Ontario program helps treat anxiety disorders during and after pregnancy that largely go unrecognized

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Lacey Kempinski’s first six months of motherhood were a blur of anxiety. She was terrified of dropping her first-born son down the stairs. She put signs up around the house to remind visitors to wash their hands before touching him and had trouble breathing when he was taken out of her sight. “There weren’t a lot of joyful moments,” said Ms. Kempinski, of Paris, Ont.

While pregnant with her second son, she was diagnosed with perinatal anxiety and enrolled in an experimental therapy program in Hamilton – one of the few in Canada for a condition that goes largely unrecognized, even though it is estimated that one in five women meet the diagnostic criteria for an anxiety disorder during pregnancy and the first year after delivery.

Now, after two years of monitoring participants and their outcomes, the program’s creators are sharing their findings in the hope that more women will get help.

Clinical and health psychologist Sheryl Green said she created the program at the Women’s Health Concerns Clinic at St. Joseph’s Healthcare because she found no existing guidelines, recommendations or treatment protocols for women with perinatal anxiety – even though her clinic receives more referrals for this condition than for any other.

“Postpartum depression is on everybody’s radar, and that’s fantastic,” Dr. Green said. But since perinatal anxiety can also negatively affect everything from labour and delivery to the child’s development, “it is so incredibly important to have this effectively identified and treated.”

Perinatal anxiety is believed to be more common than postpartum depression, but it receives relatively little attention. Many women mistake their symptoms for the expected jitters of new parenthood, and those who do recognize that they have anxiety have few treatment options, especially non-pharmacological ones.

Postpartum depression often includes feelings of hopelessness or inadequacy and an inability to experience pleasure, whereas perinatal anxiety can involve excessive worrying, intrusive anxious thoughts, panic attacks and avoiding people, places or activities out of fear. Some women can experience both conditions concurrently (singer Alanis Morissette recently opened up about her own experience with both depression and anxiety after the birth of her third child).

While some psychiatric medications are considered safe during pregnancy, they are not risk-free, Dr. Green said, so many women are reluctant to take them while pregnant or nursing. Moreover, medication does not always deliver adequate relief.

So, she gathered elements of existing cognitive-behavioural therapy (CBT) programs for treating various anxiety and mood disorders, and assembled them into her own perinatal program.

CBT, a form of therapy aimed at changing dysfunctional thoughts and behaviours, is effective for treating anxiety disorders, but women who are pregnant or postpartum have very specific needs, Dr. Green said. Given the demands of motherhood, she shortened the typical CBT protocol of 12 sessions to six weekly group sessions and allowed women to bring their babies. She also made the content applicable to the concerns new mothers commonly face, from finances and work to relationships and personal identity.

She and her team recently finished a two-year randomized control trial to test the program and said the results are encouraging. Women who participated in the six-week program had significant improvements in their anxiety symptoms, regardless of whether they were symptoms of social anxiety, obsessive-compulsive disorder (OCD) or any other type of anxiety, said Eleanor Donegan, a clinical and health psychologist and research analyst at the clinic.

They also had reduced depression and stress and maintained these improvements in a three-month follow-up.

Identifying women with perinatal anxiety is nevertheless a challenge. Nichole Fairbrother, a clinical associate professor at University of British Columbia’s department of psychiatry, who was not involved in the trial, said women with OCD can be reluctant to reveal that they have unwanted thoughts of harming their babies.

Even though they are not at risk of acting on those thoughts, she said, “no one talks about it because it’s terrifying to people to talk about.”

She said it is unlikely pregnancy or childbirth actually trigger most types of anxiety. But even if a woman’s anxiety predates her pregnancy, it is important to address it during the perinatal period, as it can affect the developing fetus, the woman’s birth experience and her parenting, Dr. Fairbrother said.

In Hamilton, the clinic continues to offer the program, which is covered by the province, and the team expects to publish its findings soon and is sharing its CBT protocol with other experts.

Ms. Kempinski said she still uses some of the things she learned from the program, even though her sons are now 4 and almost 2. For example, when she panics, she uses something called the “best friend” technique: She thinks about what she would tell her best friend in the same situation. Another strategy involves thinking through all the “what if” scenarios and considering the likelihood of the worst possible outcomes.

The techniques don’t work all the time, she said, but she has learned to be easier on herself when she recognizes that she is having an anxious moment.

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