Depression in Pregnancy: A Guided Self-Help Workbook

Accessing the right mental health support during pregnancy is important. Dr Rachel Mycroft, Clinical Psychologist, South London and Maudsely NHS Trust shares more on the workbook for depression in pregnancy that can be used as part of guided self-help interventions.

Postnatal depression is often the first thing that comes to mind when we think about perinatal mental health. But many women experience low mood during pregnancy. Sometimes the depression was present before the pregnancy. Other times, the many psychological, physiological and practical adjustments associated with pregnancy can result in feeling down. At times it can be difficult to know what might be commonly experienced changes related to pregnancy, such as tiredness or lack of energy, and what might be linked to an episode of depression. It can be challenging to feel sad or tearful at a time when others may expect you to feel very happy.

Accessing support at this time is really important to help you to be in the best place you can be ready to meet your baby.

There is good evidence that psychological approaches such as Cognitive Behaviour Therapy (CBT) are effective in helping low mood, including around the time of having a baby. For mild depression, it may be useful to learn about these techniques via self-help materials. Researchers at King’s College London and the South London and Maudsley NHS Foundation Trust have developed a workbook for depression in pregnancy that can be used as part of guided self-help interventions. Guided self-help is available for mild depression in IAPT services (IAPT stands for Increasing Access to Psychological Therapies). You can usually refer yourself to your local IAPT service, or ask your GP to refer you. Before now, very few guided self-help materials specific to the perinatal period were available. IAPT services across London now have access to this specially tailored workbook and can offer guided self-help for depression in pregnancy.

The workbook describes common experiences of low mood in pregnancy. It covers a variety of techniques such as finding the right balance of activities, working with negative thinking patterns and managing relationships. It takes account of common themes that can come up during pregnancy, such as needing to ask for help, worries about the birth and attitudes towards parenting. Exercises are used to help you to reflect on how you feel about your baby (including negative feelings or absence of feelings for the baby) and to plan what things will be important to you once the baby is born. Health and lifestyle are particularly important during pregnancy, and there is a chapter about this topic. Throughout the workbook there are also links to other relevant resources and organisations.

The workbook is available to practitioners delivering guided self-help in NHS settings (please email the research administrator at the Section of Women’s Mental Health at King’s College London admin-swmh@kcl.ac.uk for further details, as the workbook was developed as part of a research programme led by Professor Louise Howard, Head of the Section of Women’s Mental Health).

If you are seeking help for depression in pregnancy or postnatally, please self-refer to your nearest IAPT service: you can search for this on the NHS Choices website. You should be given a priority appointment if you indicate that you are pregnant or in the first year after birth. If you are offered guided self-help then you can ask your practitioner for a copy of the workbook and he or she will be able to support you in working through it. GPs should also be aware that this workbook can support tailored interventions for depression in pregnancy available as guided self-help within IAPT.

Dr Rachel Mycroft is a Clinical Psychologist working in Perinatal Community Services with the South London and Maudsley NHS Foundation Trust. She has over 12 years’ experience of perinatal mental health and perinatal psychological therapies. She has particular skills in Cognitive Behaviour Therapy (with BABCP accreditation) as applied in the perinatal period and special interests in tokophobia (fear of childbirth) and birth trauma. She has recently worked on a randomised controlled trial of guided self-help for depression in pregnancy at Kings College London. She is Chair of the South London Perinatal Mental Health Network as well as contributing to other key organisations such as the British Psychological Society Faculty of Perinatal Psychology. She regularly delivers supervision, teaching and training in perinatal mental health and perinatal psychological therapies across a range of settings.

Acknowledgement: This workbook was informed by independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number: RP-PG-1210–12002) and the National Institute for Health Research (NIHR) / Wellcome Trust King’s Clinical Research Facility. The study team also acknowledges the study delivery support given by the South London NIHR Clinical Research Network. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

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