Online CBT Workshop Improves Postpartum Depression Outcomes

Ryan J. Van Lieshout, MD, PhD

A cognitive behavioral therapy (CBT) workshop could yield several positive outcomes for mothers in treating postpartum depression (PPD), particularly during the COVID-19 pandemic.

A team, led by Ryan J. Van Lieshout, MD, PhD, Department of Psychiatry and Behavioral Neurosciences, McMaster University, determined whether an online 1-day CBT-based workshop added to the standard treatment regimen can improve postpartum depression, anxiety, social support, mother-infant relationship quality, and infant temperament more than just treatment as usual alone.

It is estimated that postpartum depression affects approximately 20% of mothers. However, only 10% of this patient population receives evidence-based treatment for the disorder.

In the randomized controlled trial, the investigators examined 403 patients with postpartum depression in Ontario between April 20 and October 4, 2020. Included in the study were adult women with Edinburgh Postnatal Depression Scale (EPDS) scores of at least 10 with an infant younger than 12 months.

The Study

Each participant was randomly assigned to receive either a live, interactive online 1-day CBT-based workshop delivered by a registered psychotherapist, psychiatrist, or clinical psychology graduate student in addition to treatment as usual (n = 202) or treatment as usual (n = 201).

The treatment as usual group was eligible to be wait-listed to receive the online workshop 12 weeks later.

The mean age was 31.8 years.

Outcomes

The investigators sought primary outcomes of the change in EPDS scores in experimental and wait list control groups 12 weeks after baseline. They also sought various secondary outcomes, including maternal anxiety based on the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7), social support scored on the Social Provisions Scale, the quality of the mother-infant relationship characterized by the Postpartum Bonding Questionnaire, and infant temperament, which was based on the Infant Behavior Questionnaire-Revised Very Short Form.

Significant Improvements

There was a significant mean reduction in EPDS scores for the workshop arm from 16.47 to 11.65 at baseline (B = −4.82; P < .001). This online therapy was also linked to higher odds of a clinically significant decrease in EPDS scores (OR, 4.15; 95% CI, 2.66-6.46).

In addition, the mean GAD-7 scores decreased in the CBT group from 12.41 at baseline to 7.97 after 12 weeks (B = −4.44; 95% CI, −5.47 to −3.38; P < .001).

Similarly to the postpartum depression scores, participants in this group were more likely to experience a clinically significant change (OR, 3.09; 95% CI, 1.99-4.81).

The mothers also saw improvements in the remaining secondary outcomes.

Scores improved in bonding (B = −3.22; 95% CI, −4.72 to −1.71; P < .001), infant-focused anxiety (B = −1.64; 95% CI, −2.25 to 1.00; P < .001), social support (B = 3.31; 95% CI, 1.04-5.57; P < .001), and positive affectivity/surgency in infants (B = 0.31; 95% CI, 0.05-0.56; P < .001).

“In this randomized clinical trial, an online 1-day CBT-based workshop for PPD provides an effective, brief option for mothers, reducing PPD and anxiety as well as improving social support, the mother-infant relationship, and positive affectivity/surgency in offspring,” the authors wrote.

The study, “Effect of Online 1-Day Cognitive Behavioral Therapy–Based Workshops Plus Usual Care vs Usual Care Alone for Postpartum Depression,” was published online in JAMA Psychiatry.