Inquiry-Based Stress Reduction for Postpartum Anxiety and Stress During Armed Conflict: A Randomized Clinical Trial

Importance

The postpartum period presents heightened vulnerability to stress and anxiety, particularly during wartime. While pregnancy interventions are well-studied, postpartum mental health requires targeted approaches. Inquiry-Based Stress Reduction (IBSR), combining mindfulness with cognitive reframing, has reduced depression and stress in various populations and could provide postpartum women with stress management tools during prolonged conflict.

Objective

To evaluate the effects of IBSR on anxiety and perceived stress in postpartum women during armed conflict.

Design, Setting, and Participants

This randomized clinical trial comprised an 8-week intervention and 4-week follow-up, conducted from June 9, 2024, to January 19, 2025. Participants included women aged 18-45 years up to 2 years postpartum with no psychiatric history, recruited via social media.

Interventions

Participants were randomly assigned (1:1) to either an 8-week IBSR group-based intervention or a waitlist control group. The IBSR program included weekly 3-hour group sessions and 1-hour guided home practice sessions.

Main Outcomes and Measures

Primary outcomes were anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7]) and perceived stress (Perceived Stress Scale [PSS-10]). Secondary outcomes included emotional regulation, psychological well-being, quality of life, resilience, and perceived social support. Assessments were conducted at baseline (T0), postintervention (T1), and 4-week follow-up (T2).

Results

Among 105 randomized participants (mean [SD] age, 31.9 [6.2] years), 91 (86.7%) completed all assessments. Thirty percent of intervention participants (12 of 40) dropped below the clinical anxiety threshold (GAD-7 score <8) vs 7.7% of controls (5 of 65) (χ² = 9.01; P = .002). The intervention group showed greater reductions in anxiety (Cohen d = −0.55; 95% CI, −1.00 to −0.10; P < .05) and perceived stress (Cohen d = −1.09; 95% CI, −1.56 to −0.62; P < .01), maintained at follow-up. Cognitive reappraisal improved significantly (Cohen d = 0.99; 95% CI, 0.52-1.45; P < .01). No significant differences emerged for psychological well-being, resilience, quality of life, or social support.

Conclusions and Relevance

IBSR significantly reduced anxiety and stress in postpartum women during wartime, with effects maintained at 4-week follow-up. This intervention offers a scalable nonpharmacological approach for conflict-affected settings.

Trial Registration: ClinicalTrials.gov Identifier: NCT06490094