OUR PSYCHOLOGICAL HEALTH

Below is a summary of important points from the research articles I have featured on The Unexpected Trip concerning the psychological effects of miscarriage and infertility on women and couples, symptoms & behaviors, and treatments to consider.
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15- 24% of pregnancies end in miscarriage.

Studies have shown that women with infertility (including miscarriage) have the same levels of anxiety and depression as do women with cancer, heart disease, and HIV+ status. If this seems surprising, remember that procreation is the strongest instinct in the animal kingdom.

Studies have shown that after miscarriage, women experience:

*  PTSD (25%)

*  Acute stress disorder (28%)

*  Obsessive compulsive disorder

*  Panic disorder

*  Major Depression (51%)

*  Intrusive recollections, distress at reminders, flashbacks, strong feelings of helplessness, nightmares (77%)

The level of PTSD at 1 month is equivalent to that of other traumatized populations and it can last for several months.

Studies show that there is no lessening of distress for women who miscarry early.
 
Without treatment, symptoms worsen, and women and men experience psychosocial impairment and increased risk of future miscarriage.
 
There is a great need for routine screenings for disorders, after miscarriage, and expeditious administration of psychological treatment.
 
Symptoms you may see as a clinician: intense fear, helplessness, or horror; dreams, flashbacks, repetitive thoughts; avoidance of trauma-related stimuli; increased arousal (hypervigilence, exaggerated startle response, irritability); significant impairment in important areas of functioning; dissociative symptoms such as derealization, depersonalization, numbing.[Duration: 2 days-4 weeks (for ASD), >1 month (for PTSD)]
 
Women are particularly vulnerable to the above symptoms if they feel responsible, feel a lack of control, or feel a bond with unborn child.
 
Talk therapy is not as helpful as active therapies like CBT and ACT, with their focus on adaptation and repetitive thoughts. (PTSD, ASD, and OCD all involve repetitive thoughts.)

Acceptance and Commitment Therapy 

ACT (acceptance and commitment therapy): works on capacity to accept one’s experience, become more psychologically flexible and less avoidant of triggers, such as family events and social activities associated with babies and young children—activities that once provided the couple with intimacy, sense of belonging, enjoyment are now sources of stress and anxiety.

This is called experiential avoidance, and it is strongly correlated with increased amounts of infertility stress, marital dissatisfaction, depression, and isolation.

Avoidance takes a lot of energy and it results in feelings of helplessness and lack of control.

Infertile couples experience inconsistency between what is important to them and their actual life situation because living out their key value of becoming a parent has been thwarted. This creates a great challenge for the couple. ACT helps couples continue to live their lives committed to value-directed behavior in the face of not being able to fulfill their most cherished value.

ACT helps couple observe their negative thoughts rather than “buy into” them.

 

References

Bowles, S.V., Bernard, R.S., Epperly, T., Woodward, S., Ginzburg, K., Folen, R., Perez, T., & Koopman, C. (2006). Traumatic stress disorders following first-trimester spontaneous abortion. Journal of Family Practice, 55 (11), 969 – 973.

Brier, N. (2004). Anxiety after miscarriage: a review of the empirical literature and implications for clinical practice. Birth, 31, 138 – 142.

Cumming, G.P., Klein, S., Bolsover, D., Lee, A., Alexander, D., Maclean, M., & Jurgens, D. (2007). The emotional burden of miscarriage for women and their partners: trajectories of anxiety and depression over 13 months. BJOG, 114, 1138 – 1145.

Eifert, G.H. & Peterson, B.D. (2011). Using acceptance and commitment therapy to treat infertility stress. Cognitive and Behavioral Practice, 18, 577 – 587.

Katz, S. (2008). Mindful care: an integrative tool to guide holistic treatment in enhancing fertility. Perspectives in Psychiatric Care, 44 (3),207 – 210.

Lykeridou, K., Gourounti, K., Sarantaki, A., Loutradis, D., Vaslamatzis, G., & Deltsidou, A. (2011). Occupational social class, coping responses and infertility-related stress of women undergoing infertility treatment. Journal of Clinical Nursing, 20, 1971 – 1980.

Sejourne, N., Callahan, S., & Chabrol, H. (2010). The utility of a psychological intervention for coping with spontaneous abortion. Journal of Reproductive and Infant Psychology, 28 (3), 287 – 296.

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