Eficacia de la Terapia Cognitivo-Conductual en el Manejo del Estrés Prenatal e Impacto en el Cortisol y Desarrollo Infantil

Résumé

The general objective of this Doctoral Thesis was to investigate the efficacy of Cognitive-Behavioral Therapy (CBT) for stress coping in pregnant women, applied in face-to-face and telematic modalities. The thesis compiles seven studies published in journals indexed in the Journal Citation Report (JCR), divided into two blocks of objectives. The first block, entitled "Effectiveness of CBT in pregnant women and effects on offspring" has two specific objectives: 1) to analyze whether there is a relationship between cortisol levels in hair and/or psychological stress during conception and the first weeks of pregnancy with respect to the sex of the fetus; and, 2) to evaluate the effectiveness of CBT in reducing stress in pregnant women at the psychological and hormonal level, and how this effectiveness is related to neurodevelopment and cortisol in the baby. Studies 1 and 2 address these specific objectives. The results of study 1 showed an association between higher levels of cortisol in hair at the time of conception and the first weeks of pregnancy and a higher probability of having a female fetus. However, no relationship was found between maternal psychological stress and fetal sex. Thus, the research results appear to support explanatory theories suggesting that cortisol concentrations at the time of conception play an important role in determining the sex of the fetus. Study 2, a follow-up of a randomized controlled trial, included two groups of pregnant women: one that received CBT to manage stress during pregnancy and a control group that received usual care. The results showed that, the babies in the Therapy Group (TG) had lower hair cortisol concentration at birth, but no significant differences were found between the two groups in relation to cortisol levels at 6 months. With respect to neurodevelopment, the results revealed that the TG infants presented a higher level of cognitive and motor neurodevelopment at 6 months of age. To conclude the first block, studies 1 and 2 reveal that there is a relationship between the mother's cortisol concentration during conception and the first months of pregnancy and fetal sex. On the other hand, CBT for stress coping is effective, applied during pregnancy, in the reduction of stress and psychopathological symptoms and, in addition, it could have implications on infant cortisol concentrations in the short term and on motor and cognitive neurodevelopment in the medium and long term. The second block of objectives is entitled "Effectiveness of telematically implemented CBT in pregnant women during a health crisis" and addresses three specific objectives through five studies. The first specific objective of the second block focused on analyzing perinatal psychological health during the pandemic, both during pregnancy and after delivery. In order to achieve this objective, studies 3 and 4 were carried out. On the one hand, the results of study 3 showed that the group of pregnant women during the health crisis presented higher levels of depressive symptomatology and phobic anxiety, as well as higher levels of perceived stress compared to those pregnant women before the crisis. Along the same lines, the findings of study 4 revealed that women who gave birth during the pandemic had higher levels of depression, anxiety, hostility, phobic anxiety, somatization, obsessions and compulsions, interpersonal sensitivity, and psychoticism. The second specific objective of the second block consisted of investigating the interaction of resilience, stress and anxiety in pregnant women in two different stress situations: before and during the COVID-19 pandemic. To address this objective, study 5 was carried out, in which the relationship between psychological resilience, perceived stress, pregnancy-specific stress and anxiety was studied in the same way as in the two previous studies, through two cohorts of pregnant women: the first evaluated before the pandemic; and the second evaluated during the pandemic. In both groups, resilience was observed to decrease levels of pregnancy-specific stress and general perceived stress, as well as anxiety symptomatology. Likewise, pregnancy-specific stress and perceived stress correlated with each other and, in turn, predicted the increase in anxiety symptoms. The third and last specific objective of the second block focused on studying the feasibility and efficacy of CBT for stress management in pregnant women, applied telematically during the pandemic. In order to achieve this objective, studies 6 and 7 were carried out. Through both studies, it was proven that CBT for stress management applied telematically in pregnant women is feasible and effective in reducing stress levels and psychopathological symptoms of anxiety, depression and obsessions-compulsions, as well as in increasing resilience. To conclude block 2, health crises such as pandemics, involving restrictions in mobility and social contact, lead to increased stress and psychopathological symptoms in the perinatal period. However, psychological resilience can act as a protective factor against increased stress and anxious symptoms, both in crises and in ordinary contexts. Finally, a CBT-based psychological intervention program for stress management, applied telematically, can increase levels of psychological resilience and reduce stress levels and psychopathological symptoms in pregnant women. In summary, the results obtained in the two blocks of objectives demonstrate that CBT is effective in reducing stress and psychopathological symptoms in pregnant women, both in face-to-face and telematic modalities. In addition, a relationship was found between maternal cortisol concentrations during conception and the first months of pregnancy and fetal sex. The CBT intervention also showed implications on cortisol concentrations in infants in the short term and on their motor and cognitive neurodevelopment in the medium and long term. On the other hand, during health crises, such as pandemics, stress and psychopathological symptoms increase in the perinatal period. However, psychological resilience can act as a protective factor against increased stress and anxious symptoms in crisis contexts and ordinary situations. In this way, the application of a CBT-based psychological intervention program for stress management in a telematic manner can improve psychological resilience and reduce levels of stress and psychopathological symptoms in pregnant women.