BMC psychology · 2026
Comparison of the effect of internet-based and in-person cognitive behavioral therapy on the fear of childbirth in primiparous pregnant women: a randomized controlled trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Piri Kosar, Gholamzadeh Jofreh Maryam, Haghighizadeh Mohammad Hosein, Afshari Poorandokht, Makvandi Somayeh
Аннотация
INTRODUCTION: Fear of childbirth (FOC) is a significant factor contributing to requests for elective cesarean sections. This study aimed to compare the effectiveness of internet-based cognitive behavioral therapy (ICBT) versus in-person cognitive behavioral therapy (CBT) on fear of childbirth and delivery mode preference among primiparous pregnant women.
METHODS: In this randomized controlled trial, 72 primiparous pregnant women with high fear of childbirth (based on the Wijma Delivery Expectancy/Experience Questionnaire [W-DEQ-A]) were randomly allocated into three equal groups: in-person CBT, internet-based CBT (ICBT), and a control group. The interventions were delivered in eight 60-90-minute sessions. Data were collected using demographic questionnaires, W-DEQ-A, and a delivery mode preference question at three time points: before, immediately after, and one month after the intervention. Data were analyzed using repeated measures ANOVA, chi-square, and one-way ANOVA in SPSS version 25.
RESULTS: At baseline, groups were similar in W-DEQ-A scores. Both in-person CBT and ICBT significantly reduced total scores and most subscales compared with the control group, with large effect sizes. In-person CBT showed greater improvement than ICBT in total score, lack of self-efficacy, and lack of positive anticipation, while other subscales were comparable. Effects persisted at follow-up. Both interventions also increased preference for vaginal delivery, especially in the in-person CBT group (8.7% to 60.9%), whereas no statistically significant change was observed in the control group over time. Analysis accounting for repeated measures confirmed these group-level differences over time. These findings demonstrate that both CBT modalities effectively reduce fear of childbirth and positively influence delivery mode preference.
CONCLUSION: Both in-person and internet-based CBT effectively reduce fear of childbirth and improve related psychological outcomes. In-person CBT shows slightly greater benefits in self-efficacy and positive anticipation, while other domains are similarly improved by both modalities. Effects persist at follow-up, and both interventions increase preference for vaginal delivery. These findings support integrating CBT, particularly blended or flexible approaches, into routine prenatal care to enhance maternal psychological well-being and childbirth outcomes.
METHODS: In this randomized controlled trial, 72 primiparous pregnant women with high fear of childbirth (based on the Wijma Delivery Expectancy/Experience Questionnaire [W-DEQ-A]) were randomly allocated into three equal groups: in-person CBT, internet-based CBT (ICBT), and a control group. The interventions were delivered in eight 60-90-minute sessions. Data were collected using demographic questionnaires, W-DEQ-A, and a delivery mode preference question at three time points: before, immediately after, and one month after the intervention. Data were analyzed using repeated measures ANOVA, chi-square, and one-way ANOVA in SPSS version 25.
RESULTS: At baseline, groups were similar in W-DEQ-A scores. Both in-person CBT and ICBT significantly reduced total scores and most subscales compared with the control group, with large effect sizes. In-person CBT showed greater improvement than ICBT in total score, lack of self-efficacy, and lack of positive anticipation, while other subscales were comparable. Effects persisted at follow-up. Both interventions also increased preference for vaginal delivery, especially in the in-person CBT group (8.7% to 60.9%), whereas no statistically significant change was observed in the control group over time. Analysis accounting for repeated measures confirmed these group-level differences over time. These findings demonstrate that both CBT modalities effectively reduce fear of childbirth and positively influence delivery mode preference.
CONCLUSION: Both in-person and internet-based CBT effectively reduce fear of childbirth and improve related psychological outcomes. In-person CBT shows slightly greater benefits in self-efficacy and positive anticipation, while other domains are similarly improved by both modalities. Effects persist at follow-up, and both interventions increase preference for vaginal delivery. These findings support integrating CBT, particularly blended or flexible approaches, into routine prenatal care to enhance maternal psychological well-being and childbirth outcomes.