The Wisdom of Cognitive-Behavioral Therapy (CBT): A Perfect Gift for New Moms

Originally published at adaa.org.  

When a baby arrives, gifts are most often given to the new little bundle of joy rather than to the new parents.  Parents might find their homes heaped with adorable onesies, brightly colored chew toys, and board book editions of childhood favorites. What do new parents need?  I suggest some wisdom of cognitive-behavioral therapy (CBT) from a book, a supportive friend, a group for new parents, or maybe even some sessions with a skilled therapist.

Why is CBT such a natural intervention for new moms?  

The Mismatch Between Expectations and Reality
From the day of birth, many moms experience a stark discrepancy between what they expect from birth and new motherhood and what actually happens.  Many moms create a formal birth plan, or at the very least, spend nine months imagining what their baby’s birth will be like.  As they say, “best laid plans!”  Events outside of one’s control might change many facets of this carefully thought out event, including of course how the baby is delivered (e.g., cesarean section instead of a natural birth).  
Another mismatch can be how woman imagine that they will feel the moment they meet their baby and how they actually feel.  We all hear about immediate love and bonding.  But, what if it doesn’t happen?  Many women first hold their newborn after hours of painful labor; no food, drink, or rest; and stressful moments pertaining to both mom’s and baby’s health.  It is no wonder that when moms finally meet their babies, we are often totally exhausted and frankly, pretty out of it!  And before we can even say hello, or examine all of the baby’s precious little fingers and toes, there is pressure to learn to nurse (which does not come as naturally as one might expect) and an influx of visitors (some wanted, and some not so wanted).  Is it any wonder that many women do not feel an immediate bond, but rather feel a flood of all sorts of emotions – some on the more negative end of the spectrum?
A helpful strategy to embrace is acceptance.  We cannot change how our birth experience goes.  We cannot change how we feel in those first few hours or days of motherhood.  Rather, we can look at this personal narrative without judgment.  “This is different from what I expected and that’s okay,” “I feel different than I thought I would and that’s okay.”  
New moms should also recognize the impermanence of their feelings.  In any given hour, let alone in those first days and weeks, new moms will experience a whole range of feelings, from positive to negative.  We can recognize these feelings with interest, rather than with judgment.   
Research into unwanted thoughts has also taught us that the more we try to suppress thoughts, the more we have them.  Therefore, new moms should be encouraged to let in all thoughts and to share their thoughts and experiences with others.  The more we do this, the less scary our thoughts become.  And by sharing experiences with others, we often find that other are feeling the exact same way.  


Negative Self-Talk
As the weeks of new motherhood progress, negative self-talk can go along with it.  This is especially true when people are sleep deprived and when hormones are raging.  There is a lot of time to think when you have a new baby, especially because new babies are not great conversationalists!
Here are some examples of negative self-talk:
•    If the baby is crying endlessly and can’t be soothed
     --“The baby doesn’t like me.” “I don’t know how to help him.”
•    If breast-feeding isn’t going well,
     --“I am a failure at this.”  “This is supposed to be natural.  Maybe I shouldn’t have even had a baby.”
•    If there are moments of negative thoughts or emotions like boredom or loneliness or anger,
     --  “I shouldn’t be feeling this way.”  “I should be grateful to even have a baby”
Cognitive therapy teaches us to ask, “Is there another way to look at this situation?”  Another great way to approach negative thoughts is to ask, “What would I say to my sister or best friend if she believed this?”
This might lead us to the following calming thoughts:
•    “Babies cry.  Sometimes for no reason.  And that is okay.”
•    “My job is to feed my baby.  There are lots of ways to accomplish that task” or “The baby and I are learning a new skill.  Any new skill takes time and practice.”
•    “All feelings are valid.  Some moments will be happy or funny and some will be frustrating or boring.  I can notice these feelings, but I don’t need to judge myself for them.”
•    “I have no idea how other moms are feeling.  Chances are many other moms are feeling the same way as I am.”


Falling into the Baby Blues or Post-Partum Depression
Being home with a new baby can take on an aimless quality.  Babies do not adhere to a schedule and planning things around them can be awfully hard.  While a lot of women are used to holding down challenging jobs, they might have a hard time adjusting to days where it is difficult to even find time to shower or do laundry.  Women who have a perfectionistic streak might fall into the trap of avoidance rather than doing things less than perfectly.  For example, a new mom might choose to miss lunch with a friend if she doesn’t have time to shower first or might stop cleaning the house because she can’t do it as perfectly and completely as she did before baby.  Days at home with a new baby can lead to feelings of loneliness, sadness, anger, and anxiety.  
Many new moms will find it helpful to draw on the lessons of behavioral activation, making a schedule to bring some structure to each day.  These daily schedules should include some very manageable items that bring them a sense of mastery (e.g., clean one room in the house, rather than the whole house; write two thank you notes) and a sense of pleasure or fun (e.g., get together with a fellow new mom; watch a fun TV show while baby naps).  Each week should include some social activities (I’m a big fan of having new mom friends) and, after the first 6 weeks or so, some activities that a woman used to enjoy before becoming a mom (e.g., resuming an exercise class; meeting a friend for a coffee).  While the schedule will need to be somewhat flexible due to the needs of a new baby, moms should also be mindful that they might need to change their own expectations of what they should accomplish in a day or how they should look or feel before going out.   
​

Suggested resources for new moms:

•    This Isn’t What I Expected, by Karen Kleinman & Valerie Raskin
•    Becoming a Calm Mom: How to Manage Stress and Enjoy the First Year of Motherhood, by Deborah Ledley
•    Motherhood Sessions podcast, Alexandra Sacks (and also her book with Catherine Birndorf What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood)

*Although I have referred mostly to new moms in this post, the lessons of CBT are relevant to all new parents.