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
- 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, - 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.