Head Trash Clearance 1

HEAD TRASH CLEARANCE 1 HEAD TRASH CLEARANCE AND PERINATAL MENTAL HEALTH A preliminary study on the efficacy of Head Trash Clearance in reducing perinatal anxiety and depression. Barnard, M.Pa., & Leachman, A. aSchool of Psychology, University of Nottingham, University Park, Nottingham, UK NG7 2RD. Email: [email protected] (M. Barnard), [email protected] (A. Leachman) HEAD TRASH CLEARANCE 2 Abstract There is an increased prevalence of tokophobia and fear of childbirth (FOC) reported within current research. However, studies on the efficacy of tokophobia and FOC specific interventions are limited, let alone those in online settings. The current study aimed to assess the effectiveness of the Fearless Birthing Programme, an online intervention which aims to specifically reduce levels of pregnancy and childbirth anxiety using the Head Trash Clearance method. Over the course of three months in trimester two, pregnant participants completed a series of questionnaires on perinatal anxiety and depression; at some point during those three months, access to the Fearless Birthing Programme was also provided, with the aim of measuring changes in anxiety and depression as a consequence of programme access. Analyses suggested that there were only marginal reductions in anxiety and depression over time, regardless of when programme access was granted. However, participants enjoyed the programme and found it as useful as other pregnancy and birth preparation activities they were part of. A discussion of the challenges faced when conducting perinatal mental health intervention research is provided, and it is argued that research into factors affecting attrition rates and self-discipline would be useful to the field as a whole. Further RCT research into the Head Trash Clearance Method as a general therapeutic tool would be of benefit. Lay summary More women than ever now say they have a fear of giving birth, with some even reporting a fear of childbirth, also known as tokophobia. It is important for these women to have access to scientifically tested interventions to help reduce these fears. However, not many studies exist that test such interventions. This study aimed to test the effectiveness of the Fearless Birthing HEAD TRASH CLEARANCE 3 Programme, an online programme which aims to clear a person’s fears of childbirth using a technique called Head Trash Clearance. During trimester 2 of their pregnancy, people took part in a study where they were given access to the programme, and their levels of pregnancy specific anxiety and depression were recorded before and after using this programme. The results of the study suggest that levels of anxiety and depression did not dramatically reduce as a result of using the programme. However, people also said that they found the programme helpful and useful. We suggest that the programme could still be a helpful tool for pregnant women, there are several things scientists can do to improve the quality of tokophobia and FOC research as a whole. These improvements, as well as more research into Head Trash Clearance, would help us understand what techniques work for people who are anxious during pregnancy. Keywords Fearless Birthing programme, Head Trash Clearance, Reflective Repatterning, tokophobia, anxiety, depression. HEAD TRASH CLEARANCE 4 A preliminary study on the efficacy of Head Trash Clearance in reducing perinatal anxiety and depression. Introduction Concerns about anxiety during pregnancy have resulted in an increasing amount of research focus in recent years. It has been suggested that it has a significant prevalence within the pregnant population; reviews of studies into pregnancy anxiety have reported a worldwide prevalence of tokophobia and non-phobic fear of childbirth (FOC) of between 6.3% to 14.8% (Nilsson et al., 2018; O’Connell et al., 2017). Studies into pregnancy anxiety without tokophobia have reported similar prevalences such as 15.6% in a Swedish sample (Rubertsson et al., 2014), and over 90% of pregnant women have reported at least moderate pregnancy anxiety within an Indian sample in trimesters 1 and 3 (Madhavanprabhakaran et al., 2015). The consequences of pregnancy anxiety are also of concern. Not only is it associated with an increased risk of postnatal depression (Heron et al., 2004), it can also lead to an increased frequency of unhealthy behaviours during pregnancy such as smoking and increased caffeine consumption (Lobel et al., 2008). It is also associated with changes in pregnancy duration, with studies showing both increases in pregnancy duration (Qiao et al., 2012) and increased risk of early delivery (Lobel et al., 2008; Rini et al., 1999). Due to its occurrence and consequences, it is important to understand the ways in which pregnancy anxiety can be reduced in expectant mothers. HEAD TRASH CLEARANCE 5 Intervention methods have been suggested as a way of reducing pregnancy anxiety. For example, research comparing intensive therapy methods, defined as a combination of routine antenatal checks and cognitive therapy, have been shown to reduce pregnancy anxiety and increase the proportion of women choosing vaginal delivery as opposed to caesarean (Saisto et al., 2001). However, these interventions are often conducted face-to-face, and this presents practical challenges within today’s society. Due to the challenges of the COVID pandemic, medical facilities now try to schedule virtual appointments and therapy sessions wherever possible. Additionally, for those with concerns with their mental health during pregnancy, they may wish to seek help from less formal and flexible sources such as the internet (Ashford et al., 2016). Thus there has been a significant increase in recent years in evaluating the efficacy of internet based therapies to treat antenatal mental health. Some interventions have focused on simply increasing the amount of information available to pregnant women (Tsai et al., 2018). However, a large proportion of intervention studies on antenatal mental health share the common factor of being grounded within cognitive behavioural therapy (CBT) or mindfulness methods. These methods include exercises or modules to try and challenge negative thoughts and apply learned strategies to written assignments which then receive feedback from a trained therapist or apply self-compassion techniques to everyday tasks. Such techniques have been applied to specific pregnancy issues and mental health issues with positive findings. For example, a CBT based intervention for pregnancy loss resulted in reduced symptoms of PTSD, grief, anxiety, and depression (Kersting et al., 2013). Studies into general wellbeing interventions have found reduced levels of negative affect (Haga et al., 2020) and increases in self-compassion up to six weeks post-intervention (Gammer et al., 2020). Finally, HEAD TRASH CLEARANCE 6 studies into pregnancy-related depression interventions have found lower antenatal depression scores (Forsell et al., 2017) and postnatal depression scores and the frequency of automatic negative thoughts (Solness et al., 2020) post-intervention. Taken together, this suggests that internet-based interventions for antenatal and postnatal mental health are promising methods for improving the wellbeing of pregnant women with a wide variety of mental health concerns. Similar interventions can be found for those women who have a FOC, albeit the amount of available research is limited. Pregnant women who have taken part in online FOC interventions have reported that they feel that the exercises help relax them and worry less about the antenatal and postnatal periods (Baylis et al., 2020) Whilst some still feel some doubts, they feel less hopeless than before and feel that they would be able to use active coping methods in labour (Nieminen et al., 2015). However, findings from empirical and randomised controlled trials (RCTs) are more mixed. For example, an online intervention comprising of psycho-education, cognitive restructuring, and in vivo exposure methods saw a decrease in FOC with what the authors argue was a large effect size (Nieminen et al., 2016); large effect sizes were also reported for anxiety symptom severity reduction following enrolment on the ‘MUMentum’ program (Loughnan et al., 2019). Another method combining text, audio, photos, and assignments saw no changes in FOC immediately post-intervention, but instead lower levels of FOC one year postpartum (Rondung et al., 2018). Another intervention targeting Iranian women found that not only did an online CBT intervention reduce FOC, but it also increased the rate of women subsequently choosing a vaginal birth as opposed to a caesarean birth (Shahsavan et al., 2020), which is similar to Saisto et al.’s (2001) findings regarding face-to-face intervention. Taken together, this suggests that whilst the benefits of internet interventions for FOC are appreciated HEAD TRASH CLEARANCE 7 by pregnant women, findings from research are mixed and more research needs to be conducted in order to rigorously assess their efficacy. One approach that has gained an increased in interest and popularity over recent years is called Fearless Birthing. Developed by Alexia Leachman, its principles and techniques are based primarily within the field of Reflective Repatterning (Leachman, 2018b). Reflective Repatterning is a technique that uses the law of opposites to create neutrality; negative emotions on a subject are made more positive and vice versa, thus balancing the feelings one has towards something and removing

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