PresenterCompanyProductResearchOther: Wendy Cartern/a Disclosure.

Presenter Company Product Research Other:

Wendy Carter n/a n/a n/a n/a

Wendy Carter, Ph.D., Sophie Grigoriadis, M.D., Ph.D., Lori Ross, Ph. D. & Paula Ravitz, M.D.

Objectives1) Review existing literature on Postpartum

Depression (PPD), relationship distress and psychotherapy interventions for PPD with couples

2) Describe a newly modified couples IPT approach (Conjoint IPT- PPD) to treating PPD in the context of relationship distress

 3) Highlight and illustrate the applicability of this

approach in a case study

Postpartum DepressionApproximately 13% of women meet criteria for

a MDE with postpartum onset (APA, 2000; Dietz, 2007; O'Hara & Swain, 1996)

Women who become depressed within the first year following childbirth are more likely to: become depressed following future

pregnancies (Cooper & Murray, 1995)have difficulty developing secure attachment

with their children (Murray et al., 1999)

PPD and the Family SystemPPD is linked to immediate and enduring

delays in the social, emotional and cognitive growth of children

PPD negatively impacts the emotional well-being of partnersE.g. greater rates of anxiety and

depression; increased stress in relationships with both partners and children

Relationship Distress and PPD

Relationship distress:

Identified as a moderate predictor of PPD (Beck, 2001)

Related to more severe depressive symptoms of greater duration (Fisher et al., 2002; Patel et al., 2002)

Related to increased risk for developing chronic mental health problems (Campbell et al., 1992; Viinamaki et al., 1997)

Depressive symptoms predicted postpartum relationship adjustment (Whisman, Davila, Goodman, 2011)

Postpartum relationship difficulties informed by attachment styles ( e.g. Feeney et al., 2003)

Sources of relationship distressIncreased conflicts and disputes in the

postpartum period (Dennis & Ross, 2006; Johnstone et al., 2001)

Less instrumental and emotional support from partners (Dennis & Ross, 2006)

Women’s perceptions of unequal division of childcare and household responsibilities (e.g. Des-Rivieres-Pigeon et al., 2002; Terr et al., 1991)

Postpartum relationship difficulties informed by attachment styles ( e.g. Feeney et al., 2003)

Couple Interventions for PPD Misri et al. 2000 Examined the impact of a partner-

supported intervention on mood and relationship perception among 29 women diagnosed with PPD

Randomly assigned to either: Control group (attended 7 psycho-educational sessions solo) OR Intervention group (attended 3 sessions solo and 4 sessions with partner)

Women accompanied by their partners reported: Reduced psychological distress

Fewer depressive symptoms

More positive perceptions of their relationships with partners

Couples Therapy for Depression Barbat & D’Avanco (2008) –

meta-analysis comparing couple therapy to individual psychotherapy for depression 567 participants from 8 clinical trials

Findings: Fewer Depressive Symptoms: Couples = Individual Reduced Relationship distress: Couple > Individual Only the couples form of IPT (IPT-CM) linked the context of depression to relationship distress in couples

Couples form of IPT: IPT-CMFoley et al. (1989)--individual IPT and IPT-CM

among 18 participants with comorbid depression and Role Disputes with their spouse

Fewer Depressive Symptoms:IPT-CM = Individual IPT

Improved Relationship Adjustment: IPT-CM = Individual IPT

Improved Relationship Functioning: IPT-CM > Individual IPT

Rationale for Conjoint IPT-PPDRelationship distress both a predictor and an

outcome of PPDIPT-CM demonstrated successful for treatment

of depression and improved relationship functioning among couples whose primary issue is relationship disputes

IPT-PPD successfully adapted to for use with perinatal and postpartum women in the treatment of depression (O’Hara et al. 2000; Spinelli and Endicott 2003; Stuart and O’Hara 1995; Zlotnick et al. 2006)  

Conjoint IPT-PPD90 minute sessions for 12 weeks with trained IPT

therapistAdaptations specific to the postpartum periodPsycho-education about depression in the

postpartum period Review expectations of parenthood and changes

in dynamics since the birth of the child While the identified problem area is Role

Disputes, postpartum is a major time of transition and may integrate work on Role Transitions

Case Study: Ellen & DanielBoth in their early thirties Together for 3 years Two children (2 years and 4 months)

Ellen– diagnosed with a MDE with postpartum onset

symptoms perpetuated by the distress in their relationship

Pre-treatment Edinburgh Postnatal Depression Scale=16

Pre-test Scores Dyadic Adjustment Scale (Spanier, 1976)

ELLEN DANIEL

Overall Dyadic Adjustment

93* 109*

Dyadic Consensus

55 50*

Dyadic Satisfaction

25* 37*

Affectional Expression

4* 8*

Dyadic Cohesion

11* 15

PHASE OBJECTIVESInitial PhaseSessions 1-4

Provide psycho-education about PPDLink PPD to relationship distressClarify the therapeutic contractAssess the mental health functioning of both the mother and her partnerConduct individual interpersonal inventoriesExplore relationship modelsExplore the history and current conflicts in the relationshipAssign homework to clarify each party’s “dispute list”

Middle PhaseSessions 5-10

Identify key disputesDevelop an action planRenegotiate key disputes

Final PhaseSessions 11-12

Acknowledge and explore issues related to terminationRecognize growth and improvementsNavigate ongoing issues and future obstaclesImpart a sense of hopeEvaluate the need for future treatment

PHASE OBJECTIVESInitial PhaseSessions 1-4

Provide psycho-education about PPDLink PPD to relationship distressClarify the therapeutic contractAssess the mental health functioning of both the mother and her partnerConduct individual interpersonal inventoriesExplore relationship modelsExplore the history and current conflicts in the relationshipAssign homework to clarify each party’s “dispute list”

Middle PhaseSessions 5-10

Identify key disputesDevelop an action planRenegotiate key disputes

Final PhaseSessions 11-12

Acknowledge and explore issues related to terminationRecognize growth and improvementsNavigate ongoing issues and future obstaclesImpart a sense of hopeEvaluate the need for future treatment

Communication

Analysis

PHASE OBJECTIVESInitial PhaseSessions 1-4

Provide psycho-education about PPDLink PPD to relationship distressClarify the therapeutic contractAssess the mental health functioning of both the mother and her partnerConduct individual interpersonal inventoriesExplore relationship modelsExplore the history and current conflicts in the relationshipAssign homework to clarify each party’s “dispute list”

Middle PhaseSessions 5-10

Identify key disputesDevelop an action planRenegotiate key disputes

Final PhaseSessions 11-12

Acknowledge and explore issues related to termination

Recognize growth and improvementsNavigate ongoing issues and future

obstaclesImpart a sense of hopeEvaluate the need for future

treatment

Dyadic Adjustment Scale

Ellen Daniel

Pre-Test

Post-Test

Pre-Test Post-Test

Overall Dyadic Adjustment

93* 126 109* 133

Dyadic Consensus

55 58 50* 52

Dyadic Satisfaction

25* 38 37* 45

Affectional Expression

4* 9 8* 12

Dyadic Cohesion

11* 20 15 23

Conclusion and Next StepsTo date, no other couples therapy approaches where

at least one member of the dyad was clinically depressed have included modifications that overtly address depression during the postpartum or at any other specific life stage

Conjoint IPT-PPD may be a useful psychotherapeutic intervention with couples struggling in the postpartum period to negotiate conflicts

A randomized controlled clinical trial is now required to study the effectiveness of conjoint IPT-PPD in comparison to usual practice