New mothers have it tough. Having a baby and introducing a new member of the family to take care of is a full-time job.
These new responsibilities are already challenging for a regular healthy person. It’s even harder for mothers who experience postpartum depression. Unfortunately, postpartum depression is quite common: research suggests that nearly 1 in 5 healthy mothers experience postpartum depression (Shorey et al., 2018).
Beyond making it more difficult to engage in caretaker responsibilities, postpartum depression can even impact the relationship between the mother and the baby. New moms might feel additional guilt that they are not happy to see their baby, and feel distressed that the mother-child relationship does not feel easy and natural.
These can lead to certain negative thoughts (also called “thinking errors”) that further impact mood.
- “I am not being a good mother”
- “I should be able to easily develop a relationship with my baby. There’s something wrong with me”
- “Why am I like this?”
Below, I discuss a few cognitive behavioural strategies that I have used in group therapy for perinatal women experiencing anxiety and/or depression.
Showing self-compassion in postpartum depression through the Best Friend technique
We are often much tougher to ourselves than we are to a close friend or family member. The best-friend technique (further elaborated in this post), is a way to show ourselves the same compassion we might show to a ‘best-friend’.
You might begin by writing down a situation: “Feeding my baby in the morning”
Then write down some of the thoughts you had about yourself at the time. “I was thinking to myself that I was really exhausted and somewhat unhappy. I felt like I was a bad mother, because mothers should be happy to take care of their kids. But I just felt really out of it, which makes me feel super guilty.”
Now, write down how you might respond to a friend who was having the same difficulty: “Of course it makes sense that you are feeling exhausted! It’s 6:20am and you haven’t been sleeping well because your baby has been crying throughout the night. You haven’t had any food and haven’t had some time for yourself to recharge for the last 3 weeks. Just because you are not always happy doesn’t mean you are a bad mother or that you don’t love your baby. In fact, you’re a fantastic mother for ensuring that your baby’s needs are met in spite of the fact that you feel so low.”
Now, check in to see if your emotions have changed. “I feel a little less guilty and a bit happier. I realize that I do love my baby and just because I’m tired doesn’t mean I’m a bad mother. I do think I need a bit of a recharge so I might ask my partner to look after my baby tonight so I can take a nice bath”.
Restructuring postpartum negative thoughts using the Thought Record
The Thought Record is a clinical tool that is often used by CBT therapist to as another way to tackle negative thoughts that come up. The thought record takes a negative thought and evaluates it using evidence for and against the thought. Both the thought record and best-friend technique can be used, though I would encourage you to try each one and see which works best for you!
Here’s an example.
Situation: “My baby was crying and I wasn’t able to soothe him”
Thought: “I can’t make my baby happy; I am a bad mother”
Emotions: guilty (90%), depressed (80%), anxious (85%)
Evidence for the thought. My baby was crying and he was unhappy. I tried several strategies (e.g., feeding him, rocking him gently back and forth, burping him) but nothing worked.
Evidence against the thought: There have been many times in the past where I have been able to make him happy. There have also been times where he has been very happy to see me and was smiling. Just because he is crying doesn’t mean that I have done something wrong.
Using both evidence for/against the thought, develop a balanced thought: Although my baby was crying and I can’t make him happy 100% of the time, this doesn’t mean that I am doing something wrong. There are many times where I have been able to make him happy and my presence comforts him. Babies cry sometimes; that’s what I do. I am doing my best”.
Remember, thought records work best when we back up our evidence with plenty of facts! So draw examples from past experiences if you can.
Behavioural strategies for postpartum depression
Beyond cognitive strategies, behavioural strategies such as activity scheduling can be a great way to increase mood and nourish ourselves to handle life’s daily challenges.
New mothers typically have many things in their day pulling for their attention; therefore, it’s important to schedule activities that give them the best bang for their buck.
Make a list of different activities that are low cost to do, but high in value. For example, if you enjoy drinking tea, then planning a few minutes in the morning for yourself to drink a hot cup of tea while reading a nice book, for example. Another example might be having your partner take of the baby while you take some time for yourself in a hot bath or have an afternoon lunch with your friend. Make a list of activities and choose the ones that give you the biggest bang for your buck! If you’re interested in learning how to develop specific and feasible, please see this article on developing SMART goals!
- Postpartum depression is very common among new mothers
- Cognitive strategies, such as the ‘best-friend’ technique and thought records, help by providing self-compassion and challenging negative thoughts
- Behavioural strategies, such as activity scheduling, are a great way to nourish ourselves and improve mood