CBT for Postpartum Anxiety: A Manual for New Mothers

Your life has just been turned upside down with the addition of this little bundle. You may have heard others talk about postpartum depression, but you may notice that you’re feeling more anxious than depressed. Postpartum anxiety can be just as debilitating and needs to be talked about too.  

You might be searching the internet, trying to figure out what you’re feeling and what to do about it. Great news, you have come to the right place.

Cognitive Behavioral Therapy (CBT) is an evidence-based approach to treating many mental health struggles, including postpartum anxiety. CBT gives tangible strategies for working through anxiety so you’re not just stuck in your own cycle of worry.

The CBT Basics

CBT believes there is a link between thoughts, emotions, and behaviors.

For example, if you are thinking “my baby is going to stop breathing while they sleep” this might lead to feeling anxiety, panic, or restlessness. CBT would tell us that these thoughts and emotions might lead us to check on our baby repeatedly and intentionally avoid sleeping.

THOUGHT: “my baby is going to stop breathing while they sleep”

Leads to…

EMOTIONS: anxiety, panic, or restlessness

Leads to…

BEHAVIOR: checking on our baby repeatedly and avoiding sleep.

The equation goes: our thoughts contribute to our emotions, which contribute to how we behave. CBT tells us that if we can change the thought, we can change everything that follows.

What CBT is NOT

Positive Thinking

CBT can be misunderstood for “positive thinking” so let’s put that myth to rest. It can feel a bit like a slap in the face when you’re struggling and someone tells you to “look at the bright side”.

CBT does challenge you to shift or reframe your thoughts. The key to this is to make sure the way it’s reframed feels believable, authentic, and should help to reduce the intensity of the anxiety at hand. 

For those who choose to reframe with something like ‘everything is going to be okay,’ I often ask, ‘Do you actually believe that?’ or ‘Does that thought really give you relief?’” If the answer is no, then it’s back to the drawing board to find another perspective.

Gaslighting Yourself

There’s a debate in the therapy world about whether CBT is just teaching clients how to gaslight themselves. Now of course, everyone gets to have their own opinion but I’ll tell you why I disagree.

Related to the paragraph above, gaslighting involves attempting to convince yourself of something that is not true or possibly attempting to downplay your own emotions.

It’s imperative that the new outlook on our thoughts be believable and authentic, as well as reduce the intensity of your anxiety.

How Does CBT Relate to Postpartum Anxiety?

Identifying the Big Picture

It’s tough to effectively cope with anxiety unless we understand it. A benefit to utilizing CBT is the goal of working to understand the big picture.

Breaking it down into thoughts, emotions, and behaviors can shed some light into what might have triggered your anxiety. You may also start to notice themes within these triggers.

For example, you pause and start to reflect on your anxiety. You find out that the root thought is “my baby is going to sleep terribly tonight so I’m not going to sleep. It’s going to be a bad night”.

Perhaps this thought and the anxiety that follows might appear every evening. This shows us exactly what is triggering us and as a result, we can be better prepared.

Challenging the Negative Voice

A lot of the moms I see, come into therapy with a deep inner critic. They have this mean monster in their head talking to them in a way they would not treat someone else.

“You are so lazy”, “you don’t play with your daughter enough, she’s bored”, “you are a bad mom”, “you can’t ask for help, you will be such a burden”, “you’re daughter deserves a better mom”. Sound familiar?

From a CBT perspective, if this negative self-talk is not addressed then we know the anxiety will persist. This self-talk might not ever fully go away. The goal is to be able to notice it, call it out, and reframe it into something more realistic.

Sneaky Perfectionism

Many people label themselves perfectionists. Even if you’re aware this is a habit, there are sneaky ways perfectionism can show up that aren’t so obvious.

What’s great about the practice of CBT is once we break it down and identify the trigger/ thought we can see things clearer. This intentional practice of pausing to take inventory can shed light on certain thoughts or worries that might have quickly passed by without notice.

Getting Out of the Comfort Zone 

Most people have heard of the phrase “exposure therapy”. This is also an intervention of CBT.

In some cases, the avoidance of a certain task or behavior can contribute to someone’s anxiety. An example might be a mom avoiding taking her baby out in public for fear of the baby crying and making a “scene”.

In this case, if staying in the house is contributing to the mom’s anxiety and she’s feeling a bit stir-crazy, it might be beneficial to implement some exposure.

Please know that exposure therapy does not mean you are going to be pressured or pushed into the deep end of your fears. This strategy is done slowly, intentionally, and with your willingness.

Realistic Relaxation Skills

Sometimes your body is dysregulated and it needs some TLC. There are times when reframing your thoughts might not be the coping skill that’s most effective.

Turning to some tried and true relaxation skills is another strong point of CBT. Deep breathing, Progressive Muscle Relaxation, and Meditation are three skills which can be helpful when you feel those physical anxiety symptoms (restlessness, shakiness, increased heart rate, rapid breathing, muscle tension).

Common but NOT Normal

Please remember that while postpartum anxiety is a common experience, it is not normal. It’s so great that moms are opening up about the emotional hardships in pregnancy, birth, and motherhood. When these hardships are over-normalized, it leads to this belief that this must be what it’s supposed to feel like.

Asking for Help

Struggling with postpartum anxiety is not something most people plan for when they think of motherhood. CBT can be a very effective strategy for these symptoms of anxiety and you do not have to continue to suffer through your symptoms. 

Motherhood is a tough job so, if there is an area where the load can be lighter, let’s dig in.

Julianne Peters is here to help you overcome symptoms of anxiety and depression during your journey in motherhood.  Feel free to reach out to Julianne to get scheduled and work together!