American Journal of Nursing Research
ISSN (Print): 2378-5594 ISSN (Online): 2378-5586 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Nursing Research. 2020, 8(2), 269-277
DOI: 10.12691/ajnr-8-2-16
Open AccessArticle

Effect of Cognitive Behavioral Therapy on Anxiety, Stress, Depression, and Coping Pattern among Pregnant Women with Preeclampsia

Samia I Hassan1, Ahlam Mohammed Ibrahim Gouda1, , Ahmed El-Monshed2 and Hanan Abderahman Mostafa Kandeel3

1Woman's Health & Midwifery, Nursing Department, Faculty of Nursing, Mansoura University, Egypt

2Psychiatric and Mental health Nursing Department, Faculty of Nursing, Mansoura University, Egypt

3Obstetric and Gynecologic Nursing, Faculty of Nursing, Alexandria University, Egypt

Pub. Date: February 11, 2020

Cite this paper:
Samia I Hassan, Ahlam Mohammed Ibrahim Gouda, Ahmed El-Monshed and Hanan Abderahman Mostafa Kandeel. Effect of Cognitive Behavioral Therapy on Anxiety, Stress, Depression, and Coping Pattern among Pregnant Women with Preeclampsia. American Journal of Nursing Research. 2020; 8(2):269-277. doi: 10.12691/ajnr-8-2-16


Aim: Investigate the effect cognitive behavioral therapy on anxiety, stress, depression, and coping pattern among pregnant with pre- eclampsia. Method: Design: Quazi experimental (pre and posttest) design. Setting: Antenatal outpatient clinic and high-risk inpatient department in Mansoura University Hospital. Subjects: Eighty eix pre- eclamptic women who attending antenatal outpatient clinic, and high risk inpatient department, Mansoura University Hospital, subjects were divided randomly into two equal groups. Tools: Five tools were used for data collection, structured interview schedule, Beck Anxiety Inventory, Perceived stress scale (PSS), Beck depression inventory-II (BDI-II) and Coping Patterns Scale: Adopted from Genedy. Results: The study findings revealed that there was a statistical significant difference in scores of depression, anxiety, and stress pre and post the cognitive behavioral therapy among the intervention group (P≤0.001) with large effect size (η2=0.7). Conversely, in the control group, there was no statistical difference in scores of depression, anxiety, and stress pre and post the routine care (P>0.05).Conclusion: Cognitive-behavioral therapy can be used as a treatment option for reducing pregnancy-specific anxiety, stress and depression in preeclamptic women. Recommendations: Educational programs are important for improving mental health for mothers and reduce the common maternal mood disorders post-pregnancy.

anxiety cognitive behavioral therapy coping pattern depression preeclampsia and stress

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Ricci, S. S. (2013).Essentials of Maternity, Newborn, and Women's Health Nursing.3rdedn. China, Wolterskluwer Health, Lippincott Williams & Wilkins Co, pp. 380-381,433.
[2]  Oats, J. & Abraham, S. (2017):Llewellyn-Jones Fundamentals of Obstetrics and Gynaecology. 10th edn. Chapter 6, Antenatal care. China, Elsevier Co, pp. 40,54,87.
[3]  Hawton K, Clark DM. (2014).Cognitive behaviour therapy for psychiatric problems. Tehran: Arjomand
[4]  NICHD (2017): High-Risk Pregnancy: Overview. Retrieved 2017-11-07.
[5]  El Deeb SIH, El-Bakry MM, Nouh AAA and Mohamed SME. (2015): prevalence of pregnancy induced hypertension Zagazig university Hospital. Thesis of master degree in obstetrics and Gynecology. Faculty of medicine Zagazig University
[6]  Sanchez SE, Puente GC, Atencio G, et al., (2013): Risk of spontaneous preterm birth in relation to maternal depressive, anxiety and stress symptoms. J Reprod Med; 58: 25-33
[7]  Dunkel C & Tanner L(2012): Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. CurrOpin Psychiatry; 25: 141-148. (Egypt Today staff, 2017)
[8]  Beijers R, Jansen J, Riksen-Walraven M, et al (2010): Maternal prenatal anxiety and stress predict infant illnesses and health complaints. Pediatrics.; 126: e401-9. Available: Accessed 17 July 2014.
[9]  Kinsella MT & Monk C.(2013): Impact of maternal stress, depression & anxiety on fetal neurobehavioral development. Clinical Obstetric Gynecology. 52: 1-15.
[10]  National Institute of Mental Health.Anxiety disorders. (2016). (Accessed 6.20.2016).
[11]  WorldHealth Organization Depression. (2016). (Accessed.
[12]  Tayebe Abazarnejad1 Atefeh Ahmadi2 Esmat Nouhi, Moghaddameh Mirzae Monavare Atghai (2019): Effectiveness of psycho-educational counseling on anxiety in preeclampsia, Trends Psychiatry Psychother., ahead of print Epub Aug 01.
[13]  Marina Iniesta-Sepu´lveda, Eric A. Storch (2017): Cognitive-behavioral therapy as an effective, safe, and acceptable intervention for OCD during pregnancy. Rev. Bras. Psiquiatr. 2017; 39: 84.
[14]  Abalos E, et al., (2014): Pre-eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG; 121 (Suppl 1): 14-24.
[15]  Kenny LC, et al., (2014): Early pregnancy prediction of preeclampsia in nulliparous women, combining clinical risk and biomarkers: the Screening for Pregnancy Endpoints (SCOPE) international cohort study. Hypertension.; 64: 644-652.
[16]  Jauniaux E, Steer P (2016): Predicting pre-eclampsia: 100 years of trying and failing. BJOG.; 123: 1066.
[17]  Bilano VL, Ota E, Ganchimeg T, Mori R, Souza JP(2014): Risk factors of pre-eclampsia/eclampsia and its adverse outcomes in low- and middle-income countries: a WHO secondary analysis. PLoS One; 9: e91198.
[18]  Verbeek R., Arjadi J., Vendrik H(2015): Anxiety and depression during pregnancy in Central America: a cross-sectional study among pregnant women in the developing country Nicaragua; BMC Psychiatry, 15: 292
[19]  Rezaee R, FaramarziM(2014): Predictors of mental health during pregnancy. Iran J Nurs Midwifery Res; 19: 45-50.
[20]  Faramarzi M, Pasha H(2015): The role of social support in prediction of stress during pregnancy. J BabolUniv Med Sci.; 17 (11): 52-60
[21]  Yu Y, Zhang S, Wang G, Hong X, Mallow EB, Walker SO, et al.,(2013): The combined association of psychosocial stress and chronic hypertension with preeclampsia. Am J Obstet Gynecol; 209(5): 438.e1-438.e12.
[22]  Leeners B. Stiller R, Neumaier-Wagner P, Kuse S, Schmitt A, Rath W (2008): Psychosocial distress associated with treatment of hypertensive diseases in pregnancy. Psychosom; 49(5): 413-19.
[23]  Thiagayson P, Krishnaswamy G, Lim ML, Sung SC, Haley CL, Fung DS, et al., (2013): Depression and anxiety in Singaporean high-risk pregnancies - prevalence and screening. Gen Hosp Psychiatry; 35: 112-16.
[24]  Stewart NE. (2015). Clinical practice, Depression during pregnancy. N Engl J Med.; 365: 1605-11.
[25]  Guardino CM & SchetterCD (2013): Coping during pregnancy: a systematic review and recommendations. Health Psychol Rev. (10): 37-41.
[26]  Holly & CasseyL (2010):. Stress and coping in pregnancy. International Journal of Nursing Care. 2 (2) 63.
[27]  Yali, AM & Lobel M.(2002): Stress resistance resources and coping in pregnancy. Stress and coping.; 15(3): 289- 309.
[28]  De Longis A & HoitzmanS (2005): Coping in context: The role of stress, social support and personality in coping. Journal pers.; 37(6): 1-24.
[29]  Arulkumaran N, Lightstone L. (2013): "Severe pre-eclampsia and hypertensive crises". Best Practice & Research Clinical Obstetrics & Gynecology, 27 (6): 877-884.
[30]  Solehati, T,& Rustina, Y(2013): The effect of Benson relaxation on reduction of pain level among post caesarean section mother at Cibabat Hospital, Indonesia. Journal of Nursing and Health Care (JNHC). 1 (1) available at:
[31]  World Health Organization (WHO) (2013): Demographic Health Survey in Egypt.
[32]  Barcelona de Mendoza V, Harville E, Savage J, Giarratano G.(2015). Association of complementary and alternative therapies with mental health outcomes in pregnant women living in a post disaster recovery environment. J Holist Nurs.; 26. pii: 0898010115609250. [Epub ahead of print]
[33]  Beck AT, Epstein N, Brown G, et al., (1988): An inventory for measuring clinical anxiety: psychometric properties. J Consult ClinPsychol.; 56: 893-7.
[34]  Jabbari Z, Hashemi H, Haghayegh SA.(2012). Survey on effectiveness of cognitive behavioral stress management on the stress, anxiety, and depressionof pregnant women.
[35]  Cohen, S, Kamarck, T & Mermelstein R. (1983): A Global measure of perceived stress. Journal of health and social behavior; 24(4) 385-396.
[36]  Beck, (1996): Maternal depression and child behaviour problems: A meta-analysis. Journal of Advanced Nursing, 29(3), 623-629.
[37]  Bergman K, Sarkar P, O’Connor TG, et al(2007): Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry; 46: 1454-1463.
[38]  Genedy ASE, Ibrahim RM, & Abo Shabana K R(2011): Coping patterns among pre-eclamptic pregnant women. Unpublished Master Thesis Ain Shams University.
[39]  Hanan El-Sayed Mohamed El-Sayed ,HananAwad M Elmashad, Adel Al-Wehedy Ibrahim(2017):Benson's Relaxation Therapy: Its effect on Stress and Coping among Mothers with High Risk Pregnancy, International Journal of Nursing Didactics, 7: 06 June.
[40]  Hafez SK, Dorgham L.SH and Sayed S.A.M (2014): Profile of High Risk Pregnancy among Saudi Women in Taif-KSA. World Journal of Medical Sciences 11 (1): 90-97.
[41]  Kaboli KS, Mahmoodi Z, Tourzani ZM, Tehranizadeh M, et al., (2017): The Effect of Group Counseling Based on Cognitive-Behavioral Approach on Pregnancy-Specific Stress and Anxiety. Shiraz E-Med J. May; 18(5): e45231.
[42]  AsghriE Faramarzi M, and Khan A M (2016): The Effect of Cognitive Behavioural Therapy on Anxiety, Depression and Stress in Women with Preeclampsia, J ClinDiagn, Res. 2016 Nov; 10(11): QC04-QC07.
[43]  Jabari Z, Hashemi H, HaghayeghAB (2012): The effect of stress management, cognitive - behavioural stress, anxiety and depression in pregnant women. Journal of Health System Research.; 8(7).
[44]  Stewart DE. (2011). Clinical practice, Depression during pregnancy. N Engl J Med.;365: 1605-11.
[45]  Nieminen K, Malmquist A, Wijma B, Ryding EL, Andersson G, Wijma K.(2015). Nulliparous pregnant women's narratives of imminent childbirth before and after internet-based cognitive behavioural therapy for severe fear of childbirth: a qualitative study. An International Journal of Obstetrics and Gynecology.; 122(9): 1259-65.
[46]  Green SM, Haber E, Frey BN, McCabe RE. (2015). Cognitive-behavioural group treatment for perinatal anxiety: a pilot study. Arch womansment health. 2015; 18(4): 631- 38.
[47]  Netsi E, Evans J, Wulff K, O'Mahen H, Ramchandani PG. (2015). Infant outcomes following treatment of antenatal depression: Findings from a pilot randomized controlled trial. J Affect Disord.; 29(188): 252-56.
[48]  Carta G, D'Alfonso A, Parisse V, Di Fonso A, Casacchia M, Patacchiola F. (2015). How does early cognitive behavioural therapy reduce postpartum depression? ClinExpObstet Gynecol.; 42(1): 49-52.
[49]  Mahmoudjanlou N, Hasansadeh R, Mirzaian B, Gholampour F, Mostafaei M, Hafezian, M.(2014). The role of cognitive - behavioural therapy (Internention) in reducing blood pressure and stress during pregnancy and before pregnancy. Reef Resources Assessment and Management Technical paper.; 40: 835-46.
[50]  Arch J, Dimidjian S, Chesslck CH. (2012).Are exposure - based cognitive behavioural therapies safe during pregnancy? Health Pregnancy.; 308-09.
[51]  J.Mayrink ,M. L. Costa, and J. G. Cecatti (2018):Preeclampsia in 2018: Revisiting Concepts,Physiopathology, and Prediction, Hindaw, the Scientific World Journal Volume 2018, Article ID 6268276, 9 pages,
[52]  Meijer L, Bockting LH, Beijers C, Verbeek T, Stant D, Ormel J, et al. (2011). Pregnancy outcomes after a maternity Intervention for stressful emotions (PROMLSES): Study protocol for a randomized controlled trial. Int J Car Sci.; 6: 215-21.
[53]  Garg AX, Immaculate FN, Eric M, Jessica MS and John JK et al, (2014): Gestational Hypertension and Preeclampsia in Living Kidney Donors. N Engl J Med, 372: 124-133.