Eshre

1. The Mindfulness Based Program for Infertility (MBPI):
How does it work in reducing depression?
Ana Galhardo1, 2 Mariana Moura-Ramos2 Marina Cunha1, 2 José Pinto Gouveia2
1Instituto Superior Miguel Torga; 2CINEICC – Faculty of Psychology and Educational Sciences of the University of Coimbra
INTRODUCTION
Participants:
The MBPI was applied in 5 groups (Lisbon: 2: Oporto: 2; Coimbra:1) between May
2009 and May 2010. A total of 55 women were recruited through the Portuguese
Fertility Association (patients association) website. Control group (N = 37) were
recruited through the same procedure, but were allocated to the control group due
to impossibility to attend the group sessions. All subjects gave their informed
consent. The MBPI sessions were held between May 2009 and May 2010.
Instruments:
Beck Depression Inventory (BDI) [6,7] Infertility Self-Efficacy Scale (ISE) [8, 9]
Procedures:
The MBPI included 10 weekly sessions, in a group format, of two hours each.
Participants completed self-report measures before and after the MBPI (10 weeks
interval).
Significant differences were found on self-efficacy (F1,90 = 13.88, p < 0.008)
and depressive symptoms (F1,90 = 8.06, p = .006) between intervention and
control group from baseline to post intervention.
The intervention group reported a significant increase in self-efficacy and
decrease in depressive symptoms (both p < 0.001), while control group reported
no significant changes. A mediation analysis was conducted to examine
whether changes in self-efficacy mediated the effect of the PBMI intervention in
reducing depressive symptoms. Statistical analysis was performed using
PROCESS macro in SPSS with bootstrap procedures (5000 samples).
Mediation effect was significant (estimate = 1.61, Bias Corrected Bootstrap
confidence interval: .50; 3.47).
Infertile women who received the PBMI intervention increased their perceptions
on self efficacy in dealing with infertility, which in turn decreased their
depressive symptoms.
OBJETIVES
The aim of the current study was to explore the mechanism by which the PBMI
helps reducing depressive symptoms.
METHOD
RESULTS
DISCUSSION
The findings demonstrated the mechanism by which the PBMI is effective in
reducing depressive symptoms in infertile patients is by increasing the patients’
confidence levels on aspects of cognitive, emotional and behavioral skills related
to infertility.
Depressive symptoms are related to distorted thoughts about oneself, the world
and the future and themes of worthlessness and self-blame are rather frequent.
With mindfulness practice, participants became more conscious of their internal
and external experience in the present moment with an attitude of openness and
curiosity. Thus, painful thoughts and feelings related to the past or to the future
are recognized without trying to suppress or modify them and this may lead to a
decrease of the impact of these private events [10].
By increasing the perception of oneself as being able to cope with painful
experiences such as infertility these women might present a more positive
emotional status, persist with medical treatment or achieve a family-building
resolution other than the one with biological children [8]. In fact women showing
higher levels of self-efficacy tend to look at demanding tasks, such as dealing
with infertility, from a standpoint of challenge rather than of threat, set significant
goals and commit to accomplishing them [11].
Limitations and contributions
This was not a blind study given the nature of practical impediments to collecting
the sample. Participants' recruitment was conducted via Internet, which means
that they have Internet access and may be particularly informed and motivated to
some kind of psychological intervention.
Despite the limitations mentioned, the current study allows a better
understanding of the mediator effect of self-efficacy on depressive symptoms and
highlights the importance of promoting self-efficacy, specifically addressing the
way infertile patients perceive their abilities to face infertility and the strains of
medical treatment when designing psychological intervention programs.
Mindfulness based approaches have been applied and proved efficient to several
health problems such as chronic pain, cancer, anxiety disorders, and depression
[1]. The Mindfulness Based Program for Infertility (MBPI) is based on the
Mindfulness Based Program for Stress Reduction [2], the Mind Body Program for
Infertility [3] and basic principles of Acceptance and Commitment Therapy [4] and
was developed specifically for targeting infertile patients.
The MBPI is intended to develop values clarification, mindfulness and acceptance
skills, conducting to valued actions. The cultivation of awareness through
mindfulness practice might be a way of being in touch in an open and non-
judgmental way, moment by moment, with painful inner mental states (e.g.
feelings, thoughts, and memories). Furthermore, attitudes of kindness, curiosity
and willingness to be present with the unfolding experience are promoted as well
as the ability to recognize own experiences as part of the larger human
experience.
This psychological group intervention program showed to be effective in reducing
depressive symptoms, internal and external shame, entrapment and defeat, in
infertile female patients. Inversely it led to a significant improvement in
mindfulness skills and in the perception of self-efficacy to deal with infertility [5].
The MPBI group and the control group were equivalent concerning
sociodemographic variables (age, years of education, marital status, years of
marriage) and clinical variables (infertility duration, infertility diagnosis, previous
psychological interventions). No significant differences were found between the
groups regarding the studied variables at the baseline (before the MBPI
intervention).
References
[1] Baer, R. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical
review. Clinical Psychology:Science and Pratice, 10, 2, 125-143.
[2] Kabat-Zinn, J. (1990). Full catastrophe living. New York: Delta.
[3] Domar, A. D., Seibel, M. M., & Benson, H. (1990). The Mind/Body Program for Infertility: a
new behavioural treatment approach for women with infertility. Fertility and Sterility, 53, 2,
246-249.
[4] Hayes, S. C. , Strosahl, K, & Wilson, K. G. (1999). Acceptance and Commitment Therapy.
New York: The Guilford Press.
[5] Galhardo, A., Cunha, M., & Pinto-Gouveia, J. (2013). Mindfulness Based Program for
Infertility: Efficacy study. Fertility and Sterility, 100, 4, 1059-1067.
[6] Beck, A., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for
measuring depression. Archives of General Psychiatry, 4, 561-571.
[7] Vaz-Serra, A., & Abreu, J. (1973a). Aferição dos quadros clínicos depressivos I – estudo
de aplicação do “Inventário Depressivo de Beck” a uma amostra portuguesa de doentes
deprimidos. Coimbra Médica, XX, 623-644.
[8] Cousineau, T. M., Green, T. C., Corsini, E. A., Barnard, T., Seibring, A. R., & Domar, A. D.
(2006). Development and validation of the Infertility Self-Efficacy scale. Fertility and Sterility,
85(6), 1684-1696. doi: S0015-0282(06)00366-9 [pii]10.1016/j.fertnstert.2005.10.077
[9] Galhardo, A., Cunha, M., & Pinto-Gouveia, J. (2013). Measuring self-efficacy to deal with
infertility: Psychometric properties and confirmatory factor analysis of the Portuguese version
of the Infertility Self-Efficacy Scale. Research in Nursing and Health, 36, 65-74. doi:
DOI:10.1002/nur.21516
[10] Williams, M., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through
depression. New York: The Guilford Press.
[11] Yong, F. L. (2010). A study on the self-efficacy and expectancy for success of pre
university students. European Journal of Social Sciences 13(4), 514-524.
REFERENCES
Conclusions
Change in Self
efficacy in
infertility
Changes in
Depression
Intervention
2.09
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