Developing a successful prevention program for postpartum OCD

The birth of a baby can elicit many emotions, from joy and excitement to fear and uncertainty. But it can also trigger unexpected difficulties with anxiety, in particular with postpartum Obsessive Compulsive Disorder (OCD). Now University of Miami (UM) and UNC-Chapel Hill researchers have developed an effective program for the prevention of postpartum obsessive compulsive symptoms. The findings are reported online by the Journal of Psychiatric Research.

“Postpartum depression has received much attention, but anxiety related issues, especially obsessive compulsive symptoms, can also be devastating to mothers and their families,” said Kiara Timpano, assistant professor in the department of psychology at UM College of Arts and Sciences and principal investigator of the study. “Many women experiencing these difficulties are not getting the services they need because they don’t even know that what they are experiencing has a label and can be helped.”

Most new mothers have some thoughts of concern about their babies. But according to the study, some mothers experience a more severe form of anxiety known as postpartum OCD. The condition includes intrusive thoughts about bad things happening to the baby. In order to control these unpleasant thoughts, the mothers develop rituals or other behaviors in response, like checking the baby excessively or washing a baby bottle many more times than is necessary.

“The problem with OCD is that it is like a radio that’s turned up too high,” Timpano said. “Part of our work is trying to figure out how it got turned up so high and how we can help individuals turn it back down. For example, while it’s okay to wash the baby bottle once, it is problematic if a mother ends up washing it for hours at a time.”

The new study is titled “Efficacy of a prevention program for postpartum obsessive-compulsive symptoms.” The investigation was conducted in collaboration with Jonathan S. Abramowitz, professor of psychology, and Brittain L. Mahaffey, doctoral student in psychology, both in UNC’s College of Arts and Sciences; Norman B. Schmidt, psychology professor and director of the Anxiety and Behavioral Health Clinic, and Melissa A. Mitchell, doctoral student in psychology, both at Florida State University.

To develop and test the efficacy of an intervention that would not only treat mothers once their difficulties emerged, but could also prevent symptoms from developing, the team designed a prevention program based on cognitive behavioral therapy principle — a treatment technique that has been found to be highly effective for anxiety disorders. The program was incorporated it into a traditional childbirth educational class.

“My hope is that the ability to recognize women at risk of developing postpartum obsessions, along with our newly tested program, will help to reduce the burden of postpartum OCD,” Abramowitz said.

Participants were a group of 71 expecting mothers at risk for developing postpartum obsessive compulsive symptoms. Half of the group was in a class that included the prevention program, the other half was in a regular childbirth education class (control group). The mothers were followed for six months after the birth of their babies. The program included information on the warning signs of anxiety and OCD, as well as specific techniques for how to deal with the symptoms.

The prevention program was successful in reducing both the incidence of obsessive compulsive symptoms and how distressing they were. Compared to the control group, the mothers in the prevention program experienced less anxiety after the babies were born and they maintained this effect for at least six months postpartum. The team also found that the intervention reduced those thinking styles that put a mom at risk to begin with.

Moving forward, the researchers would like to build on the program they created and make the treatment even more feasible and effective.