Cognitive Behavioral Therapy Delivered Over the Internet for Women With Postpartum Depression

After a woman gives birth, she will often feel anxious, depressed, or upset. For most women,
these feelings go away within a week of giving birth, but for some, postpartum depression
(PPD) can develop. PPD involves long-term, more severe feelings of anxiety, depression, and
despair that impair normal functioning. Untreated PPD threatens both the mental health of
mothers and the development of their infants, but many cases go untreated. This may be
because of the stigma of mental health treatment, limited availability of programs, cost of
treatment, or difficulty finding the time to schedule trips out of the home. Treatment
through a Web-based program addresses all these concerns by providing a private,
cost-efficient program available anywhere with computer access. This study will develop and
test a Web-based version of cognitive behavioral therapy (CBT) to treat women with PPD to
determine its feasibility and acceptability.

Participation in this study will last 3 months. All participants will be offered a Web-based
version of CBT for PPD. The CBT program will include guided behavioral strategies for
dealing with depression, online videos of women who have used these strategies, Web forums
in which participants can ask questions of peers and experts, and periodic phone coaching.
The program will last 6 weeks. All participants will complete assessments at baseline,
post-treatment, and 3-month follow-up. Safety monitoring questionnaires will also be
completed at Weeks 2 and 4 of treatment. Assessments will include clinical interviews and
questionnaires related to the following: health; depression; demographics; maternal skills,
stress, and self-efficacy; Internet use, experience, and self-efficacy; behavioral
self-efficacy; and program acceptability.

Inclusion Criteria:

- Within 6 months postpartum

- Home access to the Internet

- Use of personal e-mail

- Score from 12 to 20, inclusive, on the Edinburgh Postnatal Depression Scale

- Diagnosed as having postpartum depression

Exclusion Criteria:

- Current diagnosis of substance abuse, bipolar disorder, or psychotic depression

- Currently receiving treatment for depressive symptoms, including antidepressant
medication or psychotherapy

- Currently has suicidal intentionality, lethality, access to means, and history of
suicide attempts