Dialectical Behavior Therapy Skills Training for High-Risk African American Pregnant Women: Feasibility and Acceptability of Implementation in Prenatal Clinics
PI: Abigail Powers Lott, PhD, ABPP
& Briana Woods-Jaeger, PhD
How might chronic stress and trauma impact your health?
When you experience a trauma, it can influence your emotions, your body, and how you experience yourself and others. Trauma can include many things, but generally includes exposure to events that are unusually or especially frightening or horrible, such as experiencing or witnessing death or serious injury or sexual violence. The cumulative effects of adverse childhood experiences (ACEs), including trauma exposure, parent mental health problems, family dysfunction, and experiences of racism can lead to prolonged activation of stress response systems, known as toxic stress. Toxic stress is seen as an important contributor to socioeconomic and racial health disparities that can persist across generations.
Being exposed to toxic stress and trauma can increase your risk for many negative health outcomes, including posttraumatic stress disorder (PTSD) and depression. Women are at twice the risk of experiencing PTSD and depression and Black adults, particularly those who live in communities with limited socioeconomic resources, experience trauma and its related effects at particularly high rates. Black women experience significant disparities in maternal and infant mortality, some of which may be attributable to toxic stress. The toxic stress response may increase risk factors for maternal and infant morbidity and mortality such as high-levels of stress hormones, high blood pressure, maternal PTSD and depression. Further, more maternal stress responses in pregnancy are associated with higher infant stress responses, increasing the risk for the transmission of toxic stress across generations.
But, there are also strategies we know that can be helpful in navigating chronic stress and trauma-related effects and can promote resilience and improve your health.
What is mindfulness and why might it be helpful for moms to be?
Mindfulness is about being in the present moment on purpose, non-judgmentally and with full awareness. Mindfulness-based interventions have been found to be helpful for a wide range of mental and physical health problems, including depression and PTSD. Dialectical Behavior Therapy (DBT) teaches skills like mindfulness and emotion regulation to help individuals feel more in control and better understand the interaction between feelings, thoughts, behaviors, and body sensations. In the context of parenting, DBT may be helpful in teaching skills to slow down and respond to emotions in helpful ways rather than feeling controlled by emotions. DBT is also helpful in reducing emotion dysregulation and dysfunction of the autonomic nervous system, which both contribute to adverse health effects in moms and babies.
What is the goal of this study?
The purpose of this study is to pilot a DBT for moms to be mindfulness intervention for trauma-exposed Black pregnant women with PTSD or depression symptoms. The study will utilize a randomized controlled trial design along with a multi-method psychological and physiological assessment approach to establish the feasibility and acceptability of an 8-session DBT intervention that is trauma-informed and culturally responsive in its approach. Preliminary mechanisms of action associated with DBT including emotion dysregulation and autonomic function will be evaluated.
What is the treatment?
The treatment consists of weekly group-based mindfulness sessions over the course of 8 consecutive weeks. Group sessions are small, usually with 3-5 other moms to be. Each session lasts 90 minutes and is currently being held over Zoom. During this treatment you will learn strategies to improve awareness of feelings, thoughts, and body sensations, and improve your control over attention and response to stress. Participants randomized to the treatment group will begin the intervention immediately, and the wait-list group will have the option to start the intervention at the end of their study participation (approximately 3 months after enrollment).
What are we measuring and how?
Before and after the intervention, the study will collect several types of data:
Clinical: A clinician will do an interview asking about trauma, PTSD, MDD, and other physical and psychological symptoms. You will also be asked to answer questions about your symptoms at the end of the intervention (or 8 weeks after the first assessment)
Physiological: Skin conductance will be collected using e-Sense software at the first and last interview.
Who are our participants?
If you are a Black/African American woman (over 18 years old), are currently pregnant and in your 1st or 2nd trimester, and have experienced trauma, you can fill out a referral form on our website (www.refertogtp.com). Our desired sample will consist of 60 participants.
We are registered on ClinicalTrials.gov as NCT# 03938350: