UNDERSTANDING THE ROLE OF INTOLERANCE OF UNCERTAINTY IN THE PERINATAL PERIOD: A TARGET FOR DETECTION AND PREVENTION OF ANXIETY DISORDERS DURING THE PERINATAL PERIOD

Abstract

Anxiety disorders are the most prevalent mental health disorders during pregnancy and the postpartum (perinatal) period, with prevalence rates as high as 25%. These disorders are associated with significant adverse outcomes for both the individual and their child and carry long-term costs to society. Despite this, research focused on early detection and prevention of these disorders remains limited. Intolerance of uncertainty (IU), defined as a dispositional trait that arises when an individual interprets uncertain situations as distressing, has been identified as a key risk factor in the development and maintenance of anxiety disorders in the general population, and more recently in the perinatal population. This dissertation explores the role of IU in the detection and prevention of anxiety disorders during the perinatal period. Specifically, we validated a self-report measure of IU to improve detection of anxiety disorders during the perinatal period and identify individuals who may be at increased risk for developing these disorders. We also developed and evaluated a cognitive behavioural therapy protocol targeting IU (CBT-IU) during pregnancy to reduce the risk of anxiety disorder onset in the postpartum in pregnant individuals with elevated IU. This program of research highlights the important role of IU during the perinatal period as a key target for both improving detection and prevention of anxiety disorders. We provide clinicians and researchers with a validated measure of IU to enhance detection of anxiety disorders in the perinatal period. We also offer preliminary support for CBT-IU in preventing the onset of anxiety disorders during the postpartum period, in which no participants receiving CBT-IU developed an anxiety disorder in the postpartum, compared to 31.6% who received care as usual. This dissertation emphasizes the importance of proactive strategies to enhance early detection and prevention of anxiety disorders during the perinatal period, with the potential to improve outcomes for individuals during this vulnerable period.