Cognitive Behavioral Therapy and Postpartum Depression?: I’m still not sure


CBT and PPD. I used to think it was an oxymoron. Cognitive behavioral therapy is hard work. Definitely worth it, but hard work, nonetheless.

Simply put, CBT is based on the notion that our feelings and behaviors are a consequence of the thoughts we are having. Regarding depression, if we reframe our negative thoughts, we will feel better.

Here are some of the fundamental principles:

1) It is time-limited which means there is a beginning and end point.  It is problem-focused and goal-directed.

2) The therapeutic relationship is a vital part of the process. CBT is a collaborative effort between the therapist and the client with a focus on learning how to think differently and then change behaviors accordingly.

3) CBT has specific agendas for each session, based on the client’s personal goals, emphasizing techniques that are taught and reviewed together. Clients are encouraged to rethink some of their default thinking patterns, such as “how do I know people are don’t like me, what evidence do I have?” “What is the worst scenario if they really don’t like me?”

4) CBT uses rational thought to help motivate change and encouraging clients to question some of their emotional responses. It is based on the theory that negative beliefs are just that, beliefs. They are not facts.

5) Homework is central feature of CBT. Goal achievement is reached by regular practice with includes monitoring their thoughts through record keeping and logs. Clients write down their automatic thoughts and together with the therapist, discover patterns of thinking that may be contributing to negative feelings self-destructive behaviors. (FYI, It’s the homework part I most object to for postpartum women)

More and more research is supporting the use of CBT for the efficient and effective treatment of anxiety and depression. And the research is rigorous and plentiful.

Here’s one. Here’s another. Here’s another. Here’s one on OCD. And here’s one more. Here’s a general primer on CBT.

For years now I have been protesting this. I have stood firm in my conviction that postpartum women are not equipped to do this work and moreover  it is unfair for us to ask even one more thing from them. After all, postpartum women are exhausted, depleted and often, despairing. It’s hard enough for them to get through the day and now we are going to ask them to keep notes of their thoughts and behaviors on a daily, or hourly basis and bring it in to therapy for review?

It sounds too tedious. Too cumbersome. Too totally irrelevant to a mother yearning for bits of sleep and peace of mind. It’s hard work, and frankly, who feels like doing homework when you are sleep-deprived paralyzed by panic?

It is worth noting that most of us “non-CBT” therapists, do utilize key concepts from CBT throughout the course of supportive therapy. As early as 1994, when “This Isn’t What I Expected” first came out, women embraced our section on replacing negative thoughts with positive thoughts (Ch.2 “Breaking Negative Thought Patterns”). Cognitive interventions are (or should be) common components of most every form of psychotherapy.

Why? Because they work.

And this is what motivated me to learn more about cognitive therapy. Meet Amy Wenzel, PhD., CBT therapist extraordinaire and co-author of “Dropping the Baby and Other Scary Thoughts.” As an affiliate of The Postpartum Stress Center, and consultant for the my current book on marriage, Amy is my go-to CBT expert. She lives and breathes CBT and believes in its merit for postpartum depression. Which is why one of the projects on our to-do list is an upcoming book on CBT for the perinatal population. For this book, she is doing most of the work (!) and I will be consulting and modifying some of the directives to fit more comfortably with the needs of postpartum women.

That’s why I need your help.

I want to hear from women who have been treated with CBT. Did it help? Did you like it? Why? Why not? If you have not been treated with CBT, has the option been made available to you? Did you oppose the suggestion? If so, why? I have my own ideas about how to adjust CBT to make it more do-able for a busy, distracted, overwhelmed, and depressed new mother. But I’d like to hear your thoughts on this subject. Please email me directly (CBT in subject line) and tell me about your experience, both good and bad. By doing this, you will be helping us design the best possible protocol for the use of cognitive-behavioral therapy for postpartum women.

As always, thanks for your input!



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