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Parent and Child Psychological Services PLLC 
941.357.4090 (Office)/ 727.304.3619 (Fax)
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Treating Anxiety During Pregnancy by Kirsten Ellingsen, PhD, PMH-C

1/20/2022

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Anxiety during pregnancy is common. This is particularly true (and more likely to be higher) if a woman had past infant loss, miscarriage, infertility, or a history of anxiety pre-pregnancy. Worry about the health and viability of a baby, delivery, role changes, as well as financial and relationship changes and demands, are real and can be expected.
 
However, when anxiety is interfering with functioning, causing distress, and persistent a women might be experiencing a Perinatal Mood and Anxiety Disorder (PMAD). In fact, PMADs are the most common medical complications of childbearing. They are under screened for and under treated worldwide.
 
Estimated rates from past studies found up to 1 in 5 (or 20%) of women experience a PMAD; understandably, these rates have started to be documented as even higher in the pandemic. Recent studies suggest significantly higher rates of depression, anxiety, posttraumatic stress symptoms, as well as feelings of isolation and loneliness for perinatal women during the pandemic. Anxiety in pregnancy has also been a predictor of postpartum depression. It is important that women are identified and provided the support needed.
 
The United Nations Children’s Fund estimates that there were 116 million births in the first ten months after the COVID-19 was declared a pandemic by the World Health Organization (WHO) (March 2020). Rates for PMADs remain high. When mood and anxiety disorders are not treated during pregnancy, there are adverse outcomes for the mother, child, and family. For mothers this might include increase in substance use, smoking, lack of medical care. Infants are more likely to be preterm, lower birth weight. The relationship, attachment and bonding between a mother and her infant can be significantly affected. It can affect spouse or partner relationships and family functioning.  Yet, there are research supported “evidence-based” treatments to help significantly reduce symptoms of anxiety and depression during the perinatal period (conception to one year after birth).

One such approach that aims to treat anxiety during pregnancy is Cognitive Behavioral Therapy (CBT). CBT focuses on the inter-connection between thoughts, feelings, and behavior. It is based on the view that how you think affects how you feel. To feel better a person needs to think “better” or in a more balanced and realistic way. The focus is on increasing awareness of thoughts and how they affect feelings and behavior. This is not ignoring or dismissing feelings. The goal is to build awareness of automatic thoughts and thought patterns that are inaccurate, overly negative, unproductive or unhelpful. It helps a person replace unhealthy and anxious thinking with more helpful and accurate thoughts.

With CBT, pregnant women with anxiety learn calming and relaxation strategies (Diaphragmatic breathing, Progressive Muscle Relaxation, Mindfulness, Guided Imagery) and cognitive coping strategies to identify, examine, and modify thoughts. Techniques to evaluate and change negative, inaccurate, or unhelpful thoughts or thinking errors are taught and practiced. Typical unhelpful cognitive distortions or thought patterns for anxiety include catastrophizing (“what if” thinking for the 1% uncertainty), predicting the future, jumping to conclusions without all the information, dismissing the positive and focusing on the negative. These are also connected to deeply held beliefs about the world, self, and interpretations about situations. It intends to help build skills to effectively manage and reduce anxiety symptoms. Self-care, practice goal setting, and support are also essential for helpful treatment pregnancy women in therapy. When loss or trauma has been experienced, women need additional grief processing and support.
 
If you or someone you know is experiencing a PMAD, please reach out for help and support. The earlier the better. Cognitive Behavior Therapy (CBT) is one “evidence-based” treatment; providers who are certified or advanced trained in EMDR and Interpersonal Therapy (IPT) are also excellent resources for depression and birth trauma and loss. Training providers can be found in the provider directory at the Postpartum Support International website https://www.postpartum.net/get-help/provider-directory/.  When symptoms are not helped with therapy, medication might we warranted and safely prescribed by psychiatrist trained to support Maternal Mental Health (MMH).
 
If you have questions or concerns, please reach out to a provider trained in MMH, talk with your OBGYN, pediatrician, primary care provider, or contact us to discuss how you can access support. Taking care of yourself is taking care of your baby. There are both formal therapy and informal support groups that can help. You are not alone. Please know that there are effective options for treatment and providers who can support you during pregnancy.
 
 
Resources and References:
 
Postpartum Support International: https://www.postpartum.net
 

Anxiety During Pregnancy: Options for Treatment By MGH Center for Women's Mental Health https://womensmentalhealth.org/posts/anxiety-during-pregnancy-options-for-treatment/How you can mange anxiety during pregnancy: https://www.health.harvard.edu/blog/how-can-you-manage-anxiety-during-pregnancy-202106252512
 
Guide: http://www.bcmhsus.ca/Documents/coping-with-anxiety-during-pregnancy-and-following-the-birth.pdf
 
What is Postpartum Depression https://www.therapistaid.com/therapy-worksheet/what-is-postpartum-depression
 
Anxiety Coping Skills: https://www.therapistaid.com/therapy-worksheet/coping-skills-anxiety

CBT Training for Therapists:  https://beckinstitute.org/training/

 

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Understanding Cognitive Distortions: aka Thinking Errors By Rachel Funnell, LMFT

1/15/2022

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Cognitive Distortions or Thinking Errors, are irrational thoughts that develop over time in response to adverse events and they influence our emotions. Everyone experiences these thinking errors to some degree, but when we engage in them regularly, they become maladaptive. Regularly engaging in cognitive distortions can lead to anxiety, depression, relationship problems and low self-esteem. Oftentimes, these thoughts are subtle and they can be difficult to recognize when it’s how you think regularly. However, it’s important to start to pay attention to which ones you may be engaging in and begin to adjust your thinking. 
There are many different types of Cognitive Distortions, but below are the most common ones. 
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All-or-nothing thinking: thinking in absolute terms, such as “always”, “never”, or “every”. This is also known as “Black or White” thinking. Things are either this or that and there are no shades of gray. Examples of this would be, “I never do a good job on my work”,  “Everytime I talk to them, they dismiss me”, or “I always have to be the one to do this.” 

Overgeneralization: making broad interpretations from a single or few events. Examples of this would be, “I felt awkward during my first job interview. I’m always so awkward” or “I got a ‘C’ on one test so I’m stupid and a failure”. 

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Mental filter: this is similar to overgeneralization in that you focus on a single negative piece of information and exclude all the positive ones. For example, you focus on the one negative comment your partner made and view the relationship as hopelessly lost, while ignoring the years of positive comments and experiences. 

Disqualifying the positive: recognizing only negative aspects of a situation and ignoring or rejecting the positive. For example, you might receive many positive comments on an evaluation but focus on the single piece of negative feedback. Or you dismiss the positive feedback and think that the person felt obligated to give you the compliment. 

Jumping to conclusions - Mind Reading: interpreting the thoughts and beliefs of others without adequate evidence. In this distortion, you assume you know what the other person is thinking. For example, “That person is looking at me. They probably think my shirt is ugly” or “The teacher didn’t call on me, she must think that I don’t know the answer.” 

Jumping to conclusions - Fortune Telling: thinking you know what will happen in the future, and that it will be bad. These conclusions are based on little to no evidence and you hold them as truth. For example, predicting that you will never find love or have a committed, happy relationship based only on the fact that you haven’t had one yet. Or thinking “I know that if I ask her out, she’s going to say no.”

Magnification (catastrophizing) or Minimization: exaggerating or minimizing the importance or meaning of events or things. Examples would be an athlete who is generally a good player, makes one mistake and believes that he is a terrible player. Or a person who believes that their own achievements are unimportant. 

Emotional Reasoning: accepting one’s feelings as facts. It’s described as “I feel it, therefore it must be true.” However, just because we feel something doesn’t make it true. Examples are, “I feel like a bad friend, therefore I must be a bad friend” or “I feel ugly, so I must be ugly.” 

Should Statements: thinking and believing that things have to be a certain way. These are statements that you make to yourself or others about what you “should” do, what you “ought” to do, or what you “must” do. For example, “I should have my kids in bed at the same time every night”, or “Women must get married and have children.” 

Negative Labeling: having a negative belief about yourself or others and thinking it applies to everything you or they do. It’s assigning judgements of value to ourselves and others based on one instance or experience. For example, “I’m so stupid. Everything I say is dumb” or you hold the door open for someone and they don’t say thank you so you think “they are such a rude person.” 

Personalization: this distortion involves taking everything personally or blaming yourself for anything that goes wrong around you, even if you had nothing to do with it. For example, “My mother is always upset. It must be because I’ve not done enough to help her.” Or “My friend didn’t have fun at the party. It must be because I did something to upset her.” 

Remember that everyone has engaged in at least one of these at some time in their life. We are human and it happens. But if you find that you are engaging in them regularly, then it may be time to work on correcting them with the help of a professional mental health therapist. 

References
positivepsychology.com/cognitive-distortions/
www.therapistaid.com



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    Parent and Child Psychological Services is a private practice serving children and families in the Sarasota, Florida area. The practice is owned and operated by Dr. Gibson, a Licensed Psychologist who is Board Certified in Clinical Child and Adolescent Psychology. ​

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Parent and Child Psychological Services PLLC 
info@childtherapysrq.com
941.357.4090 (Office)
727.304.3619 (Fax)                                                                                                                                                               
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