Mindfulness-Based Program for Infertility: efficacy study


      To present and determine the impact of the Mindfulness-Based Program for Infertility (MBPI).


      Controlled clinical trial.


      University research unit.


      Fifty-five infertile women completed the MBPI, and 37 infertile women were assigned to a control group.


      The MBPI includes 10 weekly sessions, in a group format, with a duration of about 2 hours each (men attend three sessions).

      Main Outcome Measure(s)

      Standardized measures of depression, state anxiety, entrapment, defeat, internal and external shame, experiential avoidance, mindfulness, self-compassion, and infertility self-efficacy were endorsed pre- and post-MBPI.


      The MBPI group and the control group were shown to be equivalent at baseline. By the end of the MBPI, women who attended the program revealed a significant decrease in depressive symptoms, internal and external shame, entrapment, and defeat. Inversely, they presented statistically significant improvement in mindfulness skills and self-efficacy to deal with infertility. Women in the control group did not present significant changes in any of the psychological measures, except for a decrease in self-judgment.


      Increasing mindfulness and acceptance skills, as well as cognitive decentering from thoughts and feelings, seem to help women to experience negative inner states in new ways, decreasing their entanglement with them and thus their psychological distress. Data suggest that the MBPI is an effective psychological intervention for women experiencing infertility.

      Key Words

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        • Menning B.E.
        The emotional needs of infertile couples.
        Fertil Steril. 1980; 34: 313-319
        • Burns L.H.
        • Covington S.N.
        Psychology of infertility.
        in: Covington S.N. Burns L.H. Infertility counseling a comprehensive handbook. Cambridge University Press, New York2006: 1-19
        • Wischmann T.
        • Stammer H.
        • Scherg H.
        • Gerhard I.
        • Verres R.
        Psychological characteristics of infertile couples: a study by the Heidelberg Fertility Consultation Service.
        Hum Reprod. 2001; 16: 1753-1761
        • Chen T.H.
        • Chang S.P.
        • Tsai C.F.
        • Juang K.D.
        Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic.
        Hum Reprod. 2004; 10: 2313-2318
        • Cohen J.
        • Cohen P.
        • West S.
        • Aiken L.
        Applied multiple regression/correlation analysis for behavioural sciences.
        3d ed. Lawrence Erlbaum Associates, New Jersey2003
        • Eugster A.
        • Vingerhoets A.J.J.M.
        Psychological aspects of in vitro fertilization: a review.
        Soc Sci Med. 1999; 48: 575-589
        • Greil A.
        Infertility and psychological distress: a critical review of the literature.
        Soc Sci Med. 1997; 45: 1679-1704
        • Verhaak C.M.
        • Lintsen A.M.E.
        • Evers A.W.M.
        • Braat D.D.M.
        Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment.
        Hum Reprod. 2010; 25: 1234-1240
        • Verhaak C.M.
        • Smeenk J.M.J.
        • Evers A.W.M.
        • Kremer J.A.M.
        • Kraaimaat F.W.
        Women's emotional adjustment to IVF: a systematic review of 25 years of research.
        Hum Reprod. 2007; 13: 27-36
        • Volgsten H.
        • Svanberg A.S.
        • Ekselius L.
        • Lundkvist Ö.
        • Poromaa I.S.
        Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment.
        Hum Reprod. 2008; 23: 2056-2063
        • Ramazanzadeh F.
        • Noorbala A.A.
        • Abedinia N.
        • Naghizadeh M.M.
        Emotional adjustment in infertile couples.
        Iran J Reprod Med. 2009; 7: 97-103
        • Brandes M.
        • van der Steen J.O.
        • Bokdam S.B.
        • Hamilton C.J.
        • de Bruin J.P.
        • Nelen W.L.
        • et al.
        When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population.
        Hum Reprod. 2009; 24: 3127-3135
        • Boivin J.
        A review of psychosocial interventions in infertility.
        Soc Sci Med. 2003; 57: 2325-2341
        • deLiz T.M.
        • Strauss B.
        Differential efficacy of group and individual/couple psychotherapy with infertile patients.
        Hum Reprod. 2005; 20: 1324-1332
        • Hammerli K.
        • Znoj H.
        • Barth J.
        The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and 370 pregnancy rate.
        Hum Reprod Update. 2009; 15: 279-295
        • Chan C.H.Y.
        • Chan C.L.W.
        • Ng E.H.Y.
        • Ho P.C.
        • Chan T.H.Y.
        • Lee G.L.
        • et al.
        Incorporating spirituality in psychosocial group intervention for women undergoing in vitro fertilization: A prospective randomized controlled study.
        Psychol Psychother Theory Res Prac. 2012; 85: 356-373
        • Domar A.D.
        • Rooney K.L.
        • Wiegand B.
        • Orav E.J.
        • Alper M.M.
        • Berger B.M.
        • et al.
        Impact of a group mind/body intervention on pregnancy rates in IVF patients.
        Fertil Steril. 2011; 95: 2269-2273
        • Korszycki D.
        • Bisserbe J.-C.
        • Blier P.
        • Bradwedjn J.
        • Markowitz J.
        Interpersonal psychotherapy versus brief supportive therapy for depressed infertile women: first pilot randomized controlled trial.
        Arch Women's Mental Health. 2012; 15: 193-201
        • Baer R.A.
        Mindfulness training as a clinical intervention: a conceptual and empirical review.
        Clin Psychol Sci Pract. 2003; 10: 125-143
        • Kabat-Zinn J.
        Full catastrophe living.
        Delta, New York1990
        • Domar A.D.
        • Seibel M.M.
        • Benson H.
        The mind/body program for infertility: a new behavioral treatment approach for women with infertility.
        Fertil Steril. 1990; 53: 246-249
        • Hayes S.C.
        • Stroshal K.D.
        • Wilson K.G.
        Acceptance and commitment therapy: an experiential approach to behavior change.
        Guilford Press, New York1999
        • Luoma J.B.
        • Hayes S.C.
        • Walser R.D.
        Learning ACT—an acceptance and commitment therapy skills-training manual for therapists.
        New Harbinger Publications, Oakland2007
        • Ciarrochi J.V.
        • Bailey A.
        A CBT practitioner's guide to ACT—how to bridge the gap between cognitive behavioral therapy and acceptance and commitment therapy.
        New Harbinger Publications, Oakland2008
        • Harris R.
        ACT made simple: a quick-start guide to ACT basics and beyond.
        New Harbinger Publications, Oakland2009
        • Hayes S.C.
        • Smith S.
        Get out of your mind and into your life: the new acceptance and commitment therapy.
        New Harbinger Publications, Oakland2005
        • Beck A.
        • Ward C.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Vaz-Serra A.
        • Pio-Abreu J.L.
        Aferição dos quadros clínicos depressivos I—estudo de aplicação do “Inventário Depressivo de Beck” a uma amostra portuguesa de doentes deprimidos.
        Coimbra Médica. 1973; 20: 623-644
        • Vaz-Serra A.
        • Pio-Abreu J.L.
        Aferição dos quadros clínicos depressivos II—estudo preliminar de novos agrupamentos sintomatológicos para complemento do “Inventário Depressivo de Beck.” Coimbra Médica. 1973; 20: 713-736
        • Spielberg C.D.
        Manual for State-Trait Anxiety Inventory (Form Y).
        Consulting Psychologists Press, Palo Alto1973
        • Daniel F.
        Teoria e prática psicométrica—contribuição para a validação do STAI-Y de Spielberger em estudantes do ensino superior.
        Badajoz: Universitá de Extremadura. 1996;
        • Goss K.
        • Gilbert P.
        • Allan S.
        An exploration of shame measure: the “others as shamer scale”.
        Personal Individ Diff. 1994; 17: 713-717
        • Matos M.
        • Pinto-Gouveia J.
        Shame as a traumatic memory.
        Clin Psychol Psychother. 2010; 17: 299-312
        • Andrews B.
        • Qian M.
        • Valentine J.
        Predicting depressive symptoms with a new measure of shame: the experience of shame scale.
        Br J Clin Psychol. 2002; 41: 29-42
        • Gilbert P.
        • Allan S.
        The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view.
        Psychol Med. 1998; 28: 585-598
        • Carvalho S.
        • Pinto-Gouveia J.
        • Castilho P.
        • Pimentel P.
        Entrapment—conceito, definição e características psicométricas da versão portuguesa da Escala de Entrapment.
        Psychologica. 2011; 54: 385-412
        • Carvalho S.
        • Pinto-Gouveia J.
        • Castilho P.
        • Pimentel P.
        • Maia D.
        Derrota—conceito e avaliação: características psicométricas da versão portuguesa da Escala de Derrota (Defeat Scale).
        Psychologica. 2011; 54: 465-492
        • Bond F.W.
        • Hayes S.C.
        • Baer R.A.
        • Carpenter K.C.
        • Guenole N.
        • Orcutt H.K.
        • et al.
        Preliminary psychometric properties of the Acceptance and Action Questionnaire II: a revised measure of psychological flexibility and acceptance.
        Behav Ther. 2011; 42: 676-688
        • Pinto-Gouveia J.
        • Gregório S.
        • Dinis A.
        • Xavier A.
        Experiential avoidance in clinical and nonclinical samples.
        Intl J Psychol Psychol Ther. 2012; 12: 139-156
        • Neff K.
        The development and validation of a scale to measure self-compassion.
        Self Ident. 2003; 2: 223-250
        • Castilho P.
        • Pinto-Gouveia J.
        • Bento E.
        Autocompaixão: estudo da validação da versão portuguesa da Escala da Autocompaixão e da sua relação com as experiências adversas na infância, a comparação social e a psicopatologia.
        Psychologica. 2011; 54: 203-230
        • Cousineau T.M.
        • Green T.C.
        • Corsini E.A.
        • Barnard T.
        • Seibring A.R.
        • Domar A.D.
        Development and validation of the Infertility Self-Efficacy scale.
        Fertil Steril. 2006; 85: 1684-1696
        • Galhardo A.
        • Cunha M.
        • Pinto-Gouveia J.
        Measuring self-efficacy to deal with infertility: psychometric properties and confirmatory factor analysis of the Portuguese version of the Infertility Self-efficacy Scale.
        Res Nurs Health. 2013; 36: 65-74
        • Walach H.
        • Buchheld N.
        • Buttenmuller V.
        • Kleinknecht N.
        • Schmidt S.
        Measuring mindfulness—the Freiburg Mindfulness Inventory (FMI).
        Personal Individ Diff. 2006; 40: 1543-1555
        • Segal Z.V.
        • Williams J.M.G.
        • Teasdale J.D.
        Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse.
        Guilford Press, New York2002
        • Crane R.
        Mindfulness-based cognitive therapy.
        Routledge, London2009
        • Williams M.
        • Penman D.
        Mindfulness: a practical guide to finding peace in a frantic world.
        Piatkus, London2011
        • Walser R.D.
        • Westrup D.
        Acceptance and commitment therapy for the treatment of post-traumatic stress disorder and trauma-related problems: a practitioner's guide to using mindfulness and acceptance strategies.
        New Harbinger Publications, Oakland2007
        • Williams M.
        • Teasdale J.
        • Segal Z.
        • Kabat-Zinn J.
        The mindfulness way through depression.
        Guilford Press, New York2007
        • Forsyth J.P.
        • Eifert G.H.
        The mindfulness and acceptance workbook for anxiety: a guide to breaking free from anxiety, phobias and worry using acceptance and commitment therapy.
        New Harbinger Publications, Oakland2007
        • Siegel R.D.
        The mindfulness solution—everyday practices for everyday problems.
        Guilford Press, New York2010
        • Marôco J.
        Análise Estatística com o PASW Statistics.
        ReportNumber Lda, Lisboa2010
        • Pallant J.
        SPSS survival manual: a step by step guide to data analysis with SPSS.
        4th ed. Allen & Unwin, Crows Nest2011
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2d ed. L. Erlbaum Associates, New Jersey1988
        • Field A.P.
        Discovering statistics using SPSS: (and sex, drugs and rock ‘n’ roll).
        3d ed. SAGE Publications, Los Angeles2009
        • Gilbert P.
        Body shame: a biopsychosocial conceptualization and overview, with treatment implications.
        in: Gilbert P. Miles J. Body shame: conceptualization, research and treatment. Brunner, London2002: 3-54
        • Spokas M.E.
        • Rodebaugh T.L.
        • Heimberg R.G.
        Treatment outcome research.
        in: McKay D. Handbook of research methods in abnormal and clinical psychology. Sage Publications, Los Angeles2008: 513-530
        • Deeks J.J.
        • Dinnes J.
        • D'Amico R.
        • Sowden A.J.
        • Sakarovitch C.
        • Song F.
        • et al.
        Evaluating non-randomized intervention studies.
        Health Technol Assess. 2003; 7: 1-6