Reaching Calm: A Digital Intervention to Prevent Perinatal Anxiety Disorders

My goal is to become an independent clinical scientist focused on transforming health care systems to prevent perinatal anxiety disorders. This K23 award will provide the advanced research training, protected time, mentorship, and research experience I need to launch the next stage of my career. As many as 1 in 5 perinatal individuals experience an anxiety disorder. These disorders confer significant risks to perinatal individuals and their children and disproportionately impact perinatal individuals with low socioeconomic status (e.g., uninsured, receiving public insurance, or facing housing or food insecurity). A shift in focus to prevent perinatal anxiety disorders before they rise to this level of concern is long overdue. Anxiety Sensitivity Interventions are a promising approach to the prevention of perinatal anxiety. Anxiety Sensitivity Interventions are a cognitive-behavioral-based approach to prevention. These brief interventions (<6 sessions) are designed for prevention by targeting a malleable risk factor for anxiety rather than symptom reduction. While Anxiety Sensitivity Interventions have demonstrated effectiveness in the general population, 1) their application in the perinatal population has not been explored, 2) nor have they been scaled to reach a large population. Traditional, multi-session approaches are not likely to have sufficient reach in the perinatal population. Less than 7% of affected individuals receive treatment for a perinatal anxiety disorder. Evidence-based interventions are even less likely to reach perinatal individuals with low socioeconomic status. Approaches that can reach these groups are needed. In my KL2, we identified key components for adapting Anxiety Sensitivity Interventions. Components included content personalization, additional content describing resources (e.g., doulas), user-provided information, and transparent options for data sharing. We then adapted an Anxiety Sensitivity Intervention for perinatal individuals and for digital health to create the Reaching Calm intervention, a multicomponent digital health intervention to prevent perinatal anxiety in obstetric settings. Reaching Calm includes a 1) digital Anxiety Sensitivity Intervention including SMS text messages and web-based user interface, 2) training for obstetric providers, and 3) implementation protocol for integrating anxiety prevention into the obstetric practice setting. In this K23, we will conduct a pilot cluster RCT to assess feasibility (Aim 1), acceptability, and preliminary effectiveness (Aim 2), and examine user-centered design engagement strategies (Aim 3). We will leverage our community-engaged, user-centered design, and implementation science approach to maximize reach. This work will provide the foundational knowledge and formulate the content needed to prepare an R01 submission to test Reaching Calm in a hybrid effectiveness-implementation trial, with the long-term goal of an intervention that can be sustainably integrated into obstetric settings.