Modifying CBT for Perinatal Depression: What Do Women Want?: A Qualitative Study

The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences of pregnancy and the postpartum period and its relationship to mood, and perspectives on ideal treatment content. Thematic analysis revealed a number of perinatal-specific themes that were relevant to CBT in three key domains: self, motherhood, and interpersonal. Mothers particularly struggled with: internalization of “motherhood myths,” self-sacrifice, and managing social support during this period. Shifts in women's themes across the perinatal period, and between racial and socioeconomic groups are discussed as are implications for modification of CBT to improve relevance for perinatal depression.

► We modified Cognitive Behavioral Therapy (CBT) based on perinatal depressed women's accounts of their treatment preferences.
► Women struggled with: rigid motherhood beliefs, self-sacrifice, managing social support, and troubles balancing activities.
► Some themes shifted across the perinatal period and between socioeconomic groups and depression severity.
► Modifications in CBT for perinatal depression should address self-sacrifice and interpersonal support strategies.