Abstract: Clarifying the psychological and neural mechanisms through which non-pharmacological interventions alleviate postpartum anxiety is a critical prerequisite for advancing both perinatal mental health theory and clinical practice. Kangaroo mother care (KMC), a caregiving intervention centered on sustained mother-infant skin to skin contact, has been consistently shown to reduce postpartum anxiety; however, its mechanisms have often been oversimplified as operating through a single physiological or neuroendocrine pathway. Integrating evidence from neuroscience and psychological research, this review proposes a cognitive-emotional-behavioral dynamic interaction model grounded in an extended attachment framework to explain how kangaroo mother care alleviates postpartum anxiety through coordinated, multi-level regulation, while simultaneously strengthening maternal-infant emotional bonding and stabilizing intervention effects.
At the neurophysiological level, the sustained and extensive skin to skin contact inherent to kangaroo mother care constitutes a high-density form of affective tactile input that robustly engages peripheral C-tactile afferent pathways. Compared with brief or fragmented touch, this mode of contact more effectively attenuates threat-related processing and reduces cognitive hypervigilance, providing an immediate physiological basis for anxiety reduction. Continuous affective touch further promotes sustained oxytocin release, enhancing feelings of safety and emotional connectedness, while modulating autonomic nervous system activity and suppressing hypothalamic-pituitary-adrenal axis reactivity. These processes jointly lower physiological arousal in the short term and support emotional homeostasis and psychological resilience over time. In parallel, kangaroo mother care activates dopaminergic reward circuits centered on the ventral tegmental area and nucleus accumbens, conferring positive reinforcement to caregiving behaviors and counteracting the motivational withdrawal and avoidance tendencies commonly associated with postpartum anxiety.
Building on this neurobiological foundation, this model delineates three interrelated psychological pathways through which kangaroo mother care mitigates postpartum anxiety. Cognitively, it redirects maternal attention away from catastrophic threat appraisal toward the infant’s immediate, concrete cues, while repeated positive caregiving feedback enhances parenting self-efficacy and disrupts anxiety-related maladaptive cognitive processing. Emotionally, reductions in physiological stress and improvements in sleep quality strengthen emotion regulation capacity, allowing the restoration of cognitive control resources and the maintenance of affective stability over time. Behaviorally, sustained reward system engagement fosters a positive feedback loop between caregiving behaviors and positive affect, facilitating the internalization of the maternal role and the establishment of stable, enduring patterns of adaptive caregiving. Crucially, cognition, emotion, and behavior are conceptualized as dynamically interacting rather than operating in isolation: emotional stabilization supports cognitive restructuring, cognitive improvements consolidate emotional regulation, and behavioral reinforcement further strengthens both self-efficacy and perceived safety. As postpartum anxiety diminishes, secure mother-infant attachment is more readily established and deepened; in turn, enhanced attachment quality functions as a key regulatory factor that stabilizes maternal emotional states and amplifies the effectiveness of kangaroo mother care.
Theoretically, by extending attachment theory to emphasize the role of maternal-infant emotional bonding in mothers’ own psychological regulation, this framework moves beyond the traditional infant-centered perspective of attachment research. Practically, it provides a coherent theoretical rationale for promoting kangaroo mother care as a low-cost, sustainable non-pharmacological strategy for the prevention and adjunctive treatment of postpartum anxiety. Overall, this review advances the field from the question of whether kangaroo mother care is effective to why it is effective, offering an original cognitive-emotional-behavioral dynamic interaction model that lays a systematic foundation for future mechanistic validation, intervention optimization, and the development of individualized perinatal mental health strategies.

Key words: kangaroo mother care, postpartum anxiety, cognitive-emotional-behavioral interaction model, mother-infant attachment