Can Mindfulness Help Increase Coping With Infertility Problems

Mindfulness has been extensively used as a psychotherapeutic intervention for persons facing emotional distress because of a medical condition, and a recent literature review on mindfulness and infertility problems published in the journal of Human Reproductive Sciences by Patel et al. (2020) asked can mindfulness help increase coping with infertility problems.

Coping with infertility problems

Infertility is considered to be a physiological problem, but it’s not only a medical condition as it has both psychological and social consequences on the couples affected.  Because of this Infertility is described as a “low control condition”.  This means that couples effected by infertility problems at times feel helpless and that there is not much they can do and at a loss in their situation (Covington, 2015).  This results in complex psychological issues and a hard time adjusting emotionally because of what couples have to go through from the start of the diagnosis and while undergoing infertility treatment, mainly:

1. The stress of infertility diagnosis
2. Infertility associated identity crisis
3. Dealing with the ongoing infertility treatment
4. High possibility of unsuccessful treatment cycles
5. Choosing between treatment options (like donor programs, adoption, etc.)
6. Dealing with the uncertainty of outcomes of consecutive cycles (nonresponse, abandonment, failure)
7. Dealing with unwanted effects of the repeated cycles of treatments, high rates of miscarriages, multiple gestations, going in for fetal reductions, limited live birth rates, and other obstetric risks.

Understandably because of this couples undergoing infertility treatment at times experience some form of coping problems, and it is argued that in the long run, childless couples do not benefit by adopting either a problem-based or emotionally-based coping strategy to deal with the situation.

A mean based coping strategy might be best

Research suggests that a mean based coping strategy adopting elements of both mediated by some form of mindfulness-based intervention might be the best way to go (Boivin, 2003).  In their review, Patel et al. (2020) argued that this might be because:

“Mindfulness as a coping skill enables change in the way one relates to stressors, the associated thoughts, and emotions rather than changing or altering the stress itself. It transforms the perception of self, consciousness, reality, and creates a change in perspectives of “self as content (e.g., I am infertile)” to “self as a context (e.g., I am a person experiencing conception problems).” It allows deliberate exposure, compassionate acceptance as well as the extinction of fears and behavioral avoidance associated with fertility‑related stimuli.”

Patel et al. (2020, p. 5)

It is argued that this is because mindfulness helps in the stabilization of cognitive capacities, reduces autonomic arousal to stressors, and helps with emotional regulation. These are thought to be disease-specific coping mechanisms at work in reducing negative thinking in individuals with physical or psychological disorders. Because of this in their review, Patel et al. (2020) argued that mindfulness practice might help couples cope better with the psychological issues related to infertility. Considering also that research indicates that mindfulness-based interventions might lead to a reduction in emotional distress, pain perception, depression and anxiety when one engages in a regular daily routine practice (Hanley et al., 2015; Perich et al., 2013; Williams et al., 2014)    

Why might mindfulness help increase coping with infertility problems

In their systemic review of existing mindfulness literature on mindfulness interventions and infertility Patel et al. (2020) argued the following:

1. Mindfulness-based interventions may help improve the psychological outcomes of couples with infertility because mindfulness can help reduce stress, anger, depression, anxiety, which positively impact well-being and quality of life of infertile women.  Patel et al. (2020) hypothesized that this is because research indicates that mindfulness increases attentional capacity reducing mind wandering, emotional reactivity, avoidance coping strategies and cognitive fusion with emotions.  This increases meta-cognitive awareness and flexibility, which in turn creates the space for a decentered engagement with distressing thoughts and emotions increasing well-being.   
2. They also argued that there is an indication that the resulting increases in a mindful attitude from mindfulness interventions might help women with infertility problem.  They found that women participating in mindfulness interventions reported that mindfulness helped them responded in a more kind, compassionate, receptive, and accepting manner toward themselves and others whether infertility treatment was successful or not.  Which, in turn, helped improve their moods, made them more receptive to social support and improved the marital relation.  
3. Finally arguing that because stress can cause tubal spasm, anovulation, abnormal gamete transport, progestational deficiencies, and hyperprolactinemia which can potentially lead to the luteinized unruptured follicle syndrome. Considering that research indicates that mindfulness-based interventions can buffer the physiological and psychological effects of stress, it could be that mindfulness practice might act as a physiological buffer against such symptoms.

Issues with existing research on mindfulness-based interventions and infertility

Still, in their review, Patel et al. (2020) point out the lack of randomized control trials when it comes to mindfulness and infertility and the lack of research comparing mindfulness with other contemporary therapies.  So although mindfulness might help, there is no real hard evidence showing if mindfulness results in better outcomes when compared to contemporary therapies.

Moreover, in their review Patel et al. (2020) also identified that there might be a publication bias as drop out factors and adverse effects are rarely investigated in mindfulness studies, with experts in the field cautioning against perceiving mindfulness as a “panacea”.  This considering that research on the risks, harms, and potential barriers to home practice are rarely examined in mindfulness-based interventions (Hanley et al., 2015).  While also pointing out that there is a lack of research on the potential effects of mindfulness-based interventions on infertile couples as a dyad and its effects on men with infertility problems.

Although in their review, Patel et al. (2020) argue that mindfulness can help increase coping with infertility problems.  Still, a note of caution needs to be expressed against such a statement as it could be argued that although mindfulness-based interventions might potentially result in benefits for persons with infertility problems because of its potential use as a trans-diagnostic tool.  Still, as Patel et al. (2020) pointed out, there is no substantial evidence that mindfulness can be potentially better or act as a replacement for contemporary therapies.  Pointing out that much more research in the form of randomized trials is needed to confirm the efficacy of mindfulness as a potential game-changing intervention for persons with infertility problems.  

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References

Boivin, J. (2003). A review of psychosocial interventions in infertility. Social Science & Medicine, 2325-2341. doi:10.1016/S0277-9536(03)00138-2

Covington, S. N. (Ed.). (2015). Fertility Counseling: Clinical Guide and Case Studies. Cambridge: Cambridge University Press.

Hanley, A., Warner, A., & Garland, E. L. (2015). Associations between mindfulness, psychological well-being, and subjective well-being with respect to contemplative practice. Journal of Happiness Studies, 16, 1423-1436. doi:10.1007/s10902-014-9569-5

Perich, T., Manicavasagar, V., Mitchell, P. B., & Jillian, B. (2013). The association between meditation practice and treatment outcome in Mindfulness-based Cognitive Therapy for bipolar disorder. Behaviour Research and Therapy, 51(7), 338-343. doi:10.1016/j.brat.2013.03.006

Williams, J. M., Crane, C., Bamhofer, T., Brennan, K., Duggan, D. S., Fennell, M., . . . Rusell, I. (2014). Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial. Journal of Counseling and Clinical Psychology, 82(2), 275-286. doi:10.1037/a0035036