Perinatal Behavioral Health & Psychotherapy Program
Many individuals experience changes in their mood during pregnancy and the postpartum (the perinatal period), and research shows that at least 1 out of every 5 people experience more significant changes that interfere with their daily lives. These mental health symptoms can include depressed mood, irritability, anxiety, upsetting thoughts, and sleep problems, among others. Our clinic provides “evidence-based” therapy to people experiencing mental health concerns during the perinatal period. “Evidence-based” therapies are treatments that have been supported by research to improve mental health symptoms and increase well-being. This is different from supportive therapy, which often focuses on providing general listening and encouragement.
Our clinic also provides both generalist and specialist forms of treatment. That means that all of the providers in our clinic are trained to treat the most common mental health symptoms during the perinatal period (for example, depression and anxiety), but different providers also have specialized training in specific struggles that people may face, such as trauma, insomnia, or eating disorders. Our clinic is committed to providing culturally-tailored care, so that all aspects of your identity (e.g., culture, race, gender, sexual orientation, spirituality) are valued and integrated into treatment. Every individual will complete a comprehensive psychological assessment before beginning in our program, to ensure that they are matched with the provider best able to address their needs and goals.
The Perinatal Behavioral Health and Psychotherapy program providers work closely with medication providers, when it makes sense to do so. Perinatal individuals may choose to try therapy alone or therapy in combination with medication. If you are interested in receiving both, we can refer you for medication management through our psychiatrist and nurse practitioner colleagues in the Perinatal Mood and Anxiety Disorders clinic.
Most Common Treatment Approaches
Cognitive behavioral therapy (CBT) is a gold standard treatment used for depression, anxiety, panic attacks, bipolar disorder, psychosis, substance use, among other mental health concerns. Many people struggle with more than one diagnosis at the same time. Perinatal CBT has been extensively researched, with strong evidence of its effectiveness in treating perinatal depression and anxiety (see Li et al., 2022) and even preventing these symptoms in the perinatal period (see Waqas et al., 2022). CBT focuses on the connection between thoughts, feelings, and behaviors, and applying skills to each of these areas to help promote well-being. This therapy helps people to identify symptom triggers and to change unhelpful and distressing thoughts, feelings, and behaviors. The overall goal of CBT is to find solutions to current problems so that people can gain more control over their lives, and feel better as soon as possible. Treatment is often relatively short-term (6-12 sessions).
Acceptance and Commitment Therapy (ACT) is another treatment that can be used to address perinatal mood and anxiety disorders. This type of therapy aims to increase psychological flexibility using strategies such as acceptance of thoughts and feelings, mindfulness, and identifying and acting on values. In place of avoidance and struggling, ACT may help individuals improve their ability to experience and respond to internal events (e.g., thoughts, emotions, physical sensations, memories), allowing them to live more in line with what matters most to them. ACT is useful for treating depression, anxiety, obsessive-compulsive disorder, substance use disorders, psychosis, and many other psychological problems.
This treatment emerged more recently than other commonly used therapies such as Cognitive-Behavioral Therapy, so it has slightly less research in the perinatal window. However, existing evidence points to unique benefits during pregnancy and the postpartum period. For example, an acceptance-based approach may help individuals change the way they relate to unhelpful or judgmental thoughts about themselves, parenthood, comparisons to others, how perinatal experiences “should” or are “supposed to be”, or the physical sensations and uncertainties of pregnancy. Additionally, ACT’s emphasis on values and committed actions may support individuals’ ability to navigate life transitions, form new values-aligned habits, and accept — or even embrace — the many challenges inherent to pregnancy and the postpartum period. ACT can also be particularly helpful for individuals dealing with grief and loss.
Specialized Concerns
Obsessive Compulsive Disorder (OCD) can exist before pregnancy, but the neurobiological changes of pregnancy and the postpartum period increase people’s risk of developing OCD. About 2-3% of birthing parents will develop OCD in pregnancy or the postpartum period, and non-birthing parents are also at increased risk during this time. OCD has two main symptoms- obsessions, which are unwanted thoughts, images, or impulses that occur over and over, and compulsions, which are repetitive thoughts or behaviors that a person does in order to get relief from the distress of the intrusive thoughts. OCD which develops in the perinatal period often involves intrusive thoughts about the baby, especially thoughts about illness or contamination, harm happening to the baby, or sexual thoughts involving the baby. People with OCD are often terrified or horrified by these thoughts, and can be afraid to talk about them due to fear of judgment or the belief that their children might get taken away. These fears (and misunderstanding and misdiagnosis of perinatal OCD) can get in the way of much needed treatment. Our program uses the gold standard treatment for OCD, a type of Cognitive Behavioral Therapy called Exposure plus Response Prevention.
The effects of trauma can disrupt life during pregnancy, the postpartum period, or in the aftermath of a perinatal loss. While we treat people with a history of many different types of traumatic events, there are a few types that are particularly common in this season of life:
- Perinatal, obstetrical, or neonatal traumas: During pregnancy, delivery, or the first few weeks after delivery, you and/or your baby may experience life-threatening complications that require extensive medical treatment. Relatedly, you may have previously had these types of experiences, which may make a current pregnancy particularly stressful.
- History of sexual trauma: A history of sexual trauma can complicate pregnancy, delivery, and choices around feeding your baby. For some people who have experienced this type of trauma, they may experience intense emotions, thoughts, or memories about previous traumatic experiences associated with medical visits, body changes, and breastfeeding, among other situations.
- History of developmental trauma: If you experienced physical or emotional abuse in childhood or adolescence, especially by caregivers, the transition to parenthood can come with unique challenges. For example, some people have difficulty with knowing how to express love, fear, or anger in healthy ways, or knowing how to strike the right balance of discipline and compassion with their own children. You may feel well equipped to parent, but need to grieve some of your own experiences in childhood. You also may still be relying on support from caregivers who caused trauma to you in childhood, and may need to navigate setting new boundaries with them.
- Domestic or interpersonal violence: If your relationship is unsafe- emotionally, physically, sexually, or financially- pregnancy and the postpartum period can be a time when you feel particularly trapped and unsupported. You deserve support, and our clinic is here to help provide it for you and your family, whether you choose to remain in the relationship or separate.
We teach coping skills for common struggles associated with trauma, but also offer treatment to address the underlying symptoms at their source- so you can heal from trauma, not just cope with it. We use several different evidence-based treatments for symptoms of traumatic stress, including Prolonged Exposure and Cognitive Processing Therapy.
It is very common for people to experience challenges with their sleep during pregnancy and postpartum. Some of these challenges may include difficulties falling or staying asleep, waking too early, or having a restless mind at night. Many people find that they are more likely to experience anxiety, depression, and other mood symptoms when their sleep is poor. So, addressing sleep concerns may help with these mood-related symptoms, too.
In the Perinatal Sleep Program, we offer a 6-week individualized treatment that involves learning skills to improve your sleep quality, daily functioning, and overall mindset about your sleep. You will be asked to track your nightly sleep and practice daily skills that you learn each week. If you complete this program during pregnancy, we also will check in with you each month during early postpartum to reinforce the skills that you learned. The treatment is called Cognitive Behavioral Therapy for Insomnia, and this particular treatment also incorporates mindfulness skills.
The peripartum period is marked by many physical changes happening in a short period of time as well as an increased focus on weight and nutrition. For some individuals, the peripartum period can trigger a relapse of a previous eating disorder or be a vulnerable time for the onset of disordered eating. Symptoms that you might be struggling with disordered eating may include being preoccupied with your food intake or body image, having strict rules regarding your eating, having episodes of loss of control over your eating, and/or purging. Our program offers specialized treatments targeted to the unique challenges of navigating disordered eating during the peripartum period. Your treatment will focus on regulating your eating, decreased eating disorders symptoms (including restriction, binge eating, and/or purging), addressing body image concerns, and increasing skills to manage emotions.
Research shows that it is not unusual for couples to experience greater relationship dissatisfaction for up to three years after having a child. The Connected Couple class is a 10-week virtual class designed for couples experiencing increased conflict or relationship strain during pregnancy or the first year of postpartum period. A variety of skills are taught with simple practice suggestions each week. These skills include ways to nurture closeness and mutual support, communicate in ways that increase validation and understanding, and manage conflicts more effectively. Since this is a class format, participants will be expected to have cameras on and participate. However, there is no expectation to share personal information due to the educational emphasis. Our goal is that the class will feel comfortable, enjoyable and will provide tools that couples can use right away.
Dialectical Behavior Therapy (DBT) is a transdiagnostic therapy with around 40 years of research. It helps people who struggle with experiencing emotions more intensely and quickly than the average person, and who have a difficult time returning to feeling like their regular selves. DBT also helps people who struggle a lot in relationships (especially with assertiveness, or not being too passive or too aggressive), and who have difficulty being in the present moment, because they are either wrapped up in painful memories from the past, or anxious worries about the future. DBT has been scientifically studied and found to be incredibly effective at treating people with a history of trauma, PTSD, depression and bipolar disorder, eating disorders, anxiety disorders, self-injury, chronic suicidality, and borderline personality disorder. DBT is also helpful for people who have numerous current stressors, and for whom other treatments have not been helpful in the past. Our program specifically focuses on applying DBT to people who are either pregnant, postpartum, or post-pregnancy loss.
What is involved in treatment?
Our program is small, only serving 16 participants at a time. We provide “full model” or “comprehensive” DBT. This means that treatment involves the following four components:
- Weekly individual therapy,
- Weekly 90-minute group skills training class, where you learn four specific sets of skills:
- Mindfulness: skills to help remain in the present moment in a nonjudgmental way (instead of the painful past or feared future),
- Emotion Regulation: skills to help keep your emotions in a manageable range,
- Distress Tolerance: skills to help you get through extremely painful events, without acting on urges that might make circumstances worse,
- Interpersonal Effectiveness, or skills to help you assert your needs and boundaries, while building up the relationship and your self-respect.
- Phone coaching: access to your therapist outside of scheduled sessions when you are having trouble applying skills or aren’t sure how to cope with a situation,
- Peer consultation: your DBT therapist will also participate in consultation, to help them learn and grow as DBT therapists, as well as to help you solve complex problems when therapy feels stuck.
Most people are in the program for 6 to 12 months. Treatment often consists of two phases: stage 1, where we focus on increasing coping skills and stabilizing emotional reactivity, and stage 2, where we focus on treating trauma and emotional avoidance. You must participate in all components to be a part of the program.
Many in the peripartum period experience bonding and attachment challenges with their baby. This may look like difficulty feeling close to one’s baby, low positive emotion when with or thinking about one’s baby, challenges caring for baby, and difficulties playing with baby. There are many possible causes for this, including postpartum depression, anxiety, traumatic stress, sleep deprivation, low support in the caregiving process, among other causes. Similar challenges with attachment and connection can occur with one’s toddlers or older children. In therapy, you would learn skills to develop closeness and intimacy with your children, cultivate attentiveness towards your child, soothe your child, decrease behavioral issues (for toddlers and school aged children), and increase your distress tolerance when overwhelmed in the parenting journey.
Unfortunately, loss can occur at any time in life, including pregnancy and the postpartum. We specialize in supporting parents grieving after a miscarriage, stillbirth, or death of a child. However, we also support people grieving other losses during this period of life. Our program uses a variety of treatment approaches, including ACT (described above), to help people navigate the struggles of grief, while caring for themselves and their loved ones.
Support Group Resources for Individuals
https://www.postpartum.net/get-help/psi-online-support-meetings/
https://www.compassionatefriends.org/find-support/online-communities/