The period of pregnancy and of post-partum A moment of great psychological vulnerability is notoriously for a woman and the impact of depression in this phase of life is well documented by literature (Stein and collaborators, 2014).
This applies above all to the pregnant woman has already had previous episodes of greater depression: in these subjects, in fact, the relapse indices reach 30-40% (Di Florio et al., 2013; Goodman & Tully, 2009).
The method of preventing the most used depressive repercussions in the pregnancy and post-partum period is pharmacotherapy, despite the data available to us (Dimidjian & Goodman, 2014) indicate a clear subjective preference for non-pharmacological care, if available.
In fact, among the women treated with antidepressants in pregnancyat least 50% do not follow the therapy with continuity and of this percentage almost 7 out of 10 will have a depressive impact (Cohen et al., 2006; Roca et al., 2013).
The scarcity of psychosocial preventive treatments, however, does not provide an alternative (however desired!) To the use of antidepressants and this often leads these women to totally renounce the prevention of repercussions with potentially harmful results both for themselves and for the goodness of the mother-child bond in the post-natal period.
If on the one hand the cognitive therapy based on Mindfulness (Mindfulness-based Cognitive Therapy, MBCT; Segal, Williams & Teasdale, 2002) is now notoriously an effective tool for the prevention of depressive repercussions in the general clinical population (Chiesa & Serretti, 2011; Piet & Hougaard, 2011), only recently the protocol has been adapted specifically for this subject subject.
The new intervention (Mindfulness-Based Cognitive Therapy- PerinateL Depression, MBCT-PD), implemented by Dimidjian and collaborators (2015) is based on the standard model of the MBCT which places the subject with previous history of depression in a condition of vulnerability for which, in every situation of stress or change, the emotional-cognitive associations of the previous depressive episodes they reactivate the risk of relapse (Segal et al., 2002).
The formal and informal strategies of MindFulness and Cognitive Behavioral Techniques are used to help subjects to be more aware of these mechanisms and make them less automatic.
The implementations made by the American group of Dimidjian and colleagues to adapt the basic model to the context of pregnancy and the perinatal period include:
- Greater emphasis on the informal MindFulness practices to face the increase in the load of energy and time scheduled in the pre and post partum period.
- The inclusion of “meditation based on loving kindness” practices to reduce and/or prevent the tendency to self-criticism typical of subjects at risk of depression. These practices are based on the conscious use of loving and accepting phrases aimed at itself and the child.
- The increase in cognitive-behavioral strategies (role palying, psychoeducation) aimed at self-care and increase in social support in the post-partum period.
The intervention is structured in 8 pre-parto group sessions and an individual session after childbirth: between one meeting and the other participants, an audio-registrate guide for meditation practice is provided.
The protocol was subjected to a first investigation by obtaining both high levels of interest and adherence to treatment (during the sessions and in the practice of homework) and a significant reduction of depressive symptoms Up to 6 months after childbirth (Dimidjjian et al., 2015).
A recent analysis conducted by the same research group has used a randomized trial on two samples of 43 subjects (pregnant women with a diagnosis of major depressive episode in anamnesis, but not in progress) assigned in a controlled way to the MBCT-PD protocol or to a standard treatment usually provided by the national health system.
The results found lower rates of symptomatological impact among women who had joined the MBCT-PD protocol compared to the other group, with a substantial difference between the two samples (relapse rate 18.4% vs 50.2%), despite the fact that there were no other interfering variables (further psychotherapy and/or pharmacological treatments).
The results also confirmed that the benefits received by the participants in the Mindfulness treatment they are stable over time (follow up at 6 months after childbirth) and that the women involved perceive the intervention as highly satisfactory, confirming data of previous studies according to which the forms of psychological and non -pharmacological prevention are generally preferred by patients in pregnancy and their families (Le Et al., 2011; Tandon et al., 2011).
