Addressing attachment in the context of a postnatal depression treatment Presentation to MCHN Meeting Dr Carolyn Deans Clinical Psychologist (Victoria University) This study has DEECD approval

POSTNATAL DEPRESSION PND a prevalent condition amongst mothers e.g. Buist et al (2008) with negative long-term outcomes Evidence for prevention of PND is at best equivocal see O’Hara (2009) Effective treatments are available to treat PND: Medication see O’Hara (2009) IPT see Reay et al (2010) on group IPT for PND Cognitive behavioural therapy see Milgrom et al (2005)

PND AND THE CHILD PND is known to have negative outcomes for child: behavioural, social, psychological and cognitive e.g. Burke (2003) Disruption of attachment potentially most damaging outcome due to long-term susceptibility to depression Attachment: precursor or outcome? Mothers with poor attachment at higher risk of PND PND affects mother’s ability to bond with her child

‘TREATING THE CHILD’ More evidence of relationship factors involved in the development of PND than in MDE: Bilszta et al (2008) Interpersonal Therapy (IPT) focusses on relationships, uses attachment theory Teaches clients to improve their communication skills by understanding others’ communication better, expressing themselves better, and recognising their needs for support This intervention is a Group IPT: 3-5 women per group, lasting for 10 weeks

OUR RESEARCH PROPOSAL Based on Interpersonal Therapy Addition of themes surrounding attachment and two weeks focussed on the relationship with the baby Influenced by ‘Circle of Security’ work of Hoffman et al (2006): improvement in maternal sensitivity responding to baby’s cues and providing what is needed (comfort, guidance, room for exploration)

GROUP OUTLINE PreClinical assessment PreIndividual session 1Introduction and psycho-education 2 / 3Role transitions 4 / 5Communicating with baby MidPartner session 6 / 7Resolving disputes 8Patterns in relationships 9 / 10Consolidating progress and farewells

WHAT AM I ASKING OF YOU? Collaborate on a “Treatment As Usual” protocol – you tell me what the current best practice is and agree to use that Inform potential participants (EPDS>12 or your clinical judgment of psychosocial risk) of the study and ask if you can provide their details to me Provide TAU for all mothers in the study I need about 70 mothers: 35 in each arm of the study 35 ‘treatment’ mothers = about 7 groups

WHAT ARE THE BENEFITS FOR YOU? Input from Prof Buist on best practice model (if you want it!) Professional development training in EPDS, PND, IPT, and attachment work Additional source of free treatment for mothers in distress – which we know works for the PND! Able to jointly explore which women respond to treatment I can provide advice on referral options for those who are not eligible for/do not agree to participate in the trial

Randomised into groups Group treatment (groups of 3-5)Treatment as Usual Contact via researchers for initial information and assessment Suitable (participate in study)Unsuitable (re-referred to MACH Nurse) Identification by MCHN of potential participant You provide information and ask if you can give me their name and phone number

MEASURES Mental HealthEdinburgh Postnatal Depression Scale (EPDS) then Clinical Interview (SCID-II) + Beck Scales (BDI/BAI) Parenting Stress Index – Short Form (PSI-SF) Interpersonal functioning Questionnaire (SAS-SR) Mother-baby relationship Videotape 20 minutes (Emotional Availability Scales) Maternal Attachment Inventory (MAI) Infant Characteristics Questionnaire (ICQ)

Dr Carolyn Deans: MetroWest Psychology Clinic: 138 Nicholson St, Footscray Ms Melanie Quinn: Prof Anne Buist University of Melbourne / Northpark Private Hospital CONTACTS