Consider Online CBT for Your Perinatal Patients
Dr Daniela Solomon PhD
Women in pregnancy and postpartum have an increased vulnerability to depression and anxiety disorders.
Depressive and/or anxiety symptoms in pregnancy are often not recognised or diagnosed because of overlapping symptomatology with pregnancy itself. Thus, although approximately 56 000 Australian women are diagnosed with perinatal depression annually, depression remains undertreated during pregnancy. Maternal anxiety and depression are associated with poor perinatal outcomes and behavioural problems in infancy. Additionally, suicide is a leading cause of death among women during pregnancy and the first year following childbirth (AIHW 2010).
Pregnant women with major depressive disorder report that psychological therapies such as Interpersonal Therapy (IPT) and Cognitive Behaviour Therapy (CBT) are a more acceptable treatment than pharmacotherapy. A recent meta-analysis of 28 Randomised Controlled Trials (RCTs) showed that interventions during pregnancy are less effective than postpartum interventions, probably because of high attrition due to the barriers pregnant women experience with attending sessions outside their homes. Although current evidence is limited, internet-based self-help interventions may help overcome treatment barriers as they can be followed at home and when convenient.
Internet interventions have already demonstrated good effectiveness in decreasing affective symptoms in general. Benefits include absence of waiting time to treatment as well as a reduction in therapist time and costs. This type of intervention therefore presents a promising approach to the treatment of depressive and anxiety symptoms in pregnant women.
In a recent pilot trial computerised cognitive behaviour therapy (CCBT) was given to pregnant women. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195252/) Eighty percent of participants showed a response to treatment at post-trial and sixty percent showed remission after only eight sessions of CCBT. A follow-up trial of a larger group with mild to severe affective symptoms are currently underway.
Untreated affective disorders and their complications also result in considerable costs. If shown to be cost-effective, internet-based psychological therapies will not only offer new possibilities to treat pregnant women for affective symptoms, improve perinatal outcomes and to prevent the development of postpartum depressive disorders, but reduce the cost burden of health care utilisation.
References
Dennis CL, Dowswell T. Psychosocial and psychological interventions for prevention of postnatal depression. Cochrane Database Syst Rev. 2013, February 28th, Issue 2. Art. No.: CD001134. DOI: 10.1002/14651858.CD001134.pub3.
Kim DR, Hantsoo L, Thase ME, Sammel M, Epperson CN. Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2014 Oct;23(10):842-8. doi: 10.1089/jwh.2014.4867. Full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195252/
Gerhard is a full professor of Clinical Psychology at Linköping University, Sweden since 2003, an
d affiliated researcher at the Karolinska Institute, Sweden. Professor Andersson is an internationally recognized researcher in the field of CBT delivered through information and communication technology, as well as the author of the book “The Internet and CBT: a clinical guide”.
UPDATED
The PTSD Program for people with Post Traumatic Stress Disorder.
Do you know anyone who has difficulty motivating themselves to exercise? I think we all know people who get too depressed to exercise or too anxious to leave the house. But there are other people who, despite a lack of “diagnosis”, find exercise hugely difficult to contemplate.
As someone who has practiced medicine for almost four decades I have had the opportunity to observe firsthand the upsurge in the use of opioid pain killers in non-cancer pain.