Table 3.

Brief intervention synopsis, themes, and cognitive behavioral therapy (CBT) elements.

Author(s) and country			Brief synopsis		Themes		CBT elements
Guided
	Forsell et al [49], Sweden	The iCBTa Internet Psychiatry Clinic is an intervention for antenatal depression and is an adapted version of iCBT for depression. The platform is a form of guided self-help treatment consisting of reading material (about 75,000 words), assessments, homework, and worksheets via a secure online platform. The platform can be accessed anytime and anywhere using a computer or mobile device with an internet connection. There are 10 modules of guided self-help by nonexpert therapists trained in CBT.		Introduction, being pregnant, behavioral activation, cognitive restructuring, relationships, anxiety and worry, sleep problems, and summary and relapse prevention		Psychoeducation (depression, CBT, myths, facts, and physiological changes), behavioral activation (positive and negative reinforcement behaviors), cognitive restructuring (negative automatic thoughts, acceptance, cognitive biases), psychoeducation (relationships, communication, role transition, anxiety and fear of labor and sleep), and homework
	Guo et al [50], China	Mindful Self-Compassion Program (MBSP) is aimed at promoting self-regulatory skills of pregnant women at high risk for postpartum depression focusing on self-compassion. The program utilizes videos involving different types of exercises with guided instructions sequentially provided after completion of a previous module. The 6-week program lasts 10 hours with guided instructions: 36 episodes each lasting about 15 minutes		Not available		Largely based on mindfulness CBT; understanding and applying self-compassion, skills to manage difficult emotions rather than solving specific problems, exercises with guided instructions. Users were encouraged to practice the skills during the day and provided with an online diary book for reflection.
Unguided
	Barrera et al [47], United States	The Mothers and Babies Internet (e-MB) is aimed at Spanish- and English-speaking pregnant women to reduce the risk of postpartum depression. The e-MB consists of fully automated lessons and is sequential in nature, whereby each session needed to be completed first before proceeding to the next lesson. Following completion of each session, participants may access the lesson and worksheets infinitely for review. The e-MB consisted of 8 flexible sessions of fully automated self-help.		Not available		Information pages, audio, video, images, and worksheets based on the cognitive behavior framework, social learning theory, reality management training, attachment theory, and diverse sociocultural issues
	Duffecy et al [48], United States	The Sunnyside website group intervention consisted of 10–15-minute didactic lessons using text and video material and included several interactive features in the form of (1) an activity feed, which was a constantly updating feed that displayed each of the women’s activity on the site, whereby other participants can like and comment or provide feedback to other women’s posts, (2) discussion questions posted by study staff after each session to encourage interaction, (3) individual garden plot and community garden linked to individual’s profiles and providing gamification and interactive features individually and between other users, (4) contact moderator tool to report any issues with the site or with group members. After each session, participants are prompted with a “call to action” encouraging them to apply the skills learned during the sessions. The intervention consisted of an 8-week unguided online program.		Your mood and your pregnancy, worries about me and my baby, mood management, challenging your thinking, positive activity during pregnancy, physical activity during pregnancy, partner communication and support, body image and sex during pregnancy and postpartum, relationships with your mother and mother-in-law, challenges in relationships with friends and others, monitoring kick counts and other pregnancy anxiety, anxiety and parenthood, relaxation, employment issues, during and after the birth, moving forward, and conclusions		Psychoeducation, mood management, thought challenging, positive and physical activities, relationship with partner and others in the social circle, anxiety during pregnancy and parenthood, relaxation, employment issues and managing resources during and after labor; 5 interactive CBT tools: thought restructuring (think), mood tracking (feel), activity scheduling and monitoring (do), relaxation (relax), and goal setting (achieve)
	Haga et al [51], Norway	Mamma Mia is a free universal preventive intervention for perinatal depression. The intervention is delivered by email and interactive websites, combining text, pictures, prerecorded audio files, and user input. User receives an email with a hyperlink for each session that lasts around 10 minutes each. The hyperlink directs the user to the Mamma Mia web page, and the intervention content proceeds sequentially to the next web pages (tunnel information architecture) to ensure continuity of the program narrative. The intervention consists of 3 fully automated phases with 44 sessions over 11.5 months: phase 1 (during pregnancy); phase 2 (infant is 2-3 weeks old, for 6 weeks); and final phase (10 sessions over an 18-week period)		Knowledge, expectancies and attitudes, attachment, emotion regulation, and help-seeking, relationship satisfaction, and communication skills		Assessment of depressive symptoms, metacognitive therapy, positive psychology, couples’ therapy, breastfeeding, and psychoeducation; the metacognitive element emphasized the process of inflexible and recurrent thinking style due to negative thoughts, feelings, or beliefs. Acceptance commitment therapy and mindfulness elements were also incorporated.
	Loughnan et al [52], Australia	The MUMentum Pregnancy transdiagnostic intervention targets anxiety and depression symptoms and is delivered via the online Virtual Clinic system. The program emphasized a short, illustrated story centered around 2 fictional characters experiencing depression and anxiety during pregnancy. The characters learn to manage their symptoms by applying CBT skills in the context of the character experiences, challenges, and symptoms common during pregnancy. The system employs a 7-day lockout period implemented between lessons to ensure participants spend time revising and implementing the lesson material before moving onto the next lesson. Of this, participants are also notified via email and SMS reminders regarding new lessons and to stay on schedule. The 4-week program consists of 3 brief unguided self-help lessons with only technical support.		About anxiety and depression, identifying symptoms, cognitive behavioral model, prioritizing self-care, physical symptoms, partners and supporters, controlled breathing, progressive muscle relaxation, about thoughts, identifying unhelpful thoughts, shifting unhelpful thoughts, accepting uncertainty, thought challenging, coping cards, structured problem-solving, unhelpful behaviors (low activity; avoidance), facing your fears, activity planning and monitoring, graded exposure, assertive communication, relapse prevention		Transdiagnostic intervention for depression and anxiety during pregnancy; involved psychoeducation, cognitive restructuring, problem-solving, behavioral activation, and relapse prevention; each lesson illustrated the characters’ stories: introduction to core CBT skills, summary, and action plan to implement the skills and several supplementary resources.
	Sun et al [53], China	The Spirits Healing (in Chinese) app is a mindfulness training program for use during pregnancy for perinatal depression and other mental health problems. It was available for Android and iOS operating systems in mainland China. The app provides reading materials, recordings for guided practice, videos, and a mindfulness journal that can be accessed anytime and utilized at users’ own pace. Weekly reminder messages were sent via WeChat for users to complete the training. Participants were awarded 2 yuan (US $0.30) for completion of each week of training or each completion of assessment. The 8-week mindfulness CBT training automatically updated every day, and participants practiced according to their own schedules.		Understand mindfulness, be in the present, be mindful of negative emotions, accept difficulties, thoughts are just thoughts, enjoy daily happiness, mindful pregnancy and childbirth, continued mindfulness practice		Following psychoeducation information via the app, formal mindfulness training techniques were introduced. Users are encouraged to continue to practice, and they are supplemented with recordings and a mindfulness journal. Formal training included body scan, mindful breathing, mindful stretching, and mindful meditation. Informal training included encouragement to practice every day, pausing in the midst of daily life, mindful eating, mindful walking, and 3-minute breathing practices.

^aiCBT: internet-based CBT.