From fear to bonding: a randomized controlled trial of CBT-based group counseling on the experience of becoming a mother in marginalized adolescent mothers

Abstract

Adolescent motherhood, especially in marginalized populations, presents psychological and emotional challenges that can affect maternal-infant bonding and maternal self-efficacy. This study evaluated the effect of cognitive-behavioral group counseling on the experience of becoming a mother among adolescent mothers in marginalized areas of Urmia through a randomized controlled trial. This cluster-randomized controlled trial was conducted between September and December 2024 in Urmia, Iran. Health centers were randomly allocated to intervention or control groups using a computer-generated random sequence. Eighty-eight adolescent mothers were recruited via census sampling. The Depression, Anxiety, and Stress Scale (DASS-21) was used to screen and exclude mothers with depressive symptoms before randomization. Participants were randomly assigned to an intervention group receiving seven weekly cognitive-behavioral group counseling sessions or to a control group receiving routine care. Data were collected using a demographic questionnaire and the Being a Mother Scale (BaM-13). Statistical analyses included chi-square, independent t-tests, and repeated measures ANOVA using SPSS 20. The intervention group showed significant improvement in the experience of becoming a mother, with mean BaM-13 scores decreasing from 36.54 ± 2.20 at baseline to 15.30 ± 2.50 at three months post-intervention. The control group's scores remained stable. Repeated measures ANOVA revealed significant effects of time ( p < 0.001) and a time-by-group interaction ( p < 0.001), confirming improvements were exclusive to the intervention group. Cognitive-behavioral group counseling effectively enhances adolescent mothers’ experience of becoming a mother by fostering emotional closeness, positive child experiences, and personal growth. This intervention may benefit maternal health in marginalized populations. IRCT20250126064520N1, The date of registration: 2–19-2025. Ethical approval code: IR.UMSU.REC.1403.134 Date: 4.8.2024.