Treating Postnatal Depression A Psychological Approach for Health Care Practitioners

by Milgrom, Jeannette; Martin, Paul R.; Negri, Lisa M.

• ISBN13: 9780471986454
• ISBN10: 0471986453
• Edition: 1st
• Format: Paperback
• Copyright: 2000-02-08
• Publisher: WILEY

Summary

When mothers feel depressed in the months after childbirth, their feelings have often been dismissed as understandable reactions to the stress of caring for a new baby, perhaps complicated by family and marital demands. Most mothers cope, with varying degrees of support and success, but for many the neglect and misunderstanding of postnatal emotional problems can lead to long-term difficulties, with implications for their families as well as for mental health services. This book provides an understanding of depression following childbirth which draws together current theories and a synthesis of key research with a framework for intervention. It provides a novel way of thinking about postnatal depression, and a treatment program which is based on this model. The clinical programs and interventions which are outlined have been found to be effective at reducing postnatal depression. These programs are aimed at developing coping skills in women which: Reduce the symptoms of postnatal depression Improve maternal functioning in terms of self-esteem, assertiveness and coping Address marital and partner difficulties which often arise Deal with parent-infant difficulties the may exist Facilitate the use and development of existing social networks The authors have reviewed current knowledge on postnatal depression, and given guidelines for best practice in a variety of approaches to treatment and prevention, Included is a detailed account of a tried-and-tested 10-week treatment program, together with materials and resources that a busy clinician might need to implement a similar program. Treating postnatal Depression will be a valuable resource for clinical psychologists, counsellors, psychiatrists, nurses, health visitors, midwives and other professionals who need to understand and deal with the emotional problems of mothers and babies. "A very readable book which presents an excellent overview of this important topic, and allows the authors to share their wealth of clinical experience in the clinical management of depressed mothers." Professor Peter Lewinsohn, University of Oregon "This book is a very timely and accessible approach for health care workers who treat women with postnatal depression Medical interventions alone are rarely adequate in the management of this disorder, an understanding of the psychological issues is essential, and this comprehensive manual, which deals with how to approach the complexities of the disorder, will aid workers significantly and, ultimately, benefit those who are suffering." Professor Anne Buist, University of Melbourne Austin & Repatriation Medical Centre

Author Biography

Jeannette Milgrom is Professor of Psychology in the Melbourne School of Psychological Sciences at the University of Melbourne, Director of Clinical and Health Psychology at Austin Health and Founder and Director of the Parent-Infant Research Institute, Australia. She is internationally recognized for her work with mothers and babies. She is the author of six books, including Psychology and Psychiatry: Integrating Medical Practice and Treating Postnatal Depression: A Psychological Approach for Health Care Practitioners, and over 110 scientific articles and chapters.

Paul R. Martin is Professor and Head of the School of Psychology at Griffith University, Australia.

Lisa M. Negri is the author of Treating Postnatal Depression: A Psychological Approach for Health Care Practitioners, published by Wiley.

Table of Contents

About the authors	xiii
About the contributors	xv
Foreword	xvii
John Cox
Preface	xxi
Acknowledgements	xxiii
PART I: UNDERSTANDING POSTNATAL DEPRESSION
Introduction	2	(2)
Postnatal Depression in the Community	4	(26)
Symptoms and Experience of postnatal depression	4	(5)
Diagnosing the presence of a depressive disorder	9	(2)
Onset	11	(1)
Incidence	11	(2)
Long-term consequences	13	(1)
Psychosocial risk factors for postnatal depression	14	(8)
Developing a Biopsychosocial model of postnatal depression	22	(6)
Preview: towards a treatment of postnatal depression	28	(2)
Overcoming Depression and Postnatal Depression	30	(19)
Treatment of depression based on behavioural theory: the evidence from research on clinical outcome	30	(2)
Treatment of depression based on cognitive theory: the evidence from research on clinical outcome	32	(2)
Treatment of depression based on biochemical theories: the evidence from research on clinical outcome	34	(2)
Caveats in the research into the efficacy of treatment approaches to depression	36	(1)
Adaptation of treatment for postnatal depression: the evidence from research on clinical outcome	36	(5)
Our model of therapeutic intervention	41	(8)
Assessing Postnatal Depression and Treatment Options	49	(23)
Assessing postnatal depression	49	(5)
Measuring other risk factors	54	(1)
Marital relationships and partner functioning	55	(3)
Medication	58	(2)
Assessing infants	60	(4)
Other assessment and treatment issues	64	(4)
Summary	68	(1)
Suggested reading	68	(2)
PART II: TREATING AND MANAGING POSTNATAL DEPRESSION: THE GETTING AHEAD OF POSTNATAL DEPRESSION GROUP PROGRAM
Introduction	70	(2)
Phase I: Behavioural Interventions	72	(39)
Understanding and Managing Postnatal Depression	72	(11)
Notes for therapist	72	(1)
Therapist checklist for Session 1	73	(1)
Introduction to Session 1	73	(2)
About the presenters	75	(1)
Ground rules	75	(1)
Activity 1: getting acquainted exercise	76	(1)
Group discussion: pregnancy, birth, now	77	(1)
What is postnatal depression?	78	(1)
Introduction to our approach to treatment: the biopsychological model of postnatal depression	79	(1)
Preview Session 2	80	(1)
Homework	80	(3)
Pleasant Activities---How Can I Find the Time?	83	(10)
Notes for the therapist	83	(1)
Therapist checklist for Session 2	84	(1)
Introduction to Session 2	85	(1)
Psycho-education: the biopsychosocial model of postnatal depression (continued)	85	(3)
Activity 2: pleasant activities and mood	88	(1)
Group discussion	89	(1)
Psycho-education: increasing pleasant activities	89	(3)
Preview Session 3	92	(1)
Partners' session	92	(1)
Homework	92	(1)
Relaxation on the Run	93	(9)
Notes for the therapist	93	(1)
Therapist checklist for Session 3	93	(1)
Introduction to Session 3	94	(1)
Activity 3: consolidating pleasant activities in our lives	95	(1)
Psycho-education: relaxation training	95	(1)
Activity 4: Jacobson's progressive deep muscle relaxation (30 minutes)	96	(2)
Group discussion	98	(1)
Psycho-education: relaxing on the run	98	(1)
Group discussion	99	(2)
Activity 5: relaxation plan for high tension times	101	(1)
Preview Session 4	101	(1)
Partners' session	101	(1)
Homework	101	(1)
Assertiveness and Self-Esteem---Telling Others What I Think and How I Feel	102	(9)
Notes for the therapist	102	(1)
Therapist checklist for Session 4	103	(1)
Introduction to Session 4	103	(1)
Psycho-education: assertiveness skills	104	(1)
Group discussion: aggressive/passive/assertive styles	105	(1)
Activity 6: assertiveness training	106	(1)
Psycho-education: self-esteem	107	(1)
Activity 7: love letter	108	(1)
Preview Session 5	108	(1)
Homework	108	(3)
Phase II: Cognitive Interventions	111	(28)
Unrealistic Expectations of Parenting---Influences from the Past	111	(6)
Notes for the therapist	111	(1)
Therapist checklist for Session 5	112	(1)
Introduction to Session 5	112	(1)
Psycho-education: family of origin	113	(1)
Activity 8: my family of origin	113	(2)
Psycho-education: challenging unhelpful thoughts and unrealistic expectations of parenting	115	(2)
Preview Session 6	117	(1)
Partners session	117	(1)
Homework	117	(1)
My Internal Dialogue---the Missing Link	117	(7)
Notes for the therapist	117	(1)
Therapist checklist for Session 6	118	(1)
Introduction to Session 6	119	(1)
Psycho-education: self-instruction techniques are the missing link	119	(1)
Group discussion: difficulty following through with tasks	120	(1)
Activity 9: self-instruction	120	(2)
Psycho-education: using self-instruction	122	(1)
Preparation for termination	123	(1)
Partners session	124	(1)
Preview Session 7	124	(1)
Homework	124	(1)
Developing a More Helpful Thinking Style	124	(6)
Notes for the therapist	124	(1)
Therapist checklist for Session 7	125	(1)
Introduction to Session 7	125	(1)
Psycho-education: mind games---negative thoughts make me feel worthless and depressed	126	(2)
Activity 10: tuning into my thoughts	128	(1)
Group discussion	128	(1)
Psycho-education: ways to reduce negative thoughts and increase positive thoughts	129	(1)
Group discussion	129	(1)
Preparation for termination	130	(1)
Preview Session 8	130	(1)
Homework	130	(1)
Challenging my Internal Critic	130	(9)
Notes for the therapist	130	(1)
Therapist checklist for Session 8	131	(1)
Introduction to Session 8	132	(1)
Activity: starting to challenge thoughts and changing feelings	132	(1)
Psycho-education and activity: disputing and shifting cognitive distortions	133	(4)
Preview Session 9	137	(1)
Homework	137	(2)
Phase III: Relapse Prevention and Evaluation	139	(22)
Introduction	139	(1)
Putting it All Together---Travelling on	140	(5)
Notes for the therapist	140	(1)
Therapist checklist for Session 9	141	(1)
Introduction to Session 9	141	(1)
Group discussion: what changes in my mood have I noticed?	142	(1)
Group discussion: what about another baby?	143	(1)
Psycho-education: maintaining your gains	143	(1)
Group discussion: social support	144	(1)
Individual exercise: my goals	144	(1)
Group discussion: termination	145	(1)
Business	145	(1)
Finish	145	(1)
Consolidating What I Have Learned	145	(5)
Notes for the therapist	145	(5)
Evaluating Treatment Efficacy	150	(11)
Has my intervention been effective?	150	(1)
Qualitative methods	150	(2)
Research results on the Getting Ahead of Postnatal Depression program	152	(1)
Participant characteristics at pretreatment	153	(1)
Evaluation of cognitive-behavioural therapy for the treatment of postnatal depression	154	(1)
Changes in the parent-infant relationship	155	(1)
The Getting Ahead of Postnatal Depression program	156	(1)
Conclusion	156	(4)
PART III: CLINICAL MANAGEMENT OPTIONS
Introduction	160	(1)
Including Fathers	161	(21)
Jennifer Ericksen
Notes for the therapist	161	(2)
Partners and Postnatal Depression	163	(10)
Notes for the therapist	163	(1)
Introduction to Session 1: partners session	164	(1)
Aims of the treatment sessions	165	(1)
What is postnatal depression?	166	(7)
The Couple Relationship	173	(5)
Notes for the therapist	173	(1)
Introduction and session content	173	(5)
Doing it Ourselves	178	(4)
Notes for the therapist	178	(1)
Introduction and session content	179	(3)
Including Infants: Baby H.U.G.S.	182	(33)
A Brief Review of the Literature	182	(16)
Key concepts in infancy	182	(5)
Postnatal depression and child development	187	(3)
Expanding our model to explain the consequences of postnatal depression on the infant	190	(2)
Evidence of the ability to change the mother-infant interaction	192	(4)
Baby H.U.G.S.: an intervention program designed for depressed women and their infants	196	(2)
A Program for Parent--Infant Difficulties	198	(2)
Notes for the therapist	198	(2)
Suggested reading list	200	(1)
Let's Play---Play and Physical Contact	200	(5)
Notes for the therapist	200	(1)
Introduction and session content	201	(3)
Homework	204	(1)
Let's Learn about your Baby---Observing and Understanding your Baby's Signals	205	(6)
Notes for the therapist	205	(5)
Homework	210	(1)
Let's Examine our Feelings---Parental Responses to Infant Cues	211	(4)
Notes for the therapist	211	(2)
Homework	213	(2)
Individual Treatment: A Flexible Approach	215	(21)
Jennifer Ericksen
Carol Richards
Introduction	215	(3)
Phase 1: extended assessment	218	(10)
Phase 2: goal setting	228	(2)
Phase 3: treatment	230	(5)
Final session	235	(1)
Concluding Comments on Clinical Issues	236	(8)
Making the group program work	236	(3)
Prevention	239	(3)
Research: future directions	242	(1)
Concluding comment	243	(1)
References	244	(15)
Index	259