Patient and therapist experiences of exposure therapy in pregnancy: a qualitative analysis of the ADEPT feasibility trial of intensive and weekly CBT

Objectives: To understand patient and therapist experiences of time-intensive and weekly exposure-based therapy for anxiety disorders delivered during pregnancy.Design: A qualitative study using semi-structured interviews with patients and therapists who had taken part in a feasibility trial of predominantly online time-intensive versus weekly CBT in pregnancy. Setting UK therapists and patients in a primary care setting Participants In-depth interviews were conducted with 45 women who had participated in the trial and 6 therapists who had delivered the treatments. Analysis: Data were analysed using reflexive thematic analysis. Results: Five themes were developed from the data that showed convergence from therapist and patient perspectives. These were: ‘Acquiring tools to navigate the perinatal period’; ‘Motivated yet constrained by pregnancy’; ‘Having the confidence to face fears and tolerate uncertainty’; ‘Momentum with the need for flexibility’; ‘Being isolated from the face-to-face world’.Conclusions: Exposure therapy is acceptable and helpful in pregnancy and can lead to lasting gains. Exposure is a key element of treatment and needs to be confidently conducted by therapists with perinatal knowledge and expertise. Treatments need to consider the unfolding context of pregnancy. The momentum of intensive therapy can lead to rapid improvements, but can be demanding for both patients and therapists, especially fitting round other commitments. Online treatments can work well and are a good fit for perinatal women, but this needs to be balanced with the need for connection, suggesting a hybrid model of delivery is the ideal.