The effect of a prenatal hypnotherapeutic programme on postnatal maternal psychological well-being
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The aim of this study was to develop and evaluate the effect of a prenatal hypnotherapeutic programme on the maintenance and promotion of postpartum psychological well-being of a group of first-time mother. Relevant literature on pregnancy, early motherhood and psychological well-being were explained in order to abstract important facets and perspectives to use as a background for the development and implementation of an intervention programme for the facilitation of psychological well-being of first-time mothers. Theoretical perspectives on, and practical applications of, clinical hypnosis were further analysed and used as foundation for the development of the hypnotherapeutic intervention. A hypnotherapeutic programme was developed, based on existing theoretical knowledge regarding pregnancy, childbirth and early motherhood, as well as clinical hypnosis, with specific emphasis on Ericksonian principles and ego state therapy techniques, enriched from the perspective of psychofortology. The empirical study consisted of a quantitative component and a qualitative component. In the quantitative component, a pretest-posttest-follow-up comparative design was implemented, with random assignment of participants to the experimental and control groups within the limits of practicalities. Both groups, each consisting of 23 women in their first pregnancy, completed the following questionnaires: (i) Perception of Labour and Delivery Scale (PLD), adapted from Padawer et al. (1988). Feelings about the baby and relationship with the baby (FRB), adapted from Wwllett and Parr (1997), Maternal Self- Confidence Scale (MSC), adapted from Ruble et al. (1990) and Maternal Self-Efficacy Scale (MSE) (Teti & Gelfand, 1991), to explore aspects of psychological well-being related to early motherhood; (ii) The Edinburgh Postnatal Depression Scale (EPDS) of Cox et al. (1987) and the General Health Questionnaire (GHQ) (Goldberg & Hillier, 1979), to investigate aspects of psychological well-being as evident by the absence of pathology; and (iii) the Satisfaction with Life Scale (SWLS) (Diener et al., 1985), the Affectometer 2 (AFM) (Kammann & Flett, 1983), the Sense of Coherence Scale (SOC) of Antonovsky (1979) and the Generalised Self-efficacy Scale (GSE), developed by Schwarrer, (1993), to measure general psychological well-being. The Stanford Hypnotic Clinical Scale (SHCS) (Morgan & Hilgard, 1978) was used for the experimental group to assess hypnotisabili. The qualitative component consisted of in-depth interviews and an analysis of written responses of mothers in the experimental group. They commented on their experience of the programme and its impact at two weeks and ten weeks postpartum. Results from the empirical study indicated that the experimental group showed significantly more symptoms of depression and symptomatology during the prenatal evaluation than the control group. Since the experimental group was possibly more vulnerable than the control group in a psychological sense, the effect of the intervention programme could not be deduced from a pure comparison of postnatal evaluation scores between the groups. Therefore, it was decided to explore the significance of differences within each of the experimental and control groups, as well as between the experimental and control group, using the mean difference scores between prenatal and postnatal evaluation on each variable. Results indicate that the hypnotherapeutic programme was effective in enhancing most aspects of psychological well-being within the experimental group. This strengthened sense of psychological well-being was evident both in the immediate postpartum period and at ten weeks postpartum. The control group showed a spontaneous increase in psychological well-being later in the postpartum period. The programme thus assisted mothers in the more vulnerable experimental group to experience a stronger sense of psychological well-being sooner after the baby's birth. The experimental and control groups were further compared on the mean differences in prenatal versus postnatal scores on measures of psychological well-being. The results suggest that the hypnotherapeutic intervention contributed to an enhanced sense of psychological well-being in mothers in the experimental group, in comparison to the control group, during the early postpartum period, as measured by variables related to motherhood, absence of pathology and general psychological well-being. At ten weeks postpartum, the differences between the experimental and control group were less obvious. However, a very important finding was that mothers in the experimental group continued to show a significant improvement in psychological well-being as indicated by the absence of pathology. Specifically, there was a continued decrease in depression and general symptoms of pathology. Findings from the quantitative study were supported by remarks by mothers in postpartum and follow-up interviews, as well as their written responses, as part of a qualitative exploration of their experience of the programme and its impact on them. The findings give compelling evidence that a hypnotherapeutic intervention, focusing on the enhancement of strengths and inner resources, could alleviate depression and psychological distress during the perinatal period, as well as prevent the exacerbation of symptoms. Findings from the current study indicate that the developed prenatal hypnotherapeutic programme was effective in enhancing the psychological well-being of mothers experiencing a first pregnancy. Recommendations for clinical practice and further research were made, based on the current research findings. The contribution of the current study lies in the fact that it is the first to explore pregnancy, childbirth and early motherhood from a salutogenidfortigenic perspective, and to utilise hypnosis to facilitate psychological well-being in this context. It contributed to scientific knowledge in the fields of developmental psychology, psychofortology and clinical hypnosis.
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