Mindfulness is Associated with Better Perinatal Mental Health Among Uncertainty Produced by Covid-19

Mindfulness is Associated with Better Perinatal Mental Health Among Uncertainty Produced by Covid-19


By John M. de Castro, Ph.D.


use of a mindfulness-based meditation app may benefit patients who are navigating the stressors of being pregnant during the COVID-19 pandemic.” –  Orli K. Florsheim, MD


The period of pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight.


In addition, immediately after birth it is common for the mother to experience mood swings including what has been termed “baby blues,” a sadness that may last for as much as a couple of weeks. But some women experience a more intense and long-lasting negative mood called postpartum depression. This occurs usually 4-6 weeks after birth in about 15% of births; about 600,000 women in the U.S. every year. For 50% of the women the depression lasts for about a year while about 30% are still depressed 3 years later.


Hence, it is clear that there is a need for methods to treat depression, and anxiety during the perinatal period. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy and to relieve postpartum depression.


The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress for everyone including women during the perinatal period. Mindfulness is known to decrease the psychological and physical responses to stress and to improve well-being during the perinatal period. So, mindfulness training may be helpful in coping with the mental and physical challenges during the perinatal period resulting from the COVID-19 pandemic.


In today’s Research News article “The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8171361/ ) Sbrilli and colleagues recruited pregnant women or women who had given birth in the last 6 months during the Covid-19 pandemic. They were measured for Intolerance of uncertainty, mindfulness, and psychological symptoms, including anxiety, depression, and somatization.


They performed a path analysis and found that in these perinatal women intolerance of uncertainty was associated with psychological symptoms, especially anxiety and depression, directly and also indirectly by being associated with lower mindfulness which was, in turn, associated with greater psychological symptoms. The mindfulness facets that were significant in the indirect path were acting with awareness, non-reactivity, and describing.


The present study is correlational and as such caution must be exercised in reaching causal conclusions. But mindfulness has been shown in prior research to produce reductions in anxiety and depression. So, reduced mindfulness in the present study was probably the cause of the increased psychological symptoms. What’s new here is the finding that intolerance of uncertainty is directly and through mindfulness indirectly associated with increased psychological symptoms in perinatal women.


Intolerance of uncertainty is a fear of the unknown. During Covid-19 this fear is greatly amplified and the present results suggest that this results in greater anxiety and depression in these women. But since mindfulness is an intermediary it is possible that improvements in mindfulness, perhaps through training, could intervene to block the effects of intolerance of uncertainty on psychological symptoms. This is supported by the findings that mindfulness during Covid-19 improves psychological well-being.


Anxiety and depression during pregnancy can affect the birth and condition of the newborn. In addition, after birth they can affect post-partum depression. So, improving mindfulness is important during the perinatal period to improve the health and well-being of the infant and the mother. This becomes more important during the pandemic where uncertainty can exacerbate anxiety and depression.


So, mindfulness is associated with better perinatal mental health among uncertainty produced by Covid-19.


The strength of mediation habits may play a role in pregnant women’s mental health during COVID-19. Stronger meditation habits may prevent increases in stress despite increased worry related to getting infected by COVID-19 and may reduce symptoms of depression and PTSD.” – Jennifer Huberty


CMCS – Center for Mindfulness and Contemplative Studies


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Study Summary


Sbrilli, M. D., Haigler, K., & Laurent, H. K. (2021). The Indirect Effect of Parental Intolerance of Uncertainty on Perinatal Mental Health via Mindfulness During COVID-19. Mindfulness, 1–10. Advance online publication. https://doi.org/10.1007/s12671-021-01657-x




The COVID-19 pandemic is associated with mental health difficulties, especially during pregnancy and early postpartum. Intolerance of uncertainty (IU) and reduced capacity for mindfulness—a protective factor for child-bearers—may be particularly relevant factors driving mental health problems given the unpredictable nature of the pandemic. The current study aims to shed light on modifiable paths to perinatal psychological distress by testing whether there is an indirect effect of IU on psychological symptoms through a perceived reduction in mindfulness during the pandemic.


Pregnant individuals (67%, n = 133) and new mothers within 6 months postpartum (33%, n = 66) participated in a cross-sectional online survey assessing IU, current and retrospective pre-pandemic mindfulness (FFMQ), and psychological symptoms (anxiety, depression, somatization; BSI). Perceived change in mindfulness was captured by including retrospective mindfulness as a covariate in the PROCESS macro used for analyses.


Tests of the direct association between mindfulness, IU, and psychological symptoms showed significant effects of IU (b = 0.46, SE = 0.064; p < .001) and perceived decrease in mindfulness during the pandemic (b =  − 0.72, SE = 0.08, p < .001) on psychological symptoms (R2 = .21–.34; F[2, 197] = 51.13–52.81, p < .001). The indirect effect of IU on symptoms via perceived decrease in mindfulness during the pandemic (b = 0.13, SE = 0.043, 95%CI [.060, .226]) was significant (R2 = .41, F[3, 195] = 45.08, p < .001).


Results suggest that mothers who are less able to tolerate uncertainty experience more psychological symptoms, in part due to perceived reduction in mindfulness during the pandemic. Future research should examine whether IU is a screening risk marker and target for mindfulness-based interventions to improve maternal well-being and family outcomes.



Relieve Uncertainty and Panic Disorder with Mindfulness

By John M. de Castro, Ph.D.


“Panic gains momentum from the energy we put into fighting it, and the fact is, we don’t always need to fight it. Life happens to you and me as it happens to all people, whether we are ready for it or not, and all we really need to do is be open to experiencing it one moment at a time.” – Krista Lester


Anxiety and fear happen in everyone and under normal conditions are coped with adaptively and effectively and do not continue beyond the eliciting conditions. But, in a large number of people the anxiety is non-specific and overwhelming. Anxiety Disorders are the most common psychological problem. In the U.S., they affect over 40 million adults, 18% of the population, with women accounting for 60% of sufferers They typically include feelings of panic, fear, and uneasiness, problems sleeping, cold or sweaty hands and/or feet, shortness of breath, heart palpitations, an inability to be still and calm, dry mouth, and numbness or tingling in the hands or feet.


A subset of people with anxiety disorders are diagnosed with Panic Disorder. These are sudden attacks of fear and nervousness, as well as physical symptoms such as difficulty breathing, pounding heart or chest pain, intense feeling of dread, shortness of breath, sensation of choking or smothering, dizziness or feeling faint, trembling or shaking, sweating, nausea or stomachache, tingling or numbness in the fingers and toes, chills or hot flashes, and a fear that they are losing control or are about to die. A common additional symptom of panic disorder is the persistent fear of having future panic attacks. The fear of these attacks can cause the person to avoid places and situations where an attack has occurred or where they believe an attack may occur. Needless to say patients are miserable, their quality of life is low, and their ability to carry on a normal life disrupted.


There are a number of treatments for Panic Disorder including psychotherapy, relaxation training, and medication. Recently it’s been demonstrated that panic disorder can be treated with mindfulness practice. In particular, Mindfulness Based Cognitive Therapy (MBCT) has been shown to be particularly effective. It is not known, however, the exact mechanism of action of MBCT effects on Panic Disorder. In today’s Research News article “Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder.” See:


or below or view the full text of the study at:


Kim and colleagues investigate whether an intolerance of uncertainty may be a key factor in Panic Disorder and the response to MBCT. Intolerance of uncertainty is defined as a “dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications, and involves the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events.”


Kim and colleagues recruited patients suffering with Panic Disorder and treated them with an 8-week program of Mindfulness Based Cognitive Therapy (MBCT). They measured Panic Disorder intensity, depression, and intolerance of uncertainty both before and after treatment. They found that MBCT produced significant decreases in all measures, with patients having significantly lower levels of Panic Disorder intensity, depression, and intolerance of uncertainty after treatment. They also found that before treatment, the higher the level of intolerance of uncertainty, the greater the intensity of Panic Disorder and the higher the level of depression. In addition, the greater the reduction in intolerance of uncertainty produced by MBCT, the greater the reduction in Panic Disorder intensity. The significant association between intolerance of uncertainty and Panic Disorder intensity was present even after the pre-treatment level of Panic Disorder intensity and Depression were accounted for.


These results suggest that Mindfulness Based Cognitive Therapy (MBCT) is an effective treatment for Panic Disorder. They further suggest that the effectiveness of MBCT is at least in part due to it reducing the intolerance of uncertainty that is characteristic of Panic Disorder patients. Mindfulness training in general and MBCT in particular increase attention to what is transpiring in the present moment and decrease thinking about the future. Since intolerance of uncertainty is a worry about future events, it would seem reasonable that MBCT would reduce it. Since intolerance of uncertainty is clearly related to Panic Disorder, its reduction should reduce Panic Disorder.


It should be noted that the study did not contain a control (comparison) condition. So, it cannot be concluded that MBCT was responsible for the improvements. It is possible that a placebo effect or spontaneous remissions were responsible. Regardless, the results are suggestive that MBCT is a safe and effective intervention for the relief of Panic Disorder, depression, and intolerance of uncertainty. So, relieve uncertainty and panic disorder with mindfulness.


“mindfulness takes ‘thinker’ out of thought, and teaches us to step back and observe our minds and our thoughts. Mindfulness is learning to see exactly what is happening. It ‘disengages’ our ‘automatic pilot’ and gives us the necessary space to see cause and effect as it happens in ‘real’ time. Cause: thought. Effect: panic and/or anxiety.” – Bronwyn Fox


CMCS – Center for Mindfulness and Contemplative Studies


Study Summary

Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S.-H. (2016). Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder. Psychiatry Investigation, 13(2), 196–202. http://doi.org/10.4306/pi.2016.13.2.196



Objective: Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

Methods: We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

Results: There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

Conclusion: IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.