6 months of Cognitive Behavioral Therapy for PPD distilled into one blog post

I took this photo the day I completed my six months of CBT and group therapy for postpartum depression and anxiety.  It was a satisfying moment; feeling accomplished at something for the first time in a long while.  It certainly wasn’t the end of the road for me and perinatal mood disorders, but I was happy at least I had acquired a set of useful tools to deal with the day-to-day drudgery and ongoing balancing act of managing a mood disorder while being a parent (and an adult in general).

 

A friend of mine is currently having a hard time, as so many mothers do in North America, and I was reminded of the lessons I learned and prompted to put them in writing for easy access–for myself as well as others.  So here it is:

 

Six months of CBT distilled

 

1. Ask for and accept help, even if it’s embarrassing.

It may seem tempting to tell yourself, “I can get so-and-so to come over and help as soon as I’ve gotten around to tidying up a bit,” or some other ‘If –> Then’ scenario.  Don’t wait any longer.  Ask for help, and if someone is kind enough to offer, accept it.  Don’t try to minimize your needs to avoid inconveniencing others.  If you need help, you need it!

2. Get outside and get some sun on your skin.

Sunlight is beneficial to your mental health in a variety of ways.  It helps to regulate your circadian rhythms, which may be disturbed if you are having trouble sleeping, or sleeping too much.  It can wake you up and give you a little boost to just get one thing done today.  It also helps your body synthesize vitamin D, which especially in the winter you may be deficient in.  Some symptoms of Vitamin D deficiency are extreme fatigue, joint pain and depression.  Sound familiar?  Even 20 minutes outside in a winter coat is better than staying on your butt inside.  Make it a goal to do it at minimum every other day.

3. Get some exercise, even if it seems insignificant.

Pushing a stroller around a mall for an hour, even if you have no money and don’t even care enough to bother window shopping will get a few endorphins flowing through your body and give you a bit of a mood boost.  The summer of 2014 when I was undergoing the CBT and group therapy, I was flat broke more often than not, but one of the best things I did for myself was take my kids to the farmers market every Saturday.  I had a kind friend who had sent me a gift card for a local veggie vendor, so I always had an excuse to get out there, even if I didn’t have enough money to even afford a coffee besides.  Sometimes it was sunny, sometimes not, but it always got me out pushing the stroller around and getting a bit of exercise.  Make small achievable exercise goals.  If once a week is all you can muster, celebrate that.  If you think you can work your way up to 3-4 times a week or more, maybe consider making a walk to a destination like Tim Hortons for a cheap but enjoyable treat.  Don’t set your goals too high too fast, as it will only add to the mom-guilt when you can’t achieve them.  Save BeachBody for a time when you’re feeling more well.

4. Eat at least two decent meals a day.

Sounds easier said than done, right? It doesn’t have to be so.  Decent doesn’t mean fancy, it can be a sandwich with sliced carrots and celery or maybe an apple on the side.  Just make sure you eat regularly, and not just fistfuls of cereal out of the box or leftover Easter chocolate. Particularly if you’re breastfeeding, you need to sustain yourself with nutrients.  Your baby will always get what he/she needs from your milk, but if you’re not replenishing it in your diet, it will be at your body’s detriment.  Do yourself a favour and stock up on easy to grab raw snacks like crunchy veggies, fruit and nuts.  Be conscious of going overboard on the carbs, as it’s always a temptation for folks when they’re beyond burnt out, but they only provide temporary relief from symptoms and often make you crash harder when your blood sugar drops after a while.  And don’t forget to drink lots of water!  Set a reminder on your phone or keep a tally on a whiteboard in your kitchen.

5. Get out and see a friend

It’s easy to push socialization to the back burner when you are behind in so many things, feel like garbage and can’t be bothered to brush your hair.  But getting out and being seen and heard by someone who knows you and appreciates you for being you, and not just a diaper-changing milk-machine, can be very therapeutic.  Humans need socialization for their emotional well being, so don’t put it so far down the list that you end up going weeks or months without any meaningful adult interaction.  Consider it a must for your mental health, and make a date, even if it’s just running errands together.

6. Be kind and forgiving of yourself.

Perinatal mood disorders (in case you haven’t heard, depression isn’t the only problem that affects new moms, anxiety, OCD and PTSD happen too) are a BITCH.  They rob you of an accurate view of yourself and tell you you’re a failure or a bad mom. It’s not true. You have an illness and it needs to be treated, same as if you had pneumonia or hepatitis. It is not something to feel guilty about or that you should just get over.  So don’t sweat when you have days where the best you can do is get out of bed and change into cleaner pyjamas.  If you find that it’s too much of a struggle to get the basic necessities for your child (food, safety, clean diapers), or are having suicidal thoughts, go to the doctor immediately.  Make sure your spouse (or closest relative or friend if there is no spouse) knows exactly how badly you feel.  It may seem like it’s totally obvious to you, but your spouse may not realize the extent to which the mood disorder is affecting you.  That said, take it one day, one hour, one moment at a time. Breathe. Let it go. Start again.  This shit is HARD, and it’s ok to be gentle with yourself about it.

7. Get enough good-quality sleep.

Yeah. That may seem like a pipe-dream for some new families.  But if you’re getting your circadian rhythms set properly with some sunlight, and you’re getting a bit of exercise, it may be easier to get good quality sleep when sleep time is available.  Sleep with your infant in your room so you don’t have to go far for night feedings.  Take a nap during the day.  If you have an older child that won’t nap, make an arrangement with a friend or neighbour to take him for an hour or two a few times a week so you can catch up on zzz’s.  Regular, (mostly) uninterrupted sleep is crucial to your brain and mental health.  Make it a priority and enlist the help of your co-parent to get it figured out for yourself.

Moving Forward

Once you’ve done two or three things on the above list, make a list of the things you need to get done to get your responsibilities and life back on track. Laundry? Dishes? Vacuuming, picking up? Delegate those tasks to friends who ask how they can help, or if no one’s offering, ask them.  Ask older siblings and spouses to pick up an extra task.  If they’re not available or it’s going to be more work than it’s worth to convince them, ask from your local friends and family.  If none of those exist, consider hiring a maid or a postpartum doula. If the money’s not there, consider asking well-meaning but geographically distanced relatives and friends for help to hire a professional.  Find a way to surround yourself with support.

Please let me know if you’re having trouble with any of this, or comment if you want to share more tips for weathering perinatal mood disorders.

With love and admiration,

Macau Birth Doula

 

 

December 6

Today marks three years since my 20 week ultrasound with my daughter; the day it was confirmed for me that she was to be born a girl. It also happens to be the anniversary of the massacre at the ‪#‎ÉcolePolytechnique‬, a day that is marked in remembrance every year in Canada, as the National Day of Remembrance and Action on Violence Against Women.

It is also a lesser-known anniversary: the day that marked the beginning of my most recent struggle with anxiety and depression. Perinatal mood disorders may be triggered by many different things during a woman’s childbearing year; for me it was the thought of bringing a female child into a world that more or less realistically is dangerous for females. Although I fought through panic attacks telling myself they were isolated episodes and could be explained away, I did not seek treatment for my disorder for almost a year later. It did not even really occur to me that ‪#‎PPD‬ might actually also mean PRE-partum (terrible grammar, but you know) depression or anxiety.

So here’s to raising the awareness. Perinatal mood disorders happen. They can be treated. There’s no reason to delay treatment or try to just work it out alone. Help is available.

 

Attachment Parenting, Depression and Cognitive Dissonance

**TRIGGER WARNING: Perinatal depression, anxiety, mom-guilt**

 

Infant sleep hygiene is such a touchy subject because of the cognitive dissonance it incites. As a self-professed gentle parent, I feel like I should always walk the talk, but in all honesty, as a person who experienced severe perinatal mood disorders, there were times I had to prioritize my values, and yes, this led to some cry-it-out. I believed what my maternal instincts were telling me, but I had to do what I did to keep myself and my family safe. I’m sure most mothers are not quite as perfect as they’d like to be, so I’m just trying to make the point that knowledge is power. Know better, and do better when you can. Sometimes the best you can do is make a compromise until you find a better solution, with infant sleep and other parenting choices, knowing is half the battle, figuring out how to make it work for you and your family is the rest of it.

When you have to walk away

Sometimes your baby will cry. Sometimes it is something you might be able to figure out if you were in a normal state of mind, but in the all-consuming fog that is depression, the simple answer just isn’t coming to you. If you find you’re at the end of your rope and you and your babe are just ratcheting up each other’s anxiety, step away for a few minutes. Do some deep breathing, singing, jumping jacks, whatever it is you need to do to remind yourself this is not your fault. And more importantly, this is not the baby’s fault. It sounds terrible, but I am sure I am not the only one who has had the fleeting thought that the baby is trying to punish me for being a bad mother.  For the longest time, when my baby got upset I could hear in her cries the accusation “you’re not good enough!”  With cognitive behavioral therapy I learned coping skills that helped me to immediately recognize these “hot thoughts” and replace them with more rational ones.  In the interim, the best choice for me was to take a moment and collect myself before my raging emotions ran away with me and I did something destructive.

When the Attachment Parent becomes detached

It’s long been a coping mechanism for me to detach from my emotions when my anxiety got to be too much.  Having a newborn/infant/toddler does not allow for a whole lot of detachment. By their very nature they require conscious connection to learn their value and worth and how to regulate strong emotions and so much more.  For a long time, I was not able to provide this. After my daughter was born, in the throes of PTSD, including frequent panic attacks, flashbacks, insomnia, etc, I became an expert at playing Candy Crush on my phone. It was a crutch, admittedly, but a crutch I direly needed to keep myself and my children safe.  Again, through therapy and education I learned the value of taking a time out, even just for 5 minutes to regulate my emotions.  Better regulated, I could return to my children and be my whole, imperfect self and seek their forgiveness. Children are incredibly flexible, if you give them the benefit of allowing them to see you in your honest and open state. Sometimes coming to them and just saying “mommy’s hurting right now, I need your love and patience” made a world of a difference. My 3 year old in particular is exceptionally sensitive and empathetic, and allowing him in (once I’ve had the chance to calm myself to a state where I’m conscious and aware of my emotions) rather than pushing him away when I’m at the end of my rope helps to heal both of us.

Facing and healing the Mom-Guilt

We put a tremendous amount of pressure on ourselves as mothers to be the best we can possibly be. What that looks like varies from person to person, but suffice it to say, we all do our best for our children. Except when we don’t. Sometimes we have bad days, and with postnatal depression the bad days seem to come more often than not.  So how do we forgive ourselves for doing less than what we know to be our best?

Self-care is key. We can’t expect ourselves to perform at the top of our mom-game if we aren’t caring for ourselves first. When we are well, we do well. When we are less than our best, we still do the best we can in the moment. The first and most important self-care I do is letting go of yesterday and focussing on what I can do for my family today.  Recognize if it is less than what they truly need, and then ask for help.  If there are a few days in a row where I’m lagging, I ask my husband for help in pointing this out in a compassionate way so I can examine my recent self-care habits to see if there is anything I can change. Sometimes it’s as simple as going to bed an hour or two earlier for a couple nights so I can catch up on some sleep.

Self-Care activities to try

Go to bed an hour earlier. Get out once per week without the kid(s) for an hour or two to get a latte and a manicure, or a massage, or just read a book at the park.  Wear ear plugs and a sleep mask to bed. Download some self-hypnosis scripts for aiding in relaxation and improving outlook and optimism.  Chat with a friend.  Turn on some happy music and have a dance party with the kids. Get in the bath with the kids and let them pour water on your head and giggle. Go for a walk in the park, get surrounded by trees or feel the ocean breeze.  Take a yoga class or put on an exercise DVD.  Drink lots of water.  Journal your feelings. Find friends with whom you can share all your fears, emotions and insecurities.  Develop a ritual to Let. Them. Go.  Practice breathing exercises. Meditate. Give yourself the opportunity to be vulnerable, it will heal you more than you can realize.

I promise once you have set aside the time a few days a week to practice some self-care, parenting the way you want will come easier.

If you feel that you are suffering from a perinatal mood disorder (depression, anxiety, PTSD, OCD) please reach out to your health care practitioner for help and guidance to set up a treatment program that will work for you.