Digital therapy prevents anxiety increasing during pregnancy and after birth

A new digital therapy helped prevent anxiety from increasing during pregnancy and after birth among people with high levels of repetitive negative thinking, a trial found.

The self-led programme significantly reduced anxiety compared with usual maternity care. Participants also reported lower levels of depression and repetitive negative thinking.

The findings suggest digital support could help prevent lower levels of anxiety from escalating in pregnant women and birthing people without a diagnosed mental health condition.

Professor Colette Hirsch, lead researcher and professor of cognitive clinical psychology at King’s College London, said: “We know there is a large unmet need amongst those women who experience anxiety before and after birth, but who do not have a diagnosis and who often do not receive mental healthcare support.

“If left untreated, this anxiety can lead to further challenges for parent and child.”

The trial, led by King’s College London, involved 268 participants and tested an online intervention called REducing Levels of AnXiety (RELAX).

The programme targets repetitive negative thinking, which involves repeatedly dwelling on worries or possible negative outcomes and is associated with anxiety.

Previous research had suggested that this approach could help people experiencing high levels of anxiety. This was the first trial to investigate whether it could prevent lower levels from increasing.

Anxiety disorders affect approximately one in five pregnant women or birthing people.

Perinatal anxiety, which occurs during pregnancy and after childbirth, has been associated with an increased likelihood of premature birth, lower birth weight, reduced maternal responsiveness to infants and psychological disorders in children.

The randomised controlled trial examined whether adding RELAX to usual maternity care could prevent anxiety from increasing during pregnancy and after birth.

Participants were over 18, between 16 and 28 weeks pregnant, and reported high levels of repetitive negative thinking alongside anxiety symptoms ranging up to moderate severity.

People with a current psychiatric diagnosis or risk of suicide were excluded.

Of the 268 participants, 134 were randomly assigned to receive RELAX alongside usual maternity care.

The others received assessments and usual care, which could include maternity monitoring, contact with a health visitor and information about accessing psychological services.

Those using RELAX completed 12 short online sessions over four weeks on a laptop or tablet.

Each session involved listening to 30 scenarios based on pregnancy-related concerns or everyday situations that could be interpreted positively, neutrally or negatively.

The training encouraged participants to consider more positive interpretations rather than automatically anticipating negative outcomes.

Participants receiving RELAX had significantly lower anxiety levels before and after birth than those receiving usual care alone.

They also reported lower levels of depression and repetitive negative thinking.

Among those assigned to RELAX, 81.3 per cent completed at least 10 of the 12 sessions.

Most reported positive experiences and said they would recommend the intervention to others.

Hirsch said: “Our digital therapy aims to address the symptom of repetitive negative thinking where people constantly consider the negative outcome of situations, and which has been shown to predict and maintain anxiety.

“This is the first study to show that a digital therapy addressing this type of thinking prevents the increase of anxiety during pregnancy.

“Integrating RELAX into maternity care for those with, or at risk of increasing anxiety has the potential to improve maternal mental health and by taking a digital approach we can reach a large number of people.”

The programme was co-developed by psychologists, researchers, clinicians and people with personal or professional experience of perinatal anxiety.

Its online format could make preventive mental health support more accessible to pregnant women and birthing people who might not otherwise receive treatment.

Hirsch added: “Pregnancy can be such a cherished and critical time, but it is also a time when everyday situations can cause worry and anxiety. As a digital therapy that can be used by pregnant and birthing people in their own homes, RELAX has the potential to prevent this anxiety escalating when it is still manageable, aligning with many of aspects of the NHS 10-year plan and providing much-needed support to this group.”

Following feedback from participants and other stakeholders, the intervention is being developed into an app called LENS4Pregnancy.

The research team is working with people who have experienced anxiety during and after pregnancy, alongside clinicians, policymakers, charities and healthcare providers, to develop plans for its implementation.

The study was funded through the Efficacy and Mechanism Award, a partnership between the UKRI Medical Research Council and the National Institute for Health and Care Research, and delivered through the NIHR Biomedical Research Centre: Maudsley.