This experimental study aimed to determine the effect of MBSR on anxiety, depssion, and stress in women with bleeding in the first trimester of pgnancy, leading to termination of pgnancy referred to Zeinabieh Hospital in Shiraz in 2020. Sampling was performed from August to November 2020 for four months.
Zeinabieh Hospital in Shiraz is a unique women's hospital and is a referral center for women from other cities and even neighboring provinces.
Available sampling method was performed. The study's objectives were described to all women who came to the study site with bleeding in the first trimester of pgnancy and led to the termination of pgnancy. If they met inclusion criteria and wished to participate in the study, written informed consent was obtained. According to the Random Allocation table, they were placed in the control or intervention group.
Inclusion criteria included willingness to participate in the study, no history of known mental illness, no use of psychological drugs from two months before the start of the study, and no accident that caused anxiety, depssion, and stress, wanted pgnancy.
Exclusion criteria include unwillingness to continue cooperating with the research or the occurrence of an unfortunate incident that caused anxiety, stress, or depssion, not participating in more than one session of the intervention.
Sample size
Considering the study power of 80% and the significance level of 5%, and based on pvious studies (10), 10% drop,57 people were considered for each intervention and control group.
Data collection tools
1- Demographic characteristics questionnaire that includes information about age, sex, level of education, occupation, blood type, willingness or unwillingness to become pgnant, history of infertility and IVF, number of pgnancies, number of children, history, and type of pvious deliveries, history of abortion, and hemoglobin level.
2- DASS21 questionnaire (Depssion, Anxiety and Stress Scales)
DASS21 questionnaire is an international and valid questionnaire that includes 21 questions in which all three factors of anxiety, depssion, and stress are evaluated. For each of the variables, seven questions are assigned, and each question has a four-point Likert with the answer: Basically, it is low, medium, and high, which are scored from 0 to 3. The intensity / frequency of 4 points, the degree to which they have experienced each state in the last week. In neutral terms, the number is zero, and in the most robust case, the number 3. The subject score in this questionnaire varies between zero and 63, and the higher score is more expssive of stress, depssion, and anxiety.
Procedure
After receiving the ethical code and obtaining informed written consent, both groups performed a p-test. Then group intervention (each group between 8 to 15 people) was performed in 8 sessions of 2 hours once a week for the intervention group. Interventions were performed in a counseling room that was quietly ventilated and even carpeted for convenience and practical training. Some daily exercises had to be done at home, and they were taught to have 40 minutes of daily exercise. It was recommended that they could gradually divide the time into 40 minutes and combine the exercises with the usual daily activities to become aware of the mind. Reminders of homework were done via text message. The intervention was done by a researcher who has taken a counseling course in midwifery and is also trained in mindfulness. Table 1 describes a summary of counseling sessions.
Table.1: Summary of sessions of counseling based on MBSR approach for reduction of anxiety, depssion and stress in women with early loss of pgnancy
Session
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Content
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1
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Greeting and declaration of counseling rules, definition of the concepts of mindfulness and the main variables, description of the internal and external flow of the mind, Eating raisins, home works.
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2
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Reviewing pvious home works, mindful thinking, Mindful examination of body and sitting meditation, home works.
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3
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Reviewing pvious home works, focus on being psent, practice seeing and hearing consciously in three minutes, focus on five senses in five minutes, home works.
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4
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Reviewing pvious home works, stress and the body's reaction, Practicing thoughts-emotions-body senses-behavior relationships, three minutes of concentration on an unpleasant event, mindful walking, home works.
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5
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Reviewing pvious home works, effective responses to stress, Three-Minute Breathing Space (3MBS), meditation in daily life, home works.
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6
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Reviewing pvious home works, conscious mind interactions, take care of yourself, practicing speaking and listening consciously, practicing consecutive thoughts in an hour, getting feedback from participants from practicing, psenting homework Homemade.
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7
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Reviewing pvious home works, being more careful, Mindful Yoga, making the unpleasant event enjoyable, providing homework
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8
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Reviewing pvious home works, mountain meditation, summarization of all sessions, homework (13).
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During the consultation, the control group received routine post-pgnancy care. Two groups completed the posttest questionnaire two weeks after the last session. After the post-test, a pamphlet of the summary of counseling sessions was provided to the control group to observe the ethical aspects. During the study, four people in the intervention group and four people in the control group were excluded. One person was due to re-pgnancy in the intervention group, and another person attended the meetings instead of her. Two people refused to participate in more than two counseling sessions. Two people declined to answer the posttest in the control group, one because of participating in the psychological counseling session and one because of re-pgnancy. Therefore, statistical analysis was performed on 53 people in each group.
Statistical Analysis
For data analysis from SPSS software version 23 and Paired-test, Wilcoxon, Independent T-test, Mann Whitney, and Chi-square were used.