Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention

Abstract

Perinatal mood and anxiety disorders are a leading cause of morbidity and mortality for childbearing women. Current treatments, such as cognitive behavioral therapy and interpersonal therapy, have demonstrated modest success in addressing perinatal psychiatric symptoms; however, additional treatment options are needed to address the limitations of current approaches, particularly for women experiencing moderate to severe perinatal mental illness during pregnancy or postpartum. We discuss the use of acceptance and commitment therapy (ACT) as a promising treatment approach that may be uniquely suited for perinatal women due to its emphasis of values, mindfulness, and acceptance; these psychological constructs notably address the significant psychiatric and behavioral health condition comorbidity, somatic symptoms, and stigma associated with perinatal mood and anxiety disorders. In addition, we describe the development of a four-session ACT-based group intervention at the Perinatal Psychiatry Inpatient Unit at the University of North Carolina at Chapel Hill. Sessions focus on core ACT processes of acceptance, cognitive defusion, present-moment awareness, value identification, and goal setting, and we describe how each of these processes is relevant to the perinatal population. Implications for future clinical applications and research investigations are discussed.

Psychological Flexibility and Depression in New Mothers of Medically Vulnerable Infants: A Mediational Analysis

“…Findings from previous studies indicate that psychological flexibility is indeed amenable to intervention and acceptance and mindfulness strategies to affect such change are readily available. To date, one group treatment based on ACT has been developed for perinatal mood and anxiety disorders but has yet to be fully evaluated [40]. Interestingly, results indicated that treatment conditions were differentially related to psychological flexibility early in the post NICU discharge period.…”

Postpartum Stress and Neural Regulation of Emotion among First-Time Mothers

“…Distraction has been shown to be an effective regulation strategy for decreasing mothers' emotional intensity and bilateral amygdala activation while listening to infant cry sounds (Firk et al, 2018). Acceptance and commitment therapy (ACT) approaches, such as mindfulness and cognitive defusion may be particularly helpful among postpartum samples (Bonacquisti et al, 2017). Teaching mothers mindfulness skills can promote adaptive coping in stressful contexts (e.g., poverty, relationship conflict) and parenting challenges (e.g., nursing, sleep deprivation) to facilitate sensitive and responsive parenting (Duncan & Bardacke, 2010;Gershy et al, 2017).…”

Acceptance and Commitment Therapy for perinatal mood and anxiety disorders: A feasibility and proof of concept study

“…Recently, Acceptance and Commitment Therapy (ACT) has been highlighted as a psychological intervention that is well placed to meet the needs of women presenting with moderate‐to‐severe perinatal mood and/or anxiety disorders (Bonacquisti, Cohen, & Schiller, 2017). Commonly referred to as a ‘third wave’ or ‘contextual’ behavioural therapy, ACT is grounded in an empirical, principle‐focused approach (Hayes, Luoma, Bond, Masuda, & Lillis, 2006; Hayes, Villatte, Levin, & Hildebrandt, 2011).…”

“…A growing number of randomized controlled trials (RCTs) summarized in a series of systematic reviews and meta‐analyses attest to the efficacy of ACT for a range of psychiatric disorders and chronic health conditions including mood and anxiety disorders, psychosis, chronic pain, cancer, diabetes, epilepsy, obesity, and substance abuse (A‐Tjak et al ., 2015; Hayes et al ., 2011; Öst, 2014; Powers, Vording, & Emmelkamp, 2009; Ruiz, 2012). The trans‐diagnostic nature of ACT and the comorbidity of physical and mental health problems during the perinatal period are cited as reasons why ACT maybe uniquely beneficial for moderate‐to‐severe perinatal mental health problems (Bonacquisti et al ., 2017). However, to our knowledge, there are no published studies evaluating the feasibility, safety, or effectiveness of ACT for women with mood and/or anxiety disorders during the perinatal period.…”