Developing pregnancy-specific dialectical behavior therapy skills to promote multigenerational mental health

PROJECT SUMMARY/ABSTRACT Emotion dysregulation in pregnancy is an impairing transdiagnostic vulnerability factor that has critical implications for two generations. Although mental health in pregnancy has been a focus of basic and translational research, most studies have focused on maternal depression or anxiety, neglecting other severe clinical disorders characterized primarily by emotion dysregulation (e.g., personality disorders; self-injurious thoughts and behaviors). The proposed study will test the premise that targeting emotion dysregulation may have transformational benefits for pregnant women and, importantly, may function as a prenatal intervention to affect infant health prior to birth. This innovative R61/R33 proposal proposes a novel group skills intervention that will address the unique emotional needs of pregnancy by applying effective elements of dialectical behavior therapy skills—a treatment that is ideally suited for improving emotion regulation. We expect that reducing maternal prenatal emotion dysregulation will in turn improve infant neurobehavioral and self-regulation at birth and 6 months, making this a novel preventive intervention for infants. Data from our laboratories supports the premise that high prenatal emotion dysregulation associates with blunted maternal physiology and infant neurobehavioral dysregulation. Unknown is whether it is possible to improve maternal and infant health with a unique, emotion- focused intervention designed to engage two key targets: maternal emotion regulation skills or physiological regulation via respiratory sinus arrhythmia (RSA). In the R61 phase, participants will be randomized to our newly developed perinatal DBT skills (DBT-P) compared with an assessment only (AO) control (N=40/group) to establish target engagement of increased emotion regulation skills or resting-state RSA. In the R33 phase, findings will be extended by comparing DBT-P with an active control (Moms2B), an established prenatal group health-based intervention to improve nutrition (N=50/group), to determine whether DBT-P improves newborn and infant behavior regulation. Across both phases, women will be enrolled based upon high emotion dysregulation scores (≥88) on the Difficulties with Emotion Regulation Scale (DERS) and outcomes will be assessed with a pre-post, intent-to-treat design. Target engagement is defined as increases in clinician-assessed emotion regulation skills (clinical target) or resting-state RSA (biological target). To accomplish these innovative aims, we will use our established protocols to recruit, enroll, and retain dysregulated pregnant participants and our existing strategies for assessing newborn neurodevelopment using the Neonatal Network Neurobehavioral Scale (NNNS) and infant self-regulation. This study capitalizes on the talents of the investigative team, which unites experts in maternal-infant mental health, clinical trials management, and DBT. Our study is significant because it will result in a novel intervention targeted specifically for emotionally dysregulated pregnant women with the innovative potential to improve infant regulation prior to birth.