Document Type : Original Article

Authors

1 Reproductive Health (Ph.D.) and Clinical Psycologist, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Counseling (Ph.D.), Department of Psycology and Educational Sciences, Yazd University, Yazd, Iran

Abstract

BACKGROUND: In the COVID‑19 outbreak, women with a history of miscarriage need more mental
health. Anxiety and meta‑worry as consequences of miscarriage, besides concerns due to pregnancy
during coronavirus, show the necessity of appropriate online and face‑to‑face educational counseling.
This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus
face‑to‑face method on anxiety and meta‑worry in these women.
MATERIALS AND METHODS: In this randomized clinical trial, 80 women with a history of
miscarriage, anxiety, and meta‑worry referred to Imam Jafar Sadegh hospital (labor, women ward
and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two
groups (n = 20/each). The participants received 8‑session metacognitive educational counseling
package online or face‑to‑face. Data were collected by Beck Anxiety Inventory, Wellz meta‑worry
questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS
software (Anova and Repeated measure statistic tests).
RESULTS: Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91,
P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93,
P =  0.56); with fewer anxiety scores in the online group. Meta‑worry in the 12th week (online
group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to
baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta‑worry scores in the
online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27,
P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85,
P = 0.96); with less score of belief about worry in the online group.
CONCLUSION: Online and face‑to‑face metacognitive educational counseling methods decreased
anxiety, meta‑worry, and belief about worry in women with miscarriage. But online educational
counseling was more effective. Distance online counseling in COVID‑19 can help the mental health
of women with miscarriage.

Keywords

  1. Cunningham F, Leveno K, Bloom S, Hauth J, Gilstrap L 3rd,
    Wenstrom K. William’s Obstetrics. McGraw Hill, New York; 2018.
    2. Qu F, Wu Y, Zhu YH, Barry J, Ding T, Baio G, et al. The association
    between psychological stress and miscarriage: A systematic
    review and meta‑analysis. Sci Rep 2017;7:1731.
    3. Tavoli Z, Mohammadi M, Tavoli A, Moini A, Effatpanah M,
    Khedmat L, et al. Quality of life and psychological distress in
    women with recurrent miscarriage: A comparative study. Health
    Qual Life Outcomes 2018;16:150.
    4. Gong X, Hao J, Tao F, Zhang J, Wang H, Xu R. Pregnancy loss and
    anxiety and depression during subsequent pregnancies: Data from
    the C‑ABC study. Eur J Obstet Gynecol Reprod Biol 2013;166:30‑6.
    5. Lee L, McKenzie‑McHarg K, Horsch A. The impact of miscarriage
    and stillbirth on maternal‑fetal relationships: An integrative
    review. J Reprod Infant Psychol 2017;35:32‑52.
    6. Mohebbi B, Tol A, Sadeghi R, Mohtarami SF, Shamshiri A.
    Self‑management Intervention Program Based on the Health Belief
    Model (HBM) among Women with Gestational Diabetes Mellitus:
    A Quazi‑Experimental Study. Arch Iran Med 2019;22:168‑73.
    7. Capobianco L, Faija C, Husain Z, Wells A. Metacognitive beliefs
    and their relationship with anxiety and depression in physical
    illnesses: A systematic review. PLoS One 2020;15:e0238457.
    8. Strawn JR, Levine A. Treatment response biomarkers in anxiety
    disorders: From neuroimaging to neuronally‑derived extracellular
    vesicles and beyond. Biomark Neuropsychiatry 2020;3:100024.
    9. Uvnäs‑Moberg K, Handlin L, Petersson M. Self‑soothing
    behaviors with particular reference to oxytocin release induced
    by non‑noxious sensory stimulation. Front Psychol 2014;5:1529.
    10. Dehghani Firouzabadi R, Sekhavat L, Ghafoorzadah M,
    Tabatabaii R, Farajkhoda T. A comparison between efficacy
    of vaginal isosorbide mononitrate and low dose syntocinon
    on cervical ripening at labor. Iran J Obstet Gynecol Infertil
    2011;14:29‑36.
    11. Shahhosseini Z, Pourasghar M, Khalilian A, Salehi F. A review
    of the effects of anxiety during pregnancy on children’s health.
    Mater Sociomed 2015;27:200‑2.
    12. Ren L, Yang Z, Wang Y, Cui LB, Jin Y, Ma Z, et al. The relations
    among worry, meta-worry, intolerance of uncertainty and
    attentional bias for threat in men at high risk for generalized
    anxiety disorder: a network analysis. BMC Psychiatry 2020,;20,452
    ;2-11. https://doi.org/10.1186/s12888-020-02849-w
    13. Sabouri M, Shakibazadeh E, Mohebbi B, Tol A, Yaseri M, Babaee S.
    Effectiveness of an educational intervention using theory of
    planned behavior on health care empowerment among married
    reproductive‑age women: A randomized controlled trial. J Educ
    Health Promot 2020;9:293.
    14. Kajbaf MB, Ghasemiannejad Jahromi A, Ahmadi Forushani SH.
    The effectiveness of spiritual and existential group therapy on
    the rates of depression, death anxiety and afterlife belief among
    students: A study based on the reports of people with death
    experience. JSR 2016;16:4‑13.
    15. Hajnasiri H, Behbodimoghddam Z, Ghasemzadeh S, Ranjkesh F,
    Geranmayeh M. The study of the consultation effect on depression
    and anxiety after legal abortion. J Nurs Educ 2016;4:64‑72.
    16. Nordahl H, Wells A. Metacognitive therapy for social anxiety
    disorder: An A‑B replication series across social anxiety subtypes.
    Front Psychol 2018;9:540.
    17. Sattary Najaf Abady R. The effectiveness of meta‑cognitive
    treatment on test anxiety in students. J Behav Sci 2015;9:27‑32.
    18. Margoob MA, Mushtaq D. Serotonin transporter gene
    polymorphism and psychiatric disorders: Is there a link? Indian
    J Psychiatry 2011;53:289‑99.
    19. Kraus R, Stricker G, Speyer C. Online Counseling: A Handbook
    for Mental Health Professionals. McGraw Hill, New York.:
    Academic Press; 2010.
    20. Situmorang DDB. Online/cyber counseling services in the
    COVID‑19 outbreak: Are they really new? J Pastoral Care Counsel
    2020;74:166‑74.
    21. Sule B. Technology based counseling: Perspectives of Turkish
    counselors. Proc Soc Behav Sci 2015;8:176‑431.
    22. Kruglova K, O’Connell S, Dawadi S, Gelgoot E, Miner S, Robins S,
  2. et al. An mHealth app to support fertility patients navigating the
    world of infertility (Infotility): Development and usability study.
    JMIR Form Res 2021;5:e28136.
    23. Wallin EE, Mattsson S, Olsson EM. The preference for
    internet‑based psychological interventions by individuals without
    past or current use of mental health treatment delivered online:
    A survey study with mixed‑methods analysis. JMIR Ment Health
    2016;3:e25.
    24. Lohr PA, Aiken AR, Forsyth T, Trussell J. Telephone or integrated
    contraception counselling before abortion: Impact on method
    choice and receipt. BMJ Sex Reprod Health 2018;44:114‑21.
    25. Coleman PK, Coyle CT, Rue VM. Late‑term elective abortion and
    susceptibility to post‑traumatic stress symptoms. J Pregnancy
    2010;2010:130519.
    26. Zolfagharii H, Miri M, Mokhtarpour H. The effectiveness of
    metacognitive therapy on cognitive deficits in elderly with
    substance use. J Aging Psychol 2015;1:11‑21.
    27. Beck AT, Epstein N, Brown G, Steer RA. An inventory for
    measuring clinical anxiety: Psychometric properties. J Consult
    Clin Psychol 1988;56:893‑7.
    28. Wells A. Emotional Disorders and Metacognition: Innovative
    Cognitive Therapy. UK: John Wiley & Sons; 2002.
    29. Sharifi‑Shaki S, Aakhte M, Alipor A, Fahimi‑Far A, Taghadosi M,
    Karimi R, et al. The effectiveness of mindfulness‑based cognitive
    therapy in reducing anxiety and meta‑worry in women with
    recurrent miscarriages. KAUMS J 2015;19:334‑40.
    30. Lysaker PH, Gagen E, Klion R, Zalzala A, Vohs J, Faith LA, et al.
    Metacognitive reflection and insight therapy: A recovery‑oriented
    treatment approach for psychosis. Psychol Res Behav Manag
    2020;13:331‑41.
    31. Miegel F, Demiralay C, Moritz S, Wirtz J, Hottenrott B, Jelinek L.
    Metacognitive training for obsessive‑compulsive disorder:
    A study protocol for a randomized controlled trial. BMC
    Psychiatry 2020;20:350.
    32. Moritz S, Klein JP, Lysaker PH, Mehl S. Metacognitive
    and cognitive‑behavioral interventions for psychosis: New
    developments. Dialogues Clin Neurosci 2019;21:309‑17.
    33. Rajput SK, Tiwari T, Chaudhary AK. Effect of preoperative
    multimedia based video information on perioperative anxiety
    and hemodynamic stability in patients undergoing surgery under
    spinal anesthesia. J Family Med Prim Care 2021;10:237‑42.
    34. GhanbariE, Yektatalab S, MehrabiM. Effects of psychoeducational
    interventions using mobile apps and mobile‑based online group
    discussions on anxiety and self‑esteem in women with breast
    cancer: Randomized controlled trial. JMIR Mhealth Uhealth
    2021;9:e19262.
    35. Golshani F, Mirghafourvand M, Hasanpour S, Seiiedi Biarag L.
    The effect of cognitive behavioral therapy on anxiety and
    depression in Iranian infertile women: A systematic and
    meta‑analytical review. Iran J Psychiatry Behav Sci 2020;14:e96715.
    36. Akhteh M, Alipor A, Sarifi Saki S. Effectiveness of stress
    management training in reducing anxiety and meta‑worry
    of women who had abortion several times. Sci J Manage Syst
    2014;3:120‑9.
    37. Delaram M, Soltanpour F. The effect of counseling in third
    trimester on anxiety of nulliparous women at the time of
    admission for labor. Zahedan J Res Med Sci 2012;14:61‑5.
    38. Anthonysamy L. The use of metacognitive strategies for
    undisrupted online learning: Preparing university students in
    the age of pandemic. Educ Inf Technol (Dordr). 2021 Apr 20:1-19.
    doi: 10.1007/s10639-021-10518-y. Epub ahead of print. PMID:
    33897268; PMCID: PMC8056832.
    39. Kermani H, Mozaffari AA. The study of Iranian users’ reasons
    in preferring Telegram on other Instant Messaging Applications.
    Med Stud J 2018;13:8‑21.
    40. Mehdipour Y, Noori T, Mehraeen E, Khajepour E, Balochzehi
    Shahbakhsh F, Farhadi E. Utilization of telemental health
    services from the viewpoints of psychology students of Zahedan
    Universities. J Health Biomed Inform 2015;1:122‑30.
    41. SalehMoghaddam A, Mazloum S, Zoka A. The effect of
    educational videos on preoperation anxiety among patients
    before undergoing open heart surgerywithout pump. Urmia
    Nursing and Midwifery Faculty 2016;14:648‑57.
    42. Ghalibaf A, Karimi H, Moghadam N, Bahaadinbeigy K. Assessing
    satisfaction, technology usability, and therapeutic alliance in
    tele‑psychotherapy from patients’ and counselor’s perspective.
    J Health Adm 2015;18:92-105.
    43. Cicila LN, Georgia EJ, Doss BD. Incorporating internet‑based
    interventions into couple therapy: Available resources and
    recommended uses. Aust N Z J Fam Ther 2014;35:414‑30.
    44. Wells A. Metacognitive Therapy for Anxiety and Depression.
    New York: Guilford Press; 2011.
    45. Abbaszadeh A, Sabeghi H, Borhani F, Heydari A. A comparative
    study on effect of e‑learning and instructor‑led methods on
    nurses’ documentation competency. Iran J Nurs Midwifery Res
    2011;16:235‑43.
    46. Kashani F, Moghimian M, Salarvand S, Kashani P. Nurses’
    knowledge, attitude, practice about effective communication skills
    in patient education. J Res Dev Nurs Midwifery 2016;12:59‑67.
    47. CarlbringP, AnderssonG, CuijpersP, RiperH, Hedman‑Lagerlöf E.
    Internet‑based vs. face‑to‑face cognitive behavior therapy for
    psychiatric and somatic disorders: An updated systematic review
    and meta‑analysis. Cogn Behav Ther 2018;47:1‑18.
    48. Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH.
    Therapist‑supported Internet cognitive behavioural therapy
    for anxiety disorders in adults. Cochrane Database Syst Rev
    2015 Mar 5;(3):CD011565.