Mindfulness and Acceptance in the Neonatal Intensive Care Unit: A Trauma-informed Approach

Preterm labor or other medical conditions resulting in Neonatal Intensive Care Unit (NICU) admission has an immense potential to be a traumatic event for both parents and their babies. Birth trauma in the context of the NICU may lead to a heightened stress response, decreasing one’s ability to cope with those stressors. This experience may have long-lasting effects for both parents and infants, necessitating a better understanding of interventions that can be offered during NICU admission and beyond to address trauma responses from both a physical and psychological perspective. The positive effects of mindfulness and acceptance-based interventions have the potential to help alleviate stress and anxiety and improve safety, connectedness, and bonding with lasting effects beyond the NICU. This research project aims to discuss the stressors of preterm birth or other medical conditions resulting in NICU admission and to explore mindfulness and acceptance interventions that have been studied in the NICU. This project also hopes to address the opportunity to further fill the gaps within the research of mindfulness and acceptance interventions in the context of the NICU, especially from a trauma-informed perspective. Implications of this project are relevant for both medical and mental health providers treating NICU parents and infants

Predictors of disordered eating behaviors among South Asians living in the United States: A work in progress

Introduction: According to the National Association for Anorexia and Associated Disorders (ANAD), approximately 9% of the worldwide population is affected by eating disorders. Roughly 28.8 million Americans will have an eating disorder in their lifetime (Arcelus et al., 2011). Eating disorders are amongst the most serious and deadly mental illnesses. In fact, eating disorders have the second highest risk of death amongst mental illnesses with 10,200 deaths occurring every year directly attributed to them (Arcelus et al., 2011). In particular, Asian Americans may be understudied in terms of eating disorder behaviors (Goel et al., 2022). With respect to eating pathology, Asian American college students report higher rates of restricted eating compared with their white peers (Uri et al., 2021). Asian American college students also report higher rates of purging, muscle building, and cognitive restraint than their white or Non-Asian BIPOC counterparts (National Association of Anorexia Nervosa and Associated Disorders, 2022). This suggests that Asian Americans may exhibit eating disorders or disordered eating behaviors at the same rate as white individuals, but their experiences may be underreported or unrecognized. South Asians in particular experience unique psychological consequences from societal pressures. For example, many South Asian women experience weight stigma and competing body appearance ideals (thin and healthy; Goel et al., 2021). They additionally report having pressure to have light skin and no body hair (Goel et al., 2021). Together these factors significantly impact body image and self-esteem which in turn can lead to disordered eating behaviors. Objectives: Current literature suggests that culture plays a role in the etiology and maintenance of eating disorders (Haworth-Hoeppner, 2000; Kadish, 2012; Miller & Pumariega, 2001) . However, there is little information about the role of acculturation, especially concerning South Asian women living in the United States. To address this gap in the literature, the main purpose of the study is to investigate the association between level of acculturation and disordered eating behaviors among South Asian Americans living in the United States. Methods: Using a cross-sectional survey design, the researcher will electronically distribute a survey using RedCap. Recruitment will be conducted through chain referral recruitment, distribution through email listservs, social media outlets such as Twitter, Instagram, and Facebook, and other community outreach groups such as church and temple email listservs. This poster will present this study as a work in progress and will address clinical implications and future research objectives

Maternal psychiatric functioning and maternal-infant attachment among mothers of infants in the neonatal intensive care unit (NICU)

Introduction: A growing body of research suggests that an infant’s admission to a neonatal intensive care unit (NICU) may adversely impact maternal psychiatric functioning, affecting quality of life, well-being, and patient outcomes. Additionally, there is accumulating evidence that stressful reproductive events related to a NICU admission) may even exacerbate pre-existing maternal psychiatric symptoms. The purpose of the current study was to examine the relationships between maternal mental health symptoms, including anxiety and stress, and maternal-infant attachment among mothers of infants in the NICU. By examining the psychiatric functioning measures both at the time of initial NICU admission and again 2-4 months later for a follow up assessment, we were able to evaluate the change in maternal stress and anxiety over time and the relationship with maternal-infant attachment while in the NICU. Methods: One hundred twenty-seven mothers were recruited from their infants’ NICU bedside at three hospitals in the Philadelphia area and completed self-report measures of anxiety, stress, and maternal-infant attachment during the NICU admission and then measures of anxiety and stress again 2–4 months later. A series of bivariate correlations, paired samples t-tests, and linear regression analyses were used to evaluate the primary study aims. Results: NICU mothers self-reported elevated rates of anxiety and stress symptoms. Furthermore, maternal-infant attachment was negatively associated with anxiety and stress symptoms. Anxiety symptoms were higher during initial NICU admission compared to 2-4 months later, while there was no significant difference in stress symptoms at initial assessment or follow up assessment. Discussion: The current study evaluated the relationship among maternal psychiatric symptoms (i.e. anxiety and stress) and maternal-infant attachment in mothers at their infant’s initial NICU admission and assessed this change over time. The results of this study suggest that more research can be done to explore the different sources of stress and anxiety symptoms at time of initial NICU admission and later when the majority of mothers have brought their infant home. For example, this study demonstrated that stress remains high both during NICU hospitalization and post-discharge; perhaps mothers were initially experiencing stress about their infant’s health while in the NICU, and later were stressed about adequately fulfilling increased responsibility with intensive care for their infant at home without the support of NICU staff). An increased understanding of the source of stress is important to help inform possible screening protocols and interventions to address mothers’ psychiatric symptoms while their infant is still in the NICU to better prepare them for the transition of bringing their infant home

Development and evaluation of a virtual postpartum psychosocial support program based upon acceptance and commitment therapy (ACT)

INTRODUCTION: Improving psychological adjustment and support among women in the postpartum period has great personal and public health significance, with the potential to improve quality of life and functioning for women, children, and families. Despite growing recognition of this need, availability and accessibility of specialized postpartum treatments remain limited, particularly in the current context of the COVID-19 pandemic and the subsequent lack of in-person treatment options. This project sought to address this need through the development and evaluation of a postpartum psychosocial support program that is delivered in a virtual format. OBJECTIVES: The purpose of the project was two-fold: (1) to develop a structured treatment manual for an innovative program, based upon principles of Acceptance and Commitment Therapy (ACT), and (2) to assess feasibility, acceptability, and preliminary effectiveness of the program and the virtual delivery format through a pilot study of postpartum women. METHODS: The program contained six virtual individual sessions and two surveys before and after participation to evaluate outcomes. The material contained in the six sessions was drawn from evidence-based ACT principles, such as values identification, acceptance, and emotion regulation. Women who were over 18 years old, within one year postpartum of a live birth, living in Pennsylvania, and did not have suicidal ideation, psychosis or substance use disorder, were eligible to participate. RESULTS: Five postpartum women participated in the pilot intervention. The program was acceptable and feasible, with favorable feedback given by participants about the virtual format and content. Using the Acceptance and Action Questionnaire and the Edinburgh Postnatal Depression Scale, scores decreased from pre to post evaluations in 4 out of 5 participants. CONCLUSION: This innovative model of care presents a novel intervention (ACT) in a unique format (virtual group), which has significant implications for practice in terms of the delivery of psychological services and the way in which telehealth can be used for group therapy in this population. Additional implications for practice will be discussed as the program review continues

Maternal attitudes, adjustment, health behaviors, and social support among mothers of infants in the neonatal intensive care unit

Introduction: A growing body of research suggests that an infants’ admission to a neonatal intensive care unit (NICU) is associated with adverse maternal mental health outcomes. Maternal attitudes, adjustment to motherhood, social support, and health behaviors may be important modifiable factors that could improve quality of life and well-being among NICU mothers. The current study examined the relationships among maternal attitudes, adjustment to motherhood, health behaviors, social support, and psychological functioning in NICU mothers. Methods: One hundred twenty-seven women were recruited from NICUs at three hospitals in the Philadelphia area and completed self-report measures while in the NICU. Descriptive analyses were conducted on the main variables, and a series of bivariate correlations and linear regression analyses were used to evaluate the primary study aims. Results: Descriptive statistics indicated that NICU mothers had diverse attitudes towards motherhood, specifically regarding body image, somatic symptoms, romantic relationships, sex, and their baby. In general, they perceived high levels of social support, which varied based upon psychological and reproductive characteristics. Statistically significant findings revealed that maternal attitudes, adjustment, and perceived social support variables were negatively correlated with anxiety, stress, and depressive symptoms. Discussion: This study demonstrates that certain maternal variables are related to psychological functioning among NICU mothers, such as maternal attitudes, adjustment, and social support. Determining how to bolster these variables as a protective mechanism for mothers during the stressful NICU experience is an important future direction. This study suggests that developing and implementing unique programs and interventions that target these variables in the NICU setting may benefit mothers, families, and infants

Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms

Untreated postpartum mood and anxiety disorders (PMADs) place women and their families at risk for negative biopsychosocial sequelae. Innovative and tailored treatments are needed to address potential disruptions in maternal functioning. Third-wave cognitive-behavioral approaches, including acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT), hold promise for optimizing functioning given the focus on values-based living, rather than symptom reduction. Purpose: The purpose of this paper is to describe the development of an innovative psychotherapy group for women with symptoms of PMADs. Methods: This seven-session group, Motherhood and Me (Mom-Me), includes selected skills training from ACT, DBT, and Emotion-Centered Problem-Solving Therapy. Results: Mom-Me group sessions are described, and an outline of key information (session goals, content, and homework assignments) is provided to facilitate practical implementation. Conclusion: In line with third-wave approaches, this group was developed to enhance maternal functioning, which, in turn, may help women cope with psychological distress during the transition to motherhood

Motherhood and Me (Mom-Me): The Development of an Acceptance-Based Group for Women with Postpartum Mood and Anxiety Symptoms

Untreated postpartum mood and anxiety disorders (PMADs) place women and their families at risk for negative biopsychosocial sequelae. Innovative and tailored treatments are needed to address potential disruptions in maternal functioning. Third-wave cognitive–behavioral approaches, including acceptance and commitment therapy (ACT) and dialectical behavioral therapy (DBT), hold promise for optimizing functioning given the focus on values-based living, rather than symptom reduction. Purpose: The purpose of this paper is to describe the development of an innovative psychotherapy group for women with symptoms of PMADs. Methods: This seven-session group, Motherhood and Me (Mom-Me), includes selected skills training from ACT, DBT, and Emotion-Centered Problem-Solving Therapy. Results: Mom-Me group sessions are described, and an outline of key information (session goals, content, and homework assignments) is provided to facilitate practical implementation. Conclusion: In line with third-wave approaches, this group was developed to enhance maternal functioning, which, in turn, may help women cope with psychological distress during the transition to motherhood

Small-for-Gestational-Age Births in Pregnant Women with HIV, due to Severity of HIV Disease, Not Antiretroviral Therapy

Objectives. To determine rate and factors associated with small-for-gestational-age (SGA) births to women with HIV. Methods. Prospective data were collected from 183 pregnant women with HIV in an urban HIV prenatal clinic, 2000–2011. An SGA birth was defined as less than the 10th or 3rd percentile of birth weight distribution based upon cut points developed using national vital record data. Bivariate analysis utilized chi-squared and t-tests, and multiple logistic regression analyses were used. Results. The prevalence of SGA was 31.2% at the 10th and 12.6% at the 3rd percentile. SGA at the 10th (OR 2.77; 95% CI, 1.28–5.97) and 3rd (OR 3.64; 95% CI, 1.12–11.76) percentiles was associated with cigarette smoking. Women with CD4 count >200 cells/mm3 at the first prenatal visit were less likely to have an SGA birth at the 3rd percentile (OR 0.29; 95% CI, 0.10–0.86). Women taking NNRTI were less likely to have an SGA infant at the 10th (OR 0.28; 95% CI, 0.10–0.75) and 3rd (OR 0.16; 95% CI, 0.03–0.91) percentiles compared to those women on PIs. Conclusions. In this cohort with high rates of SGA, severity of HIV disease, not ART, was associated with SGA births after adjusting for sociodemographic, medication, and disease severity