When Connie Chow of Edmonton, Alta., couldn't access a therapist to help her through postpartum depression, her husband suggested she try online therapy.
"I was isolating myself," recalls Chow. "He noticed that I didn't want to leave the house with the baby and that I would worry or fixate on sleep and breastfeeding. I didn't eat or care to shower much. I had thoughts of self-harm from not being a good mom.
I knew I needed help but was not willing to leave the house to get it. I was referred to a therapist who specializes in postpartum depression and anxiety but she was very busy and it was difficult to book an appointment with her."
Postpartum depression in Canada
Postpartum depression (PPD) affects up to 15 per cent of mothers in Canada. Symptoms can include feeling extremely sad, crying spells for no reason, feelings of worthlessness and hopelessness, frightening thoughts and panic attacks.
The best form of treatment is a combination of medication and therapy, in particular cognitive-behavioural therapy (CBT) but women in Canada often have a hard time gaining access to a therapist due to a number of factors including therapist shortages, geographical distance, stigma, and cost.
The therapist would suggest an exercise such as going for daily walks, writing positive things in a journal, coming up with a goal or answering a series of questions. Then I would attempt to accomplish them and explain how I did it.Connie Chow
Since she didn't feel able to leave the house to see a therapist even if one became available, Chow took her husband's advice and began an eight-week, therapist-assisted, online cognitive behavioural therapy program (or TAICBT for short) covered through his work insurance.
TAICBT has been gaining momentum in Canadian workplaces of late because it's cheaper than providing in-person therapy coverage for employees and studies indicate the two are equally as effective in treating mild to moderate depression and anxiety.
"Emails varied week by week for approximately two months," says Chow. "The therapist would suggest an exercise such as going for daily walks, writing positive things in a journal, coming up with a goal or answering a series of questions. Then I would attempt to accomplish them and explain how I did it."
Online Therapy Is Effective For Women With PPD
CBT is a problem-focused, goal-oriented, short-term form of psychotherapy that usually lasts between six to 20 sessions. It helps people identify distortions in a patient's thinking by having them monitor their thoughts during difficult situations. This learned self-awareness is what begins to help people change their thoughts and emotional and behavioural reactions.
TAICBT is online CBT administered and monitored by a therapist via email or telephone. According to a published, peer-reviewed 2016 Canadian study, TAICBT is an "efficacious, well-utilized, and desirable intervention for women with PPD" and appeared "more efficacious at reducing symptoms of PPD, parental stress, and improved psychological and environmental quality of life" compared to women in a wait-list control group.
In the study, 50 new mothers from Saskatchewan with mild to moderate depressive symptoms were randomly assigned to receive TAICBT or go on a wait-list for traditional in-person therapy.
The women in the online therapy group experienced decreased PPD symptoms compared to the women in the wait-list group. Approximately 20 per cent of mothers who tried online therapy were considered improved, while over 62 per cent were considered recovered. Sixty per cent of mothers completed the entire program and messaged their therapist on average five times, showing "significant program adherence."
In the postpartum period, there are unique barriers including unpredictable child schedules, childcare responsibilities, and increased difficulty with travelling that online strategies can address.Dr. Simone Vigod
"I think that online/e-health strategies are an excellent way to address barriers to in-person care," says Dr. Simone Vigod, a psychiatrist and lead of the Reproductive Life Stages Program at Women's College Hospital in Toronto, where they are running and testing online therapy for mothers with postpartum depression.
"In the postpartum period, there are unique barriers including unpredictable child schedules, childcare responsibilities, and increased difficulty with travelling that online strategies can address."
Vigod says there has been an "explosion" of digital/online therapy and most of the research to date has been positive in terms of its efficacy. Though she and her team are hoping to bring TAICBT to Women's College Hospital, she thinks more needs to be done to really understand who is most likely to benefit from therapy delivered online and whether there are some situations where in-person care might be more beneficial.
"For example, if someone would benefit from the behavioural activation of coming to in-person appointments and/or if the lack of someone to watch the baby even during an online encounter might negatively impact the therapy," says Vigod.
"From some of our work doing online groups, some mothers have indicated that they even prefer asynchronous posts as opposed to live chats because it is so hard to predict when they might be able to find time themselves to do it. All this to say that we do need more evidence to make sure that we are utilizing online therapy in the best way possible."
With respect to CBT specifically, Vigod says there is good evidence for its efficacy but it is not going to necessarily be the right therapy for everyone with depression or anxiety, so before starting treatment, she says a person should receive a good assessment of whether CBT is the right therapy for them.
Chow says online therapy was a good starting point for her and she would recommend it to other mothers in her situation.
"I had done therapy before so I was just worried about finding a good fit with an online therapist," says Chow.
"It really helped me when I couldn't leave the house and was a good bridge to my mommy program. I wish I had known about it earlier. It would have helped me realize that my thoughts weren't healthy and maybe I would have been able to enjoy the newborn experience more."
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