Efficacy of an internet-based cognitive behavioral stress management training in women with idiopathic preterm labor: A randomized controlled intervention study

J Psychosom Res. 2017 Dec:103:140-146. doi: 10.1016/j.jpsychores.2017.10.014. Epub 2017 Oct 28.


Objective: This randomized controlled trial aimed at evaluating the efficacy of an internet-based cognitive behavioral stress management program (IB-CBSM) for pregnant women with preterm labor (PTL) on birth outcome and stress-related psychological and biological parameters.

Methods: 93 pregnant women with PTL (gestational age 18-32) were assigned to either the IB-CBSM (n=50) or a control group (CG) based on distraction (n=43). Participants in both groups worked through six weekly modules. Birth outcome measures included gestational age, neonatal weight and length at birth and the rate of preterm birth (PTB). Questionnaires assessed psychological wellbeing and the activity of the HPA-axis was measured with the cortisol awakening reaction (CAR), both before (T1) and after the intervention (T2).

Results: Birth outcome and psychological wellbeing did not differ between IB-CBSM and CG. However, psychological wellbeing was higher after both interventions (PSS: ηp2=0.455, STAIX1: ηp2=0.455, STAIX2: ηp2=0.936, PRAT: ηp2=0.465, EPDS: ηp2=0.856). Cortisol levels were stable and did not alter differently between groups from T1 to T2. Higher cortisol levels were associated with lower gestational age at birth, whereas no significant correlations were found between weight and length at birth.

Conclusions: Although there were no significant differences between the two groups and birth outcome, psychological and biological parameters, both interventions (CBSM and CG) showed equivalent effects and proved to be beneficial with regard to psychosocial distress and well-being. Further research is needed to investigate CBSM and distraction interventions for pregnant women at risk for PTB together with a non-intervention control condition.

Keywords: Birth outcome; Cortisol; Internet-based therapy; Preterm birth; Preterm labor; Psychological wellbeing.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Education, Distance
  • Female
  • Health Behavior
  • Humans
  • Internet / statistics & numerical data*
  • Obstetric Labor, Premature / psychology*
  • Pregnancy
  • Premature Birth / psychology*
  • Prospective Studies
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires