Effects of an emotional regulation program on maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression among South Korean mothers of premature infants in the neonatal intensive care unit원문보기
Choi, Hyo Sin
(Department of Nursing, Daegu Health College)
,
Lee, Kyung Eun
(Department of Nursing, Keimyung College University)
,
Shin, Yeonghee
(College of Nursing, Keimyung University)
Purpose: This study aimed to evaluate the effects of a rational emotive behavior therapy (REBT)-based emotional regulation program for mothers of premature infants in the neonatal intensive care unit (NICU). Methods: The study utilized a nonequivalent control group pretest-posttest design. Seventeen...
Purpose: This study aimed to evaluate the effects of a rational emotive behavior therapy (REBT)-based emotional regulation program for mothers of premature infants in the neonatal intensive care unit (NICU). Methods: The study utilized a nonequivalent control group pretest-posttest design. Seventeen mothers were recruited for the experimental group and 21 mothers for the control group. Data were collected from July 9, 2018, to Oct 12, 2018 from mothers of premature infants in the NICU regarding parental stress, state anxiety, depression, and maladaptive cognitive emotion regulation. The experimental group received eight sessions of the REBT-based emotional regulation program for 3~4 weeks, and the control group only received standard nursing care. Results: Significant differences were found between the two groups in maladaptive cognitive emotion regulation (Z=-3.88, p<.001), stress (Z=-2.76, p=.006), state anxiety (Z=-3.72, p<.001), and postpartum depression(Z=-2.62, p=.009) after the intervention in the experimental group. Conclusion: The REBT-based emotional regulation program for mothers of premature infants was effective for reducing maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression. Therefore, it may be necessary to provide an REBT-based emotional regulation program for mothers of premature infants in the NICU in clinical practice.
Purpose: This study aimed to evaluate the effects of a rational emotive behavior therapy (REBT)-based emotional regulation program for mothers of premature infants in the neonatal intensive care unit (NICU). Methods: The study utilized a nonequivalent control group pretest-posttest design. Seventeen mothers were recruited for the experimental group and 21 mothers for the control group. Data were collected from July 9, 2018, to Oct 12, 2018 from mothers of premature infants in the NICU regarding parental stress, state anxiety, depression, and maladaptive cognitive emotion regulation. The experimental group received eight sessions of the REBT-based emotional regulation program for 3~4 weeks, and the control group only received standard nursing care. Results: Significant differences were found between the two groups in maladaptive cognitive emotion regulation (Z=-3.88, p<.001), stress (Z=-2.76, p=.006), state anxiety (Z=-3.72, p<.001), and postpartum depression(Z=-2.62, p=.009) after the intervention in the experimental group. Conclusion: The REBT-based emotional regulation program for mothers of premature infants was effective for reducing maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression. Therefore, it may be necessary to provide an REBT-based emotional regulation program for mothers of premature infants in the NICU in clinical practice.
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문제 정의
80. The program's aim was to help mothers who shared the common experience of a NICU admission to identify their own irrational beliefs through the REBT-based emotion regulation program and to assist them in changing their negative emotions to more positive emotions through the process of finding appropriate, rational beliefs. Considering that the participants in the program were postpartum mothers, and the timing of infants' NICU discharge is different, a long-term program is not appropriate and the effectiveness of the counseling program is seen in a total of eight to 10 sessions [16]; this study conducted of a total of eight sessions.
This study tested the effects of an eight-session REBT-based emotion regulation program on cognitive changes and negative emotions among mothers of premature infants in the NICU. The results showed that applying the REBT-based emotion regulation program reduced MCER, stress, state anxiety, and postpartum depression.
This study was conducted to develop and test the effects of an emotion regulation program for mothers of premature infants in the NICU based on REBT theory. The REBT-based emotion regulation program applied in the present study was an interventional program designed to reduce negative emotions of mothers by correcting their thoughts.
가설 설정
Hypothesis 1: There will be a significant difference between the experimental and control groups in the change of the MCER score after the intervention .
Hypothesis 2: There will be a significant difference between the experimental and control groups in the change of the stress score after the intervention.
Hypothesis 3: There will be a significant difference between the experimental and control groups in the change of the state anxiety score after the intervention.
Hypothesis 4: There will be a significant difference between the experimental and control groups in the postpartum depression score after the intervention.
제안 방법
group. A pretest survey was conducted on both groups to investigate the general characteristics, characteristics of premature infants, MCER, stress, state anxiety, and postpartum depression. The questionnaire survey was completed by each mother and an explanation was provided for parts that were difficult to understand.
Prior to conducting this study, the researcher completed the cognitive behavioral therapy specialist course at the Korea Institute for Counseling and Develop- ment's Lifelong Education Center in July 2017 and obtained a second-degree certificate of cognitive behavioral psychothera- py. In addition, the researcher participated in the group counseling program of the Korea REBT Cognitive Behavioral Treatment Institute and completed the 30-hour course.
Participants included mothers who gave birth to a premature infant admitted to the NICU at A university hospital in D city, and mothers who satisfied the following inclusion criteria were selected: gave birth to a premature infant for the first time, with a gestational age of less than 28 weeks and a birth weight of more than 1,000 g and less than 2, 500 g; were over 18 years old; had a spouse; were able to read, write, and communicate in Korean; understood the intent of this study and wished to participate; gave birth to a premature infant with no congenital defects or complications; and gave birth and was discharged from the hospital within 1 week.
, Armonk, NY, USA). The general characteristics of the participants were analyzed in terms of frequency, percentage, mean, and standard deviation (SD). Meanwhile, the x2 test, Fisher's exact test, and linear-by linear association method were used to test the homogeneity of the general characteristics in the experimental and control groups.
The initial draft of the program was designed by a re- searcher, the first author of this study, based on an analysis of existing literature and needs surveys on emotion regulation programs. Five South Korean and 10 international studies on emotional regulation programs for mothers of premature infants from January 2001 to November 2017 were analyzed based on prior studies that used Ellis's [13] REBT theory to reduce negative emotions.
This scale consists of 10 items graded on a 4-point scale with 0 points for "always so" and 3 points for "not at all". The items included symptoms such as depression, anxiety, guilt, and suicidal ideation in the past week. The total score ranged between 0 and 30 points, with higher scores indicating a higher level of postpartum depres- sion.
Written consent was obtained from mothers who voluntarily agreed to participate in the study. The researcher assigned subject identification codes to protect personal information, and promised to keep the collected survey data for 3 years and then discard it using a document shredder.
When someone expressed interest in the study, the NICU nurse got in touch with the researcher. The researcher directly provided information to mothers of premature infants in the NICU regarding the goals and objectives of the study, the benefits and risks of participating in the study, and confidentiality. Written consent was obtained from mothers who voluntarily agreed to participate in the study.
Considering that the participants in the program were postpartum mothers, and the timing of infants' NICU discharge is different, a long-term program is not appropriate and the effectiveness of the counseling program is seen in a total of eight to 10 sessions [16]; this study conducted of a total of eight sessions. The study was designed to be conducted two to three times a week, for 3~4 weeks, based on prior studies of intervention programs for NICU inpatient mothers [8]. Each session was 70 minutes, with 15 minutes of introduction, 40 minutes of activities, and 15 minutes of closing [16].
In addition, this study was conducted among a small number of mothers at a single institution due to difficulties in recruiting participants. This study also had the limitation of not controlling for the medical conditions of premature infants, familial support, and trait anxiety of moth- ers, all of which could influence negative emotions.
This study used a pretest-posttest, nonequivalent quasi-ex- perimental design to develop an REBT-based emotion regulation program for mothers of premature infants in the NICU and to test its effects on MCER, stress, state anxiety, and postpartum depression.
To measure stress, we used the original Parental Stressor Scale for NICU, which was translated, modified, and supplemented by Jeon [6]. This tool was originally designed to measure parental stress caused by the physical, psychological, and social environment of the pediatric intensive care unit, and was modified by Miles, Funk, and Carlson [20] for the NICU.
대상 데이터
sessions (n=2). Consequently, a total of 38 participants (21 in the control group and 17 in the experimental group) were included in the final analysis.
In this study, groups were composed of 3~5 people based on the timing of the births and the needs surveys. A small group size can foster positive support and modeling among mothers, and it can be an opportunity for in-depth empathy and mutual assistance [18].
The content validity of the initial program was tested by a seven-member expert panel using the content validity index (CVI) with respect to the appropriateness, applic- ability, and usefulness of the program. The expert panel comprised one psychiatrist, one clinical psychology expert, one counseling and educational psychology expert, two nursing professors, and two nurses with more than 10 years of NICU experience. The CVI was calculated to be more than .
Gorsuch, and Lushene [22]. The original tool contains state and trait anxiety scales, which consist of 20 items each. We used the state anxiety scale, which measures the emotions of tension and worry caused by a particular sit- uation, as these emotions can be controlled by situational factors.
Each session was 70 minutes, with 15 minutes of introduction, 40 minutes of activities, and 15 minutes of closing [16]. The program was conducted during the NICU hospitalization of the baby, and the small group was run by the researcher.
The researcher has more than 10 years of work experience in the NICU of the university hospital, and has experience in teaching child nursing. Prior to conducting this study, the researcher completed the cognitive behavioral therapy specialist course at the Korea Institute for Counseling and Develop- ment's Lifelong Education Center in July 2017 and obtained a second-degree certificate of cognitive behavioral psychothera- py.
데이터처리
The dependent variables-MCER, stress, state anxiety, and postpartum depression-were analyzed using the Mann- Whitney U-test, a non-parametric mean comparison method. The pretest-posttest differences in the experimental and control groups were analyzed using the Wilcoxon signed rank test, a non-parametric paired test. The Mann-Whitney U-test was used for group comparison with respect to the amount of pretest-posttest change for hypothesis testing.
이론/모형
The pretest-posttest differences in the experimental and control groups were analyzed using the Wilcoxon signed rank test, a non-parametric paired test. The Mann-Whitney U-test was used for group comparison with respect to the amount of pretest-posttest change for hypothesis testing.
Educational dissonance, questioning techniques, and cognitive tasks were used for cognitive dis- sonance; creating coping statements and rational emotive imagery were used for emotional dissonance; and rational role reversal and behavior reinforcement were used for behavioral dissonance. The content validity of the initial program was tested by a seven-member expert panel using the content validity index (CVI) with respect to the appropriateness, applic- ability, and usefulness of the program. The expert panel comprised one psychiatrist, one clinical psychology expert, one counseling and educational psychology expert, two nursing professors, and two nurses with more than 10 years of NICU experience.
Meanwhile, the x2 test, Fisher's exact test, and linear-by linear association method were used to test the homogeneity of the general characteristics in the experimental and control groups. The dependent variables-MCER, stress, state anxiety, and postpartum depression-were analyzed using the Mann- Whitney U-test, a non-parametric mean comparison method. The pretest-posttest differences in the experimental and control groups were analyzed using the Wilcoxon signed rank test, a non-parametric paired test.
by Jeon [6]. This tool was originally designed to measure parental stress caused by the physical, psychological, and social environment of the pediatric intensive care unit, and was modified by Miles, Funk, and Carlson [20] for the NICU. This study used 20 items in 4 categories: 1) NICU environ- ment; 2) appearance and treatment of the infant; 3) relationship with the infant and change in the parental role; and 4) communication with medical staff.
To measure postpartum depression, we used the Edinburgh Postnatal Depression Scale-Korean Version (EPDS-K), developed by Cox, Holden, and Sagovsky [23] and translated by Han, Kim, and Park [24]. This scale consists of 10 items graded on a 4-point scale with 0 points for "always so" and 3 points for "not at all".
To measure state anxiety, we used the State-Trait Anxiety Inventory (STAI) form-Korean YZ (STAI-KYZ), which was translated and standardized by Hahn, Lee, Chon, and Spielberger [21] based on the STAI-Y originally developed by Spielberger, Gorsuch, and Lushene [22]. The original tool contains state and trait anxiety scales, which consist of 20 items each.
성능/효과
After the intervention, both the experimental and control groups showed a significant decrease in stress scores, but the magnitude of the change in stress scores was significantly higher in the experimental group than in the control group. The reason for the reduced stress in control group is believed to be due to the continuous information and support provided by the medical staff.
The experimental group showed a significant decrease in MCER from the pretest score to posttest score. The control group showed an increase, but the difference was not significant.
Accordingly, hypothesis 3 was supported. The experimental group showed a significant decrease in postpartum depression from the pretest score to posttest score. The control group also showed a decrease from the pretest score to posttest score, but the difference was not significant.
Accordingly, hypothesis 2 was supported. The experimental group showed a significant decrease in state anxiety from the pretest score to posttest score. The control group showed an increase, but the difference was not significant.
The results showed that applying the REBT-based emotion regulation program reduced MCER, stress, state anxiety, and postpartum depression.
This study found that irrational beliefs, such as rumination and catastrophizing, caused an increase in anxiety. Mothers of premature infants showed anxious reactions as they repeatedly thought about their own fault in giving birth prematurely and worried about anything and everything that could happen to their child.
후속연구
nursing. With studies on psychological intervention for reducing postpartum depression in mothers of premature infants in the NICU being scarce in South Korea, the present study produced findings that could contribute to expanding research on REBT-based postpartum depression inventions for mothers of premature infants in the NICU. Moreover, the present study was meaningful in that it applied an REBT- based emotion regulation program to mothers of premature infants in the NICU to correct their thinking and reduce negative emotions to help enhance their mental health.
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