Cognitive behavioral therapy for mothers may help prevent future psychiatric illness in infants

Cognitive behavioral therapy (CBT) delivered to new mothers by individuals who previously recovered from post-partum depression (PPD) may help prevent future psychiatric illness in their children, finds new research led by McMaster University.

The findings, published in the Journal of Affective Disorders on June 9, examined the effects of group CBT - a form of psychological treatment - on infant emotion regulation.

PPD and its associated symptoms affect up to one in five new mothers and birthing parents. More than two-thirds of the costs associated with PPD are due to its effects on children.

The research, led by Ryan Van Lieshout, examined the effects of group CBT on infants' emotional regulation by tracking 73 pairs of mothers and babies undergoing PPD treatments between 2018 and 2020. The participants were randomly assigned into two groups, with the experimental group receiving immediate CBT and the control group waiting nine weeks before starting therapy.

Early problems with emotion regulation are very important because they are involved in the development of almost all kinds of mental health problems later in life."

Van Lieshout, Associate Professor of the Department of Psychiatry and Behavioural Neurosciences and the Canada Research Chair in Perinatal Mental Health

"This is the first time that anyone has shown in a randomized controlled trial - the strongest study design possible in humans - that treating mothers with an inexpensive, scalable talking therapy (CBT) can lead to adaptive changes in infant brain functioning," he said.

Each group underwent weekly two-hour CBT sessions delivered over nine weeks. Investigators compared infants' emotion regulation between the two groups and tracked progress among the infants by measuring their brain function using electroencephalography (EEG; a measure of brain activity), the functioning of other parts of the nervous system by recording their heart rate with electrocardiography (ECG) tests and surveying mothers about their babies' temperament.

The study found that infants whose mothers were treated with peer-delivered CBT immediately had more adaptive changes in both EEG and ECG measures of emotion regulation, compared with infants whose mothers were on the nine-week waitlist. Mothers in first group also experienced a clinically significant reduction in PPD symptoms following treatment.

"The development of emotion regulation is largely shaped by maternal interactions early in life and infants depend on continuous exchanges with caregivers to regulate any emotional distress," said Van Lieshout. "The constant give-and-take between parents and infants forms the foundation of their future self-regulatory capacity beyond infancy."

Ten individuals who recovered from PPD delivered the group CBT treatment after undergoing training which included two days of in-classroom learning, followed by a nine-week observership. Peer facilitators are sometimes preferred over professional therapists, due to their lived experiences and perspectives.

To conduct the study, researchers partnered with Kids Can Fly, a Canadian not-for-profit organization committed to supporting child development.

"Our organization is incredibly pleased to partner with this study. One of our philosophies is that supporting parents is one of the best strategies to support and impact babies. This study indicates that doing so has measurable impact," said Becca McLellan, executive director of Kids Can Fly.

"We are encouraged by the prospect of this model of support delivery being replicated for larger-scale use in the general population. We are very excited to see this paper move into broader circulation because its results are meaningful and have implications on future community work."