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A pilot randomized controlled trial of time-intensive cognitive–behaviour therapy for postpartum obsessive–compulsive disorder: effects on maternal symptoms, mother–infant interactions and attachment

Published online by Cambridge University Press:  31 January 2017

F. L. Challacombe ,
P. M. Salkovskis ,
M. Woolgar ,
E. L. Wilkinson ,
J. Read  and
R. Acheson
F. L. Challacombe*
Affiliation:
Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK South London & Maudsley NHS Foundation Trust, London, UK
P. M. Salkovskis
Affiliation:
Department of Psychology, University of Bath,Bath, UK
M. Woolgar
Affiliation:
South London & Maudsley NHS Foundation Trust, London, UK
E. L. Wilkinson
Affiliation:
South London & Maudsley NHS Foundation Trust, London, UK
J. Read
Affiliation:
South London & Maudsley NHS Foundation Trust, London, UK
R. Acheson
Affiliation:
Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
*
*Address for correspondence: F. L. Challacombe, Centre for Anxiety Disorders & Trauma, 99 Denmark Hill, London SE5 8AZ, UK. (Email: [email protected])
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Abstract

Background

There is increasing recognition that perinatal anxiety disorders are both common and potentially serious for mother and child. Obsessive–compulsive disorder (OCD) can be triggered or exacerbated in the postpartum period, with mothers reporting significant effects on parenting tasks. However, there is little evidence concerning their effective treatment or the impact of successful treatment on parenting.

Method

A total of 34 mothers with OCD and a baby of 6 months old were randomized into either time-intensive cognitive–behaviour therapy (iCBT) or treatment as usual (TAU). iCBT took place after randomization at 6 months postpartum and was completed by 9 months. Maternal symptomatology, sensitivity in mother–infant interactions and parenting were assessed at baseline and reassessed at 12 months postpartum. At 12 months attachment was also assessed using Ainsworth's Strange Situation Procedure. A healthy control group of mothers and infants (n = 37) underwent the same assessments as a benchmark.

Results

iCBT was successful in ameliorating maternal symptoms of OCD (controlled effect size = 1.31–1.90). However, mother–infant interactions were unchanged by treatment and remained less sensitive in both OCD groups than a healthy control group. The distribution of attachment categories was similar across both clinical groups and healthy controls with approximately 72% classified as secure in each group.

Conclusions

iCBT is an effective intervention for postpartum OCD. Sensitive parenting interactions are affected by the presence of postpartum OCD and this is not improved by successful treatment of OCD symptoms. However, the overall attachment bond appears to be unaffected. Longitudinal studies are needed to explore the impact of postpartum OCD as the child develops.

Keywords

Attachmentcognitive–behaviour therapymother–infant interactionsobsessive–compulsive disorderrandomized controlled trials
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 8 , June 2017 , pp. 1478 - 1488
Copyright
Copyright © Cambridge University Press 2017 

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