Background: A multitude of interventions encompassing complementary and alternative therapies have emerged as viable means to regulate psychological distress and fear of birth. These interventions encompass practices such as self-affirmation, breathing exercises, and massage, all of which contribute to the mother's and fetus's well-being. Aim: was to examine the effect of self-affirmation versus back massage on psychological distress and fear of birth among primigravida women. Design: Quasi-experimental research design (pre and post-test non-equivalent control group design) was adopted. Setting: This study was conducted out patient of obstetric and gynecological clinics at Kafr El-Sheikh General Hospital. Subjects: A purposive sample consisting of 80 primigravida women was recruited according to inclusion criteria. Tools: Three tools were employed, a structured demographic and obstetric data interview schedule:, kessler Psychological Distress Scale, and the Wijma Delivery Expectancy/Experience Questionnaire.  Results: Pre-intervention, there was no significant difference between both groups in terms of psychological distress and fear of birth. However, starting from the 4 ,6, 8 Weeks Post-intervention , significant differences emerged, with the self-affirmation group showing a greater reduction in distress and an increase in psychological well-being , also, significant differences on reducing fear  of birth starting from the 4, 6, 8 Weeks Post-intervention  (P < 0.001) compared to the back massage group. Conclusion: self-affirmation group generally exhibited better psychological well-being, lower distress levels than the back massage group. Also, had a pronounced effect on fear of birth reduction. Recommendations: Incorporate self-affirmation into the policy of antenatal care to improve psychological distress and fear of birth among pregnant women.