Бесплатный фрагмент - Pregnancy Loss, Stillbirth and Neonatal Death

Disclaimer

This material is provided for informational and educational purposes only. It is not intended to serve as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition.

Psychological aspects of experiencing miscarriage, stillbirth, or the loss of a newborn

The loss of a pregnancy or newborn constitutes a profound tragedy that can significantly impact a woman and her partner, resulting in emotional, psychological, and physical repercussions. This experience is not merely one of sorrow but also a time characterized by intense emotions and inquiries that frequently lack straightforward or definitive answers. Psychological support in these circumstances is crucial for the restoration of emotional well-being and the preservation of familial relationships.

Psychological responses to loss

The grieving process can be multi-faceted and may differ based on an individual’s personality, experiences, and coping mechanisms. Nonetheless, there are several common reactions that women and their partners may encounter.

Mourning and lamentation

One of the foremost responses to loss is profound grief. Women may undergo intense emotional reactions, including tears, sensations of emptiness, helplessness, anger, and even shame. The loss of an unborn child entails not only the loss of life but also the forfeiture of hopes, dreams, and future plans. This experience can be traumatic and may leave enduring impacts on a woman’s emotional well-being.

Emotions of guilt and self-reproach

Women frequently start to attribute blame to themselves for the events that transpired. In instances of miscarriage or missed abortion, they may contemplate whether their actions contributed to the outcome. These feelings of guilt are exacerbated when the reasons for the loss remain ambiguous, leaving the woman unable to comprehend the precise cause of the tragedy.

Anxiety and apprehension

Many women who have endured miscarriage or neonatal loss often experience increased anxiety and apprehension regarding future pregnancies. The anticipation of further losses may be accompanied by heightened sensitivity, concerns about infertility, or the dread of recurrent loss. This anxiety can also manifest as physical and emotional distress, including insomnia, depression, and irritability.

Alienation and solitude

Women who have endured loss often experience feelings of alienation and isolation, particularly when those around them fail to comprehend their pain or are unsure of how to respond. At times, loved ones with whom they might confide may diminish a woman’s grief, asserting that «nothing terrible has occurred» or «everything will be alright.» Such responses can intensify feelings of loneliness and despair.

2. Influence on collaborations

The loss of a child can profoundly affect not only a woman but also familial relationships. Men may also experience grief; however, their emotional expressions often differ — they may suppress their feelings, which subsequently influences their relationships with their partners. A man’s psychological state may be intertwined with his own trauma of loss and a sense of powerlessness in confronting his partner’s suffering.

Some couples may encounter challenges in communication as each partner processes loss in distinct ways. A woman might perceive that her husband fails to comprehend her grief, and the same may be true in reverse. This disparity in understanding can generate tension within the relationship.

3. Psychological assistance in managing grief

Listening and Assistance

It is essential for the woman and her partner to feel supported, cared for, and understood by their loved ones. It is vital that their experiences are recognized rather than overlooked. Acknowledging their pain and loss serves as the cornerstone for their emotional healing.

Psychotherapy and counseling services

Psychotherapeutic support can play a crucial role in the healing process. A therapist assists individuals in understanding and processing their experiences while equipping them with effective strategies to cope with grief. Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and other approaches designed to elucidate experiences and alleviate stress can be beneficial during psychological interventions.

Support networks

Being surrounded by individuals who have undergone similar experiences can be particularly beneficial. Support groups provide a platform for sharing experiences, fostering a sense of community and alleviating feelings of isolation. Emotional support, coupled with the understanding that others are navigating comparable challenges, can greatly facilitate the recovery process.

Childhood memories

Many women seek methods to commemorate the memory of their child despite the loss. This may involve establishing a memorial, engaging in a symbolic farewell ritual, or preserving personal items linked to the child. Such practices assist a woman or couple in completing the farewell process and finding a means to incorporate the experience of loss into their lives.

4. Prolonged repercussions and rehabilitation

Recovering from loss can be a prolonged journey. Women who have endured a miscarriage, stillbirth, or the loss of a newborn may require several months, and at times even years, to navigate the repercussions of their grief. Emotional recovery is intricately connected to physical healing following childbirth or medical procedures related to miscarriage. It is crucial not to hasten or impose a «quick recovery» on yourself or your partner, but rather to permit the experience to unfold at your own pace.

Psychotherapeutic Approaches

Experiencing a miscarriage, stillbirth, or the loss of a newborn constitutes an immensely painful and traumatic event that can inflict profound emotional scars. Psychotherapy is instrumental in supporting women and their partners throughout the recovery process, assisting them in navigating grief, guilt, anxiety, and other psychological challenges.

Various psychotherapeutic approaches may be employed based on the patient’s condition and requirements. Essential psychotherapeutic methods that can prove effective in these circumstances include:

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) assists clients in managing negative thoughts and emotions while altering harmful behavior patterns. In the context of miscarriage or neonatal loss, CBT seeks to aid clients in processing traumatic experiences and alleviating feelings of guilt, shame, and anxiety.

Application in psychotherapy:

— Addressing negative beliefs such as «I’m guilty» and «I’m not worthy of being a mother» assists clients in transforming them into more adaptive alternatives.

— Instruction in relaxation techniques and breathing exercises to alleviate stress and anxiety.

— Addressing traumatic stress, including the avoidance of rumination and the restoration of internal equilibrium.

2. Acceptance and Commitment Therapy (ACT)

ACT assists clients in embracing their emotions instead of evading or repressing them. This approach enables them to navigate the anguish of loss by learning to coexist with it and acknowledging it as an integral aspect of life, rather than permitting it to undermine their inner tranquility.

Application in psychotherapy:

— Assist in acknowledging challenging emotions such as sadness, anger, and anxiety, while navigating through these feelings.

— Cultivating mindfulness skills to observe your experiences without succumbing to them.

— Cultivating personal values and objectives that empower patients to reclaim their inner resources and progress despite their grief.

3. Gestalt Therapy

Gestalt therapy emphasizes the individual’s awareness and inner experience, facilitating an understanding of their experiences and acknowledging their influence on the present. This therapeutic approach can aid in restoring emotional integrity following trauma, such as the loss of a child.

Application in psychotherapy:

— Establishing a secure environment for articulating your emotions and experiences associated with loss.

— Employing the «empty chair» technique to articulate unexpressed emotions, such as coping with the loss of a child or addressing latent feelings of guilt.

— Addressing the effects of loss on present relationships and personal experiences, while facilitating the restoration of inner harmony.

4. Psychoanalysis and psychodynamic therapy

Psychoanalysis aids in comprehending the unconscious motives and responses that may obscure or intensify the experience of loss. It enables individuals to grasp the fundamental sources of fear, guilt, and grief linked to loss.

Application in psychotherapy:

— Engaging with unconscious defense mechanisms, including repression, denial, or projection.

— Addressing early traumas and their influence on the perception of loss, while rebuilding relationships with oneself and others.

— Letting go of guilt and discovering more constructive methods to cope with loss.

5. Existential Psychotherapy

Existential therapy assists individuals in navigating tragedy through the lens of life’s meaning and human existence. This therapeutic approach emphasizes the pursuit of significance in life, even in the face of loss and suffering.

Application in psychotherapy:

— Discovering significance in the experience of loss and acknowledging how this event can facilitate personal growth and development.

— Navigating the complexities of life and death, confronting the fear of loss, and exploring the significance of personal experiences.

— Assist in rebuilding confidence in one’s life and enhancing the capacity to adapt in the future.

6. Systemic family therapy

The loss of a child can profoundly affect family dynamics. Systemic therapy facilitates enhanced communication, diminishes conflict, and assists families in navigating the anguish of loss within their relationships.

Application in psychotherapy:

— Engaging with relationships within couples and the entire family, facilitating the expression of emotions, and recognizing the pain experienced by each family member.

— Addressing potential conflicts or misunderstandings that may emerge from varying experiences of loss.

— Reestablishing connections and harmony within the family by addressing attitudes and roles.

7. Group therapy and support networks

Group therapy and support groups offer participants the chance to share their experiences, provide mutual support, and recognize that they are not alone in their struggles. This fosters a sense of connection and enables individuals to benefit from one another’s insights.

Application in psychotherapy:

Sharing experiences with others who have endured similar grief fosters a sense of community.

Groups can offer a platform for sharing distress and obtaining psychological support from professionals and fellow participants.

It can serve as a source of strength and motivation for women and their partners to progress despite the loss they have endured.

8. Therapeutic practices employing rituals and symbols

Rituals and symbolic actions can assist individuals in articulating their grief and loss. This may involve establishing a memorial, conducting a farewell ceremony, or embracing symbols to honor the child’s memory.

Application in psychotherapy:

— Organizing symbolic commemorative events or activities, such as composing a letter, assembling a photo album, or engaging in remembrance rituals.

— Establishing new family traditions to honor the child’s memory while progressing forward.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is among the most effective psychotherapeutic methods for addressing miscarriage, stillbirth, or neonatal loss. CBT emphasizes the identification and modification of negative, irrational, and harmful thoughts and beliefs, while also fostering the development of healthier coping strategies for stress and grief. This approach assists patients in recognizing and managing their emotions, as well as altering behaviors that may exacerbate their condition.

Fundamental principles of cognitive behavioral therapy for grief

— Addressing negative thoughts and beliefs: The loss of a pregnancy or newborn frequently engenders thoughts such as: «It’s my fault,» «I cannot be a good mother,» «I do not deserve to be happy,» «The child I lost will never love me.» These beliefs can precipitate depression, guilt, and self-blame. Cognitive Behavioral Therapy (CBT) assists in identifying these negative thoughts and facilitates their replacement with more rational and constructive alternatives.

Instead of the thought, «I can’t survive this loss,» cognitive behavioral therapy assists the patient in substituting it with a more realistic perspective: «I am experiencing pain, but over time, I can learn to cope with this grief and move forward.»

— Addressing guilt: Women who have endured miscarriage or neonatal loss frequently experience feelings of guilt, believing they could have averted the situation. Cognitive Behavioral Therapy (CBT) assists in alleviating this guilt by guiding patients to recognize that numerous factors contributing to miscarriage or stillbirth are beyond their control and that their actions did not precipitate the tragedy.

Engaging in a conversation with a therapist who clarifies that the physical or genetic factors contributing to miscarriage are not influenced by the woman’s actions, and she bears no responsibility for the occurrence.

— Overcoming fear and anxiety: The loss of a child can instigate profound fear regarding future pregnancies, accompanied by anxiety that the tragedy may recur. Cognitive Behavioral Therapy (CBT) tackles these fears through desensitization techniques and gradual exposure to reality, thereby alleviating anxiety and enhancing preparedness for future occurrences.

Gradually developing an awareness of and confronting fear through discussions and exercises designed to alleviate anxiety, while also processing the notion that a recurrence of the tragedy is improbable.

— Cognitive restructuring and behavior modification: Transforming negative beliefs about oneself and one’s future is crucial for recovery from loss. Cognitive Behavioral Therapy (CBT) employs strategies that assist the individual in viewing the loss as an integral aspect of life, rather than a catastrophic error. Additionally, it is vital to alter behaviors that may intensify depression, such as evading social interactions or engaging in social isolation.

A patient may start to recognize instances when she refrains from communication and, with the assistance of a therapist, learn to engage more actively with her loved ones, thereby aiding her in overcoming isolation.

Relaxation and stress management techniques: Following a miscarriage or pregnancy loss, a woman may encounter intense emotional responses, including anxiety, insomnia, and physical tension. Cognitive Behavioral Therapy (CBT) assists women in managing these reactions through relaxation exercises, such as breathing techniques, progressive muscle relaxation, meditation, and various other stress reduction methods.

Instructing a patient in deep breathing techniques to alleviate anxiety and physical tension.

Stages of Cognitive Behavioral Therapy for Grief

— Evaluation of the situation and establishment of therapeutic objectives: At the onset of therapy, the therapist and patient engage in a dialogue regarding experiences related to the loss and pinpoint underlying issues — these may encompass anxiety, depression, guilt, or apprehension about the future.

— Identifying negative automatic thoughts: The therapist assists the patient in recognizing negative thoughts linked to the experience of loss. These thoughts are frequently irrational and overly generalized. The patient learns to identify these thoughts and scrutinize their validity.

— Thought restructuring: At this stage, the therapist assists the patient in transforming negative thoughts into more constructive and rational alternatives that enhance emotional well-being and alleviate stress levels.

— Psychoeducation: Psychoeducation regarding the processes of grief and loss assists the patient in recognizing that loss is an inherent aspect of life, and that the accompanying pain and experiences are natural. The therapist further elucidates strategies to mitigate the effects of traumatic experiences on future well-being.

— Behavioral intervention: It is essential to modify behaviors that may exacerbate the condition, such as avoiding certain situations or social interactions. The patient acquires new behavioral strategies to effectively manage grief and facilitate recovery.

— Final stage of therapy: In the final stage of therapy, the patient consolidates the skills and knowledge acquired and continues to focus on recovery. The therapist assists in preparing the patient for their future and fostering positive outlooks ahead.

An illustration of a cognitive behavioral therapy session addressing the experience of a miscarriage.

— Session topic: Addressing guilt and negative beliefs.

— Goals: Alleviate guilt and anxiety, transform irrational beliefs regarding loss.

Step 1: Engage in a dialogue regarding the client’s present condition — exploring his emotions and the manner in which he processes the loss.

Step 2: Recognize negative automatic thoughts, such as «I failed to protect my child» or «I am not a good mother.» Confront these thoughts with rationality and supporting evidence.

Step 3: Substitute these thoughts with more rational alternatives, such as «I could not control the factors leading to the miscarriage» or «I did everything within my power to sustain the pregnancy.»

Step 4: Exploration of potential strategies for alleviating guilt and confronting future anxieties. Conclusion of the session with relaxation techniques.

Examples of cognitive behavioral therapy (CBT) exercises for managing miscarriage, stillbirth, or neonatal loss:

Identifying and altering negative automatic thoughts

Goal: To assist the patient in identifying and transforming negative thoughts that exacerbate their emotional condition.

Exercise:

— Document the negative thoughts that arise when you contemplate the loss. Examples: «It’s my fault,» «I cannot move past this loss,» «I do not deserve to be happy.»

— For every thought, consider the following questions:

Is there any evidence to substantiate this notion? What does experience indicate?

— Are there alternative, more objective analyses of the situation?

What alternative perspective could I develop that would be more constructive and realistic?

A demonstration of cognitive substitution:

— Negative thought: «I cannot endure this.»

— Realistic thought: «This is quite painful, yet I have navigated challenging periods in my life and possess the skills to manage them. I can endure this and adapt to living with this pain.»

2. Maintaining an emotional journal

Goal: To cultivate awareness of and mitigate the profound emotions linked to loss through consistent self-reflection.

Exercise:

— For one week, document all the emotions that emerge while navigating the experience of loss.

— You may begin each entry with the question: «What did I feel today?» For instance: «I felt sorrowful because I reflected on the baby.»

— After articulating your emotions, respond to the subsequent questions:

— What actions elicited this emotion?

— Was this behavior constructive, or did it amplify my emotions?

What measures can I implement to manage these emotions in the future?

— Emotion: Sorrow.

— Reason: I encountered a song that evoked memories of childhood.

— Behavior: I retreated to my room and remained there for several hours, experiencing feelings of loneliness and isolation.

— Solution: In the future, I will endeavor to engage in open communication with my loved ones, rather than avoiding it, and will express my feelings.

3. Pragmatic evaluation of fear and anxiety

Goal: To alleviate excessive anxiety and fear that may emerge after a loss.

Exercise:

— Compile a list of your most significant fears regarding the future, such as: «I fear that I may not conceive again,» «I fear that the next pregnancy may result in another miscarriage.»

— Evaluate each fear on a scale from 1 to 10, with 1 representing the least likely fear and 10 indicating the most likely.

— Document the facts or evidence that could mitigate each of these concerns. Examples:

— Fact: Numerous women experience miscarriages yet successfully bear healthy children later in life.

— Fact: I took every possible measure to maintain my health throughout my pregnancy, yet I cannot control all influencing factors.

Example of fear evaluation:

— Fear: «I will not be able to conceive again.»

— Rating: 8/10.

— Facts that mitigate this fear: «My doctor has confirmed that my reproductive organs are functioning normally, and many women experience miscarriages yet successfully conceive again.»

4. The «Letter to a Child» Approach

Objective: Alleviation of guilt and sorrow through writing, articulation of emotions, and fulfillment of the grieving process.

Exercise:

— Compose a letter to your lost child that conveys your emotions, experiences, and regrets. This letter can be deeply personal and symbolic.

— Articulate all that you would express if given the opportunity, such as: «I love you deeply, and it pains me that I was unable to safeguard you. You will forever reside in my heart.»

After composing the letter, you may engage in a farewell ritual if it proves beneficial: incinerate the letter, release it into the river, or retain it as a memento.

Sample letter:

My dearest child, I miss you profoundly. It is hard to accept your absence, and the thought of not being able to embrace you brings me pain. You will eternally reside in my heart. I will live for you and strive to remain strong.

5. Explore alternative perspectives

Objective: To alleviate feelings of guilt and self-criticism by analyzing the situation from various perspectives.

Exercise:

— Consider the events from the viewpoint of an external observer, such as a close friend who is witnessing your circumstances.

— What insights would he offer regarding your emotions and experiences? How might he reflect on your actions?

Consider how this perspective can assist you in transforming your attitude towards yourself and your experiences.

Example of situational analysis:

— Perspective: «If this occurred to my friend, I would not assign blame; rather, I would offer my support. It is not her fault, and she is doing everything possible to heal.»

— Reflection: «Why am I unable to extend the same compassion to myself? I am deserving of support as well.»

6. Mindfulness Meditation

Goal: To assist an individual in navigating experiences while fostering awareness of the present moment without judgment.

Exercise:

— Locate a tranquil environment and concentrate on your breathing. Permit yourself to experience each inhalation and exhalation.

When thoughts of your loss start to distract you, refrain from self-judgment. Instead, redirect your focus to your breathing.

After a few minutes, pause to acknowledge your feelings. Observe the emotions that surface and permit them to exist without attempting to suppress them.

Example:

During meditation, you may experience feelings of sadness or pain. Simply acknowledge these emotions: «Yes, I am feeling sad at this moment, and that is acceptable.»

An illustration of a cognitive behavioral therapy (CBT) session addressing the experiences of miscarriage, stillbirth, or neonatal loss:

Context and Objectives of the Session:

A client, Ekaterina, experienced a miscarriage during her fifth month of pregnancy and is seeking therapy. She grapples with feelings of guilt, grief, and anxiety regarding the possibility of another loss. The objective of the session is to assist Ekaterina in mitigating her guilt, alleviating her anxiety, and confronting negative thoughts about the future.

Step 1: Initiating communication and conveying support

Therapist:

«Ekaterina, I appreciate your presence. This must be an incredibly challenging time for you. It is essential that you feel secure and express your emotions candidly. Could you share what has been the most difficult aspect of this loss for you?»

Catherine:

«I feel as though I have failed to protect the baby. I believed everything would be fine, and then this occurred… I continually think it is my fault. I fear that I will make another mistake and lose the baby once more.»

Step 2: Recognizing Negative Automatic Thoughts

Therapist:

«I recognize that you feel a sense of responsibility for the loss. Let us endeavor to explore the thoughts that are causing you distress. What particular thoughts arise when you reflect on the loss of a child?»

Catherine:

«I fear that I may not be a good mother. I frequently make mistakes, and what if it occurs again? I am concerned that I may not be able to provide my child with a fulfilling life.»

Therapist:

«These thoughts appear quite challenging. Let us document them for subsequent analysis to determine which may be distorted. For instance: „I cannot be a good mother.“ We should inquire: What does this thought entail, and is there evidence to support its validity?»

Stage 3: Cognitive Restructuring

Therapist:

«You express doubt about your ability to be a good mother. What are your thoughts on the qualities of a good mother? Can you provide examples of how you demonstrated care and love for your child, even in the context of not being able to continue the pregnancy?»

Catherine:

«Throughout my pregnancy, I prioritized my well-being, diligently monitored my health, and attended all essential checkups. I maintained the belief that if I adhered to the proper practices, everything would turn out well.»

Therapist:

«This is indeed significant, and you have demonstrated responsibility and compassion. However, it is essential to recognize that numerous factors influencing the trajectory of your pregnancy may lie beyond your control. For instance, genetic or physical elements may be outside your influence. Let us consider how you might reframe your thoughts to adopt a more realistic perspective. How could you transform the thought, „I can’t be a good mother,“ into something more constructive?»

Catherine:

«I suppose I could remind myself, „I did my utmost, and my love and care were sincere, even if circumstances arose that were beyond my control.“»

Therapist:

«Excellent, that perspective is significantly more realistic and aids in alleviating your guilt. Now, let us consider strategies for managing your fear of the future. For instance, you mentioned your apprehension about losing someone again. What reflections arise regarding your future when such thoughts occur?»

Stage 4: Engaging with Fear and Anxiety

Catherine:

«I am deeply fearful that it will occur once more. The thought of becoming pregnant again fills me with dread, as I am apprehensive about the possibility of losing the baby again.»

Therapist:

«I understand. Let us attempt to analyze this fear. Please rate it on a scale from 1 to 10, where 1 signifies unlikely and 10 indicates a high probability. How likely do you believe it is that you will experience the loss of a child again?»

Catherine:

«I would rate it an 8 out of 10. I fear I will be unable to evade it.»

Therapist:

«Understood. Now, let us consider how we can mitigate this fear. For instance, what measures can we implement to prepare for a future pregnancy? Are there any actions you can undertake to diminish the chances of this occurring again?»

Catherine:

«I will continue to monitor my health and undergo further tests to ensure everything is in order. Additionally, I wish to discuss with my doctor the potential causes of the miscarriage.»

Therapist:

«These are excellent measures that will enhance your sense of control and confidence. They will assist in alleviating your anxiety. Keep in mind that while the risk of miscarriage is present, it is not always within your control. Can you evaluate your fear after considering it from this perspective?»

Catherine:

«I currently rate it a 5 out of 10. I believe I can implement measures to mitigate my risk and prioritize my well-being.»

Step 5: Examination of self-help strategies and conclusion of the session

Therapist:

«Excellent, Ekaterina. We have engaged in several beneficial exercises that have aided you in alleviating guilt and diminishing your anxiety. To sustain these improvements, it is essential to persist in practicing these skills in your daily routine. For instance, maintain an emotional journal, document your thoughts and feelings, and strive to analyze them with greater objectivity. Additionally, continue developing your pregnancy plan, which will enhance your confidence.»

Catherine:

«I feel somewhat improved after our conversation. It is essential for me to take proactive steps for my well-being and future, rather than endure in solitude.»

Therapist:

I am pleased to hear that you are feeling better. It is essential to prioritize self-care and practice kindness towards yourself. Grieving is a process that requires time. We can further explore these topics in our future sessions.

Catherine:

«Thank you for your support. I am prepared to further develop myself and my experiences.»

Conclusion of the session:

The client developed skills in recognizing and altering negative thoughts while addressing her fears and anxieties regarding the future. She learned to adopt a more constructive perspective on her loss, which diminished feelings of guilt and anxiety. Ekaterina also began to understand that she possesses control over her health and future choices, thereby alleviating her fear of a recurrence of the tragedy.

The outcomes of cognitive behavioral therapy (CBT) for addressing miscarriage, stillbirth, or neonatal loss can be substantial; however, they are contingent upon the individual client’s attributes, the intensity of their grief, available support systems, and the level of professional assistance. Nonetheless, several notable changes and enhancements can be recognized that clients generally undergo following the completion of therapy.

Diminished feelings of guilt and self-reproach

One of the most prevalent psychological effects following the loss of a child is guilt. A woman may perceive herself as responsible for the loss. Through cognitive behavioral therapy, clients start to acknowledge that numerous factors, such as genetics or health, lie beyond their control, rendering guilt unproductive. Therapy aids in diminishing self-criticism and fosters greater tolerance and compassion.

2. Alleviating anxiety and apprehension regarding the future

Many individuals who have endured miscarriage or the loss of a child harbor concerns about the possibility of experiencing such a loss again. Cognitive Behavioral Therapy (CBT) assists women in alleviating excessive anxiety and fosters a more realistic perspective when evaluating future risks. Developing the ability to objectively assess potential threats while employing self-soothing techniques, such as relaxation or breathing exercises, contributes to a reduction in stress.

3. Modifying cognitive distortions

In therapy, women learn to identify and confront cognitive distortions, such as catastrophizing (anticipating the worst possible outcome) or generalizing (e.g., «all future pregnancies will resemble this one»). Addressing these distortions aids in alleviating fears and fostering a more balanced understanding of their experiences.

4. Acknowledgment of loss and grief

Acceptance of loss is a crucial component of therapy. In sessions, clients come to understand that loss is an integral part of their lives and that it is essential to develop coping mechanisms for this grief. Acceptance diminishes the intensity of pain and encourages individuals to acknowledge their emotions, transforming them into constructive actions rather than suppressing them.

5. Restoring self-assurance

The therapeutic process also aids in restoring confidence in one’s strengths and capabilities as a prospective mother. A woman recognizes that, despite previous losses, she maintains her worth and potential for motherhood. Therapy facilitates the overcoming of fear and the discovery of inner strength to pursue the next steps.

6. Engaging with relationships and support

Miscarriage or child loss can significantly affect relationships with partners and loved ones. Cognitive Behavioral Therapy (CBT) assists clients in navigating their emotions within these relationships, guiding partners to support one another, articulate their feelings openly, and reinforce their connection. The therapist can also facilitate enhanced communication and address potential feelings of alienation.

7. Formulating decisions regarding the future

After engaging with CBT, clients often come to understand that they possess the autonomy to make decisions regarding their future, including the option of conceiving, attempting again, or exploring alternative avenues to motherhood. A crucial aspect of this process involves preparing for subsequent steps and ensuring they can advocate for their own best interests.

8. Overall enhancement of the psycho-emotional condition

Overall, cognitive-behavioral therapy (CBT) fosters enhancements in psycho-emotional well-being. Women often discover greater ease in managing grief, anxiety, depression, and other adverse experiences linked to loss. This can result in significant improvements in their overall psycho-emotional health and quality of life.

Example of therapeutic outcomes:

Masha, who experienced an early miscarriage, ceased to feel overwhelming guilt after undergoing therapy, recognizing that her loss was beyond her control. She learned to adopt a positive perspective on her efforts to maintain her health and understood that not all circumstances are within her control. Masha began to feel more assured in making decisions regarding future pregnancies, addressing her fears and restoring her self-confidence.

Ekaterina, having endured a miscarriage, markedly alleviated her anxiety regarding the future. She transformed her distorted beliefs about her capacity to be a good mother and came to perceive loss as an integral aspect of her life experience, rather than a personal failing.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is a psychotherapeutic modality that emphasizes the acceptance of challenging emotions and thoughts, alongside actions that are congruent with the client’s values and life objectives. This approach can be particularly beneficial for women who have endured miscarriage, stillbirth, or neonatal loss, as it alleviates the distress linked to grief, anxiety, and guilt, while concurrently fostering the restoration of inner resilience and equilibrium.

Key principles of Acceptance and Commitment Therapy (ACT) in the context of experiencing miscarriage or child loss:

— Embracing Pain and Grief: Rather than resisting grief and evading pain, ACT encourages clients to accept the entirety of their experiences. Challenging emotions, including sadness, fear, and despair, are not repressed but integrated into life. Acknowledging that painful experiences are an inherent aspect of grief and loss is essential.

— Exercise: The client is encouraged to visualize an image that represents loss and to reflect on the associated physical sensations, such as chest pain or abdominal tension. Subsequently, through breathing exercises, the client learns to «embrace this pain» rather than evade it.

— Distancing oneself from one’s thoughts: ACT assists clients in recognizing that their thoughts do not constitute objective reality; rather, they are simply mental occurrences. For instance, the thought, «I cannot be a good mother because I lost my child,» is regarded as merely a thought, not an absolute truth. This perspective diminishes the impact of negative thoughts and provides the client with the opportunity to make decisions that are not solely driven by their emotions.

— Exercise: Acknowledge that thoughts do not equate to facts. For instance, a client may engage in an exercise where they mentally reiterate a distressing thought («I lost my child, so I am a bad mother») and come to understand that these are merely thoughts that can be contested and do not accurately represent their true character.

— Distancing from negative emotions. The principle of distancing entails assisting the client in learning to de-identify from their experiences, such as not being defined solely by «grief» or «loss.» This approach enables the client to mitigate excessive fixation on emotions and to recognize them as an integral, albeit transient, aspect of their life.

— Exercise: Envision emotions as clouds drifting across the sky. While they may be dark, they eventually dissipate, revealing a clear sky beyond. This exercise aids the client in recognizing their emotions as transient and fleeting.

— Recognizing Your Values and Creating Meaning. A fundamental aspect of Acceptance and Commitment Therapy (ACT) is assisting clients in identifying their core values and aspirations, which can serve as a compass for their healing journey. Rather than fixating on their past experiences, the therapist encourages clients to concentrate on what truly matters to them in life and what they wish to pursue despite their suffering.

— Exercise: The client is encouraged to compile a list of their values, such as «being a good mother,» «living life to the fullest,» or «helping others.» Subsequently, they select one action that resonates with this value and undertake it, regardless of their discomfort.

— Acting in accordance with values. It is essential not only to recognize your feelings and values but also to take action despite the discomfort. ACT instructs clients to engage in behaviors that uphold their values, even in challenging circumstances. This may involve, for instance, choosing to attempt conception again, resuming regular activities, or attending to the needs of other family members.

— Exercise: The client may initiate small actions that facilitate progress, such as reinstating a regular daily routine, engaging in a hobby, or assisting a close acquaintance.

— Mindfulness (mindfulness) Mindfulness practices in ACT assist clients in focusing on the present moment, rather than ruminating on past regrets or future anxieties. This approach can aid clients in managing painful memories of loss and learning to refrain from excessive contemplation of them.

— Exercise: Mindful Breathing. The client practices slow, deep breathing while concentrating on bodily sensations. This technique aids in grounding oneself in the present moment and alleviating anxiety.

An illustration of an ACT therapy session for coping with a miscarriage:

Therapist: «Hello, Ekaterina. Thank you for being here. We recognize that you have endured a significant loss. Today, we will focus on how to navigate your feelings and experiences, not by suppressing them, but by accepting them, allowing you to continue living despite the pain.»

Ekaterina: «I sense that all of this has become an integral part of my being. I cannot forget this loss. It is exceedingly difficult for me…»

Therapist: «These emotions can be quite overwhelming. Instead of resisting them, let us aim to embrace them. Acknowledge that you are currently experiencing this grief. It is crucial to recognize that pain is an integral aspect of your journey, yet it does not wholly define you. Can you identify where this pain manifests in your body?»

Ekaterina: «It feels as though someone is constricting my heart… located in my chest.»

Therapist: «Concentrate on these sensations. Acknowledge them while breathing steadily, not attempting to eliminate the pain, but simply permitting its presence. Visualize the pain as a cloud that slowly dissipates. Are you prepared to accept this pain alongside you, without seeking to evade it?»

Ekaterina: «I will make an effort. It is challenging, yet I recognize its necessity.»

Therapist: «Excellent. Remember, you are not alone in this. While the pain persists, it does not define your identity. Your values and actions are significant. What is important to you in this situation? What role do you wish to assume in your recovery?»

Ekaterina: «I aspire to be a good mother when I feel prepared once more… Additionally, it is essential for me to prioritize my own well-being.»

Therapist: «Excellent. Let us take a modest step toward restoring your sense of self-worth. For instance, you might allocate time for self-care: enjoying walks outdoors, maintaining a nutritious diet, or simply unwinding. This will reinforce your values.»

Results of acceptance and commitment therapy for individuals experiencing miscarriage, frozen pregnancy, or the loss of a newborn:

— Acceptance of loss: The client starts to recognize their pain and loss as an essential aspect of life, rather than something to be evaded or repressed.

— Alleviating fear and anxiety: Employing acceptance strategies can assist in diminishing anxiety regarding potential losses or pregnancy.