Managing Postpartum Anxiety: Tips for Treatment and Support
Navigating through postpartum anxiety can feel like being trapped in a whirlwind of thoughts, isolated, and unsure of what's going on. For many mothers, it's easy to get caught in a cycle of denial, attempting to suppress those thoughts, or operate from a reactive and panicked mode. But let's face it: those knee-jerk responses often end up making things worse, not better. So, what's the alternative? What can you do when those automatic reactions don't quite hit the mark anymore? This blog post will explore three levels of interventions you can try: self-help strategies, support from others, and the role of professionals in your journey.
Self-Help
Why should you consider self-help strategies? For many new mothers, they can be the first line of action, especially when facing barriers such as time constraints, financial limitations, and accessibility. Depending on the severity, duration, and impact of your symptoms, self-help can be a great initial step, or all that is required to acquire new skills and improve your well-being.
So, let's talk about self-care. What does it mean to you? Is it about finding moments of peace in the chaos? Or maybe it's about taking care of yourself amid the whirlwind of parenthood?
Self-care isn't just about indulgent treats; it's about everyday habits that nurture your emotional and physical health. Picture a postpartum mental health pyramid (illustrated below), with physical well-being at the base. That's where exercise, healthy eating, and sleep come in. For new moms, these basics are often overlooked (for good reason!) but are crucial for mental stability, especially if you're dealing with depression or anxiety.
Here’s my disclaimer: believe me, I get it. It's tough, and it takes creativity to fit these self-care items into your postpartum life. Sometimes, you might need to chat with family member, a therapist, or even a hotline for ideas. And remember, think of self-care in small doses—it doesn't have to be a big production.
The Pregnancy and Postpartum Mood Workbook: The Guide to Surviving your Emotions when Having a Baby suggests breaking the first category of self-help into the "just surviving" level of self-care. This level is like a red stop light—it signals that we must pause and attend to these fundamental needs before moving forward in life (Warren & Berger, 2021). It’s easy to overlook the following list of everyday tasks as daily living, but for a new parent, they are indeed a level of self-care that can help you feel better.
Now let's delve into the postpartum mental health pyramid. Picture it as a checklist. At the base are the "just-surviving" self-care activities, offering options to improve your well-being. As you ascend, reaching the peak involves incorporating additional self-care practices into your routine, which can further uplift the overall mood of new mothers (Warren & Berger, 2021).
Adapted from Warren & Berger (2021)
You can check The Pregnancy and Postpartum Mood Workbook: The Guide to Surviving your Emotions when Having a Baby which offers a checklist of some of these items along with journaling prompts for further exploration. Let’s discuss each a little further.
Personal hygiene: This encompasses activities like showering, brushing teeth, and wearing clean clothes.
Communicating with loved ones: This involves connecting with your partner or other significant individuals in your life.
Maintaining a basic schedule: Establishing and sticking to a simple routine for predictability and stability.
Cuddling your baby: Cuddling your infant, particularly through direct skin contact, creates opportunities for the release of oxytocin, a natural hormone that can help reduce feelings of anxiety. Oxytocin acts as a calming agent in the brain, soothing stress reactions and fostering a strong emotional connection between caregivers and infants, encouraging more bonding moments (Palmer, 2010).
Exercise: Engaging in regular physical activity, such as walking, stretching, or your preferred exercise, can enhance your mood and help alleviate anxiety. It's important to consult with your doctor before starting any physical activity during the postpartum period.
Sleep: Although getting enough sleep (even if it's between baby feedings) is a basic level of self-care, with a baby postpartum, it is certainly more complicated. But it’s important to note that when you're not getting enough sleep, it messes with everything—your mood, patience, focus, and self-care. Sleep deprivation, especially when compounded by mood or anxiety disorders, can escalate issues. Even if your new baby sleeps "well," it disrupts your previous sleep routine, adding to exhaustion. If you're lying awake when your baby's sleeping, unable to quiet your mind, it can heighten frustration and anxiety. Exploring sleep hygiene, brainstorming solutions, practicing mindfulness, and discussing concerns with your healthcare provider can be helpful initial steps.
Nutrition: Adjusting your diet can alleviate anxiety symptoms by stabilizing blood sugar levels and boosting serotonin production.
Breathing Exercises: Relaxation without talking about breathing? Unthinkable! For overwhelmed new moms, your stress and anxiety are signaling that it’s time to pause and take a deep breath—literally! Anxiety affects your entire body, triggering symptoms like racing heart, shallow breathing, and muscle tension. To counteract this, activating the parasympathetic nervous system through relaxation techniques like controlled breathing can help alleviate tension and promote calmness.
Taking care of these fundamental needs is crucial for alleviating feelings of deprivation and chronic fatigue. While they may seem like minor self-care activities, these small actions can make a significant difference when you're experiencing stress or anxiety.
Once you've tended to your basic needs and feel grounded, you can focus on implementing proactive health-enhancing activities.
Mindfulness: Mindfulness, defined by Jon Kabat-Zinn, involves purposefully paying attention to the present moment without judgment (Kabat-Zinn, 2003, p. 145). Research shows that mindfulness practices, such as meditation and yoga, can reduce stress and anxiety, even for new mothers. Accessing mindfulness resources has never been easier, with books, videos, classes, and apps available, such as Smiling Mind, which offers short, convenient sessions designed to fit into busy schedules and cover a number of mindfulness topics.
Self-Compassion: Recognizing the importance of self-compassion in the postpartum period involves more than just being kind to ourselves; it's about accepting and understanding ourselves amidst challenges. Self-compassion has been linked to improved maternal mental health and parenting. Dr. Kristen Neff's, a leading expert in self-compassion, includes mindfulness, self-kindness, and recognizing our shared humanity, as part of her definition of self-compassion. Despite its importance, applying self-compassion can be challenging during parenthood, especially when societal pressures and personal responsibility overshadow gentleness towards oneself.
It's crucial for new parents to acknowledge their common humanity and avoid self-blame amidst challenges, considering societal expectations and limited resources postpartum. Additionally, integrating self-compassionate coping strategies, such as accepting anxiety with kindness and practicing self-compassion exercises (many of which are included on Dr. Neff’s website) can be beneficial in navigating the complexities of the postpartum period.
Moments of fun: Engaging in social activities, whether it's spending time with friends, going on a date night, or having a phone chat with a friend, can be beneficial for your well-being. Laughter and playfulness have physical advantages, reducing stress hormones and increasing endorphins.
Time alone: Taking a moment to pause and gather your thoughts, perhaps through journaling, practicing mindfulness, or reading a book, can provide a valuable opportunity for reflection, relaxation, or focusing on something meaningful to you. If you need ideas, you could try meditative coloring, listening to calming music, or simply sitting quietly with a cup of tea.
Exercise routine: Regular exercise is crucial for boosting mood and establishing a routine can make it a consistent part of your life, providing a reliable way to manage anxiety. If you're looking for ideas, consider activities like walking, yoga, dancing, exercise videos, visiting a physical therapist to strengthen and repair your body postpartum, or even gardening, whatever gets you moving and brings you joy. Remember to consult your doctor before starting any physical activity during the postpartum period.
Learning to delegate: Delegating tasks to your partner, family, or friends can provide valuable support. Consider seeking assistance with household chores from a family member, a mother’s helper, or a house cleaner. Ordering groceries online can also save you time and energy. If delegating feels challenging, the book Dropping the Baby and Other Scary Thoughts (Kleiman & Wenzel, 2020) offers practical strategies for learning how to delegate effectively. Additionally, consulting with a therapist can help identify barriers and develop these skills further.
Setting boundaries: Mastering the skill of setting boundaries isn't easy, but seeking professional guidance or using self-help tools can help refine these skills. Why are these skills valuable for a postpartum mother? Because during the early postpartum phase, when well-meaning individuals may intrude on your time with the baby or offer unsolicited advice, setting boundaries becomes essential. This may entail politely declining invitations to events you'd rather skip. Other strategies include setting limits on visitation hours, scheduling specific days for social interactions, and openly communicating your needs and preferences to friends and family members.
Self-Help Materials and Books
With self-help resources like books such as Dropping the Baby and Other Scary Thoughts, The Pregnancy and Postpartum Mood Workbook: The Guide to Surviving your Emotions when Having a Baby, What About Us?: A New Parents Guide to Safeguarding Your Over-Anxious, Over-Extended, Sleep-Deprived Relationship, and apps like CALM and Happify, you can take charge of your own recovery journey. These tools empower you to learn and grow at your own pace. While using these resources may require dedication and practice, studies indicate that they're more beneficial than doing nothing at all (Kleiman & Wenzel, 2020).
Social Support
Dealing with anxiety and depression alone is tough, and seeking help can be challenging. Research has shown that appropriately provided social support may buffer postpartum stress for new mothers (De Sousa Machado et al., 2020).
In Dropping the Baby and Other Scary Thoughts, the authors explore various support avenues accessible to new mothers, ranging from financial aid to emotional reinforcement. These forms of support can help ease stress for mothers, which may in turn lessen anxiety and frightening thoughts. Here's a visual outline adapted from (Kleiman & Wenzel, 2020) to illustrate this process:
Adapted from Kleiman & Wenzel (2020)
Understanding how to build and maintain a support system can help to fortify new mothers’ resources and cope better with stressors and scary thoughts. Drawing from insights in This Isn’t What I Expected (Kleiman & Raskin, 1994) and Dropping the Baby and Other Scary Thoughts, (Kleiman & Wenzel, 2020) three fundamental types of social support emerge for new mothers: practical support, emotional support, and psychosocial support. We’ll break down each category and provide you with suggestions for each.
Practical support: involves tangible assistance with tasks such as household chores and childcare. Accepting offered help without guilt is vital for self-care, especially for those accustomed to managing stress alone. There are several barriers that can exist to obtaining practical support including communicating needs directly (as assuming support may not always materialize), perceptions about the self-sacrificing nature of motherhood, perfectionism, difficulty navigating conversations regarding delegation or boundary setting to let someone else into your life.
If this is difficult, it could be helpful to explore these barriers more fully with a confidante or a professional therapist. Another option is to use a postpartum workbook such as The Pregnancy and Postpartum Mood Workbook: The Guide to Surviving your Emotions when Having a Baby to question the barriers that exist for you in obtaining this support.
Emotional support: Support isn't just about tangible help; it's also about the comfort, reassurance, and encouragement we receive from others. To make the most of the support available, start by reaching out to people you trust and feel comfortable talking to. Express your needs openly and don't hesitate to lean on friends, partners, or healthcare providers. Remember, scary thoughts can affect both you and those around you, so it's crucial to address them together.
The lack of awareness about postpartum anxiety distress highlights the need for more understanding and support from everyone involved. Kleiman and Wenzel (2020) suggest considering who you turn to for support, when you reach out, and why you need help. Consider the following questions.
Adapted from Kleiman & Wenzel (2020)
For partners, open and honest communication is key. Expressing concerns about anxiety or distress can strengthen the bond between partners, provided the response is supportive and understanding. Good communication and conflict resolution skills are essential for navigating this challenging period together.
Asking for help doesn't necessarily mean revealing all your deepest fears at once to someone you hope will understand. It's more of a process, delineated by Kleinman and Wenzel (2020) which, summarized, involves:
Express your need for support: "I'm feeling overwhelmed and need someone to confide in. Can I talk to you?"
Summarize your struggles: "Since becoming a parent, I've been struggling more than expected."
Share your findings: "I've learned that my anxiety levels may be higher than normal for new parents."
Clearly state how they can help: "I could use practical assistance with tasks and someone to listen and reassure me. I also think I need to see a counselor or doctor. Can you help me find one or watch the baby while I attend appointments?"
If you're feeling unsure about how to start these conversations with a friend or family member, consider giving them some written information to help them understand before you talk. The Assessment Guide from the Postpartum Stress Center, originally made for healthcare providers, is also helpful for family members. It covers some of the content we've been discussing in these blog posts and based on the book, Dropping the Baby and Other Scary Thoughts. It's designed to give them insight into your experience and help kickstart your conversations.
Psychosocial support: This encompasses resources, programs, or groups aimed at fostering positive mothering attitudes and mental well-being. Psychosocial support may include support groups, gatherings for new moms, parent-infant classes, or similar forums facilitating adjustment to this life transition. To access support, start by consulting your obstetrician-gynecologist or family doctor. They can guide you to programs or groups aimed at promoting healthy mothering attitudes and mental well-being.
In New York State, the website https://postpartumny.org/groups/ offers access to various online groups.
Additionally, if you'd like to speak to someone knowledgeable about mood concerns for postpartum mothers and connect with support services, you can reach out to the free National Maternal Mental Health Hotline at 1-833-852-6262 (1-833-TLC-MAMA), available 24/7 for calls or texts.
Postpartum Support International also offer virtual support groups, led by licensed professionals and providing a safe space for sharing experiences. These groups are offered free of charge and serve as a valuable supplement to traditional support avenues. Furthermore, PSI facilitates free, live phone sessions specifically for mothers every Wednesday, offering opportunities to engage in discussions with experts regarding perinatal mood and anxiety disorders. However, it's vital to remember that these sessions are not substitutes for professional healthcare or therapy. Therefore, it's essential to integrate internet support as a complement rather than a replacement for real-life support systems.
Professional Support
You're ready to begin therapy to tackle postpartum anxiety head-on. When considering treatment options to effectively manage your symptoms, it's helpful to be prepared to discuss key aspects with your therapist: your specific symptoms, how they impact your daily life, their frequency, and the level of distress they cause. This openness can pave the way for a proactive approach to therapy, facilitating the development of tailored interventions to address your needs.
Cognitive Behavioral Therapy (CBT) is recognized as the gold-standard treatment and is highly effective for anxiety disorders. Although research on its application for postpartum mothers is still limited, recent findings suggest promising results in easing postpartum worries and anxiety (Zappas et al., 2021). CBT focuses on identifying emotions and reshaping thought patterns, empowering individuals to dismantle negative thoughts and behaviors while fostering healthier cognitive habits.
Other effective treatment approaches for anxiety disorders include mindfulness-based interventions, dialectical behavior therapy, and acceptance and commitment therapy (Zappas et al., 2021; Kleiman & Wenzel, 2020).
Managing postpartum anxiety entails a comprehensive approach that encompasses self-care practices, acceptance of anxiety, mindfulness, peer support, and professional guidance. By integrating these strategies into your daily routine, you can navigate anxiety more effectively and prioritize your well-being during this challenging period.
References
De Sousa Machado, T., Chur-Hansen, A., & Due, C. (2020). First-time mothers' perceptions of social support: Recommendations for best practice. Health psychology open, 7(1), 2055102919898611. https://doi.org/10.1177/2055102919898611
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. New York: Delacorte.
Kleiman, K. R., & Raskin, V. D. (2013). This isn’t what I expected: Overcoming postpartum depression. Da Capo Lifelong, a member of the Perseus Books Group.
Kleiman, K., & Wenzel, A. (2020). Dropping the baby and other scary thoughts: Breaking the cycle of unwanted thoughts in parenthood (2nd ed.). Routledge. https://doi-org.libezproxy2.syr.edu/10.4324/9780429274657
Palmer, L. F. (2010). The baby bond: The new science behind what’s really important when caring for your baby. Sourcebooks
Warren, B., & Creager Berger, B. (2021). The pregnancy and postpartum mood workbook: The guide to surviving your emotions when having a baby (1st ed.). Routledge. https://doi-org.libezproxy2.syr.edu/10.4324/9781003144021
Zappas MP, Becker K, Walton-Moss B. Postpartum anxiety. J Nurse Pract. 2021;17(1):60–4. doi: 10.1016/j.nurpra.2020.08.017.