By BetterHelp Editorial Team|Updated March 23, 2022
Many women experience negative mental health symptoms during the postpartum period, and cognitive behavioral therapy has shown the potential to help improve depressive symptoms and quality of life. Researchers performed a meta-analysis of existing studies to look at the efficacy of ICBT for women in this period. When analyzing the eight studies selected for metanalysis, researchers supported the idea that therapist-supported internet-based cognitive behavioral therapy shows significant promise for helping women decrease stress, anxiety, and depressive symptoms during the postpartum period.
The period after birth, also known as the postpartum period, is a time of tremendous change for women. Not only are there often financial and familial differences, but women also experience significant mental and physical changes. These rapid shifts can cause stress, anxiety, and depressive symptoms.
When looking at women in the postpartum period, it is estimated that around 14% experience general stress, 25% experience symptoms of anxiety, and up to 19% experience depressive symptoms. The symptoms often exist together and can rapidly decline the ability to care for oneself and one’s family.
Because of the high prevalence of these symptoms in the postpartum period, quick and effective treatment is important. Women in this period often have very minimal time to take care of a baby and themselves, among other things like work and day-to-day demands, so having a program geared towards their needs is essential to avoid wasting time and resources.
In a review of cognitive-behavioral therapy in the postpartum period, it was found that interventions started in the postpartum period were more effective than interventions started before birth. It was also found that cognitive-behavioral therapy shows significant promise for symptoms commonly associated with the postpartum period, including stress, anxiety, and depressive symptoms.
How does cognitive behavioral therapy work?
Cognitive-behavioral therapy (CBT) is a type of psychotherapy that aims to reduce dysfunctional thinking. This premise is that all psychological disturbances are caused by dysfunctional thinking. With this technique, the idea is that you can change your behavior by modifying thoughts, beliefs, and perceptions. Over time, individual thought and behavior changes lead to much larger life changes.
One of the most common components of CBT is cognitive restructuring. Cognitive restructuring is a psychotherapeutic process focused on identifying, evaluating, and changing negative and distorted thinking. Often, individuals will develop automatic thoughts or beliefs that continually recur, leading to a distorted view of certain topics or around a certain area of life. By helping to shift this thinking to a more positive frame of mind, cognitive restructuring can help to reduce negative thinking and thought patterns.
Another common component of CBT is behavioral activation. In this form of CBT, individuals are encouraged to participate in activities that bring positive psychological benefits. By frequently scheduling these activities, participants can reduce avoidant behaviors and improve psychological well-being.
Why might internet-based therapy be beneficial for postpartum women?
While cognitive-behavioral therapy has proven efficacy in treating mental health conditions, barriers to traditional therapy can reduce access to this type of treatment. Common barriers include:
· High cost
· Transportation time
· Availability, or lack thereof, in different geographical regions
· Long wait times
· Stigmatization
· Discomfort in medical settings
These factors can be especially important for women soon after birth. Labor, delivery and newborn care are expensive, and an expanded family can leave much less wiggle room for extra expenses and new time commitments. Because of the nature of internet-based therapy, surveys have shown new mothers highly prefer it. The modules can be completed at any time, making it easy to work them around an infant’s sleep schedule. Instead of needing to transport mom and baby to an office at a specific time, new mothers can complete the modules at different times each week depending on the needs of their home life.
CBT is a good candidate for internet-delivered therapy because of its content structure. CBT often contains similar units and exercises modified to the individual’s condition, so it can easily be applied to a wide audience. In addition to this, the most effective online programs are supported by therapists. This therapist support allows the program to be further modified to the individual and give feedback throughout the program.
Internet-delivered courses have rapidly grown in popularity and accessibility over the past few years. Multiple research studies have been performed to test the efficacy of these programs in therapeutic settings. While results have been promising on the delivery of internet-based CBT, there has been little focus on how therapist-supported internet-based CBT may benefit women in the postpartum period. To look further into this, researchers reviewed several relevant studies to look for trends of type of therapy design and outcomes of participants.
Looking into the existing research
This analysis aimed to look at studies that have researched the effectiveness of therapist-supported internet-based cognitive behavior therapy (CBT) for psychological disorders, specifically in postpartum women. It was found that though previous meta-analyses have been performed on the efficacy of therapist-supported iCBT, none have focused solely on patient populations of women in the postpartum period.
This study was a meta-analysis of previous research conducted to examine the efficacy of therapist-supported internet-based cognitive behavioral therapy for postpartum women. To find eligible studies for this review, they needed to fulfill PICOS criteria (population, intervention, comparison, outcomes, and study). The necessary criteria were as follows:
1. Women over 18 years of age within at least two years from birth.
2. The intervention in the study was a therapist-supported iCBT that was delivered over the internet through websites, email, phone, or Skype.
3. The iCBT needed to include the support of therapists during the program through phone, email, text, or interactive computer interfaces.
4. The intervention had at least one element of CBT, such as cognitive restructuring, behavioral activation, or skills training.
5. There was a comparison group (attention control, waitlist, or standard treatment).
6. Outcome measures included stress, anxiety, and depressive symptoms at post-intervention.
7. The trial was a randomized controlled trial.
What did researchers find?
After going through the eight studies, researchers were able to identify trends in results in the studies and gain a broader perspective of the efficacy of therapist-supported cognitive behavioral therapy interventions for postpartum women.
The results of the meta-analysis were as follows:
The analysis included eight studies across six countries (Australia, Canada, Germany, Sweden, United Kingdom, United States) with 1,523 participants total. The studies were conducted between 2011-2016, with studies concentrated towards 2016. The mean age of participants ranged from 31 to 35 years.
Participants were postpartum women with mainly three different health conditions:
1. Depressive symptoms (5 of 8 trials)
2. Post-traumatic stress symptoms (1 of 8 trials)
3. Pregnancy loss (2 of 8 trials)
Control groups were split into waitlist treatment (4 of 8 trials), usual care (3 of 8 trials), and waitlist or usual care (1 of 8 trials).
The iCBTs were all based on cognitive-behavioral strategies and included cognitive restructuring, behavioral activation, and other elements of psychoeducation. All trials had some form of human support within the trial, and 4 of the eight trials also had peer support using the chat room.
Therapist support in the program was split between websites (7 of 8 trials), phone calls (5 of 8 trials), emails (3 of 8 trials), and text messages (1 of 8 trials).
The duration of the therapies ranged from 5 to 17 weeks and included components such as text-based reading, assignments or homework, expressive writing, and online clinics or consultation.
Efficacy of therapist-supported iCBT on stress symptoms
Five studies assessed the efficacy of therapist-supported iCBT among 451 women. Therapist-supported iCBT interventions were shown to have a large effect (0.84) on eliminating stress symptoms.
Efficacy of therapist-supported iCBT on anxiety symptoms
Six interventions looked at changes in anxiety symptoms post-intervention, including 510 participants. Therapist-supported iCBT was shown to significantly improve anxiety symptoms with a small to medium effect size (0.26).
Efficacy of therapist-supported iCBT on depressive symptoms
Eight interventions analyzed changes in depressive symptoms post-intervention, including 934 participants. Therapist-supported iCBT was shown to significantly improve depressive symptoms with a medium to a large effect size of 0.63.
What can we learn from this research?
When looking at the eight studies, researchers supported the idea that therapist-supported internet-based cognitive behavioral therapy shows significant promise for helping women decrease stress, anxiety, and depressive symptoms during the postpartum period. Most of the therapist-supported iCBT programs focused on cognitive restructuring, and these programs showed the ability to help reduce depressive symptoms, post-traumatic stress symptoms, and pregnancy loss.
Therapist-supported iCBT also showed the ability to help women with child-related traumatic events avoid nervous impulses and increase overall life quality, including reducing fear levels throughout the day. This type of therapy showed participants having the largest improvement in stress and depressive symptoms, two of the most common indicators of worsening mental health in the postpartum period.
As our society continues to integrate internet-based programs into our daily lives, therapist-supported cognitive-behavioral therapy should be considered a clinically supported option to help women in the postpartum period reduce symptoms and improve mental health. Opportunities to continue developing and implementing these programs will continue to grow, and online-based interventions help bring access to these programs to a broader audience than was previously accessible.**
