This is a cognitive behaviour therapy-based self-management guide for women from the BC Reproductive Mental Health Program. Whether you are trained in CBT or not, the guide contains information, tips and worksheets relevant to anyone working with postnatal women. The guide contains: How to use the guide:  The guide provides both information and exercises.  Depending on the degree of the symptoms, the guide can be used on its own or in combination with other treatment options such as medication.  It can be used in both individual and group formats.  It may be helpful to discuss with women the sections in the order they appear, however a certain section (e.g. Self-Care: The NEST-S Program) may be a more appropriate starting point in some instances, leading on to discussion of the other sections.  Some sections may need reviewing more than once – a lot of women find that some ideas make sense right away while others only sink in after they have been reviewed many times.  The most important thing is to pick a starting point that the woman with depression feels they can handle and make a start with that.

Information for women on “What is depression during pregnancy and following the birth?”:  If a woman thinks that she may be depressed and/or suffering from anxiety, it is important to consult a health professional. NOTE: Many women who experience depression during pregnancy or following the birth will also have symptoms of anxiety.  These range from excessive worries to overwhelming panic attacks.  Having additional symptoms of anxiety may be something that makes depression during this time different than depression at other times in a woman’s life.  A woman may also experience symptoms of anxiety during pregnancy or following the birth without being depressed. For some women, these symptoms of anxiety may be more of a problem than the symptoms of depression.

A section on getting help and the treatment options for depression.

Risk factors for depression:  A woman is at higher risk of developing depression during pregnancy or following the birth of the baby if she:

• Has had depression or anxiety in the past.
• Has taken medication for depression or anxiety and stops before/during pregnancy.
• Has family member(s) who have had depression or anxiety.
• Has problems in her relationships with partner, friends and family.
• Experienced or is experiencing violence and/or abuse.
• Has poor practical and/or emotional support from friends, family and community.
• Herself or others around her have unrealistic expectations of her as a mother.
• Finds herself alone a lot of the time and/or separated from loved ones.
• Has immigrated to Canada within the last 5 years.
• Has a low income, education, lack of adequate housing or employment.
• Has had a recent stressful life event (e.g. death of a parent, housing issues).
• Relies on alcohol, drugs or other substances to help her deal with things.
• Has had a complicated pregnancy and/or birth.
• Herself or her baby had or have health problems.

Why some women choose not to seek help:

• She may not know who to talk to.
• She may not have a health provider.
• She may be reluctant to talk to her doctor for a variety of reasons.
• She may be ashamed of her difficulties, worried about being labelled or seen as a “bad” or “unfit” mother or of having her baby taken from her.
• Other people in her life may discourage her from seeking help.  This may happen in families that believe that mental health problems are shameful or in families in which there is emotional control or abuse.

An introduction to Cognitive-Behaviour Therapy.

Cognitive-Behaviour Therapy (CBT) is a combination of 2 effective types of therapy: behaviour therapy and cognitive therapy.

Behaviour therapy focuses on getting you active in your life again.  The aim is to decrease behaviours that make the symptoms worse (e.g. staying in bed or avoiding social interactions) and increase behaviours that reduce the symptoms (e.g. getting dressed, getting exercise, staying connected with important people in your life).

Cognitive therapy helps to a) identify patterns of thinking (cognition) or self-talk which are upsetting or lead to negative behaviours and b) learn ways to challenge these thoughts when they arise and replace them with more accurate and fair thoughts.

The real strength of CBT is that it focuses on building skills to help people to take an active role in reducing their depression symptoms.  This can help to prevent future episodes of depression.  Learning and using CBT effectively requires some time, effort and motivation.  In order to get benefits from this powerful treatment, people need to practise their new skills regularly.  This can be challenging when severe depression is making a woman feel exhausted.  Professional guidance from a mental health professional with specialized CBT training and sometimes medication can be useful to decrease the symptoms enough to allow the woman with depression to work on learning and practising her new cognitive behavioural skills.

The key components of CBT include:

• Educating and empowering oneself
• Improving one’s self-care
• Making positive changes
• Healthy thinking
• Planning to maintain one’s progress and prevent relapse.

An outline of the NEST-S program: Nutrition/Exercise/Sleep/Time for yourself/Support:  This section provides some lifestyle tips that will help women to “recharge” themselves and give them the energy they need to practise the effective depression management skills covered in the guide.  Each component contains a set of useful questions for the woman to ask herself and a set of tips to assist with building new habits and routines.

Action steps for goal-setting and problem-solving, along with an explanation of methods to challenge depressive thinking:  The Making positive changes section outlines how women can set and complete goals and steps for learning how to solve their problems.  The Challenging depressive thinking section introduces four steps you can teach women to help them identify and challenge their negative thinking.  This section also provides information on managing depressing thoughts, including common “traps”, and steps that women can take to practise more accurate and helpful thinking.

A section on maintaining gains and preventing relapse, along with a sample story of personal experience in using the guide: This section helps you teach women to make a plan for how they will maintain the progress that they have made and keep their depression management skills sharp over the long term.

Building a Social Support System:  The guide identifies different social supports (emotional, practical, social network, and information supports), gives examples, and makes suggestions of possible sources.

Handouts for women:  There are reminders in the guide to let you know when there is a worksheet that might be helpful.  This section includes:

1. Self-test for depression symptoms in pregnancy and postpartum – Edinburgh postnatal depression scale (epds)
2. The Cognitive-Behaviour Therapy model of depression.
3. Goal setting worksheet.
4. Thought challenging worksheet
5. Problem solving worksheet
6. Tips for talking with your doctor about your symptoms
7. What your loved ones can do to support you

The guide offers practical, step-by-step approaches to breaking down negative thoughts, applying logical analysis to debunk false thinking “traps”, and setting SMART goals for making cumulative small changes that help to create new, more positive habits, self-image and confidence.

Click here to access this guide.