Preterm births have increased almost 31% in the last 27 years, comprise 12-13% of all live births and, as described in a 2006 Institute of Medicine report, represent a major, costly, complex public health problem. The birth of a premature infant is a traumatic event for the parents, particularly the mothers, causing stress reactions such as depression and anxiety. These stress responses in mothers have been linked to poor parenting practices and subsequently to poor cognitive, emotional and behavioral development in their vulnerable infants. To address the depression, anxiety and trauma experienced by mothers of preterm infants, we developed a three-session CBT-based intervention which decreased depression symptoms in women but not trauma symptoms. Therefore, we are requesting funds through the NIMH R34 mechanism to expand the intervention to include successful CBT-based approaches developed for the treatment of trauma and to address additional critical stressors we identified in our earlier work including alterations in the parental role and negative perceptions of the infant. Specifically, we propose to: 1) Adapt a manualized intervention to treat ASD and prevent the development of PTSD in women with preterm infants and to assist these mothers in redefining their infants and educating them to promote sensitivity to their infants; 2) Pilot the manualized treatment with 10 NICU mothers, solicit feedback from these mothers and modify the intervention based on the feedback; 3) Conduct a small (N=100) randomized trial of the trauma-focused plus mother redefinition/education intervention compared to an information/usual services comparison condition;and, 4) Conduct a 5-month longitudinal intervention with women in the intervention group (N=60) randomized to bi-monthly telephone or in-person follow-up by a therapist using the newly-adapted CBT-based treatment versus support from former NICU parents to determine whether an intervention closer to the length of conventional CBT treatment for trauma is superior to the proposed 6-session intervention in preventing the development of PTSD, promoting more positive perceptions of the infant and in reducing parental stress.
Preterm births are a prevalent, costly and complex public health problem with potentially life-long sequelae for the preterm infants and their mothers. Recent recognition of PTSD as a model to explain both maternal reactions following a preterm birth and the maladaptive parenting styles that often develop in these mothers prompts the adaptation of an intervention for delivery within the NICU with a high likelihood of success in preventing trauma in these mothers and promoting more developmentally facilitating parenting styles. Thus, the proposed treatment adaptation research has a likelihood of high public health significance and meets Objective three in NIMH's Strategic Plan-to develop better interventions for prevention, treatment and cure of mental illness.
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