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Assignment 2: Qualitative Journal Article Review:
Participants Experiences of an Internet Based Cognitive Behavioral Therapy Program
to Reduce Fear of Childbirth
Jazmin Eadie
Yorkville University
PSYC 6213: Research Methodology
Dr. Rettinger
August 13th, 2023
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Chosen topic for the final project: Psychotherapeutic methods to reduce fear of childbirth
Qualitative journal article selected
Baylis, R., Ekdahl, J., Haines, H., & Rubertsson, C. (2020). Women’s experiences of
internet-delivered cognitive behaviour therapy (iCBT) for fear of birth.
Women and Birth, 33(3). https://doi.org/10.1016/j.wombi.2019.05.006
Statement of The Problem
An internet based cognitive behavioral therapy (iCBT) program was previously
studied for its efficacy in reducing fear of childbirth (FOC) but data collection was not done
on the participants experiences (Baylis et al., 2020; Ternström et al., 2017). Therefore, Baylis
et al (2020) wanted to qualitatively examine participants experiences of completing the iCBT
program to reduce FOC.
Literature Review
Approximately 14% of people have significant levels of FOC which can be comorbid
with depression and anxiety and lead to obstetrical complications (O’Connell et al., 2017;
Storksen et al., 2012). Several treatments have been used to reduce FOC and Baylis et al
(2020) were intrigued with the use of cognitive behavioural therapy (CBT) for FOC since it’s
a primary treatment in reducing anxiety (Curtiss et al., 2021). Furthermore, several studies
have demonstrated the efficacy of iCBT and its comparability with face-to-face CBT for the
treatment of depression and anxiety (Andersson et al., 2014). This allowed Baylis et al (2020)
to have a good foundation to qualitatively examine people’s experiences in participating in an
iCBT program for FOC.
Research Questions Being Investigated
The aim of this study was to firstly examine people's experiences of the iCBT
program for FOC and secondly have the women describe the content of their FOC (Baylis et
al., 2020).
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Method
Research Design
The researchers qualitative design was phenomenological since they wanted to
examine what the participants FOC was and their perspectives on the iCBT program (Baylis
et al., 2020; Richards & Morse, 2013). Furthermore, data collection was done through
interviews, there was a small sample size, and thematic analysis was used for data analysis
which are all common components of phenomenological research (Baylis et al., 2020;
Goodwin & Goodwin, 2017; Richards & Morse, 2013).
Participants
Participants ranged in age from 25 to 38 and previously participated in the U-CARE
pregnancy trial study which investigated the use of iCBT for FOC (Baylis et al., 2020;
Ternström et al., 2017). Individuals in the iCBT arm were contacted through text messaging 1
to 2 years after participating in the study (Baylis et al., 2020). They were given a proposed
date for a phone interview and were called two times to see if they wanted to participate
(Baylis et al., 2020). The previous study had 127 women in the iCBT arm and 19 participants
completed this qualitative interview (Baylis et al., 2020).
Materials
Data collection was completed over the phone through open ended interviews that
were recorded with participants consent and transcribed (Baylis et al., 2020).
Procedure
Interviews were completed over the phone and recorded by a midwife who was not a
part of the original study (Baylis et al., 2020). Open-ended questions were used to guide the
call which lasted anywhere from 15-33 minutes (Baylis et al., 2020).
Data Analysis
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The interviewer read through the transcript interviews several times to conduct
thematic analysis and organized participants answers into various themes and subthemes
(Baylis et al., 2020). These themes were checked by the authors and edited until there was
consensus (Baylis et al., 2020).
Results
Implications for Counsellors, Clients, and Counselling
The findings of this study allow counsellors to think further about the impact that
iCBT can have on different populations and ways that structured iCBT programs could be
adapted to better fit FOC (Baylis et al., 2020). Additionally, it shows that for different life
stages some individuals might crave one on one connection more than others such as in
pregnancy since most of the respondents in this study would have preferred one on one
sessions (Baylis et al., 2020). Furthermore, this study shows that care providers need to be
flexible in how they provide their services since some individuals might feel satisfied with a
certain form of treatment like iCBT and others might not (Baylis et al., 2020).
Summary
The researchers were able to explore their research aims by examining the subjective
experiences of the iCBT participants and learned about their FOC (Baylis et al., 2020). Baylis
et al (2020) learned that the previous program did not pinpoint participants specific fears
related to FOC which commonly surrounded fear of losing control and the health of
themselves and their babies. Participants also struggled with the iCBT when it came to
motivation and found the iCBT to be demanding (Baylis et al., 2020). However, others found
it to be useful and liked the privacy it provided (Baylis et al., 2020).
Interpretation
This study’s conclusions are warranted since they are the experiences of participants
within the study. However, I don’t think they give the full picture of participants experiences
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with iCBT due to the small sample size and the fact that some subjects with negative
experiences or good experiences might have not been available or willing to participate
(Baylis et al., 2020). There are no ethical considerations that worry me about this study, but it
would be nice to review the open-ended questions to ensure they couldn’t lead to harm. This
study's strengths are that it demonstrates the personal experiences of pregnant individuals
with FOC who participated in iCBT (Baylis et al., 2020). This can be beneficial, but it can
also lead to response bias which seemed to have been accounted for in this study by its other
strength of having the interviewer be a midwife who the participants did not know (Baylis et
al., 2020; Goodwin & Goodwin, 2017). Limitations of this study included a small sample
size which is not uncommon with phenomenological studies but in this case, it means that we
might not be getting the full picture when it comes to participants experiences of the iCBT
program (Baylis et al., 2020; Richards & Morse, 2013; Goodwin & Goodwin, 2017).
Additionally, the sample in this study had a small age range, were highly educated, and
recruitment for this qualitative study was based on availability which means that the results
could lack generalizability and again not give readers the whole picture (Baylis et al., 2020;
Goodwin & Goodwin, 2017). Lastly, the largest limitation is that the interviews occurred 1 to
2 years following the iCBT program which increases the chances of recall bias (Baylis et al.,
2020).
For Future Research
Further qualitative research using focus groups and quantitative research using
surveys could be conducted to better understand pregnant people’s perspectives on varying
psychotherapeutic modalities and personal experiences with FOC. This information could
better tailor future programs related to FOC like iCBT. Furthermore, future research should
modify these modules and add components like weekly phone calls to personalize the
treatment and see if that makes a difference in iCBT’s efficacy in reducing FOC.
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References
Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided
internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic
disorders: A systematic review and meta-analysis. World Psychiatry, 13(3), 288-295.
https://doi.org/10.1002/wps.20151
Baylis, R., Ekdahl, J., Haines, H., & Rubertsson, C. (2020). Women’s experiences of
internet-delivered cognitive behaviour therapy (iCBT) for fear of birth. Women and
Birth, 33(3). https://doi.org/10.1016/j.wombi.2019.05.006
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral
treatments for anxiety and stress-related disorders. Focus, 19(2), 184-189.
Ternström, E., Hildingsson, I., Haines, H., Karlström, A., Sundin, Ö., Ekdahl, J., Segeblad,
B., Larsson, B., Rondung, E., & Rubertsson, C. (2017). A randomized controlled
study comparing internet-based cognitive behavioral therapy and counselling by
standard care for fear of birth – A study protocol. Sexual & Reproductive Healthcare,
13, 75-82. https://doi.org/10.1016/j.srhc.2017.06.001
Goodwin, K. A., & Goodwin, C. J. (2017). Research in psychology: Methods and designs
(8th ed.). Wiley.
O'Connell, M. A., Leahy-Warren, P., Khashan, A. S., Kenny, L. C., & O'Neill, S. M. (2017).
Worldwide prevalence of tocophobia in pregnant women: Systematic review and
meta-analysis. Acta Obstetricia et Gynecologica Scandinavica, 96(8), 907-920.
https://doi.org/10.1111/aogs.13138
Richards, L., & Morse, J. M. (2013). Read me first for a user's guide to qualitative methods
(3rd ed.). Los Angeles, CA: Sage Publications.
Storksen, H, T., Eberhard-gran, M., Garthus-niegel, S., & Eskild, A. (2012). Fear of
childbirth; the relation to anxiety and depression. Acta Obstetricia et Gynecologica
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Scandinavica, 91(2), 237-242. https://doi.org/10.1111/j.1600-0412.2011.01323.x