Prenatal affective cognitive training: A proof-of-concept study

Abstract

Negatively biased cognitive response to infant stimuli during pregnancy is associated with increased postpartum depression (PPD) risk. This proof-of-concept study aimed to investigate the feasibility and effects of a two-week affective cognitive training intervention on cognitive responses to emotional infant stimuli for pregnant participants at risk of PPD. Forty-three participants were included: 23 ​at high risk and 22 ​at low risk of PPD. Cognitive response to emotional infant stimuli was assessed at baseline, immediately after the intervention and at a two-week follow-up for the intervention group (n ​= ​16) and twice over two weeks for the comparison group. The intervention was feasible, as 80% completed all sessions and gave positive feedback. The intervention group showed increased sensitivity to happy infant faces (p-values < 0.02, d ​> ​0.1), more infant-directed facial expressions (p ​< ​0.001, d ​= ​0.6), greater attention toward infant stimuli (p ​= ​0.04, d ​= ​0.2), and reduced negative reactivity to infant distress (p ​= ​0.01, d ​= ​2.6). The increased sensitivity to happy infant faces correlated with fewer depressive symptoms six months after birth (r = -0.59, p = 0.03). Interpretation of the results is limited by the lack of a high-risk control group and small sample size. Randomised controlled trials are now warranted to investigate whether the effects of prenatal affective cognitive training on affective cognitive response to infant stimuli confer reduced risk of PPD.

Keywords: Attachment; Cognitive neuropsychiatry; Emotional cognition; Infant development; Mother-infant interaction; Pregnancy.

Fig. 1

Flow chart displaying study design and number of included participants. The time points stated for each assessment are median test, training, and follow-up times for participants. One high-risk lost to postpartum follow-up due to still birth.

Fig. 2

High-risk pregnant women showed increased sensitivity in the perception of infant happiness at immediate follow-up (T1) and delayed follow-up (T2) compared to baseline (red solid line) for both (A) happy infant faces and (B) neutral infant faces. For low-risk pregnant women, responses remained stable for the happy infant faces (A), while they rated neutral infant faces (B) slightly more positive at T1 (blue dotted line). Error-bars represent standard error of the mean. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

(A) High-risk pregnant women showed decreased frustration in response to the infant distress video at immediate follow-up (T1) and delayed follow-up (T2) compared to baseline (red solid line), while responses from low-risk pregnant women remained stable (blue dotted line). (B) High-risk pregnant women rated their own emotions in response to the most distressed infant cries as less negative at immediate follow-up (T1) and delayed follow-up (T2) compared to baseline (red solid line). Low-risk pregnant women rated their own emotions as more negative at T1 (blue dotted line). Error-bars represent standard error of the mean. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

(A) High-risk pregnant women spent more time gazing at the distressed infant's face in the video at immediate follow-up (T1) and delayed follow-up (T2) compared to baseline (red solid line), while low-risk pregnant women gazed less (blue dotted line). (B) High-risk pregnant women displayed more infant-directed facial expressions toward infant face images at immediate follow-up (T1) and delayed follow-up (T2) compared to baseline (red solid line), while facial expression remained stable for low-risk pregnant women T1 (blue dotted line). Error-bars represent standard error of the mean. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)