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Research code: A-10-7795-1
Ethics code: IR.IAU.KHUISF.REC.1401.028
Clinical trials code: IRCT20211229053565N1

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Abbasi E, Khayatan F, Farhadi H. Comparing the effectiveness of schema therapy with schema therapy for women with tokophobia on reducing the symptoms of tokophobia syndrome in Isfahan city. RJMS 2024; 31
URL: http://rjms.iums.ac.ir/article-1-8373-en.html
Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran , F.khayatan@khuisf.ac.ir
Abstract:   (393 Views)
Background & Aims: Tokophobia is a pathological fear of childbirth that may impact the physical and mental well-being of both the mother and the infant (1). This condition can occur in pregnant and non-pregnant women, and even in men, and may be either primary or secondary, resulting from traumatic childbirth experiences or onset during adolescence (2). Women with tokophobia may face psychological issues, postpartum depression, and challenges in accepting specialized care for newborns during pregnancy (3). They may experience feelings of isolation, guilt, and shame, and encounter difficulties in preparing for childbirth (4). Therefore, women with a fear of childbirth have various needs that require serious attention from maternal care services (5). Psychotherapy groups have been recognized as an effective method for treating this fear (6). Interventions such as psychosexual education and cognitive-behavioral therapy can help reduce the number of women requesting cesarean sections due to non-medical fear of childbirth (7). Additionally, receiving individualized care during pregnancy and postpartum is crucial for women with tokophobia (8). Schema therapy is a comprehensive approach that combines cognitive theory and developmental concepts. This approach focuses on early childhood experiences and the cognitive schemas derived from them, examining their impact throughout an individual's life (9). Schema therapy aims to identify and address maladaptive patterns in cognitive, emotional, and behavioral aspects (10). Further research is needed to more precisely determine the effectiveness of schema therapy in treating tokophobia (1, 11). Therefore, the present study aimed to answer the question of whether the effectiveness of general schema therapy and schema therapy specifically tailored for women with tokophobia is the same in reducing the symptoms of fear of childbirth in primiparous women in Isfahan?
Method: This study was a semi-experimental research with a control group, including pre-test, post-test, and follow-up, conducted in the population of primiparous women with tokophobia in Isfahan in the year 2023. Following Kok's recommendation (2002) for sample size determination in experimental research (12), 45 subjects were purposefully selected and, after matching based on the criteria for entering the study, including obtaining a minimum score (30 and above) on the Tokophobia Questionnaire (13), no history of fetal abortion and curettage, and absence of more than three sessions of absence from treatment sessions, were randomly assigned to three 15-person groups: general schema therapy, schema therapy specifically tailored for women with tokophobia, and the control group. In this research, the control group, general schema therapy group, and specifically tailored schema therapy group were replaced by the standard general schema therapy. The general schema therapy group participated in 12 group training sessions, each lasting 60 minutes, according to the protocol developed by Young et al. (2003) (14). The specifically tailored schema therapy group for women with tokophobia also underwent 12 one-hour sessions of schema therapy developed based on the needs of pregnant women with tokophobia. It is worth mentioning that the specifically tailored schema therapy package for women with tokophobia was developed based on the process of development and initial trial reliability and relied on credible sources. The agreement reached by the judges regarding the structure of treatment, duration of treatment, length of each session, content adequacy, and practicality of this treatment was 82.0. Also, in a pilot study on a group of eight, the executive and operational reliability and practicality of the specifically tailored schema therapy package for women with tokophobia were examined and confirmed. To observe ethical principles, the research was approved by the Research Committee of the University with the ethics code IR.IAU.KHUISF.REC.1401.028, and the clinical trial code IRCT20211229053565N1 was obtained. The collected data were analyzed using repeated measures analysis of variance and the SPSS-28 statistical software. The Stoll et al. (2018) 10-item questionnaire was used to measure tokophobia (15). Higher scores on this questionnaire indicate higher fear of childbirth, and lower scores indicate lower fear of childbirth. The reliability of this tool was estimated using the Cronbach's alpha method, and it was 79.6 for the entire questionnaire and 86.0 for the fear of pain and complications subscale, and 82.6 for the fear of physical changes subscale (16).
Results: Examination of demographic data showed no significant differences in age and duration of marriage in the research groups. The assumption of normality in the Shapiro-Wilk test for tokophobia scores was not significant (p>0.05), and the distribution of the present variables was normal. The calculated F value in the pre-test, post-test, and follow-up stages was not significant. The results of the analysis of variance with repeated measures showed that general schema therapy and schema therapy specifically tailored for women with tokophobia had a significant effect on reducing tokophobia severity in primiparous women with tokophobia. Therefore, for the comparison of research groups, the Bonferroni test for pairwise comparison of groups also showed a significant difference between the experimental groups and the control group (p<0.05), but there was no significant difference between the general schema therapy and specifically tailored schema therapy groups for women with tokophobia (p>0.05).
Discussion: Based on the findings of the research, it can be concluded that both schema therapy and schema therapy specifically tailored for women with tokophobia have a significant impact on reducing the severity of tokophobia symptoms in primiparous women in Isfahan. These results indicate that the use of these two therapeutic approaches can help improve the condition of women with tokophobia and have a positive effect on reducing the fear of childbirth. Additionally, the results show a significant difference between the treatment groups and the control group, suggesting that therapeutic intervention can be more effective in reducing tokophobia severity in primiparous women compared to no intervention. However, no significant difference was observed between the general schema therapy and specifically tailored schema therapy groups. This may indicate that both therapeutic approaches have acted similarly in reducing the severity of tokophobia in women with this disorder, and no significant noticeable difference was observed between these two methods. Overall, the results indicate that both general schema therapy and specifically tailored schema therapy can be effective in reducing the severity of tokophobia in primiparous women. In this regard, it can be stated that schema therapy, by reducing ineffective coping mechanisms, allows patients to effectively manage their phobias related to childbirth and pregnancy. These results can serve as a guide for designing and implementing therapeutic programs to improve the condition of individuals with tokophobia.
Type of Study: Research | Subject: Clinical Psychiatry

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