The Effect of Counseling With Cognitive Behavioral Approach (CBT) on Self-esteem and Body Image of Lactating Mothers: Randomized Control Trial

Abstract

\n Background: Self-esteem and body image are the factors that change during different periods of a woman’s life. Some of the women experience low self-esteem and negative body image in Pregnancy and postpartum. These two factors along with other factors can reduce the rate of exclusive breastfeeding among women. Cognitive-behavior therapy is one of the psychological approaches that is effective on the betterment of many of the psychological and personality disorders such as body image disorder as well as improvement of self-esteem. The aim of this randomized control trial is to recognize the effects of cognitive-behavior counseling during pregnancy period on self-esteem, body image (primary outcome) and exclusive breastfeeding (secondary outcome).Methods: In this randomized controlled trial, 70 eligible pregnant women referring to health centers of Tabriz-Iran were assigned to two groups of 35 as intervention and control groups using randomized blocking method. For intervention group, 8 sessions of cognitive-behavior therapy based on Cash and Strachan’s therapeutic protocol for body image and Michael Free’s for self-esteem were performed. Rosenberg self-esteem scale and multidimensional body self-relation questionnaire (MBSRQ) were completed before intervention, immediately after intervention, and 4 weeks after delivery. Likewise, exclusive breastfeeding questionnaire was completed 4 weeks after childbirth. Independent t-test, chi square and repeated measures ANOVA tests were used to analyze the data. Results: According to repeated measures ANOVA test and with controlling baseline score, the mean scores on self-esteem (adjusted mean difference (AMD): 7.18; 95%CI: 4.43 to 9.94; p<0.001) and body image (AMD: 49.74; 95%CI: 70.91 to 28.54; p<0.001) in the intervention group were significantly higher than the control group. 63.6% of intervention group mothers and 30.3% of control group mothers had exclusive breastfeeding which for the intervention group was significantly higher than the control group based on chi square test (p=0.007). Conclusions: Cognitive-behavior approach was effective on the improvement of self-esteem and body image and through which might lead to the increase of exclusive breastfeeding among women. Trial register number: Iranian registry clinical trials (IRCT20110524006582N33). Date of registration: 2020-8-19. URL: https://en.irct.ir/trial/43395.