Perinatal mental health & unwanted intrusive thoughts
by
Olive O’Grady
Perinatal Psychotherapist, Compassion Focused Therapist
In my work as a perinatal psychotherapist, I see a lot of new mums who experience distressing intrusive thoughts. This is a common issue during the perinatal period (pregnancy to toddler age). According to recent research, over half of new mums experience unwanted thoughts of danger or harm to their baby (Collardeau et al, 2019). These intrusive thoughts are usually frightening for those who experience them and because most new mums have never heard of intrusive thoughts, they assume they have a mental illness, which adds to the distress they feel.
What are intrusive thoughts?
Intrusive thoughts are disturbing repeated thoughts that appear as intense images of physical or sexual harm to your baby or others (Collardeau et al, 2019). They are unwanted thoughts and urges that appear suddenly in your mind and can create a lot of shame and guilt. People often use restrictive compensating behaviours to avoid triggers for these thoughts such as not being alone with their baby.
Perinatal intrusive thoughts
Both parents are susceptible to perinatal intrusive thoughts, but it is more prevalent in new mothers. It is thought that the symptoms may be in part due to hormonal changes around delivery, including oestradiol and progesterone, which may subsequently alter serotonin and dopamine levels in the postpartum period (Schiller et al 2015). In more simple terms this means the mothers body is going through sweeping hormonal and physical changes which have an impact on how the mind operates.
Mum may be physically tired and sore after giving birth or having a caesarean section. Breast feeding can also be a painful new experience and it takes time to adjust to this. Mums and Dads are exhausted as sleep patterns change and baby demands full attention and care. All of these changes can heighten anxiety as the arrival of new baby changes your world significantly. Unfortunately too, in more recent times the Covid 19 pandemic has isolated many new mothers and they have had little or no communal help to ease their anxiety. The human brain is tricky and intrusive thoughts can show up in response to all of these changes.
Did you know that therapy can help?
Any parent experiencing distressing intrusive thoughts during the perinatal period can seek help and support. These thoughts can be debilitating and have an imact on your confidence as a new parent. Mums are often apprehensive about attending therapy as they fear their thoughts will be exposed. They are confused about what is going on for them and why they are having these distressing thoughts about their baby. Common worries that mums express are, “Am I a bad person?”, “Am I a bad mother?”, “Will my baby be taken away”, “Why is this happening to me?”, “Who have I become?”. They are often deeply distressed, feel they have failed and experience a silencing shame. It is heartbreaking to see someone who was hoping for the the most joyful experience of having a new baby experiencing such fear and sadness. Fortunately I can reassure my perintal clients with intrusive thoughts that therapy can help. Not only that, but it is usually short-term work to calm and soothe the mind and nervous system, and this allows them to be the mum they want to be.
What happens in therapy?
As a compassion focused therapist, I focus on the following areas with the people I work with in therapy:
- Helping people to understand their common humanity and the prevalence of intrusive thoughts
I reassure the people I work with that having intrusive thoughts is a common human experience (especially after childbirth) and they are not alone in experiencing these. We disucss how intrusive thoughts are only thoughts and not actions, they cannot harm others. This distinction is important; thoughts cannot hurt, only actions can. It is very rare for a person with intrusive thoughts to act on their thoughts. It can happen, but usually for those with an underlying, untreated mental illness.
- Understanding how the brain works and how vicious cycles can emerge
We know the evolved brain is tricky. The older part of the brain is very focused on survival and managing threats and the newer human brain is focused on thinking, reasoning and planning. Animals don’t have the new thinking brain, they therefore only deal with actual threats that exist in the moment and they then feel calm again when the threat has passed. It is a lot different for humans with our new brain capacities as we can imagine all sorts of possible threats. Unfortunately our brain is unable to tell the difference between these imagined threats and real threats and therefore gets activated as if it the threat was happening right now. This can pose significant problems for us. In addition, humans have the ability to reflect on their thoughts and emotions and this can create distress in some instances eg: “Why am I having these thoughts, is there something wrong with me?”. You can see how this can be problematic.
The old brain wants to protect the new-born child and in combination with our developed brain it envisages highly dangerous situations. For some, the brain overreacts and produces unwanted intrusive thoughts including being a danger to your own child. Research states that these intrusive thoughts are interpreted as a signal of danger that the person must act accordingly to protect the child. (Challacome et al 2019). If a parent has a thought that they might hurt their baby (which in itself is harmless), they often react with fear and anxiety. Naturally they will try to block the thoughts which leads to the thought becoming more prominent. As the phrase goes, “What you resist persists”. In this way, the person gets into a cruel cycle of intrusive thoughts, compensating behaviours and heightened anxiety. Compassion Focused therapy (CFT) offers a way out of this vicious cycle. This recent tweet by Dennis Tirch (PhD) sums it up well.
Anxiety disorders – are problem solving strategies that have gone wrong. Your mind works to avoid anxiety and that makes anxiety grow! Radical acceptance and self compassion turnthis upsidedown. Move towards your anxiety with deep kindness for yourself and watch what happens ( Dennis Tirch PhD – Tweeted 8/3/22)
- Strengthening the compassionate self so that difficult experiences are met with kindness and support
During therapy sessions, we bring a compassionate awareness to intrusive thoughts and acknowledge the impact of these on thinking and emotion. We label the thoughts as ‘intrusive thoughts’ and acknowledge it is not the individual’s fault that these are occuring. People often say that while it is difficult to start talking about these thoughts, it is a relief to get them out and explore them in a safe therapeutic environment. During sessions, we keep a compassionate focus on the self and all the experiences that are going on internally. We work on various breath and imagery practices to strengthen the person’s ability to respond to themselves with wisdom, support and encouragement.
In time people learn not to dwell on or process the intrusive thoughts but to let them pass or change them to a positive thought or image. CFT takes a bit of time and practice but it can be helpful for soothing intrusive thoughts and allowing mum the freedom to enjoy her baby again. Towards the end of our therapy sessions when I check in with my client about their intrusive thoughts, they often repy that they don’t notice them anymore. The outcome of CFT therapy is that people often feel relieved, they have soothed their anxiety and gained a peaceful mind and enjoy being a mum. Mostly they wish they knew about intrusive thoughts before they gave birth, it would have eased their journey into motherhood. This is what motivated me to write this blog!
Seek further help and support here
- Talk to your midwife
- Contact your GP
- Arrange therapy sessions with an accredited therapist
Websites for Perinatal Mental Health
https://www.hse.ie/eng/services/list/4/mental-health-services/specialist-perinatal-mental-health/
Support for new mums
https://www.networkingmothers.ie/
References
Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019). Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol. BMC psychiatry, 19(1), 94. https://doi.org/10.1186/s12888-019-2067-x
Schiller, C. E., Meltzer-Brody, S., & Rubinow, D. R. (2015). The role of reproductive hormones in postpartum depression. CNS spectrums, 20(1), 48–59. https://doi.org/10.1017/S1092852914000480
OCD Link
https://www.mind.org.uk/information-support/types-of-mental-health-problems/obsessive-compulsive-disorder-ocd/symptoms-of-ocd/
Compassion-Focused Therapy Link
https://www.goodtherapy.org/learn-about-therapy/types/compassion-focused-therapy
Appointments
If you would like to book an appointment for perinatal therapy with Olive O Grady then please call Evidence-Based Therapy Centre on 091 727777 or get in touch via the contact page.
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