Finding Her Way Back: Alice’s Journey Through Postnatal Depression with Occupational Therapy

Summary

This case study outlines how Alice, a 34-year-old mother, overcame postnatal depression with the support and guidance of mental health occupational therapy.

Presentation

Alice is a 34-year-old woman with a previous history of anxiety and depression. She is a mother of two children, with an eldest child aged three and a six-month-old baby. Following the birth of her second child, Alice experienced a significant deterioration in her mental health. She was experiencing symptoms of postnatal depression alongside persistent anxiety, with anxiety present throughout much of her day.

Alice described feeling constantly overwhelmed by the demands of caring for two young children. She experienced frequent worries about her children’s safety and found it difficult to feel relaxed, even when both children were settled. Everyday activities that had previously been manageable had become increasingly difficult. Alice felt particularly anxious about taking both children out of the house on her own. She worried about what might happen if one child became distressed while she was attending to the other, or if something unexpected happened when she was away from home that she could not control. As a result, Alice had begun avoiding activities outside the home and was spending increasing amounts of time indoors.

Alice also described experiencing significant physical and emotional symptoms of stress. She frequently felt that she was in a state of “fight or flight”, with racing thoughts, physical tension, irritability, difficulty switching off and a heightened awareness of potential problems. At times, Alice experienced intense episodes of anger and rage. She described becoming overwhelmed by noise, competing demands and the constant need to respond to her children’s needs. She felt extremely distressed and guilty about these experiences and worried that feeling angry meant that she was a bad mother or that she did not love her children enough.

The Mental Health Occupational Therapist provided psychoeducation around the relationship between chronic stress, anxiety, emotional regulation and the nervous system. Alice was supported to understand that experiencing intense anger or rage during periods of significant overwhelm did not mean that she was a bad mother or that she did not love her children. Instead, these experiences could be understood as important signals that her stress response was highly activated and that she needed opportunities for regulation, recovery and support.

Alice had previously experienced a severe episode of anxiety following the birth of her first child. When her first baby was nine months old, she experienced an acute anxiety attack which resulted in a brief hospital admission overnight. Although she recovered from this episode, the experience remained significant for Alice and contributed to her fear that something similar might happen again. Now, with her second baby six months old, Alice was particularly concerned about another deterioration in her mental health. Her sleep had also deteriorated significantly. Although her baby’s night waking was developmentally expected, Alice found that she struggled to return to sleep after being woken. She would lie awake worrying about her children, thinking about everything that needed to be done the following day or anticipating things that might go wrong.

The combination of disrupted sleep, persistent anxiety, emotional overwhelm and the demands of caring for two young children left Alice feeling physically and mentally exhausted. Alice had also experienced a significant reduction in self-care. She frequently skipped meals, had little opportunity for uninterrupted rest and had stopped engaging in most of the activities that previously supported her wellbeing. She had limited social support and felt that the majority of the practical and emotional demands of family life rested with her.

She was referred for Mental Health Occupational Therapy to support her perinatal mental health, with a particular focus on managing stress and anxiety, improving emotional regulation, supporting sleep and self-care, increasing confidence with everyday activities and developing strategies to reduce the risk of further deterioration.

Goal

During the initial assessment, the Mental Health Occupational Therapist explored the impact of Alice’s postnatal depression and anxiety on her everyday occupational functioning. The assessment considered parenting, self-care, sleep, household responsibilities, relationships, social participation, community activities, rest and recovery.

Together, Alice and the Mental Health Occupational Therapist identified the following goals:

• To better understand and manage her anxiety and stress.
• To develop practical strategies for emotional regulation.
• To understand her experiences of anger and rage and reduce the associated distress and guilt.
• To recognise early signs of nervous system dysregulation and overwhelm.
• To improve her sleep routine and develop strategies to support sleep hygiene.
• To increase her confidence leaving the house and managing everyday activities with both children.
• To improve her self-care and ensure her basic needs were being met.
• To develop a more manageable daily routine with opportunities for rest and recovery.
• To strengthen her practical and social support network.
• To develop a personalised relapse-prevention plan in light of her previous history of anxiety, depression and hospital admission.

Intervention

1) Understanding postnatal depression, anxiety and stress

The Mental Health Occupational Therapist initially worked with Alice to develop an understanding of how postnatal depression, anxiety and chronic stress were affecting her occupational functioning. Rather than focusing solely on Alice’s symptoms, the Occupational Therapy assessment explored how her mental health was affecting her ability to manage parenting, self-care, sleep, household tasks, social participation and community activities. Alice recognised that she had become increasingly focused on potential problems and threats. She was spending a significant amount of mental energy anticipating what might happen and trying to ensure that everything was under control.

The Mental Health Occupational Therapist provided psychoeducation around the relationship between stress, anxiety, avoidance and reduced participation. Together, they identified a cycle in which increased anxiety led Alice to avoid activities that felt difficult. Avoidance provided short-term relief but gradually reduced her confidence and increased her sense that everyday activities were unsafe or unmanageable. Understanding this cycle helped Alice begin to identify areas where small, manageable changes could increase her confidence and reduce the impact of anxiety on her daily life.

2) Emotional Regulation, Sensory Processing and Understanding Rage

The Mental Health Occupational Therapist explored Alice’s experiences of emotional dysregulation and rage through an Occupational Therapy lens, considering how sensory processing, environmental demands, emotional stress, fatigue and competing daily occupations were contributing to her ability to regulate.

Psychoeducation was provided around the relationship between sensory processing and emotional regulation. Alice was supported to understand that when she was already experiencing high levels of anxiety, poor sleep and mental overload, everyday sensory input such as children crying, constant noise, physical touch, clutter, interruptions and multiple competing demands could become increasingly difficult to process. This could contribute to a state of heightened arousal and make it harder to respond calmly to everyday situations.

The Occupational Therapist completed a sensory and environmental exploration to identify situations where Alice was becoming particularly overwhelmed and considered how her home environment and daily routines could be adapted to reduce unnecessary sensory demands. Strategies included creating opportunities for reduced noise and stimulation, taking brief sensory breaks where possible, modifying the environment, using calming sensory activities and identifying early signs that her sensory and emotional capacity was becoming depleted. Alice was also supported to recognise her own sensory preferences, triggers and regulation needs, and to develop an individualised sensory regulation toolkit that could be incorporated into everyday routines. This included practical strategies such as movement, breathing, grounding, time outdoors, quiet periods and reducing environmental stimulation.

Importantly, the Occupational Therapist supported Alice to understand that experiencing rage or intense irritability did not mean that she was a bad mother or that she did not love her children. Instead, these experiences could occur when her nervous system was highly activated and her capacity to process sensory input, manage demands and regulate emotions had become overwhelmed. The focus was therefore on recognising early warning signs, understanding her sensory and emotional needs, and using practical nervous system regulation and sensory regulation strategies before reaching a point of crisis.

This intervention piece demonstrated the role of Mental Health Occupational Therapy in supporting emotional regulation by looking beyond symptoms alone and considering the interaction between the person, their sensory processing, environment, routines, relationships and everyday occupational demands.

3) Stress and anxiety management

A key focus was identifying the factors within Alice’s daily routines, environment and responsibilities that were contributing most significantly to her stress. These included constant decision-making, household responsibilities, lack of uninterrupted time, limited social support, disrupted sleep and feeling responsible for anticipating every possible need of her children.

The intervention focused on practical stress management strategies that could be incorporated into Alice’s everyday routine. Together, they explored ways of reducing unnecessary demands, simplifying routines, sharing responsibilities and creating predictable periods of recovery throughout the day. Alice was also supported to distinguish between things that required her immediate attention and things that could safely wait. This helped reduce the sense that she needed to respond to every demand immediately and supported her to develop a more manageable pace within her day. The Occupational Therapist used a graded approach to help Alice re-engage with activities she had begun avoiding which gently supported her anxiety management and built on her confidence levels. 

4) Supporting nervous system regulation

Because Alice described feeling as though she was in a near-constant state of “fight or flight”, nervous system regulation became an important component of the Occupational Therapy intervention.

The Mental Health Occupational Therapist explored the sensory and environmental factors that influenced Alice’s level of arousal. Alice identified that noise, clutter, competing demands and lack of personal space could contribute to her feeling overwhelmed. She was supported to identify simple environmental changes that could reduce unnecessary sensory and cognitive demands. This included creating a calmer space within the home, reducing unnecessary background noise where possible and identifying brief periods during the day when she could reduce stimulation. Alice also developed a personalised regulation toolkit, including grounding exercises, breathing strategies, movement, time outdoors, music and brief periods of quiet.

The Occupational Therapist emphasised that regulation did not need to involve lengthy periods of relaxation. For Alice, brief and frequent micro-opportunities to regulate her nervous system were more realistic and sustainable. 

5) Sleep hygiene and Occupational Therapy

Sleep was identified as an important factor affecting Alice’s mental health, emotional regulation and ability to cope with everyday demands. While some disruption to sleep was unavoidable due to caring for a six-month-old baby, the Mental Health Occupational Therapist explored the aspects of Alice’s sleep routine that could be modified. Alice described lying awake after night-time feeds, worrying about her children and thinking about everything she needed to do the following day.

The Occupational Therapist provided education around sleep hygiene and worked with Alice to develop a realistic sleep and rest routine. Intervention included establishing a consistent wind-down routine where possible, reducing stimulating activities before bed, creating a calmer sleep environment and developing strategies for managing racing thoughts. Alice was also supported to consider how responsibilities could be shared where possible so that she was not carrying the full burden of night-time and early-morning tasks.

The intervention recognised that sleep advice needed to be realistic within the context of caring for an infant. The goal was not to achieve perfect sleep, but to maximise opportunities for rest and improve the quality of Alice’s recovery. Alice also learned to recognise that periods of poor sleep could reduce her emotional regulation capacity the following day. This helped her understand why she was more vulnerable to anxiety and rage when exhausted and encouraged her to prioritise recovery when sleep had been particularly disrupted.

6) Rebuilding self-care and occupational balance

Alice’s own basic needs had gradually moved to the bottom of her list of priorities. She often skipped meals, had limited opportunities to shower or get dressed without interruption, and rarely engaged in activities that were solely for her own wellbeing.

The Mental Health Occupational Therapist worked with Alice to rebuild self-care in small and achievable steps. Rather than introducing an extensive self-care programme, the focus was on identifying essential activities that would support Alice’s physical and mental wellbeing. Some of these included eating regularly, staying hydrated, getting outside, maintaining personal hygiene, engaging in gentle physical activity and having short micro-moments of self-care. The Occupational Therapist also explored occupational balance and helped Alice consider how her day could include a combination of caregiving, self-care, social connection and meaningful activity. Alice began to recognise that self-care was not an optional extra that could only happen when everything else was completed. It was an important part of maintaining her capacity to care for her children and manage her mental health, and thar brief moments woven into her day were achievable.

7) Relapse prevention and ongoing mental health support

Given Alice’s previous history of anxiety, depression and hospital admission, relapse prevention was an important part of the intervention.

The Mental Health Occupational Therapist worked collaboratively with Alice to identify her early warning signs of deterioration. Some of these included increasing anxiety, withdrawing from others, neglecting self-care, disrupted sleep, increased irritability or rage, avoiding leaving the house, feeling persistently overwhelmed and losing interest in previously meaningful activities. Alice developed a personalised relapse-prevention plan outlining the strategies and supports she could use if these signs emerged. This included returning to her regulation strategies, increasing practical support, protecting opportunities for sleep and recovery, reducing unnecessary demands, linking in with her identified social supports, and contacting appropriate healthcare professionals when needed. Given her previous hospital admission, Alice was encouraged to maintain communication with her GP and wider perinatal mental health supports and to seek medical professional help if her symptoms were to significantly deteriorate.

Outcome

Following Mental Health Occupational Therapy, Alice reported a greater understanding of the relationship between postnatal depression, anxiety, chronic stress, sleep deprivation and emotional regulation. She developed a clearer understanding of her own signs of nervous system activation and became more confident recognising when she was approaching emotional overwhelm. Importantly, Alice began to view episodes of rage differently. Rather than interpreting these experiences as evidence that she was a bad mother, she was able to recognise them as an important signal that her stress levels were high and that she needed to pause, regulate and seek support.

Alice developed a range of practical stress management, anxiety management and emotional regulation strategies that could be incorporated into everyday family life. She also made improvements in her sleep routine and developed more realistic expectations around rest and recovery while caring for a young baby. Her self-care improved as she began to prioritise regular meals, personal care, movement, time outdoors and brief periods of rest. She also became more confident leaving the house with both children and gradually increased her participation in community activities. By reducing unnecessary demands, sharing responsibilities and developing greater practical support, Alice reported feeling less alone in managing the demands of parenting. Most importantly, Alice developed a personalised relapse-prevention plan and a clearer understanding of the strategies, routines and supports that helped protect her mental health and wellbeing.

This case demonstrates the role of Mental Health Occupational Therapy in perinatal mental health, supporting mothers experiencing postnatal depression, anxiety and emotional overwhelm. By addressing sensory processing, emotional and nervous system regulation, stress management, sleep hygiene, self-care and occupational balance, Mental Health Occupational Therapy can help mothers manage the demands of everyday life, strengthen emotional and sensory regulation, develop healthier coping strategies, reduce the risk of prolonged stress, overwhelm and burnout, and establish sustainable routines that support mental health and wellbeing.

Appointments

If you would like to book an appointment with our Mental Health Occupational Therapist, Laura Hackett, you can call the clinic on 091 727777, get in touch via the contact page or email admin@ebtc.ie