Postpartum depression (PPD) impacts as many as 10 to 15 percent of women following childbirth. Not only does the disorder negatively impact the woman, it can also adversely affect the family, as well as an infant's short and long-term development. Unfortunately, the postnatal period presents several barriers for seeking assistance, including lack of time due to childcare duties, not wanting to take medication due to breastfeeding concerns, and fear of stigmatization when seeking therapy. Over the past 10 years, researchers have evaluated using the Internet to offer treatment as an innovative method for addressing such face-to-face treatment barriers. Internet-delivered therapy allows a woman to complete treatment from the privacy and convenience of her home, around childcare practices.
Preliminary research has found that Internet-delivered therapy for postpartum depression can reduce symptoms of depression, anxiety, and parental stress, as well as improve quality of life. We were interested in looking deeper into this, aiming to better understand women's experience attending therapy on the Internet. With this in mind, we began conducting research at the University of Regina in Regina, Saskatchewan. Our study was connected to a larger treatment study that specifically investigated therapist-assisted Internet-delivered Cognitive Behavior Therapy (TAICBT) for women struggling with postpartum depression. The program, known as Maternal Depression Online, included seven internet-delivered therapy modules that a woman could work through on her own time. This content was adapted specifically for women with postpartum depression and included information about postpartum depression, cognitive and behavioral therapy skills, and weekly homework assignments to help the women to implement the skills into their daily lives. In addition, a therapist would contact the client on a weekly basis via email to provide support and encouragement and to answer questions. Through observing this study, we hoped to gain further information from women that could improve treatment outcomes, reduce drop out, and enhance therapist-assistance in TAICBT for postpartum depression.
The Pros and Cons of Internet Therapy
Overall, the response to Internet therapy for postpartum depression was positive. Participants consistently noted the convenience of working on the program at home around their child-caring schedule, often highlighting that traditional therapy would not be possible due to time and mobility constraints. They also felt that the program allowed for smooth and swift communication between themselves and a therapist. For instance, one woman shared: "I loved that I could access the program anytime. It fit into my schedule in a way that traditional therapy could not have, as my baby is demanding and my husband works out of town." The women also appreciated the kind of privacy Internet therapy allowed. Completing the program privately from their home prevented feelings of self consciousness that often comes with face-to-face therapy sessions. Further, the integral role of the Internet therapist was often highlighted by many participants including how the therapist assisted with motivation, provided support, and was often available outside of traditional face-to-face therapy hours.
However, Internet therapy doesn't come without its disadvantages. Over 40 percent of participants reported experiencing difficulty logging online and working through the program given their limited time and demanding childcare schedule, particularly when starting the program. Some women also struggled with finding time to complete weekly assigned homework activities within the recommended time, notably with the demands of an infant (and often other children). Although most participants reported satisfaction with the Internet therapist, a small minority expressed missing face-to-face contact with a therapist. Specifically, some participants described the Internet-delivered therapy as "not as personalized as one on one in-person counseling" and that an "in-person therapist would be able to personalize the learning process a little more, and spend more time on things I needed to spend more time on."
Improving Internet Therapy for Postpartum Depression
Overall, we gained valuable insight into women's perceptions of TAICBT for postpartum depression and how we can revise and improve the program for future users. As postpartum depression remains a stigmatized disorder, we found it particularly promising that participants described feeling less judged when completing Internet therapy, rather than attending in-person therapy where the risk of sharing their concerns may be greater. Indeed, this form of therapy may present a novel treatment approach for women to seek support who may feel uncomfortable with the more traditional in-person options. Although the participants never met their therapist in-person, they consistently reported finding their therapist helpful and supportive as they progressed through TAICBT. This was interesting as some critics argue that forming a strong therapeutic alliance is more challenging in Internet therapy.
Despite the fact that many participants reported challenges with logging into the site and finding time to complete assignments, over 60 percent of the participants completed the entire program. It appears that once the participants got the hang of this new therapeutic approach, the majority were able to complete the program. It was interesting to learn that the women were interested in an Internet social support group where they could connect with other mothers over the secure website. In the future, we are interested in adding this option to Maternal Depression Online and evaluating its effectiveness and how often it is used by participants. Perhaps with this addition, Maternal Depression will be even more well received by the participants when they have other women to reach out to for support and encouragement.
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Pugh, N. E., Hadjistavropoulos, H. D., Hampton, A.J., Bowen, A., & Williams, J. (2014). Client experiences of guided internet cognitive behavior therapy for postpartum depression: A qualitative study. Archives of Women's Mental Health. http://www.ncbi.nlm.nih.gov/pubmed/25109484
Date of original publication: December 02, 2014