I will never forget one woman who participated in the first MBCT classes I led at the University of Washington. She had suffered from depression multiple times in her life and was also deeply committed to mindfulness and her ongoing learning. During inquiry, she often referred to practicing mindfulness meditation at home with her toddler. At the end of the program, she thanked me for the skills she acquired and the broader impact of what she had learned on both her family and her. As she left, she mentioned, “I only wish I had learned all this before my daughter was born.”
Her wish lingered after that encounter, and in fact, it stayed with me for years, as I finished graduate school and became a mother myself. I was drawn to investigate: What were we, as a field and a society, doing to help support vulnerable women as they navigated this critical transition in their lives? Among women who are pregnant or postpartum, approximately 12-15% will experience depression, and among those who have been depressed in the past, 30-40% will be depressed again. This is concerning not only for moms, but also for their children, who are more likely to develop cognitive, emotional, and social problems as late as adolescence and early adulthood.
Hope for depression during pregnancy and postpartum
The majority of women struggling with depression during pregnancy, as well as postpartum depression, get no professional help; among the few who do, most receive antidepressants, despite the fact that survey research shows that most women prefer interventions that don’t include medication. There is a gap between what we offer vulnerable women during pregnancy and what they tell us they want. This gap strengthened my commitment to address the wish my client expressed in her last MBCT class.
As luck would have it, around the same time period, I met Sherryl Goodman, at Emory University, who had been studying the impact on children of depression among their mothers. Together, with Arne Beck at Kaiser Permanente, we embarked on a study to answer the question raised by my client. Could we teach MBCT to pregnant women who had prior histories of depression, and would doing so help to prevent the return of depression during pregnancy and the postpartum period?
We recently published the results from a study in which we enrolled 86 women from the obstetric clinics in Kaiser Permanente in Colorado and Georgia. We taught women all of the practices and strategies in the standard MBCT curriculum, and we added some elements that were specific to the developmental transition of becoming a mother.
- Brief, informal practices to support practice when time and energy are at a premium,
- Loving kindness meditation practices to counter self-criticism and promote connection with one’s child,
- Self-care practices to balance the pressure to care for others and practices to promote social support, and
- Yoga practices to be engaging and safe during pregnancy and postpartum.
Early evidence that MBCT can help
The preliminary evidence suggests that the answer to my client’s question is yes. We can teach MBCT to pregnant women with prior histories of depression, and it appears to help to prevent the return of depression during pregnancy and the postpartum period. Overall, women were highly engaged with the practices and classes. They attended class regularly and did the assigned practices at home about 70% of the days assigned.
Most importantly, we found that teaching MBCT to women who are at risk for depression during pregnancy significantly reduces depression relapse. In fact only 18% of women who received the MBCT intervention relapsed compared to 50% of women who received usual care (about 25% of those were prescribed medication). We didn’t study the effects on the family context or children in this study, but we’re eager to do so in future work. I haven’t seen the mom who described doing the body scan with her toddler since our first MBCT series ended years ago, and yet, her wish inspired a decade of research and guided the development of a program that may prove to offer benefit to many mothers and their children. My only lingering wish is that I could thank her!