Academic journal article Journal of Evidence-Based Psychotherapies

The Development and Piloting of a Cbt Group Program for Postpartum Depression

Academic journal article Journal of Evidence-Based Psychotherapies

The Development and Piloting of a Cbt Group Program for Postpartum Depression

Article excerpt


The perinatal period was long time considered a time of emotional wellbeing and a protective timeframe against psychiatric disorders. Motherhood is nowadays regarded as a life transition period testing and straining women's coping mechanisms. It precipitates not only psychotic episodes, but symptoms of depression are also a common feature of the postpartum period (Robertson, Celasun, & Steward, 2003). Following childbirth, depressive symptomatology is ranging in intensity from mild postpartum blues, to postpartum depression and to postpartum psychosis.

Postpartum depression is broadly defined as a non-psychotic mild to moderate depressive episode, including subsyndromal depressive symptomatology, beginning anytime in the first postpartum year. It is etiologically related to childbirth or to physiological/hormonal, social, psychological or environmental factors present in the timeframe following childbirth (O'Hara & Gorman, 2004). Applying diagnostic criteria for a DSM-IVTR (APA, 2000) postpartum specifier or a DSM-5 (APA, 2013) perinatal specifier narrows postpartum depression to a depressive episode beginning in the first 4 weeks following childbirth.

Prevalence rates for postpartum depression range from 5% to 25% depending on the characteristics of the population, the diagnostic and evaluation methods and the temporal framework used for onset (Gaynes et al., 2005). Increasing attention has been paid to postpartum depression due to its consequences not only on mother's functioning, but on the cognitive, behavioural and emotional development of her infant. Several meta-analyses synthetized the consequences of postpartum depression on child development (Grace & Sansom, 2003; Grace, Evindar & Steward, 2003; Field, 2011; Goodman & Santangelo, 2011).

Multi-dimensional psychological, social and genetic factors are thought to contribute, interact and finally trigger postpartum depressive mood. A series of meta-analyses on risk factors for postpartum depression (Robertson, Grace, Wallington, & Steward, 2004; Beck, 2001; O'Hara & Swain, 1996) point to depression and anxiety during pregnancy, a lifetime history of depression and social support.

Treatment choices for postpartum depression

Pharmacotherapy, psychological and psychosocial interventions are common treatments for postpartum depression. Antidepressant medication is the most common treatment for postpartum depression (NICE, 2007). However, in a pilot study on patient choice of treatment for postpartum depression comparing medication (sertraline) to psychotherapy (Interpersonal Therapy, IPT) most women chose psychotherapy with or without medication (Pearlstein et al., 2006). The treatment decisions for postpartum depression in women who are breastfeeding are highly influenced by their concerns about the consequences of infant exposure to antidepressant medication.

At the same time, the risks associated with antidepressant treatment during breastfeeding lower the threshold for psychological treatments (NICE, 2007). Therefore the 2007 NICE clinical guideline strongly recommends switching to psychological therapy (Cognitive-Behavioural Therapy, CBT or IPT) if previously treated with antidepressant for mild to moderate depressive episode and combining antidepressant with psychological treatment in severe depressive episode. For breastfeeding women who have a new episode of mild or moderate depression NICE recommends self-help strategies (guided self-help, C-CBT or exercise), non-directive counselling delivered at home (listening visits), brief CBT or IPT.

Four major approaches can be distinguished in literature regarding psychological treatments for postpartum depression: general counselling, interpersonal psychotherapy, cognitive-behavioural psychotherapy and psychodynamic therapy.

Interpersonal therapy has been extensively investigated and proven to be an effective intervention for postpartum depression. …

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