Background and objectives: Anxiety is prevalent among pregnant women with suspected fetal malformation. Hence, this study aimed to assess the effectiveness of IECBT in alleviating pregnancy-specific stress and anxiety in anxious women with suspected fetal malformation.

Methods: A randomized four-arm parallel-group controlled trial was conducted involving 140 pregnant women displaying anxiety symptoms before 20 weeks of gestation and suspected fetal malformation. Participants were randomly allocated into four groups, each consisting of 35 women: IECBT alone, IECBT with booster sessions, IECBT with spouse participation, and IECBT combined with spouse participation and booster sessions. The IECBT intervention comprised six 50-min therapist-led sessions for women, with an additional 20-min session for men in the IECBT with spouse participation group. Those in the IECBT with booster sessions groups received six monthly 50-min sessions post-intervention until delivery. Five questionnaires-Spielberger's State Anxiety, Pregnancy-Specific Stress, Uncertainty Intolerance, and Emotion Regulation-were administered before the trial, upon completion of the 6-week intervention, and at 3-month and 6-month post-trial follow-ups.

Results: The IECBT interventions led to significant improvements in anxiety symptoms, pregnancy-specific stress, uncertainty intolerance, and emotional regulation after therapy, with these improvements sustained at the 3-month and 6-month post-treatment assessments. However, no superiority was observed among the four IECBT models across the three measurement intervals-post-trial, 3-month, and 6-month follow-ups regarding outcome improvement. Additionally, participants expressed high satisfaction levels with all IECBT approaches, with no significant differences noted among the four groups.

Limitation: IECBT with spouse participation and IECBT with booster sessions were not therapist-guided, results might stem from the masculism culture of the population and their low responsibility and assistance in solving pregnant women's problems, especially during pregnancy, the lack of long-term follow-up of treatment effectiveness and postnatal psychological outcomes with or without fetal malformation.

Conclusions: The findings suggest that the four models of IECBT improved anxiety, stress, uncertainty, and dysregulated emotions in women with suspected fetal malformation, and such improvements remained stable up to six months after the intervention.

Keywords: Anxiety; Internet-based intervention; Pregnancy; Spouses.

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背景与目的： 焦虑在怀疑胎儿有畸形的孕妇中很常见。因此，本研究旨在评估IECBT（互联网辅助认知行为疗法）在减轻怀疑胎儿有畸形且存在焦虑症状的女性的孕期特定压力和焦虑方面的有效性。

方法： 一项随机四组平行对照试验涉及140名孕周小于20周、表现出焦虑症状并怀疑胎儿畸形的孕妇。参与者被随机分配到四个小组，每组35人：单独进行IECBT、IECBT结合加强会话、IECBT加上配偶参与以及IECBT结合配偶参与和加强会话。IECBT干预包括六次每次50分钟由治疗师引导的女性疗程，在IECBT加配偶参与小组中，男性还会参加额外20分钟的疗程。在干预后的每个月到分娩期间，接受加强会话组的参与者将获得六次持续50分钟的随访课程。在试验开始前、完成6周干预后以及3个月和6个月的后续评估时，共五个问卷——Spielberger状态焦虑量表、孕期特定压力量表、不确定性耐受性量表和情绪调节量表——被分别发放。

结果： IECBT干预后，所有四个模型均表现出显著改善的焦虑症状、孕期特定的压力水平、对不确定性的容忍度以及情绪调节能力，并且这些改进在3个月和6个月后的随访中得以维持。然而，在三次测量间隔——试验后、3个月和6个月后续访问——关于结果改善方面并未观察到四个IECBT模型中的任何一个具有优越性。此外，参与者对所有IECBT方法的满意度都很高，并且在四组之间未发现显著差异。

局限性： 配偶参与和加强会话的IECBT没有治疗师指导，结果可能源自该人群的父权文化及其在解决孕妇问题（尤其是孕期）中的低责任感和协助度。此外，在长期随访中缺乏对治疗方法有效性的评估以及带有或不带胎儿畸形后的产后心理健康状况。

结论： 研究结果表明，四个IECBT模型改善了怀疑胎儿有畸形女性的焦虑、压力、不确定性和情绪失调，并且这些改进在干预后长达六个月的时间内保持稳定。

关键词： 焦虑；互联网辅助治疗；孕期；配偶。