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ADEPT

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Qualitative Lead(s)

Professor Vanessa Lawrence

Project Lead & Team

Chief Investigator: Fiona Challacombe
Multidisciplinary team including perinatal psychiatrists, clinical psychologists, trialists, statisticians, and lived-experience advisory group members.

Project Dates

2019–2023

Funding Source(s)

NIHR/HEE Clinical Doctoral Research Fellowship

Qualitative Design used

Field of Research

Perinatal mental health; anxiety disorders; psychological therapies; intervention delivery models

Geographic/Contextual Setting

UK maternity services, primary care psychological therapy services (IAPT), and perinatal mental health services.

Optimising Psychological Treatment for Anxiety Disorders in Pregnancy — A Feasibility Study of Time-Intensive Versus Weekly Cognitive Behavioural Therapy

ADEPT was a multicentre feasibility randomised controlled trial examining the acceptability, feasibility, and preliminary outcomes of time-intensive exposure-based cognitive behavioural therapy (CBT) compared with standard weekly CBT for anxiety disorders during pregnancy. Qualitative research was embedded within the feasibility trial to explore women’s and therapists’ experiences of treatment delivery, exposure-based therapy, and intervention formats. Findings informed optimisation of treatment delivery, recruitment strategies, and procedures for a future definitive trial while providing evidence that exposure-based CBT is acceptable and beneficial during pregnancy.

Qualitative Approach and Methods

Aim of the qualitative component

To explore women’s and therapists’ experiences of receiving and delivering exposure-based CBT during pregnancy, including perceptions of treatment acceptability, feasibility, barriers to engagement, and preferences for therapy delivery formats, and to inform optimisation of intervention delivery and trial procedures.

Qualitative methodology

Interpretivist qualitative design using reflexive thematic analysis embedded within a feasibility randomised controlled trial.

Which qualitative methods were used?

  • Individual interviews with pregnant women who participated in the feasibility trial.
  • Individual interviews with therapists delivering CBT interventions.
  • Integration of qualitative findings with quantitative feasibility metrics to inform intervention and trial optimisation.

Sampling & recruitment

Women who participated in the ADEPT feasibility trial were invited to take part in qualitative interviews following completion of treatment, alongside therapists delivering the intervention. Forty-five women and six therapists participated, capturing experiences across both treatment arms (time-intensive and weekly CBT).

Data analysis: how the team made sense of the data

Interview transcripts were analysed using reflexive thematic analysis, with coding and theme development undertaken collaboratively within the research team to explore shared and divergent perspectives across patient and therapist groups.

Findings, Learning & Impact

Summary of main findings

Qualitative findings showed that exposure-based CBT was acceptable and helpful for women experiencing anxiety disorders during pregnancy, supporting confidence in delivering exposure therapy in this context. Participants valued therapy tools that helped them manage anxiety and prepare for birth and parenting, while also emphasising the importance of flexibility to accommodate the physical and practical demands of pregnancy. Intensive CBT was experienced as providing strong therapeutic momentum and rapid improvements for some women, although both treatment formats required adaptability to individual circumstances.

Why were qualitative methods used in this project, and what did they enable?

Qualitative research enabled the study to:

  • Understand women’s and therapists’ experiences of exposure-based CBT during pregnancy.
  • Identify barriers and facilitators affecting treatment engagement.
  • Compare perceived benefits and challenges of intensive versus weekly delivery formats.
  • Inform optimisation of intervention delivery and design of a future definitive trial.

Lessons learnt / reflections?

  • Exposure-based psychological therapies can be acceptable and beneficial during pregnancy when delivered with appropriate flexibility and therapist expertise.
  • Treatment engagement in perinatal populations is strongly shaped by logistical demands, physical changes, and service flexibility.
  • Embedding qualitative research in feasibility trials strengthens interpretation of quantitative measures of acceptability and engagement and supports intervention optimisation.

Impact & influence

The ADEPT feasibility study demonstrated that both treatment formats were acceptable and feasible, supporting progression to a potential definitive trial evaluating intensive CBT delivery in perinatal mental health services. Qualitative findings informed refinement of treatment delivery approaches and contributed to emerging methodological guidance on psychological therapy trials in pregnancy.

Links, Outputs & Resources

Links to publications

  • Challacombe FL, Tinch-Taylor R, Sabin K, Potts L, Lawrence V, Howard L, Carter B. Exposure-based cognitive-behaviour therapy for anxiety-related disorders in pregnancy (ADEPT): Results of a feasibility randomised controlled trial of time-intensive versus weekly CBT. J Affect Disord. 2024 Jan 1;344:414-422. doi: 10.1016/j.jad.2023.10.070. Epub 2023 Oct 15. PMID: 37848088. Available here
  • Challacombe FL, Sabin K, Jacobson S, Tinch-Taylor R, Potts L, Carter B, Lawrence V. Patient and therapist experiences of exposure therapy for anxiety-related disorders in pregnancy: qualitative analysis of a feasibility trial of intensive versus weekly CBT. BJPsych Open. 2023 Oct 12;9(6):e189. doi: 10.1192/bjo.2023.585. PMID: 37822231; PMCID: PMC10594159. Available here