Perinatal OCD Treatment

Cognitive Behavioral Therapy (CBT) is a group of therapies used by mental health therapists for treating psychological disorders. Exposure and Response Prevention (ERP) is a type of CBT. 

• The Exposure in ERP refers to the patient being exposed to the thoughts, images, objects and situations that make the patient uncomfortable and/or that start obsessive behaviors. The Response Prevention component refers to the patient making the choice not to do a compulsive behavior once “triggered.”
• All of this is done under the support and guidance of a therapist, and patients eventually learn to do their own ERP exercises to manage symptoms.
• A natural drop in anxiety or uncomfortable feelings happen over time with repeated exposures, referred to as habituation.

There have been some unfounded concerns expressed among perinatal mental health professionals that having a mother “exposed” to her obsession/fear, if her fear involves harming her baby, would not be appropriate. For example, if a mother avoids giving her baby a bath because her intrusive thoughts involve drowning the baby, some therapists are instructing their patients to avoid giving the baby a bath.  However, avoidance of discomfort serves to maintain the OCD cycle and perpetuate longer-term anxiety. According to experts in ERP, ERP therapy would involve instructing the mother to give her baby a bath, perhaps with small portions of water at first, and/or with her spouse or partner nearby, to help her understand her thoughts don’t equal a plan, and intrusive thoughts are not dangerous. Therapy helps her understand she can work through the thoughts and the discomfort she feels and won’t actually harm her baby, and most importantly with time discomfort levels resolve.

Though there hasn’t been research specific to the use of ERP in the maternal/perinatal population, experts agree there is no reason to believe that outcomes would be different in this population:

"ERP works because it promotes fear extinction. 

Its effects don't depend on how or when the fear developed."  

Jonathan Abramowitz, PhD

Evidence also suggests men with pregnancy-related onset of OCD may respond well to CBT with ERP (Abramowitz et al., 2001).

Acceptance and Commitment Therapy (ACT) to Increase ERP Readiness

Acceptance and Commitment Therapy (ACT) may be utilized to increase readiness for and maintaining commitment to ERP but is not recommended as a standalone treatment for perinatal OCD.

Psychoeducation about Intrusive Thoughts

There is promising data that shows incorporating psychoeducation about intrusive thoughts into childbirth education classes may help prevent the development of perinatal OCD.  Abramowitz and Timpano (2011) studied a prevention protocol that demonstrated significantly lower levels of obsessions and compulsions for those who received it than those who did not, with results staying consistent at 1, 3, and 6 months postpartum.  Results support the potential utility of incorporating a CBT-based obsessive compulsive symptom prevention program into childbirth education classes.

General Psychoeducation and CBT Support

Programs such as  “Mothers and Babies”, the Reach Out and Stay Strong Essentials for mothers and newborns (ROSES) and Practice Resources for Effective Postparutm Parenting (PREPP) are also effective in reducing stress and mitigating risk for perinatal intrusive thoughts and OCD.