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Ramezani M, Dehghani M, Moghadam S M, Abdollahpour S. Motivational Counseling Versus Acceptance and Commitment Therapy for Postnatal Post-traumatic Stress Symptoms: A Randomized Controlled Trial. Iran J Health Sci 2026; 14 (3) :257-272
URL: http://jhs.mazums.ac.ir/article-1-1132-en.html

Background and Purpose: Secondary tokophobia, or fear of subsequent pregnancy and childbirth, often linked to postnatal post-traumatic stress symptoms (P-PTSS), can result from a negative prior experience and lead to avoidance of childbearing. Given the importance of maintaining a young population in Iran, this study aimed to compare the effectiveness of acceptance and commitment therapy (ACT) versus motivational counseling (MC), delivered via telemedicine, on P-PTSS among women with one child and secondary tokophobia. 
Materials and Methods: This three-arm randomized controlled trial was conducted from January 2024 to March 2025 in Mashhad, Iran, and included 102 women with one child and secondary tokophobia, diagnosed using the fear of childbirth prior pregnancy (FOCPP) scale and assessed using the impact of event scale (IES). Participants were randomly assigned in six blocks to an ACT group, an MC group, or a control group. The primary outcome was P-PTSS severity, measured at baseline, 4 weeks post-intervention, and 6–8 weeks post-intervention. After attrition, 94 participants were analyzed (ACT=33, MC=32, control=29). Data were entered into a computer, and analyzed using SPSS software version 25. One-way analysis of variance and chi-square tests were performed at a significance level of 0.05. 
Results: Among the 102 women with one child and secondary tokophobia (mean age: 31.28±5.08 years), 34 were randomized to each of the three groups. Four weeks post-intervention, P-PTSS scores significantly decreased in the ACT (24.36±4.07) and MC (26.59±3.2) groups, whereas they had increased in the control group (34.13±6.11). This difference between the groups was statistically significant (P<0.001), suggesting a positive effect of the interventions. At the eight-week follow-up, the improvement continued in the ACT (22.36±3.3) and MC (23.62±2.58) groups, while the control group remained high (33.65±5.84), with a significant difference between the groups (P<0.001). However, no statistically significant differences were observed between the ACT and MC groups at either follow-up assessment. 
Conclusion: Telemedicine-based MC and ACT counseling effectively and significantly reduced postnatal PTSS scores in women with one child and secondary tokophobia at two follow-up time points. Telemedicine‑based ACT and MC appear promising for counseling women with secondary tokophobia who are considering another pregnancy; however, longer follow-up periods and broader settings are needed.