Acceptance and commitment therapy as a proposed treatment for tokophobia.

摘要

Tokophobia is a pathological fear of pregnancy that can lead to avoidance of pregnancy and childbirth. Intense fear of childbirth effects the daily lives of about six percent of pregnant women. The intense fear of childbirth can lead to considerable risk for negative experiences of labor, and feelings of dissatisfaction after childbirth. In our current system of services for gynecology and obstetrics, pre-natal care, labor and delivery care, and post-natal care, we do not have an awareness of tokophobia or an agreed upon way to conceptualize and serve women who experience this fear. As a result, we lack a consistent way to identify these women, effective therapies to treat these women, and the staff competent for such treatment. This dissertation reviews the existing research regarding Tokophobia, by which to identify and explore the biological, psychological, social, cultural, and secondary factors that contribute to tokophobia and appear important to address in any therapy to ameliorate this intense fear. Based on this review, a specific therapy is recommended, explicitly tailored to treatment of tokophobia. The Acceptance and Commitment Therapy (ACT) model, a coherent and empirically tested treatment for other expressions of anxiety, is reviewed and analyzed regarding its utility to specifically target the clinical factors crucial for women with tokophobia. The six core components of ACT's hexaflex model can be readily applied to address the biological, psychological, social, cultural, and secondary factors relevant to tokophobia. ACT's flexibly comprehensive package of treatment components, with these recommendations regarding its application for tokophobia, promises to greatly reduce suffering for women with this phobia, increase their ability to cope with the pregnancy-related anxiety and fear, while empowering them to act in a conscious and present way, consistent with their own values surrounding childbirth.