Providing Psychological and Emotional Support After Perinatal Loss: Protocol for a Virtual Reality-Based Intervention

Giulia Corno, Stéphane Bouchard, Rosa M Baños, Marie-Christine Rivard, Chantal Verdon, Francine de Montigny, Giulia Corno, Stéphane Bouchard, Rosa M Baños, Marie-Christine Rivard, Chantal Verdon, Francine de Montigny

Abstract

The loss of an infant during the perinatal period has been recognized as a complex and potentially traumatic life event and can have a significant impact on women's mental health. However, often times, psychological aftercare is typically not offered, and manualized interventions are rarely used in clinical care practice and have seldom been evaluated. In recent years, a growing number of studies have demonstrated the efficacy of virtual reality (VR) interventions to facilitate the expression and coping with emotions linked to a traumatic event. The objective of the proposed paper is to present the protocol of a randomized control trial aimed to assess a novel VR-based intervention for mothers who experienced a perinatal loss. We hypothesize that the VR-based intervention group will show significantly reduced symptoms related to grief, postnatal depression and general psychopathology after treatment relative to a treatment-as-usual (TAU) group. Participants would be randomly assigned to the TAU + VR or to the VR + TAU condition. The TAU condition as well as the VR-based intervention will last 3 weeks, after which women will complete a post-assessment. The proposed VR-based intervention will consist in three weekly sessions focused, respectively on: (1) collect information about the loss and psychoeducation about perinatal grief, and introduction to the virtual environment; (2) through the use of the virtual environment, women will be assisted in the elaboration and acceptation of loss; (3) recreate, using the specific features of the virtual environment a positive metaphor representing woman's future life. VR has proved to be a valid intervention tool in clinical psychology, and in the last years VR technologies have become more affordable to be used in clinical practice. With the present study we propose to answer to the unquestionable need for interventions addressed to ameliorate the emotional effects in women who experienced perinatal loss, by exploiting also the therapeutic opportunities offered by a new technology as VR.

Keywords: intervention; perinatal loss and grief; psychological intervention; virtual reality; women mental health.

Copyright © 2020 Corno, Bouchard, Baños, Rivard, Verdon and de Montigny.

Figures

FIGURE 1
FIGURE 1
Examples of EMMA’s World landscapes.
FIGURE 2
FIGURE 2
EMMA’s World temple.
FIGURE 3
FIGURE 3
CONSORT flowchart for the proposed clinical trial: adapted from Consort 2010.

References

    1. Agence de la santé publique du Canada (2008). Rapport sur la Santé Périnatale au Canada. Ottawa: Agence de la santé publique du Canada.
    1. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th Edn Washington, DC: American Psychiatric Association.
    1. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Publication.
    1. Andersson G., Titov N. (2014). Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry 13 4–11. 10.1002/wps.20083
    1. Attkisson C. C., Zwick R. (1982). The client satisfaction questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval. Program Plann. 5 233–237. 10.1016/0149-7189(82)90074-x
    1. Baños R. M., Botella C., Guillen V., García-Palacios A., Quero S., Bretón-López J., et al. (2009). An adaptive display to treat stress-related disorders: EMMA’s World. Br. J. Guid. Couns. 37 347–356. 10.1080/03069880902957064
    1. Baños R. M., Guillen V., Quero S., Garcia-Palacios A., Alcaniz M., Botella C. (2011). A virtual reality system for the treatment of stress-related disorders: a preliminary analysis of efficacy compared to a standard cognitive behavioral program. Int. J. Hum-Comput. St. 69 602–613. 10.1016/j.ijhcs.2011.06.002
    1. Barclay L., Everitt L., Rogan F., Schmied V., Wyllie A. (1997). Becoming a mother—an analysis of women’s experience of early motherhood. J. Adv. Nurs. 25 719–728. 10.1046/j.1365-2648.1997.t01-1-1997025719.x
    1. Beck A., Steer R., Brown G. (1996). Beck Depression Inventory, 2nd Edn San Antonio, TX: Psychological Corporation.
    1. Bennett S. M., Ehrenreich-May J., Litz B. T., Boisseau C. L., Barlow D. H. (2012). Development and preliminary evaluation of a cognitive-behavioral intervention for perinatal grief. Cogn. Behav. Pract. 19 161–173. 10.1016/j.cbpra.2011.01.002
    1. Berman M. R. (2001). Parenthood Lost: Healing the Pain After Miscarriage, Stillbirth, and Infant Death. Westport, CT: Bergin and Garvey.
    1. Bibring G. L. (1959). Some considerations of the psychological processes in pregnancy. Psychoanal. Stud. Chil. 14 113–121. 10.1080/00797308.1959.11822824
    1. Boyle F. M., Vance J. C., Najman J. M., Thearle M. J. (1996). The mental health impact of stillbirth, neonatal death or SIDS: prevalence and patterns of distress among mothers. Soc. Sci. Med. 43 1273–1282. 10.1016/0277-9536(96)00039-1
    1. Campillo I. S. L., Meaney S., McNamara K., O’Donoghue K. (2017). Psychological and support interventions to reduce levels of stress, anxiety or depression on women’s subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ Open 7:e017802. 10.1136/bmjopen-2017-017802
    1. Cox J. L., Holden J. M., Sagovsky R. (1987). Detection of postnatal depression: development of the 10-item edinburgh postnatal depression scale. Br. J. Psychiatry 150 782–786. 10.1192/bjp.150.6.782
    1. de Montigny F., Verdon C., Lord-Gauthier J., Gervais C. (2017a). Décès Périnatal : le Deuil des Pères. Montréal: Éditions du CHU Sainte-Justine.
    1. de Montigny F., Verdon C., Meunier S., Dubeau D. (2017b). Women’s persistent depressive and perinatal grief symptoms following a miscarriage: the role of childlessness and satisfaction with healthcare services. Arch. Women Ment. Hlth. 20 655–662. 10.1007/s00737-017-0742-9
    1. Ebert D. D., Van Daele T., Nordgreen T., Karekla M., Compare A., Zarbo C., et al. (2018). Internet- and Mobile-based psychological interventions: applications, efficacy, and potential for improving mental health. Eur. Psychol. 23 167–187. 10.1027/1016-9040/a000318
    1. Édition du centre de psychologie appliquée (1996). Inventaire de Depression de Beckin Manuel du BDI-II, 2nd Edn Paris: Édition du centre de psychologie appliquée.
    1. Gaudreau P., Sanchez X., Blondin J. P. (2006). Positive and negative affective states in a performance-related setting: testing the factorial structure of the panas across two samples of french-canadian participants. Eur. J. Psychol. Assess. 22 240–249. 10.1027/1015-5759.22.4.240
    1. Gauthier J., Bouchard S. (1993). Adaptation canadienne-française de la forme révisée du State–Trait Anxiety Inventory de Spielberger [A French-Canadian adaptation of the revised version of Spielberger’s State–Trait Anxiety Inventory]. Can. J. Behav. Sci. 25 559–578. 10.1037/h0078881
    1. Guy W. E. (1976). ECDEU Assessment Manual for Psychopharmacology-Revised (DHEW Publ No ADM 76-338), Vol. 1076 Rockville, MD: US Department of Health, 534–537.
    1. Hughes P., Riches S. (2003). Psychological aspects of perinatal loss. Curr. Opin. Obstet. Gyn. 15 107–111. 10.1016/j.bpobgyn.2006.11.004
    1. Hughes P., Turton P., Hopper E., Evans C. D. H. (2002). Assessment of guidelines for good practice in psychosocial care of mothers after stillbirth: a cohort study. Lancet 360 114–118. 10.1016/s0140-6736(02)09410-2
    1. Kersting A., Kroker K., Schlicht S., Baust K., Wagner B. (2011a). Efficacy of cognitive behavioral internet-based therapy in parents after the loss of a child during pregnancy: pilot data from a randomized controlled trial. Arch. Womens. Ment. Health. 14 465–477. 10.1007/s00737-011-0240-4
    1. Kersting A., Kroker K., Schlicht S., Wagner B. (2011b). Internet-based treatment after pregnancy loss: concept and case study. J. Psychosom. Obstet. Gynecol. 32 72–78. 10.3109/0167482X.2011.553974
    1. Kersting A., Wagner B. (2012). Complicated grief after perinatal loss. Dialogues. Clin. Neurosci. 14 187–194.
    1. Klier C. M., Geller P. A., Ritsher J. B. (2002). Affective disorders in the aftermath of miscarriage: a comprehensive review. Arch. Women Ment. Health 5 129–149. 10.1007/s00737-002-0146-2
    1. Leon I. G. (2001). “Perinatal loss,” in Psychological Aspects of Women’s Health Care: The Interface Between Psychiatry and Obstetrics and Gynecology, 2nd Edn, eds Stotland N., Stewart D. (Washington DC: American Psychiatric Press; ), 141–173.
    1. Loranger C., Bouchard S. (2017). Validating a virtual environment for sexual assault victims. J. Trauma. Stress 30 157–165. 10.1002/jts.22170
    1. McCabe-Beane J. E., Segre L. S., Perkhounkova Y., Stuart S., O’Hara M. W. (2016). The identification of severity ranges for the edinburgh postnatal depression scale. J. Reprod. Infant Psyc. 34 293–303. 10.1080/02646838.2016.1141346
    1. Moshe I., Terhorst Y., Cuijpers P., Cristea I., Pulkki-Råback L., Sander L. (2020). Three decades of internet-And computer-based interventions for the treatment of depression: protocol for a systematic review and meta-analysis. JMIR Res. Protoc. 9:e14860. 10.2196/14860
    1. Paris G. F., de Montigny F., Pelloso S. M. (2017). Cross-cultural adaptation and validation evidence of the perinatal grief scale. Texto Contexto Enfer. 26:e5430015 10.1590/0104-07072017005430015
    1. Peskin M., Mello B., Cukor J., Olden M., Difede J. (2019). “Virtual reality applications to treat posttraumatic stress disorder,” in Virtual Reality for Psychological and Neurocognitive Interventions, eds Rizzo A., Bouchard S. (New York, NY: Springer; ), 85–102.
    1. Potvin L., Lasker J., Toedter L. (1989). Measuring grief: a short version of the perinatal grief scale. J. Psychopathol. Behav. 11 29–45. 10.1007/BF00962697
    1. Prigerson H. G., Maciejewski P. K., Reynolds C. F., III, Bierhals A. J., Newsom J. T., Fasiczka A., et al. (1995). Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiat. Res. 59 65–79. 10.1016/0165-1781(95)02757-2
    1. Rizzo A. S., Bouchard S. (2019). Virtual Reality for Psychological and Neurocognitive Interventions. New York, NY: Springer-Verlag.
    1. Spielberger C. D. (1983). Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press.
    1. Toedter L. J., Lasker J. N., Janssen H. J. (2001). International comparison of studies using the perinatal grief scale: a decade of research on pregnancy loss. Death Stud. 25 205–228. 10.1080/07481180125971
    1. Watson D., Clark L. A., Tellegen A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. J. Pers.Soc. Psychol. 54 1063–1070. 10.1037//0022-3514.54.6.1063
    1. Zech E. (2006). Psychologie du deuil. Impact et Processus D’adaptation au Décès d’un Proche. Belgique: Mardaga.

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