Leach, Dawn Marie (2018) The role of cognitive and metacognitive factors in perinatal depression and anxiety. (PhD thesis), Kingston University, .
Abstract
Identifying vulnerability to perinatal emotional distress is an important public health issue. According to Beck’s Cognitive Theory (Beck, 1964; 2002), specific dysfunctional attitudes interact with specific stressors, such as pregnancy or childbirth, increasing risk for emotional distress. According to the Self-Regulatory Executive Functioning Model (Wells & Matthews, 1994; 1996), the appraisal and regulation of one’s thoughts, known as metacognition, are more responsible for maintaining and exacerbating emotional distress than maladaptive cognitive content. This has yet to be explored in the perinatal period. The aim of this thesis was to explore the role of cognitive and metacognitive factors in increasing risk for perinatal depression and anxiety. To accomplish this, a psychometric exploration into the Pregnancy Related Beliefs Questionnaire (Moorhead, Owens, & Scott, 2003) was conducted, which resulted in a valid and reliable measure of maladaptive attitudes specific to motherhood that was found to increase risk for the onset and severity of postnatal depression. Finally, the independent role of metacognitions in increasing risk for perinatal emotional distress was explored, outside of the contribution of dysfunctional attitudes specific to motherhood, which revealed that metacognitive beliefs about the uncontrollability and danger of one’s thoughts independently predicted the onset and severity of antenatal emotional distress, after controlling for baseline emotional distress and maladaptive attitudes about motherhood; however metacognition did not independently predict postnatal emotional distress. The results suggest, during the third trimester, when anxieties about the birth of the baby are high, beliefs that thoughts are uncontrollable and dangerous can lead to increased emotional distress. In the weeks after the baby is born, rigid attitudes about motherhood and what makes a good or a bad mother become more relevant, increasing risk for postnatal emotional distress. These results support the relevance of both cognitive and metacognitive approaches to understanding perinatal emotional distress and suggests that their strength as predictors is dependent on context. The limitations and implications are also discussed.
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