Reducing levels of anxiety in pregnancy and after birth through web-based training

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Adopted project
22 March 2022 — February 2022 to July 2025

Reducing levels of anxiety in pregnancy and after birth through web-based training (RELAX study)

This study aims to see if a new web-based training — RELAX — can reduce anxiety in pregnant women and new mothers.

40%

of pregnant women and new mothers experience high levels of anxiety (Fairbrother et al., 2017)

Anxiety in the perinatal period has multiple significant adverse consequences for women, their unborn child, children and partners, including:

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Reduced responsivity to babies (Stein et al., 2012)

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Impairments in childhood development

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Two-fold increase in risk of a child developing psychological disorders (O’Donnell et al., 2014)

Project aim

To determine whether pregnant women with high levels of repetitive negative thinking who complete the early online RELAX intervention alongside usual care have a significant reduction in anxiety later in the perinatal period, compared to those who receive usual care alone.

How the study works

Recruitment

Women are approached in person by the trial team at their 16-week midwife appointment and other relevant routine appointments. They are provided with the study information sheet, have their questions answered, and can register interest and complete a screening form on the RELAX platform. Eligible women wishing to continue are then randomised online.

n=134
RELAX intervention group

n=134
Treatment as usual group

4
assessment time-points from 16–28 weeks gestation to 12–24 weeks post-birth

The RELAX intervention

12 sessions × 25 minutes completed over four weeks, at home on personal computers, tablets or laptops.

Participants listen to short, ambiguous scenarios (covering everyday life and pregnancy) that can be interpreted both negatively and positively. Through the platform, participants learn to resolve scenarios positively and imagine themselves in the positive outcome — gradually reducing patterns of negative thinking.

The usual care group continues with normal midwifery care or regular health visitor contact.

Our collaborators

The research team collaborates with healthcare staff at:

Guy’s and St Thomas’ NHS Foundation Trust
King’s College Hospital NHS Foundation Trust
South London and Maudsley NHS Foundation Trust
University of Warwick
University of New South Wales (Sydney)

The study is funded by the NIHR and supported by the NIHR Maudsley Biomedical Research Centre (BRC) and NIHR ARC South London. It is co-sponsored by King’s College London and Guy’s and St Thomas’ NHS Foundation Trust.

Potential benefits of the project

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Online interventions increase access for women who face practical barriers to attending therapy in a clinical setting

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Reduce perinatal anxiety and improve women’s mental health in the short-term, enhancing their ability to cope with pregnancy and caring for a new baby

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In the longer term, reduce postpartum use of specialist mental health services for women receiving the intervention

How patients and the public are involved

Patients and the public have been involved in the design of the study and continue to be involved throughout. A fully costed PPI lead (Mary Newburn, co-applicant) liaises with the research team, Maternity Voices Partnerships (MVP), Parents and Communities Together (PACT), and PPI members throughout the project.

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PPI lead convenes workshops with women with lived experience of perinatal anxiety to guide development of intervention materials

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PPI advisory group refines materials on the basis of online feedback, contributes to blogs, recruitment strategies and dissemination of findings

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Three women with lived experience of perinatal anxiety sit on the Trial Steering Committee alongside midwives and perinatal mental health clinicians — meeting seven times throughout the project

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KCL’s Diversity and Inclusion strategy applied to this project — including active inclusion of Black, Asian and Minority Ethnic service users and women with multiple social disadvantages

“I am Mum to a beautiful two year-old. During my pregnancy I experienced a lot of anxiety, so it has been a real privilege to be able to be a part of and support this fantastic study to help other mothers of the future.”

Abi — PPI advisory group member and Trial Steering Committee member