Walk with Me (WWM) for Perinatal Grief

项目摘要 在怀孕期间和产后早期失去孩子会造成严重的心理痛苦 对许多妇女及其伴侣来说，这可能导致长期的心理损伤和障碍， 创伤后应激障碍长期悲伤和自杀在美国，大约有24,000名婴儿 每年有14，000多名婴儿在出生后30天内死亡。大约15%的父母会 经历过流产，超过30%的经历过流产的女性符合诊断标准。 创伤后应激障碍的标准目前，对于糖尿病患者，有效且可获得的治疗方法有限。 减轻创伤和强烈悲伤的影响，这是常见的围产期损失。先前的研究发现， 在线认知行为疗法（CBT）可有效减少围产期悲伤和创伤后压力 紊乱症状然而，有必要提供超越认知重新评估的支持计划 提供具体的策略，以减少痛苦，并增加连接到随后的可用性 怀孕，包括正念练习，并纳入与父母合作的指导原则， 经历过围产期流产。使用悲伤的指导原则和注入实用的策略，以减少 为丧亲父母的痛苦，如促进合作伙伴的参与和悲伤仪式的例子是 这是对这一人群认知行为疗法的重要补充。此外， 父母可能会遇到来自缺乏足够的医疗保健专业人员（HCP）的破坏性沟通， 训练目前还没有现成的工具可以将HCP培训与对丧亲父母的直接支持结合起来。 第一阶段项目的目标是创建一个移动的应用程序的原型， 有效地减少父母的痛苦（创伤性压力和悲伤的强度）后，围产期损失。我们 我将通过实现我们的三个具体目标来实现这一目标：具体目标1：使用迭代式的形成 开发流程，开发悲伤处理和康复活动的培训和模块， 认知行为疗法以及与经历过围产期的父母合作的指导原则 损失具体目标2：开发具有应用程序核心组件的原型。具体而言，HCP 培训和四个关键模块，包括两个关于悲伤的正常化，一个关于正念 促进应对创伤和痛苦症状，一个使用CBT策略来管理消极的 思想具体目标3：通过以下方式评估Walk With Me的可接受性、可用性和有效性： 与HCP和失去亲人的父母一起进行混合方法计划评估，以优化成功的 使用Walk With Me。

Project Summary The loss of a child during pregnancy and the early postpartum period causes significant psychological distress for many women and their partners and may lead to long-lasting psychological impairment and disorder such as posttraumatic stress, prolonged grief, and suicide. Approximately 24,000 babies in the United States are stillborn each year and over 14,000 infants die within the first 30 days of life. About 15% of parents will experience a miscarriage and more than 30% of women who experience a miscarriage meet the diagnostic criteria for posttraumatic stress disorder. Currently, there are limited efficacious and accessible treatments to attenuate the effects of trauma and intense grief that are common to perinatal loss. Prior research has found online cognitive behavioral therapy (CBT) to be effective for reducing perinatal grief and post-traumatic stress disorder symptoms. However, there is a need for programs that provide support beyond cognitive reappraisal to offer concrete strategies to reduce distress and increase availability for attachment to subsequent pregnancies including mindfulness practice and the inclusion of guiding principles for working with parents who have experienced perinatal loss. Using guiding principles of grief and infusing practical strategies to reduce distress for bereaved parents such as facilitating partner engagement and examples of grief rituals are be important additions to components of cognitive behavioral therapy for this population. Additionally, bereaved parents may experience damaging communication from health care professionals (HCPs) who lack sufficient training. There are no readily available tools that blend HCP training with direct support for bereaved parents. The goal of this phase I project is to create a prototype of a mobile application that demonstrates promise of effectiveness for reducing parent distress (traumatic stress and intensity of grief) following a perinatal loss. We will accomplish this goal by accomplishing our three specific aims: Specific Aim 1: Use an iterative formative development process to develop training and modules for grief processing and healing activities leveraging cognitive behavioral therapy and guiding principles for working with parents who have experienced perinatal loss. Specific Aim 2: Develop prototype featuring core components of the application. Specifically, HCP training and four key modules for bereaved parents including two on normalization of grief, one on mindfulness to facilitate coping with trauma and distress symptoms and one using CBT strategies to manage negative thoughts. Specific Aim 3: Evaluate the acceptability, usability, and effectiveness of Walk with Me by conducting a mixed-methods program evaluation with HCPs and bereaved parents to optimize the successful use of Walk with Me.