Internet-Based Cognitive Behavioral Therapy (iCBT) For Postpartum Depression

If you're a new parent or caregiver, you might be one of the millions of people who experience postpartum depression (PPD). PPD is more than the "baby blues." It's a serious mental health condition that deserves proper support, attention, and care from a mental healthcare team. 

PPD may not only affect new mothers. This condition can impact men, adoptive parents, and parents who belong to the LGBTQIA+ community. Regardless of your identity, PPD can make it challenging to fully engage with the experience of being a new parent. If you're unsure how to begin treatment, help is available to improve your symptoms and prepare you for parenthood.

Cognitive-behavioral therapy (CBT) is often used to treat depressive disorders like PPD. A growing body of studies has supported the effectiveness of face-to-face and internet-based CBT. If you're living with or recovering from PPD and are interested in trying CBT, looking at how this treatment works and whether online therapy may be effective for your condition may be helpful.

What is postpartum depression (PPD)?

The American Psychological Association (APA) defines postpartum depression as a mental illness that consists of a major depressive episode affecting some new parents within four weeks to six months after the birth of their child. While PPD is a serious mood disorder, it may be undertreated and underreported, and an estimated 50% of mothers with PPD are not diagnosed by a health professional. 

In addition, a significant number of non-female or LGBTQIA+ parents may not be diagnosed with PPD, as the disorder is most commonly associated with women. Due to mental health stigmas, lack of mental health services, racism, and interrelated factors, women of color are also under-diagnosed with PPD.  

What are the symptoms of PPD? 

New parents can benefit from visibility and treatment for their symptoms independent of identity. Some of the primary symptoms of PPD include the following: 

• Excessive and uncontrollable crying
• Extreme mood swings
• Exhaustion, oversleeping, or sleep disturbances
• Appetite changes
• Stomach pain
• Headaches
• Emotional "emptiness," numbness, or apathy 
• Persistent sadness
• Thoughts of worthlessness and hopelessness
• Difficulty concentrating
• Anxiety and fear

Note that some people with PPD experience a combination of emotional, mental, and physical symptoms with varying degrees of severity that may not be listed. Each PPD experience is unique. 

If you're concerned about PPD, you may have also heard about postpartum anxiety, a related but separate challenge that could have symptoms with PPD. For proper care and treatment, consult your doctor to distinguish what your symptoms may be related to. Postpartum anxiety is not a disorder listed in the DSM-5 but may still exist, as anxiety disorders and depression are often linked. 

How does cognitive-behavioral therapy (CBT) work?

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that aims to reduce maladaptive thinking patterns to change unwanted behaviors. By recognizing the connection between thoughts and actions, people can learn to cope with their thoughts, relieve their symptoms, and improve their confidence and daily functioning. 

One of the core components of CBT is cognitive restructuring, a therapeutic technique focused on identifying, evaluating, and changing negative thoughts or beliefs, which are sometimes called "cognitive distortions." This technique aims to refute and restructure these thoughts and adopt more flexible, reasonable thought patterns.  

Behavioral activation is another critical component of CBT. This skill helps clients understand how their behaviors influence emotions, like how cognitive restructuring reinforces the connection between thoughts and behaviors. Using behavioral activation, people can gain awareness of negative or maladaptive behaviors, which are often influenced by emotions. 

CBT therapists may encourage clients to schedule alternative, healthier behaviors in their daily lives, such as exercise, socializing with friends, or a hobby that boosts their mood and challenges their comfort zone. 

The value of CBT for postpartum depression

Research suggests CBT may be an effective and lasting treatment for parents with PPD and postpartum anxiety. CBT is often short-term, lasting from 12 to 16 sessions, and focuses on cognitive restructuring, behavioral activation, and other techniques that help new parents identify and combat unhelpful thoughts and behaviors. 

In a 2018 review of studies that examined the value of online CBT for PPD, researchers found that this modality effectively improved new parents' PPD symptoms, based on files from 20 randomized controlled trials with over 3,500 participants. The researchers also noted that online CBT could be more cost-effective than standard care forms, such as medication and traditional counseling services. Home-based, telephone-based, and internet-based CBT all positively affected the short-term relief of PPD symptoms. However, more research is needed to establish the long-term benefits of these treatments. 

Internet-based CBT (iCBT): A promising option for new parents

Finding time for therapy can be a source of stress for new parents. If you're a new parent, you may juggle a newborn, work, relationships, and your mental health—all of which can demand time, energy, and strategic planning. Some mental health professionals offer their services online to meet the needs of new parents and other busy clients. Among these services, internet-based CBT (iCBT) is becoming an increasingly common treatment for a wide range of mental health conditions, including PPD. 

In 2017, a group of researchers performed a meta-analysis of studies that specifically examined the value of ICBT for women who just gave birth, referred to as "postpartum women." Based on eight studies with over 1,500 participants, the researchers found that therapist-supported iCBT could effectively decrease stress, anxiety, and depressive symptoms after childbirth. 

In this study, therapist-supported iCBT is a treatment guided by a therapist who provides feedback and answers to a client's questions. It included interactive, internet-based features to strengthen the therapeutic bond between therapists and clients.  

What are the benefits of iCBT for new parents?

The above meta-analysis illuminates some of the benefits of iCBT, a promising treatment for parents and families. Based on their results and other studies, the following four benefits of iCBT for people with PPD may resonate with new parents and mental health professionals.

Parents may already use the internet for health information

In a study of pregnant and postpartum women's use of health-related apps, researchers found that both groups frequently consulted the internet for information about their health, childbirth, and related concerns. 

To meet tech-savvy parents at eye level, the researchers encourage technology creators and mental health professionals to use smartphones, laptops, and other communication technologies to offer psychological resources to new parents worldwide. 

Online therapy eliminates common barriers for new parents

With a new baby (or more) in tow, parents may express the challenge of struggling to get to a therapy session. For new parents and other busy clients, common barriers to traditional, face-to-face therapy include the following: 

• Finding someone to care for their child or children during therapy
• Expensive therapy sessions
• Transportation time
• Parking and transportation costs 
• Lack of therapy options in the area 
• A lack of PPD specialists in the area 
• Stigmatization of PPD and other mental health conditions

In the period after childbirth, also called the postpartum period, the adverse impacts of these factors may be intensified by the stress of parenthood. Labor, delivery, and newborn care are expensive, and some new parents are also navigating shifts in their bodies, relationships, occupations, and other realms.

During this transitional phase, new parents may prefer internet-based CBT and other digital therapies over face-to-face options, which may be more expensive, time-consuming, and less convenient. 

iCBT can treat a range of mental health conditions (not just PPD) 

In addition to PPD, research suggests that iCBT can be a powerful treatment for numerous mental health conditions, including generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), chronic pain, phobias, and other depressive disorders. 

In the meta-analysis of iCBT for postpartum women, the researchers found that iCBT could target various mental health concerns within the realm of pregnancy. Specifically, they assessed postpartum women with one of three health conditions:

1. Depressive symptoms 
2. Post-traumatic stress symptoms 
3. Pregnancy loss

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

To examine the effect of iCBT on these conditions, the researchers compiled eight studies conducted between 2011 and 2016 across six countries, including Australia, Canada, Germany, Sweden, the United Kingdom, and the United States, with 1,523 participants total. Across all studies, the findings indicated that iCBT could effectively reduce stress, anxiety, and depressive symptoms. 

iCBT can be flexible to a client's goals

iCBT is known for its customizability. Therapists can adapt the treatment to align with clients' needs, mental health history, and goals. While some therapist-supported iCBT programs may focus on cognitive restructuring, others emphasize behavioral activation and other skills to help clients overcome specific thoughts or behavioral patterns.

Depending on a client's comfort level with technology, iCBT can be delivered in various formats, including counseling websites, phone, messaging, or video chat. Today, online platforms like BetterHelp feature thousands of board-certified therapists, some of whom use iCBT to guide new parents through significant transitions and daily struggles. Online therapists can schedule sessions around naptime, dinner time, and work meetings. In addition, new parents may benefit from being able to send quick messages to their therapists throughout the week. 

A meta-analysis of studies shows that iCBT can be as effective as face-to-face CBT in treating PPD, anxiety, and other psychiatric disorders. Researchers suggest that therapist-guided iCBT is preferable to other forms of CBT, as it provides instant client feedback and offers a comparable sense of real, human support.