Prevention of Traumatic Stress in Mothers With Preterm Infants: A Randomized Controlled Trial

OBJECTIVE: The current study evaluates a treatment intervention developed with the goal of reducing symptoms of posttraumatic stress, depression, and anxiety in parents of premature infants. METHODS: A total of 105 mothers of preterm infants (25–34 weeks’ gestational age; .600 g) were randomized to receive a 6-session intervention developed to target parental trauma as well as facilitate infant redefinition (n = 62) or to an active comparison group (n = 43). Mothers in the intervention group received a combination of traumafocused treatments, including psychoeducation, cognitive restructuring, progressive muscle relaxation, and development of their trauma narrative. The intervention also incorporated material targeting infant redefinition, defined as the process of changing the mother’s negative perceptions of her infant and the parenting experience. RESULTS: Mothers in the intervention group reported a greater reduction in both trauma symptoms (Cohen’s d = 0.41, P = .023) and depression (Cohen’s d = 0.59, P , .001) compared with the comparison group. Patients under both conditions improved significantly in terms of anxiety, with no differences between groups. Results of the moderator analysis showed that mothers with higher ratings of baseline NICU stress benefited more from the intervention compared with mothers who had lower ratings (P = .036). CONCLUSIONS: This short, highly manualized intervention for mothers of preterm infants statistically significantly reduced symptoms of trauma and depression. The intervention is feasible, can be delivered with fidelity, and has high ratings of maternal satisfaction. Given that improvements in mothers’ distress may lead to improved infant outcomes, this intervention has the potential for a high public health impact. Pediatrics 2013;132:e886–e894 AUTHORS: Richard J. Shaw, MD,a Nick St John, PhD,b Emily A. Lilo, MPH,c Booil Jo, PhD,a William Benitz, MD,b David K. Stevenson, MD,b and Sarah M. Horwitz, PhDd aDepartments of Psychiatry and Behavioral Sciences and cPediatrics and Stanford Health Policy, and bDivision of Neonatology, Stanford University School of Medicine, Palo Alto, California; and dDepartment of Child and Adolescent Psychiatry, New York University Medical School, New York, New York