Anxiety and depression of women with pregnancy pathology in the context of early maladaptive schemes

Kuzmina Anna Sergeevna PhD in Psychology Head of the Department of Clinical Psychology, Altai State University 656049, Russia, Altai Krai, Barnaul, Lenin str., 61, office 302 annakuz87@yandex.ru Other publications by this author     Praizendorf Ekaterina Sergeevna ORCID: 0000-0002-9014-8927 Senior Lecturer of the Department of Clinical Psychology of Altai State University 656049, Russia, Altaiskii krai, g. Barnaul, ul. Lenina, 61, of. 302 catherinears@list.ru Other publications by this author

Krivoshei Kristina Olegovna Postgraduate Student, Department of Clinical Psychology, Altai State University 656000, Russia, Altai Territory, Barnaul, Lenin str., 61, office 302 03fomina@mail.ru Other publications by this author

The issues of pregnancy and motherhood are actively studied both in foreign and domestic psychology. Much attention is paid to them in the framework of personality psychology, developmental psychology, family psychology, perinatal psychology, etc. Despite the fact that there is an increase in scientific interest in the problem of motherhood and various aspects of pregnancy and childbirth, existing studies and data obtained are insufficient for a comprehensive study of this problem.

In modern realities, there is an increase in the number of women with pregnancy pathology. The most important condition for a favorable course of pregnancy, readiness for motherhood, and acceptance of the role of mother is the psychological state and psychological health of the expectant mother ^[1]. The condition and behavior of the mother are one of the most important conditions for the development of a child in the postnatal period. Therefore, the high quality of psychological support for pregnancy seems to be a necessary condition for improving women's mental health, increasing reproductive activity and increasing the birth rate, the quality of life of the population as a whole ^[2].

In order to develop programs for counseling women on psychological health issues, a comprehensive study of the factors influencing a woman's psychological state during and after a woman's pregnancy is necessary. Pathology of pregnancy in pregnant women is a factor of chronic stress and violation of the psychological health of mothers.

Pregnancy is described by many authors as a state of crisis. And this is legitimate. Considering the period of pregnancy from the standpoint of a biopsychosocial approach, the following is found: from a biological point of view, during pregnancy there is a global restructuring of the entire woman's body, her physiology, hormonal sphere; social factors imply a transition to a new social situation, the acquisition of a new social role, the restructuring of the family system, etc. Psychological factors include personal reactions, experiences related to social and physiological changes, during pregnancy and upcoming childbirth ^[3].

At the same time, the physiological state of a woman, the course of pregnancy and childbirth, the condition of the child, as well as interaction within the family depend on the psychological state of a pregnant woman, which in turn is itself represented by a developmental crisis. This crisis is accompanied by a stressful state of the expectant mother, child, spouse and, as a result, a crisis in family relations ^[4].

It is noted that maternal behavior has a complex structure and path of development, many options due to cultural and individual characteristics. According to available data, there are many clinical and psychological factors that influence readiness for motherhood and acceptance of the role of mother ^[5]. These include the context of the life path, the specifics of the relationship with the attending physician, the spouse, and the health of the expectant mother. It is noted that maternal behavior has a complex structure and path of development, many variants due to cultural and individual characteristics ^[6].

Many studies have been conducted on the experience of pregnancy and its components, the peculiarities of mother-child interaction in the postnatal period, the peculiarities of the emotional state and personal transformations, the interrelationships of the hormonal background and mutual relations with the child, etc.

The psychological state of women in the postpartum period is a combination of multidirectional feelings and emotions, and therefore is often unstable. Some authors associate it more with the experience of the maternal role than with the experience of childbirth ^[7]. This condition includes both pleasant and positive feelings and emotions, such as love, joy, and negative, complex and unpleasant experiences – anxiety, depression, fear, guilt, etc.

It should be noted that the presence of anxiety and depressive problems during pregnancy is very, very relevant. This is especially true in complicated pregnancies. Thus, an analysis of scientific sources indicates that 10-15% of women worldwide experience a typical depressive episode after giving birth to a child ^[8,9]. The occurrence of anxiety and depression is one of the most socially significant medical problems that significantly affect the health of the mother and many aspects of her life: the family as a whole, relatives and friends, and especially the child. These affective disorders can transform into a significant problem, since adequate help may either be delayed due to late diagnosis, or it may not be at all, since women quite often do not admit and do not talk about their feelings ^[10,11].

According to the cognitive behavioral approach, the emerging emotional and behavioral reactions are caused by thought processes. Emotion does not arise as a consequence of situations that occur, but is mediated by thoughts that arise about these situations. These automatic thoughts are based on beliefs, and they in turn are based on deep early maladaptive patterns. In cognitive behavioral psychotherapy, or rather in scheme therapy, J.According to Yang, schemes are stable, deeply rooted structures that determine attitudes towards themselves, people around them and the world as a whole, organizing and mediating personal experience and thereby allowing to anticipate the development of events, to determine strategies of behavior in specific situations ^[12].

Early maladaptive patterns are formed in childhood in the process of the child's interaction with parents and the immediate environment. The quality of this interaction determines whether the formed patterns will be adaptive or maladaptive in adulthood. This is influenced by how basic emotional needs were met in early childhood. Would their satisfaction be sufficient and adequate ^{[13, 14, 15, 16]}.

Young, Klosko, & Weishaar described five main categories of basic emotional needs. These include the following categories ^{[17, 18]}:

- Affection and security. This category describes the importance of a close emotional connection with other people, which allows you to feel safe, stable and accepted.

- Independence, competence and identity. This category defines the need for self-determination, adequate self-perception, development of identity and independence.

- Freedom to express your needs and emotions. This category includes emotional connections with other people, in which it is possible to openly express thoughts, feelings and emotions.

- Spontaneity, fun and play. This category emphasizes the importance of spontaneous expression of feelings and emotions outside of the overwhelming rules in order to study them, learn to understand them.

- Realistic boundaries, self-discipline and self-control. The fifth category, complementing the previous ones, highlights the exceptional importance of awareness of one's boundaries and the boundaries of other people, the ability to subordinate self-expression to rules.

Early maladaptive patterns formed on the basis of the quality of satisfaction of basic emotional needs are described in detail in the concept of J. Young.

For the effectiveness of psychological support for pregnant women, it is important to identify the mechanisms of development and maintenance of unstable and complex psychological conditions of pregnant women and women in the postpartum period. In this context, we consider it important to develop and study the problem of the relationship between the emotional state of expectant mothers and early maladaptive patterns that are activated by crisis events, which is pregnancy. Thus, a woman's negative childhood experience can lead to various negative emotions, cognitive distortions, and the realization of maladaptive behavioral stereotypes ^{[19, 20, 21, 22]}.

Thus, there is a problem of the need to resolve the contradiction between the objective need to provide psychological assistance to women with pregnancy pathology in terms of eliminating the risk of developing anxiety-depressive symptoms and the lack of scientifically sound ways and means of implementing this process.

In connection with the above, it seems significant to study anxiety and depression in women with pregnancy pathology in connection with early maladaptive regimens.

The aim of the study was to identify the relationship of the factor model of early maladaptive patterns with anxiety and depression in women with pregnancy pathology.

The subject of the study is anxiety and depression in women with pregnancy pathology.

The scientific novelty of the research. For the first time, the existence of correlations between early maladaptive patterns in women with pregnancy pathology with anxiety and depression has been theoretically substantiated and empirically proven. A factorial model of early maladaptive schemes in the structure of thinking of women with pregnancy pathology has been determined.

Research methodology: L.S. Vygotsky's cultural and historical theory of human mental development, G.G. Filippova's theoretical positions on styles of experiencing pregnancy, the concept of D.Yang's early maladaptive schemes. The study design included Jeffrey Young's "YSQ-S3R" diagnostic methodology for early maladaptive schemas, the Hospital Anxiety and Depression Scale (HADS), as well as a structured questionnaire. Mathematical and statistical methods of data processing – Spearman correlation analysis, factor analysis by the method of principal components with Varimax rotation using the software package "SPSS Statistics" 23.

The hypothesis of the study was the assumption that there is a relationship between early maladaptive patterns with anxiety and depression in women with pregnancy pathology.

Empirical basis of the study: the study was conducted on the basis of the Altai Regional Clinical Center for Maternal and Child Health with women who have pregnancy pathologies such as low water, polyhydramnios, placenta previa, uterine hypertension. The study involved 68 women with an average age of 26.4 ±8.2 with a pathology of pregnancy development.

The results of the study

Let's analyze the average rates of anxiety and depression in women with pregnancy pathology (see Table 1).

Table 1.

Analysis of the average values of anxiety and depression in women with pregnancy pathologies

The analysis of Table 1 showed that women with pregnancy pathology have subclinical symptoms of anxiety and depression.

It can be assumed that early maladaptive patterns act as a certain determinant factor in the occurrence of affective disorders, such as anxiety and depression in women with pregnancy pathology.

A qualitative analysis of the meaningful characteristics of early maladaptive regimens in women with pregnancy pathology was carried out by applying factor analysis by the method of principal components with Varimax rotation.

The model of early maladaptive regimens in women with pregnancy pathology is represented by 4 factors explaining 82.48% of the cumulative variance (see Table 2).

The first factor, the factor load of which was 27.68%, with the highest factor weight included such scales as "Emotional deprivation" (l=0.81), "Defectiveness /modesty" (l=0.80), "Dependence/Helplessness" (l=0.72), "Social alienation" (0.70), "Failure" (l=0.66), "Submission" (l=0.60), "Confusion/Undeveloped identity" (l=0.58), "Suppression of emotions" (l=0.58). Women with pregnancy pathologies feel unnecessary, unsuccessful, inferior, dependent on other people, even in small daily tasks. They feel isolated from society and the world and believe that their need for acceptance, love and care can never be satisfied. Factor 1 is called "Emotional rejection."

The second factor, the factor load of which was 21.22%, with the highest factor weight included the scale "Positivity" (l=0.73), the scale "Abandonment/instability" (l=0.63), the scale "Negativism/pessimism" (l=0.62), "Vulnerability" (l=0.61). This factor characterizes the tendency of women to blame others for their inconsistency with the strict rules and requirements of the woman herself. Women with pregnancy pathology focus on fears and negative aspects of life. The factor is called "Over-vigilance and threat expectation".

The third factor, the factor load of which was 18.77%, with the highest factor weight included such scales as "Self-sacrifice" (l=0.76), "Strict standards/Pickiness" (l=0.76), "Distrust/Expectation of ill-treatment" (l=0.58). This factor characterizes the orientation of women in meeting the needs of other people, even to the detriment of their own interests and desires, while having very strict standards and requirements for themselves. The factor was called "Focus on others."

The fourth factor, the factor load of which was 14.80%, with the highest factor weight included such scales as "Lack of self-control" (l=0.76), "Privilege/Grandiosity" (l=0.74), the scale of "Seeking approval" (l=0.56). This factor characterizes the attitude of women towards themselves as unique and privileged, while very much in need of attention and acceptance from other people. At the same time, women's behavioral reactions can be represented in the form of impulsivity, riskiness, and aggressiveness. The factor is called "Broken Boundaries".

Thus, in the obtained factor model of early maladaptive schemes in women with pregnancy pathology, the following components were identified: "Emotional rejection", "Over-vigilance and expectation of threat", "Focus on others", "Violated boundaries".

Such early maladaptive patterns may be a risk factor for the development of anxiety and depression in women with pregnancy pathology.

In order to identify the interrelationships of the factor model of early maladaptive schemes with anxiety and depression in women with pregnancy pathology, Spearman's nonparametric correlation analysis of the factor space of early maladaptive schemes and anxiety and depression scales was applied.

Let's analyze the correlation relationships.

A positive correlation of factor 1 "Emotional rejection" with the scale "Depression" was obtained (r=0.45, p=0.03). These connections indicate that for women with pregnancy pathology, who consider themselves unnecessary, superfluous, unclaimed, dependent, isolated, it is characteristic to experience depressive states associated with the loss of the meaning of life, unwillingness to plan their activities and be active in it.

A positive correlation of 2 factors "Over-vigilance and threat expectation" with the scales "Anxiety" (r=0.37, p=0.047), "Depression" (r=0.15, p=0.03) was obtained. These connections indicate that for women with pregnancy pathology with very high demands on themselves, focused on negative aspects of life, it is characteristic to experience anxious and depressive reactions.

A positive correlation of the 3 factors "Focus on others" with the scales "Anxiety" (r=0.14, p=0.027) was obtained. These connections indicate that for women with pregnancy pathology, who are oriented towards the environment, to meet the needs of everyone except themselves, the appearance of alarming symptoms in the form of insecurity, fear, and excitement is characteristic.

Thus, the results of our study confirmed the hypothesis that early maladaptive patterns have a pronounced relationship with anxiety and depression in women in late pregnancy.

In the course of the conducted empirical research, the following conclusions were formulated:

1. Women with pregnancy pathology are characterized by sublinically pronounced symptoms of anxiety and depression.

2. The factor model of early maladaptive schemes in women with pregnancy pathologies is represented by the following factors: "Emotional rejection", "Over-vigilance and expectation of threat", "Targeting others", "Violated boundaries".

3. Early maladaptive patterns are a factor in the development of anxiety and depression in pregnant women. So, for women who consider themselves unnecessary, superfluous, unclaimed, dependent, isolated, it is typical to experience depression; for women with high demands on themselves and characterized by negativism, general dissatisfaction, it is characteristic to experience anxious and depressive reactions; for women who are oriented to the environment, to meet the needs of everyone except themselves, the appearance of anxiety is characteristic.

Thus, the identified features of experiencing anxiety and depression, depending on early maladaptive patterns in women with pregnancy pathology, are a target of psychotherapeutic interaction.

The data obtained during the study indicate the need for psychological support for women during pregnancy and can be used as a basis for the development of programs for psychological intervention of the perinatal period using the scheme therapy method. The existing early childhood experience of a pregnant woman can act as a factor contributing to the development of anxiety and depression, which, in turn, determine emotional instability, personal disorders, difficulties in social and role functioning, acting as predictors in the appearance of anxiety and depression, early maladaptive patterns cannot but affect pregnancy, delivery, and quality the relationship between mother and child in the postpartum period.

The results obtained expand the available information about the peculiarities of the emotional sphere of women with pregnancy pathologies and the targets of psychotherapy from the perspective of scheme therapy.

The limitations of the study are the small sample size, as well as its geographical representation, limited only to the territory of the Altai Territory. In addition, there is an insufficient balance of samples by age and pregnancy pathologies.

We see the prospects for research on this topic in expanding the sample in terms of a comparative study of the emotional sphere of women with various pregnancy pathologies and a longitudinal study of the development of anxiety-depressive symptoms in women in the postpartum period.