Optimising psychological treatment for anxiety disorders in pregnancy: a feasibility randomised controlled trial
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12 June 2020 — adopted November 2019 • completing March 2022
Optimising psychological treatment for anxiety disorders in pregnancy: a feasibility randomised controlled trial
Anxiety disorders include a range of problems including panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and social anxiety disorder. They affect approximately 11% of pregnant women, impact on women’s day to day functioning and often last into the postnatal period if untreated.
of pregnant women are affected by anxiety disorders, which often persist into the postnatal period if untreated
In mothers, parenting, breastfeeding and mood can all be affected. Children are at an increased risk of developing behavioural and emotional difficulties. Anxiety during pregnancy has been linked to these effects on children, making pregnancy an important time to treat maternal anxiety disorders.
Research from a south London cohort found a prevalence of 15% of anxiety disorders in pregnant women (Howard et al., 2018) — rising to 25% in younger women — highlighting the particular importance of this work for local communities.
Background
Cognitive behaviour therapy (CBT) is known to be an effective treatment for anxiety disorders but is under-researched in pregnancy. Many women prefer psychological treatments to medication during pregnancy, making CBT a good fit for women with these disorders.
CBT is usually delivered over a period of three months. Recently, good results have been demonstrated with CBT delivered in fewer but longer sessions over two to three weeks for OCD, PTSD, panic disorder and social anxiety. This time-intensive CBT format (IN-CBT) has not yet been tested with pregnant women, where a shorter treatment may be a particularly good fit.
Anxiety disorders are associated with a range of adverse outcomes for both mothers and their children, including:
Impaired parenting, breastfeeding and maternal mood
Increased risk of behavioural and emotional difficulties in children
Persistence into the postnatal period if untreated
Wider impacts on family relationships and children’s long-term development
Aims of the study
This study (ADEPT) aims to investigate whether a full-scale trial of intensive Cognitive Behaviour Therapy (IN-CBT) for antenatal anxiety disorders is feasible. The study will determine:
The best means of recruiting women — whether through physical health, mental health settings or self-referral
Whether participants will accept randomisation to either IN-CBT or standard weekly CBT
Whether the intervention is delivered as intended and is acceptable to women and clinicians
The properties of the primary outcome measure and follow-up rates for participation in a full trial
How the study will be carried out
The main project is a feasibility randomised controlled trial with 30 women recruited into each of IN-CBT and standard weekly CBT (60 participants in total). Women over 18 will be included if they are 12–20 weeks pregnant and have a primary anxiety disorder (PTSD, OCD, panic disorder or social anxiety disorder).
Women will be seen for treatment in their local Improving Access to Psychological Therapies (IAPT) service throughout pregnancy
The primary study outcome is assessed at three months postnatal, when women will complete study measures and be interviewed about their experiences
Interviews will determine the perceived value, benefits, harms or unintended consequences of the intervention, the value that service providers and users place on it, and whether a full trial is appropriate and feasible
How this research addresses the needs of people living in south London
Anxiety disorders are amongst the most common disorders complicating pregnancy. This treatment trial is focused on women from south London who will be recruited by a number of routes:
Midwife referral — women identified during routine antenatal appointments
Direct self-referral — enabling women to access the study independently
IAPT services — aiming to increase participation from women of all backgrounds in a diverse south London population
How patients and the public are involved
An expert by experience panel has been set up specifically for the study. The panel meets annually to advise on study conduct, interpretation of results and dissemination
There is also an expert by experience on the data monitoring committee, ensuring lived experience informs oversight of the trial throughout its duration
Potential benefits of the research
The ADEPT study will provide detailed initial information on best practice in delivering CBT during pregnancy. If a full-scale trial found the intensive mode of delivery to be superior, this would change practice regarding the treatment of antenatal anxiety disorders.
Given the recent expansions of primary care and perinatal services, there are increasing numbers of well-trained CBT therapists who could deliver IN-CBT. Evidence from this research therefore has the potential to:
Shape clinical practice and focus NHS resources on effective perinatal treatments
Benefit children and the wider family through reduced exposure to maternal anxiety and less impact on parenting
Ultimately improve the burden on NHS services for adults and children by treating anxiety effectively before the postnatal period
Funded by an NIHR clinical lectureship. Adopted by ARC South London November 2019. Completing March 2022.
Project lead
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Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.