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Correlates and Predictors of New Mothers' Responses to Postpartum Thoughts of Accidental and Intentional Harm and Obsessive Compulsive Symptoms.
BACKGROUND: Unwanted, intrusive thoughts of infant-related harm are a normal, albeit distressing experience for most new mothers. The occurrence of these thoughts can represent a risk factor for the development of obsessive compulsive disorder (OCD). As the early postpartum period represents a time of increased risk for OCD development, the transition to parenthood provides a unique opportunity to better understand OCD development. AIMS: The purpose of this study was to assess components of cognitive behavioural conceptualizations of postpartum OCD in relation to new mothers' thoughts of infant-related harm. METHOD: English-speaking pregnant women (n = 100) participated. Questionnaires were completed at approximately 36 weeks of gestation, and at 4 and 12 weeks postpartum. An interview to assess postpartum harm thoughts was administered at 4 and 12 weeks postpartum. Questionnaires assessed OC symptoms, OC-related beliefs, fatigue, sleep difficulties and negative mood. RESULTS: Prenatal OC-related beliefs predicted postpartum OC symptoms, as well as harm thought characteristics and behavioural responses to harm thoughts. The severity of behavioural responses to early postpartum harm thoughts did not predict later postpartum OC symptoms, but did predict frequency and time occupation of accidental harm thoughts, and interference in parenting by intentional harm thoughts. Strong relationships between OC symptoms and harm thought characteristics, and concurrent sleep difficulties, negative mood and fatigue were also found. CONCLUSIONS: Findings provide support for cognitive behavioural conceptualizations of postpartum OCD and emphasize the importance of maternal sleep, fatigue and negative mood in the relationship between OC-related beliefs and maternal cognitive and behavioural responses to postpartum harm thoughts.
Cognitive behaviour therapy for olfactory reference disorder (ORD): A case study
Olfactory Reference Disorder (ORD) is preoccupation with the belief that one is emitting a foul odour. It can be a distressing and substantially impairing problem. However, very little is known about its successful treatment. This study describes the treatment of a 38-year-old female with longstanding ORD using Cognitive Behavioural Therapy (CBT). Case conceptualisation focused on identifying unhelpful beliefs and maintaining factors including safety-seeking behaviours, self-focus and avoidance. These were then targeted using a variety of techniques including discussion and behavioural experiments to facilitate belief and behaviour change. Following a 12-week treatment, measures of anxiety and depression reduced to below clinical thresholds. In addition, there were reductions on a specific measure of symptoms of ORD. Issues regarding the use of CBT to treat this particular disorder are considered.
Context is Everything: An Investigation of Responsibility Beliefs and Interpretations and the Relationship with Obsessive-Compulsive Symptomatology across the Perinatal Period.
BACKGROUND: The cognitive-behavioural model of perinatal OCD suggests the role of increased sense of responsibility during the perinatal period in the development and maintenance of obsessive-compulsive symptoms. However, the idiosyncratic nature of responsibility attitudes and interpretations of intrusions is not fully understood. AIMS: To investigate how responsibility interpretations regarding intrusions vary across the perinatal period and how this relates to obsessive-compulsive symptomatology. METHOD: 94 women (26 antenatal, 35 postpartum and 33 non-childbearing controls) completed measures of responsibility attitudes and interpretations regarding specific intrusions (either general or baby-related), as well as obsessive-compulsive symptomatology, anxiety and depression. RESULTS: Postpartum ratings of responsibility interpretations regarding baby-related intrusions were significantly higher than: i) postpartum ratings of responsibility interpretations regarding non-baby intrusions; and ii) control group responsibility interpretations. The groups were not significantly different regarding general responsibility ratings. Ratings of baby-related responsibility interpretations predicted variance in obsessive-compulsive symptomatology. CONCLUSION: The postpartum group showed significant differences in responsibility interpretations regarding baby-related intrusions. These responsibility interpretations were shown to predict obsessive-compulsive symptomatology.
Treating disturbances in the relationship between mothers with bulimic eating disorders and their infants: a randomized, controlled trial of video feedback.
OBJECTIVE: Maternal eating disorders interfere with parenting, adversely affecting mother-infant interaction and infant outcome. This trial tested whether video-feedback treatment specifically targeting mother-child interaction would be superior to counseling in improving mother-child interaction, especially mealtime conflict, and infant weight and autonomy. METHOD: The participants were 80 mothers with bulimia nervosa or similar eating disorder who were attending routine baby clinics and whose infants were 4-6 months old. They were randomly assigned to video-feedback interactional treatment or supportive counseling. Both groups also received guided cognitive behavior self-help for their eating disorder. Each group received 13 sessions. The primary outcome measure was mealtime conflict; secondary outcome measures were infant weight, aspects of mother-infant interaction, and infant autonomy. RESULTS: Seventy-seven mothers were followed up when their infants were 13 months old. The video-feedback group exhibited significantly less mealtime conflict than the control subjects. Nine of 38 (23.7%) in the video-feedback group showed episodes of marked or severe conflict, compared with 21 of 39 (53.8%) control subjects (odds ratio=0.27, 95% confidence interval=0.10 to 0.73). Video feedback produced significant improvements in several other interaction measures and greater infant autonomy. Both groups maintained good infant weight, with no differences between groups. Maternal eating psychopathology was reduced across both groups. CONCLUSIONS: Video-feedback treatment focusing on mother-infant interaction produced improvements in interaction and infant autonomy, and both groups maintained adequate infant weight. To the authors' knowledge, this is the first controlled trial to show key improvements in interaction between mothers with postnatal psychiatric disorders and their infants.
A pilot validation study of a new measure of activity in psychosis.
BACKGROUND: Wing and Brown [Wing JK and Brown GW (1970) Institutionalism and schizophrenia: a comparative study of three mental health hospitals 1960-1968. Cambridge University Press, London] demonstrated a clear relationship between activity and clinical improvement, using time budget methodology with people with psychosis. However, existing time budget measures are demanding to complete, and simpler, check-box measures of activity rely on subjective frequency judgements and do not include the full range of activities in which an individual might be involved. We report on a pilot validation of a simplified time budget measure of activity levels for routine use as a measure of change with people with psychosis. METHODS: Forty-two participants living in the local community with a schizophrenia spectrum diagnosis were grouped according to length of illness and, within the longer duration group, into high/low activity. All completed the time budget. On a second occasion, 15 participants also completed the subscales of the Social Functioning Scale (SFS) (Br J Psychiatry 157:853-859, 1990) to assess construct validity, and 15 completed the time budget to assess test-retest reliability. RESULTS: The time budget discriminated between duration and activity level groups and showed good inter-rater reliability and test-retest reliability. On the SFS, correlations with subscales measuring withdrawal, activities of daily living and employment were found. CONCLUSIONS: Results indicate that our measure is tapping the activity component of social functioning. A larger scale validation study and investigation of sensitivity to change is underway.
Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood.
BACKGROUND: Maternal mental illness is associated with negative effects on the infant and child. Increased attention has been paid to the effects of specific perinatal disorders on parenting and interactions as an important mechanism of influence. OCD can be a debilitating disorder for the sufferer and those around them. Although OCD is a common perinatal illness, no previous studies have characterized parenting and mother infant interactions in detail for mothers with OCD. METHODS: 37 mothers with postpartum OCD and a 6 month old infant were compared with 37 community control dyads on a variety of measures of psychological distress and parenting. Observed mother-infant interactions were assessed independently. RESULTS: Obsessions and compulsions were reported in both groups, although they did not cause interference in the control group. Mothers with OCD were troubled by their symptoms for a mean of 9.6 hours/day. Mothers with OCD were less confident, reported more marital distress and less social support than healthy peers and were less likely to be breastfeeding. Infant temperament ratings did not differ. Mothers with OCD were rated as less sensitive in interactions than the comparison group, partly attributable to levels of concurrent depression. CONCLUSIONS: Maternal postpartum OCD is a disorder that can affect experiences of parenting and mother-infant interactions although this may not be driven by OCD symptoms. Longitudinal studies are required to assess the trajectory and impact of maternal difficulties as the infant develops.
A pilot randomized controlled trial of time-intensive cognitive-behaviour therapy for postpartum obsessive-compulsive disorder: effects on maternal symptoms, mother-infant interactions and attachment.
BACKGROUND: There is increasing recognition that perinatal anxiety disorders are both common and potentially serious for mother and child. Obsessive-compulsive disorder (OCD) can be triggered or exacerbated in the postpartum period, with mothers reporting significant effects on parenting tasks. However, there is little evidence concerning their effective treatment or the impact of successful treatment on parenting. METHOD: A total of 34 mothers with OCD and a baby of 6 months old were randomized into either time-intensive cognitive-behaviour therapy (iCBT) or treatment as usual (TAU). iCBT took place after randomization at 6 months postpartum and was completed by 9 months. Maternal symptomatology, sensitivity in mother-infant interactions and parenting were assessed at baseline and reassessed at 12 months postpartum. At 12 months attachment was also assessed using Ainsworth's Strange Situation Procedure. A healthy control group of mothers and infants (n = 37) underwent the same assessments as a benchmark. RESULTS: iCBT was successful in ameliorating maternal symptoms of OCD (controlled effect size = 1.31-1.90). However, mother-infant interactions were unchanged by treatment and remained less sensitive in both OCD groups than a healthy control group. The distribution of attachment categories was similar across both clinical groups and healthy controls with approximately 72% classified as secure in each group. CONCLUSIONS: iCBT is an effective intervention for postpartum OCD. Sensitive parenting interactions are affected by the presence of postpartum OCD and this is not improved by successful treatment of OCD symptoms. However, the overall attachment bond appears to be unaffected. Longitudinal studies are needed to explore the impact of postpartum OCD as the child develops.
Intensive cognitive-behavioural treatment for women with postnatal obsessive-compulsive disorder: a consecutive case series.
The postnatal period has been identified as a time of increased risk for the development of OCD. Obsessions and compulsions at this time frequently focus on accidental or deliberate harm coming to the infant and may impact on the sufferer's capacities as a parent. Given the similarities in presentation between OCD at this and other times, cognitive-behaviour therapy is likely to be effective, but there is little information on whether or how adaptations of CBT can be made to maximise effectiveness and acceptability for mothers. There are no data on the impact of successful treatment on parenting. Six consecutively referred cases of postnatal OCD were treated using cognitive-behavioural therapy (CBT) intensively delivered over a two week period. All mothers improved on self-report and clinician-rated measures which were sustained at 3-5 month follow-up. Mothers reported significant benefits in terms of their own symptoms and in parenting in general. The intensive mode of delivery appears to be effective and acceptable for this group. Future work should explore whether particular difficulties in terms of parenting are experienced by this group and whether these persist beyond the remission of the maternal disorder.
A preliminary investigation of the impact of maternal obsessive-compulsive disorder and panic disorder on parenting and children.
Although there is evidence for the intergenerational transmission of anxiety disorders, there is little research in relation to specific parental disorders. This study evaluated three groups of mothers with at least one child aged 7-14, defined in terms of maternal obsessive-compulsive disorder (OCD; n=23), panic disorder (n=18), and healthy controls (n=20). Parental perceptions and symptomatology, general and disorder-specific child symptoms and mother-child interactions were investigated using self-report, informant report and independent assessment. Mothers with OCD and panic disorder expressed high levels of concern about the impact of their anxiety disorder on their parenting. Group differences in terms of child anxiety were subtle rather than clinically significant. In interactions, anxious mothers were less warm and promoting of psychological autonomy than healthy controls, and they exhibited elevated expressed emotion. Overall, the results suggested a mix of effects including trans-diagnostic and disorder-specific issues. Implications for future research are discussed.
“People in my life just play different roles”: A retrospective qualitative study of friendships among young adults who self-harmed during adolescence
Self-harm is a global public health concern presenting increasing rates in recent years, especially among young people. This population seldom access formal help, and typically rely on informal sources of support, mainly friends. The role, importance and meaning of friendships in the context of self-harm remains poorly understood, highlighting the need to explore young people’s lived experiences. In the present study we conducted semi-structured retrospective qualitative interviews, prompted by the Card-sort Task for Self-Harm About Friends (CaTS-AF), to explore the experiences of 11 young adults (M=19.09; SD=0.70; M=2, F=9) who self-harmed during adolescence. Data were analysed using Reflexive Thematic Analysis (RTA). Three themes were developed which consider 1) the role of friendships in self-harm progression; 2) the role of self-harm in friendship evolution; and 3) the meaning of friendships in the context of adolescents’ self-harm. The first two themes highlight the interdependent nature of friendships and self-harm, where these two experiences influence one another. Furthermore, not only are friendships shaped by self-harm, but they acquire specific meanings, dynamics and expectations within the context of the behaviour. Overall, friends are a key part of adolescents’ self-harm, as sources of both risk and protection. It is essential to further integrate friendships, a developmentally significant aspect of adolescents’ social experiences, into self-harm research and clinical practice.