When we hear “postpartum” it is usually followed by “depression”. While the postpartum period IS often associated with depression, other disorders are overlooked. Outside the scope of obsessions harming infants, the effects of Obsessive-Compulsive Disorder (OCD) have limited investigation into pregnancy and the postpartum period. This is concerning for two reasons. One, research shows that obsessive compulsive symptoms (OCSs) can be as severely debilitating as other disorders, including schizophrenia. Two, clinical research reflects psychological disorders, commonly depression, cause poor infant outcomes. It is alarming OCD is often overlooked due to the potential impact on infant outcomes. Pregnancy and parenthood constitute major events that create major life obstacles. Studies show these periods can create a greater risk of causing and increasing the severity of OCSs. OCSs are associated with the overall well-being of the infant (House et al., 2015).
House et al. (2015) examined if preexisting OCSs increased throughout the perinatal period. Researchers followed 56 women diagnosed with OCD over a period of 52 weeks postpartum. The study relied on assessment measures for OCD and follow-up with clinicians. Researchers found the severity of OCSs did not increase or fluctuate throughout the pregnancy and postpartum period, unlike other disorders. Maternity age and delivery method were both associated with predictors of increased OCSs. Women who gave birth having a cesarean section showed an increase in OCSs postpartum, and younger woman were associated more with OCSs. Future studies would replicate this data and include comorbid disorders.
By Perry Leynor, MA, LPC-A – Behavior Therapist with Better Living Center for Behavioral Health
House SJ., Tripathi SP., Knight BT., Morris N., Newport DJ., Stowe ZN. (2015). Obsessive-compulsive disorder in pregnancy and the postpartum period: Course of illness and obstetrical outcome. https://pubmed.ncbi.nlm.nih.gov/26173597/
According to Google Trends, “Mindfulness” has become an increasingly popular search term over the past decade, and a variety of resources are available to date, including books, blogs, videos, and courses. In addition to its popularity, mindfulness has been studied empirically and become an evidence-based treatment for common problems such as anxiety and depression. Generally speaking, mindfulness involves bringing intentional focus to the present moment and observing the things you are experiencing at that moment for what they are, without judgment. Your observations may involve noticing thoughts, feelings, or bodily sensations. Mindfulness interventions are commonly carried out in person, but this form of intervention is difficult for people who live in rural areas and has become particularly challenging due to the COVID-19 pandemic which has restricted social interactions. Fortunately, a group of researchers found that the positive effects of mindfulness could also be achieved via an online platform.
In 2013, Krusche and colleagues evaluated the effects of a web-based mindfulness course for stress, anxiety, and depression with 273 participants. The authors developed 10 online interactive sessions led by mindfulness instructors, and participants participated for at least 4 weeks, but the course was designed to follow the same sequence as an 8-week mindfulness course. Participants were also given audio and video clips for guided meditation and assigned work to complete outside of sessions, including informal practice of mindfulness (i.e., being present while doing an everyday task such as washing the dishes). After the course had ended, results showed significant decreases in scores related to stress, anxiety, and depression, and these effects maintained at a 1-month follow up. The results of this study are promising and suggest that many people experiencing emotional challenges during this time might benefit from online interventions such as telehealth and video-based mindfulness instruction and guide practice.
Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013). Mindfulness online: An evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open Science. doi:10.1136/bmjopen-2013-003498
Obsessive-Compulsive Disorder (OCD) describes a condition in which an individual has uncontrollable thoughts and/or behaviors (i.e., compulsions) that are problematic on an ongoing basis (National Institute of Mental Health), and these symptoms can be experienced by adults as well as children and adolescents. Common treatments for OCD involve exposure therapy, which is sometimes combined with a selective-serotonin reuptake inhibitor (SSRI) medication (International OCD Foundation). However, recent advances in treatment for OCD are now including Acceptance and Commitment Therapy (ACT), which is a form of therapy that encourages individuals to accept unwanted thoughts without judgment, separate themselves from their thoughts, engage in activities that move the individual toward life values, and mindfulness (see contextualscience.org/act for more information). Although there is growing evidence for ACT as a component of treatment for OCD, the majority of these studies have been conducted with adults. Therefore, Armstrong and colleagues (2013) evaluated the effects of ACT for three adolescents (ages 12-13 years old) diagnosed with OCD.
Participants in this study reported fears about contamination and dying which were linked to problematic behaviors such as excessive hand washing, frequent reassurance-seeking, and lengthy bedtime routines. Treatment occurred weekly over the course of 8 weeks and involved a variety of components. A few examples of treatment components were 1) identifying differences between obsessions and compulsions; 2) drawing activities; 3) education about and activities surrounding the futility of fighting thoughts; 4) identifying life values; 5) accepting unwanted thoughts; and 6) mindfulness. Each treatment session was 50 min and included related homework assignments. The results of this study showed that self-reported compulsions decreased by 40%, and these effects were maintained at a 3-month follow up, and treatment was rated as highly acceptable by participants as well as their parents.
Armstong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27, 175-190.
Many people witness or experience some kind of traumatic event during their lifetime; however, these events affect people in different ways. It is common for people who have witnessed or experienced a traumatic event to have some difficulty adjusting and coping, but symptoms such as flashbacks and anxiety typically improve with time (Mayo Clinic). However, for some people, symptoms get worse or persist for several months or years and interfere with daily functioning, which is usually an indication of Post-Traumatic Stress Disorder (PTSD; Mayo Clinic). A common form of treatment for PTSD is exposure-based therapy which involves intentionally imagining the traumatic experience and interacting with people, places, or things that are associated with or related to the traumatic event (Gros et al., 2012). However, some individuals with PTSD also have symptoms of depression which sometimes persist after treatment for PTSD (Gros et al., 2012). Due to this concern, Gros and colleagues (2012) sought to evaluate the effects of a treatment package for individuals with PTSD and depression which included evidence-based therapies for each of these conditions.
Eighty-two combat veterans completed participation in the current study which incorporated exposure therapy and behavioral activation (BA)—an evidence-based treatment for depression involving planning activities that are aligned with personal values. Each treatment session was 90 minutes, and participants completed eight treatment sessions. Treatment consisted of encouraging participants to plan activities consistent with personal values—some of which involved exposure to feared situations such as shopping in a crowded mall—and writing or speaking about the traumatic event (i.e., imaginal exposure). In this way, participants used behavioral activation combined with exposure therapy. Throughout the study, participants completed a variety of questionnaires designed to assess the severity of symptoms of PTSD and depression. Overall, researchers observed improvements in PTSD and overlapping symptoms of PTSD and depression; however, similar effects were not observed for nonoverlapping symptoms of depression. The authors concluded that more research is needed to determine the effects of specific treatment components on specific symptoms of PTSD and depression, and which additional treatment components may enhance treatment effects.
Although most people are familiar with Obsessive Compulsive Disorder (OCD)—or at least have a general idea and may even feel that they personally have some OCD tendencies—a lesser known form of OCD exists called scrupulosity. Scrupulosity involves obsessions related to religious or moral ideals which cause an individual to be overly concerned that their actions are sinful or are violating religious or moral doctrine (International OCD Foundation, 2010). This concern is so great that it often leads to excessive praying or trips to confession, repeating rituals involving cleansing and purifying, and avoiding situations where some religious or moral error may occur (IOCDF, 2010). One effective and recommended treatment for scrupulosity is Exposure and Response Prevention (ERP); however, another form of treatment, Acceptance and Commitment Therapy (ACT) was shown to be another effective form of treatment in a recent study by Dehlin, Morrison, and Twohig (2013). Acceptance and Commitment Therapy traditionally involves accepting undesirable thoughts and feelings, reducing the meaning of and attachment to these thoughts and feelings, and working toward acting in a way that fulfills one’s values in life and has been used in the treatment of OCD.
Dehlin and colleagues (2013) evaluated the effects of ACT on scrupulosity with five adults (three females and two males) across eight treatment sessions. In order to measure the effects of treatment, researchers tracked the participants’ compulsive behaviors as well as engagement with valued activities. In addition, researchers had participants complete assessment questionnaires. Treatment sessions were 1-1.5 hours each week and consisted of activities that helped the participants incorporate the core processes of ACT. Participants also completed weekly homework assignments. Throughout treatment, participants learned to accept unwanted thoughts, separate themselves from obsessive thoughts, view the self as a context in which thoughts occur, contact the present moment, and commit to actions in alignment with values. Results of the study showed a 74% reduction in compulsions and a 79% reduction in avoided valued behaviors, and these reductions were maintained during a 3-month follow up. In addition, participants reported high levels of treatment acceptability which, combined with the positive results of treatment, makes this a promising treatment for individuals with scrupulosity.
Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification. DOI: 10.1177/0145445512475134
International Obsessive-Compulsive Disorder Foundation (2010). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf