Addition of Online Cognitive Behavioral Therapy Workshops to Usual Care May Improve Symptoms of Postpartum Depression

August 2022

Approximately 20% of mothers develop postpartum depression (PPD) in the perinatal period. Effective and accessible treatments are needed to reach mothers at an early stage to avoid long-term negative consequences. In a new study, Van Lieshout and colleagues assessed whether cognitive behavioral therapy delivered as a 1-day online workshop could improve postpartum depression.

The investigators conducted a parallel-group randomized clinical trial. Participants had given birth within the prior 12 months and had a score of ≥10 on the Edinburgh Postnatal Depression Scale (EPDS). Participants received treatment as usual, which included patients’ choice of medication and/or therapy from her healthcare provider. They were also randomly assigned to participate in a group therapy workshop led by a therapist or to the control group. Women in the control group were permitted to participate in the workshop after 12 weeks.

The online workshop taught participants about modifiable cognitive risk factors, cognitive skills, behavioral skills, goal setting, and action planning using group exercises, discussion, and role playing. The primary outcome was the change in EPDS scores from baseline to 12 weeks after the workshop: a change of –4 points was considered to be a clinically significant change in depression. Secondary outcomes were changes on other scales for anxiety (7-item General Anxiety Disorder Questionnaire; GAD-7), supportive social relationships, mother–infant bonding, and infant behavior.

A total of 403 mothers participated in the study. Mean age of the mothers was 31.8 years, and the mean age of the infants was 5.3 months. Some participants had been treated with antidepressants (22%) and counseling (41%).

The investigators determined that there were statistically significant group × time interactions for EPDS scores and for the secondary outcome measures. After 12 weeks, EPDS scores decreased by 4.82 points from baseline in the workshop group and by 1.88 points from baseline in the control group. The odds of a clinically significant change in EPDS scores were greater in the workshop group than in the control group. Similarly, the workshop group had greater odds of a clinically significant improvement on the GAD-7 at 12 weeks, compared with the control group.

The change in use of antidepressants from baseline to 12 weeks was not significantly different between the workshop and control groups. Similarly, the groups did not differ in use of mental health services at baseline or 12 weeks later.

The investigators concluded, “this randomized clinical trial of online 1-day cognitive behavioral therapy-based workshops for PPD versus usual care during the COVID-19 pandemic suggests that when added to treatment as usual, this intervention leads to clinically significant changes in PPD and anxiety and improves social support, as well as maternal reports of mother-infant bonding, infant-focused anxiety, and positive affectivity in infants.”

Furthermore, online 1-day cognitive behavioral therapy workshops for PPD could be early and inexpensive interventions to treat those with milder PPD and to identify more serious cases in need of further intervention.


Van Lieshout RJ, Layton H, Savoy CD, et al. Effect of online 1-day cognitive behavioral therapy-based workshops plus usual care vs usual care alone for postpartum depression: a randomized clinical trial. JAMA Psychiatry. 2021;78(11):1200-1207.

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