Physiological influences within mother-infant dyads following cognitive behavioral therapy for postpartum depression

• In Event: 3-034 - Child-Directed and Bidirectional Parent-Child Effects Involving Maternal Mental Health

Integrative Statement

Postpartum depression (PPD) affects up to 20% of women in the puerperium and can impact mother-infant interactions. The transactional model posits that mothers and infants can influence one another and that these interactions can affect development (Sameroff, 2009). These interactions involve the constant matching and mismatching of behaviors and emotions, requiring infants to adjust to their infants, and vice versa. Recently, there has been increased interest in the potential physiological mechanisms underlying these mother-infant interactions. Studies suggest that in depressed mothers, the mother’s physiology precedes a similar change in her infant’s physiology while her infant’s physiology does not influence physiological changes in the mother (e.g., Bernard et al., 2017). Indeed, this evidence suggests that physiological changes play a significant role in mother-infant interactions. Despite this evidence, no studies have examined whether a psychotherapeutic intervention designed to treat PPD can produce more adaptive changes in these interaction patterns. The present study examines whether cognitive behavioral therapy (CBT) for PPD changes physiological influence patterns within mother-infant dyads.

This ongoing case-control study aims to recruit and test 60 mother-infant pairs (30 with a primary diagnosis of PPD receiving a 9-week group CBT intervention, and 30 healthy control pairs matched on infant age and family socioeconomic status). Physiological influence is assessed at two-time points a) baseline/pre-CBT and b) 9-weeks post baseline/post-CBT using respiratory sinus arrhythmia (RSA) measured while dyads participate in the Face-to-Face Still-face task (comprised of the free play, mother still-face and reunion components (Tronick et al., 1978). Two actor-partner interdependence models (Kenny & Kashy, 2000) will be used to examine whether changes occur between the pre-CBT and 9-weeks post CBT time points in the ‘partner effects’ (the effect that a given dyad member’s physiology during the free play component has on their partner’s physiology during still-face and reunion components).

Preliminary analyses of 20 dyads (10 PPD and 10 healthy control dyads) reveal that at baseline (pre-CBT), both partner effects were significant in healthy control dyads (mothers RSA influenced infant RSA and infants RSA influenced mother RSA); however, only the pathway from mother to infant was significant in the PPD dyads. At 9-weeks post baseline/post-CBT, no changes from baseline were observed in the healthy control dyads. However, in PPD dyads, both partner effects were significant following treatment.

These preliminary data suggest that prior to treatment, mother-infant dyads lead by mothers with PPD exhibit a more inflexible relationship whereby mothers negatively influence infants and are not as sensitive to the infant cues. Following treatment, mothers appear to exhibit a greater sensitivity to infant cues. This evidence not only supports the adaptive components of the transactional model of development, but also suggests that treating PPD in mothers can improve the mechanisms underlying mutually supportive mother-infant interactions, and could reduce the long-term negative impact of PPD on mothers and their infants.

Authors

• John Krzeczkowski, McMaster
  Presenting Author

• Louis Schmidt, McMaster University
  Non-Presenting Author

• Ryan J. Van Lieshout, McMaster University
  Non-Presenting Author