Due to challenges in scalability, face-to-face care has not adequately addressed the worldwide need of evidence- based postpartum depression (PPD) interventions. Internet interventions have the potential to overcome this gap by giving psychological tools to individuals who lack proper access.
According to the Center for Disease Control and Prevention (CDC), 1 in 8 mothers may experience PPD, but when other depressive symptoms are considered, the number increases to 1 in 3.1 While their offspring face more emotional, behavioral, and academic issues, mothers with PPD have higher levels of anxiety, parenting challenges, and poorer mother-infant connection.2 Furthermore, only roughly 1 in 10 women who meet diagnostic criteria for PPD receive evidence-based care from a mental health professional, which is a concerning statistic.2 Although treatment can lessen negative consequences, effective interventions must be implemented quickly and easily to have the best results.3 Hence, there is a need for evidence-based interventions that would tackle the high prevalence of PPD. In group psychotherapy sessions, despite the fact that it is beneficial, only 10 to 12 moms can be treated at once.4 Large-scale treatments, however, may be able to address PPD on the level necessary to address its prevalence.5 While easier to spread outside of conventional treatment settings, brief therapies nonetheless retain the essential components of more thorough evidence-based interventions.6 Depression has been treated in general population samples using 1-day workshops that are based on cognitive behavioral therapy (CBT), with results lasting up to 2 years following treatment.7
An Overview of an Online 1-Day CB Workshop
Generally, the online 1-day CB workshops are held on zoom, by registered psychotherapists, clinical psychology graduate students, or a psychiatrist. Before their program began, participants were given a workshop guidebook.
One of the interventions described in a recent study was a one-day interactive workshop (9 am to 4 pm) that included role acting in four modules, didactic teaching, group activities and discussions.2 The first module explored the causes of PPD with an emphasis on risk factors that can be changed in the brain (negative thoughts, maladaptive core beliefs). Cognitive abilities, especially cognitive reorganization, were the main topic of the second module. The third module developed behavioral abilities like assertiveness, behavioral activation, and problem-solving. The fourth module offered the chance to identify goals and create an action plan. Workshops added cognitive restructuring and exercises addressing concern, and sleep.2
New Moms With PPD Benefit from Online CBT-Based Workshops
Several studies showed that online CBT-based workshops have been effective in reducing PPD and anxiety, as well as enhancing social support and the mother-infant bond.2,8-10
Online 1-day CBT-based workshops used in a randomized clinical trial involving 403 mothers showed benefits in PPD and anxiety, as well as in social support, the mother-infant bond, and infants' positive affect.2 Participants needed to be at least 18 years old, have children under the age of 12, reside in Ontario, and have an Edinburgh Postnatal Depression Scale (EPDS) score of at least 10. The intervention was shown to result in a statistically significant reduction in the EPDS scores in the mothers compared to controls.2
A sample of postpartum women (n=43) with a clinical diagnosis of depression were the subjects of another randomized controlled study (RCT) in which the researchers sought to determine the effectiveness of an online CBT intervention (the MumMoodBooster program).8 Women who underwent this Internet CBT treatment ceased to meet Structured Clinical Interview for DSM-IV (SCID-IV) depression diagnostic criteria rendering the intervention as a successful therapeutic choice.8 A recently published meta-analysis in the Journal of Women & Health assessed several online-based CBT interventions, and showed that they reduced the PPD significantly.9
Online 1-Day CBT-Based Workshops Offer a Great Solution
Online CBT-Based workshops specifically the 1-day ones, seems to be an effective solution for PDD. This is attributed to several reasons among which are the high accessibility to mothers with PPD, among which some do not have the support needed to seek in-person therapy, whether taking care of the children, or means of transportation. Furthermore, online sessions can assist mothers better manage their own care and get ready for therapy sessions by preparing all their questions, points of discussions, and properly advocating for themselves and their condition at the comfort of their home, which means increasing adherence to therapy sessions.
References:
1. Meaney MJ. Perinatal maternal depressive symptoms as an issue for population health. Am J Psychiatry. 2018;175(11):1084-1093. doi:10.1176/appi.ajp.2018.17091031
2. Van Lieshout RJ, Layton H, Savoy CD, et al. Effect of online 1-Day cognitive behavioral therapy-based workshops plus usual care vs usual care alone for postpartum depression: a randomized clinical trial. JAMA Psychiatry. 2021;78(11):1200-1207. doi:10.1001/jamapsychiatry.2021.2488.
3. Cuijpers P, Weitz E, Karyotaki E, Garber J, Andersson G. The effects of psychological treatment of maternal depression on children and parental functioning: a meta-analysis. Eur Child Adolesc Psychiatry. 2015;24(2):237-245. doi: 10.1007/s00787-014-0660-6
4. Sockol LE. A systematic review and meta-analysis of interpersonal psychotherapy for perinatal women. J Affect Disord. 2018;232:316-328. doi:10.1016/j.jad.2018.01.018
5. Brown JSL, Cochrane R, Hancox T. Large scale stress management workshops for the general public: a controlled evaluation. Behav Cogn Psychother. 2000;28(2):139-151. doi:10.1017/S1352465800001053
6. Horrell L, Goldsmith KA, Tylee AT, et al.; CLASSIC Trial Group. One-day cognitive-behavioural therapy self-confidence workshops for people with depression: randomised controlled trial. Br J Psychiatry. 2014;204(3):222-233. doi:10.1192/bjp.bp.112.121855
7. Brown JS, Elliott SA, Boardman J, Andiappan M, Landau S, Howay E. Can the effects of a 1-day CBT psychoeducational workshop on self-confidence be maintained after 2 years?. a naturalistic study. Depress Anxiety. 2008;25(7):632-640. doi:10.1002/da.20365
8. Milgrom J, Danaher B, Gemmill A, et al. Internet cognitive behavioral therapy for women with postnatal depression: a randomized controlled trial of MumMoodBooster. J Med Internet Res. 2016;18(3):e54 doi:10.2196/jmir.4993
9. Roman M, Constantin T, Bostan CM. The efficiency of online cognitive-behavioral therapy for postpartum depressive symptomatology: a systematic review and meta-analysis. Women & Health. 2020;60:1, 99-112, doi:10.1080/03630242.2019.1610824