., Yu, H., Gao, Y., Xu, Q., Yin, Y., & Zhou, R. (2021). Prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic: a systematic review and meta-analysis. Asian Journal of Psychiatry, 66: 1028-80.
Zoefel, B., Huster, R.J., & Herrmann, C. H. S. (2011). Neurofeedback training of the upper alpha frequency band in EEG improves cognitive performance. NeuroImage, 54(2): 427-1431.
Health Psychology
Volume 12, Issue 47
January 2024
Pages 1-18
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