After Lee-Anne Mosselman-Clarke, a mother in Ontario, gave birth to her first child 11 years ago, she thought she understood why she felt so low during those first weeks and months of parenthood.
Her son “had really severe health issues,” she told HuffPost. “He was in the hospital for quite a while, so I just kind of pushed my own needs to the side.”
But when she gave birth to her second child two years later and experienced the same symptoms, they pointed to a different cause: postpartum depression. This time around, her midwife suggested she look into cognitive behavioral therapy (CBT).
Mosselman-Clarke began working one-on-one with a therapist, “and it was okay,” she said. “But I kept thinking, ‘I don’t want to talk to a doctor about this, I want to talk to people ... that get it.’”
She eventually found a group CBT program, which she credits with helping her recover from her depression. The group dynamic, she said, was critical: “Being able to have the empathy and compassion and not feel the guilt and shame.”
The camaraderie of the group, she believes, was an ideal counter to the isolation that both accompanied and compounded her depression. Years later, when she heard of an opportunity to train as a peer leader for this kind of a group, Mosselman-Clark was eager to sign up.
What is postpartum depression?
Up to 75% of birthing parents experience some sadness or mood swings in the weeks following delivery, according to Cleveland Clinic. This temporary emotional dip is commonly referred to as “baby blues,” and it is attributed to the steep plunge in hormone levels that occurs after birth. For as many as 1 in 5 women and birthing people, however, these feelings of sadness don’t lift, leading to a diagnosis of postpartum depression. (It’s important to note that fathers and adoptive and other non-gestational parents can experience postpartum depression, too.)
Therapy and medication can be effective treatments for postpartum depression. In fact, the FDA has just approved the first pill specifically to treat it. But with so many people impacted, and the current shortage of mental health providers, patients often face significant delays in accessing treatment. In addition, some new parents hesitate to speak about their symptoms because they feel shamed or stigmatized, further delaying their care.
An effective treatment.
Given the need for compassionate, evidence-based care that can meet such a high need, group CBT delivered by peers offers a treatment option that could be scaled to meet the needs of many patients.
The group Mosselman-Clarke led was part of a study conducted by researchers at McMaster University in Canada to assess peer-led CBT groups as a mode of treatment for postpartum depression.
Participants were identified using the Edinburgh postnatal depression scale. Those who scored 10 or higher, indicating possible depression, were offered a spot in the study.
“People who have that level of symptoms can still have a lot of struggles, but sometimes they’re not eligible for services because they’re not severe enough,” explained Dr. Ryan Van Lieshout, a professor in the department of psychiatry and behavioral neurosciences at McMaster University and one of the authors of the study.
Participants were then randomly assigned either to take part in the CBT group right away or nine weeks later. This way, researchers could compare the results of the group who received treatment with the group that had not received it yet. Throughout this time, participants in both groups received “treatment as usual,” which sometimes included individual meetings with a therapist or another provider. “The health care service used outside of the group was equivalent in the two groups,” Van Lieshout said.
The original plan was for the groups to meet in person, but because of the pandemic, they ended up meeting entirely online via Zoom. For each of the nine weeks, groups met for two hours. The second hour centered on a weekly discussion topic of interest to new parents, such as sleep. The first hour “focused on core cognitive behavioral therapy skills,” Van Lieshout said. He referred to these as “the traditional parts of CBT.”
Cognitive behavioral therapy is an evidence-based treatment whose aim is to change your thinking patterns. One of these strategies is called cognitive restructuring, in which “people learn to identify the thoughts that they’re having that might lead to shifts in their mood,” Van Lieshout told HuffPost. Once they learn to identify the thoughts that are making them feel anxious, sad or depressed, they are taught to “balance” that “harsher self-talk” with other thoughts, thereby improving their mood and reducing anxiety.
For people with postpartum depression, Van Lieshout said, such thoughts frequently express inadequacy: “I’m not good enough,” “I won’t be able to do this,” “I’m not a good mother.”
Mosselman-Clarke explained that participants were taught multiple ways of “balancing” this thought with another. One technique involves imagining what you would tell your best friend in a similar situation. “We are way harder on ourselves than we ever would be on somebody we care for,” she observed.
A thought of inadequacy, for example, might be balanced with something like: “I am able to meet my baby’s needs.”
“What I like about the peer CBT is that we are teaching them to be their own therapist. In the end, they are telling themselves these things. They’re putting the balanced thoughts into their phone, or writing it on paper and putting it on the fridge, or taking a screenshot of it —or some of them would write it on their mirror.”
Mosselman-Clarke said that some participants were skeptical of those types of actions and were surprised to experience improvements in their relationship with their babies, or their partners, after doing so.
At the end of the nine weeks, “the ones who got the treatment right away experienced clinically significant improvements in postpartum depression and anxiety,” Van Lieshout said.
“The individuals in the treatment group were 11 times less likely to meet diagnostic criteria for a full major depressive episode at the end of treatment compared to the individuals in the control group,” he continued.
Participants were assessed both at the end of the nine week cycle and again three months out, and the researchers found that the observed improvements had not gone away.
Given how common postpartum depression is, and how great the need for services, Van Lieshout believes that the study shows “recovered peers can help bridge that gap between need and availability for treatments that women just really deserve.”
The healing potential of a group dynamic.
While peer-delivered therapies have been used to treat other mental health conditions, such as substance use disorder, there is a clear case for their use in postpartum depression. A group can help combat the feelings of isolation that new parents may face, and hearing from peers that they are not alone in their feelings and that recovery is possible can bring patients hope.
It was “remarkable,” Van Lieshout said, to see “women sort of band together against a common cause or a common problem, and how they come to each other’s aid, and they support one another.”
“One of the most powerful things in helping people get better are the other members of the group,” he said.
The combination of this group dynamic and the structured, evidence-based CBT therapy, Van Lieshout believes, creates a treatment that offers “the best of both worlds.”
Van Lieshout wants expectant parents to know that postpartum depression is a common issue. “It’s not a weakness. It’s something that develops as a combination of biology and environment and ... can happen to anyone.” Equally important, he said, people should know that there are effective treatments available, and they aren’t necessarily treatments that will need to be continued in the long term.
Mosselman-Clarke would tell new and expectant parents, “adjusting to parenthood is a massive life change. And it is okay to say you’re not okay. You don’t have to fake being happy.”
“Asking for help isn’t a failure,” she added.