Table 4.
Treatment components of included studies.
| Study | Intervention | Intervention name | Treatment duration/dosage | Therapist qualifications and training and supervision | Psychoeducation on the condition and the link between thoughts, physical sensations, and behaviors | Thought monitoring and challenging/restructuring | Managing physical sensations, for example grounding and breathwork | Behavioral activation and/or graded exposure, for example to manage mood and increase pleasurable activities | Future planning and relapse prevention | Adaptations or additional components specific to the perinatal period for example disrupted sleep, isolation, role transitions, physical challenges associated with pregnancy/childbirth/breastfeeding |
|---|---|---|---|---|---|---|---|---|---|---|
| Burns et al. [56], Netsi et al. [57] | C/BT in person face-to-face | CBT for antenatal depression | Up to 12 sessions | CBT therapists with masters/doctoral experience in CBT, with training and weekly supervision form a clinical psychologist. Competence assessed using the revised cognitive therapy scale (CTS-R). | Included | Included | Included | Included | Included | Treatment provided in the individual's home, with all but one of the participants accepting this invitation. Thoughts and beliefs around motherhood, including cultural beliefs, BA in relation to cognitive restructuring around restrictions around motherhood, interpersonal/social support, and communication skills around conflict support. |
| Carter et al. [58] | C/BT in-person face-to-face | C/BT | 12 weekly sessions | Not reported | Included | Included | Included | Included | Included | Treatment could be provided in the mother's home. |
| Cho et al. [59] | C/BT in person face-to-face | CBT | 9 intervention sessions delivered as 1-h sessions that were biweekly | The therapist delivering CBT was a licensed clinical psychologist and they received supervision from a licensed supervisor for CBT | Included | Included | Included | Included | Unclear | Enhancing the marital relationship through the review and modification of dysfunctional cognition in the relationship. |
| Dimidjian et al. [48] | C/BT BA in person face-to-face (or telephone if preferred) plus usual care | BA tailored for depressed pregnant women | 10 sessions but encouraged to pace flexibly to accommodate mother's scheduling demands | Nurse midwives, practitioners, and an occupational therapist attended training in BA and clinical supervision. | Included | Unclear | Unclear | Included | Unclear | Treatment could be in the mother's home, clinic or by telephone. Clinical examples and assignments were tailored to the circumstances and challenges of pregnancy and early postpartum. |
| Forsel et al. [60] | i-C/BT GSH with online message contact with therapist | i-C/BT | 10 sessions with written messages from therapists | CBT-trained and regularly supervised therapist (supervision with psychologist, obstetricians, and psychiatrist) | Included | Included | Included | Unclear | Unclear | Pregnancy, including the relation between pregnancy and depression and a module on relationships. |
| Hayden et al. [61] | C/BT in-person face-to-face | C/BT | 10 weekly sessions | Administered by licensed clinical social workers who received specific CBT training and supervision from a licensed clinical psychologist certified as a CBT supervisor | Unclear | Included | Unclear | Unclear | Unclear | Unclear |
| Milgrom et al. [62, 63] | C/BT in person face-to-face | Beating the blues before birth CBT intervention | 8 treatment sessions of 1 h each per week | Psychologists with a background in CBT were trained in the program and delivered the intervention. | Included | Included | Included | Included | Included | Refinement to accommodate needs of postnatal women included introducing BA before cognitive strategies, addressing partner and infant issues, and issues around transition to parenthood. Partners included for one of the sessions. |
| Milgrom et al. [39] | i-C/BT GSH with telephone sessions with therapist | MumMoodBuster program | 6 sessions (at own pace but recommended one session per week) | Graduate psychology trainees, clinical psychologists, health psychologists, trained and supervised by senior psychologists. | Unclear | Included | Unclear | Included | Included | Participants and their partners were granted access to a library of resources, including parenting support and information on PND. |
| Milgrom et al. [64] | i-C/BT GSH with telephone sessions with therapist | MumMoodBuster program | 6 sessions (at own pace but recommended one session per week) | Unclear | Included | Included | Unclear | Included | Unclear | Participants and their partners were granted access to a library of resources, including parenting support and information on PND. |
| Ngai et al. [17, 65–67], Netsi et al. [57] | C/BT via telephone | Telephone-based CBT | 5 weeks | Midwife with 20 h of CBT training with supervision and fidelity control | Included | Included | Unclear | Included | Included | Goal setting in relation to the maternal role was emphasized as were coping skills and decision-making in relation to practical issues of childcare and common neonatal problems. |
| O'Mahen et al. [68] | C/BT in-person face-to-face | CBT for perinatal depression adapted for women with low incomes | 12 weeks | Masters and doctoral level social workers and psychologists with experience in CBT and/or treatment for perinatal depression. Clinical training and supervision. | Included | Included as an additional module for individuals with depressive cognitions or interpersonal difficulties | Unclear | Included | Unclear | Additional resources on perinatal specific materials and skills, including sleep hygiene. Option for treatment in the home, with 73% of sessions happening in the home. Additional module also on interpersonal support for those requiring this. |
| O'Mahen et al. [69, 70] | i-C/BT GSH with online message contact with therapist | Postnatal iBA | 11 sessions to be completed weekly or within 15 weeks | Therapists were either a specialist health visitor or clinical psychologist | Included | Not included, authors give rationale for, not including cognitive restructuring | Unclear | Included | Included | Treatment focused on helping mothers achieve a balance in valued activities in the context of competing and unpredictable demands. Signposting to resources on parenting and mother-related resources and activities and to a supervised web forum/chat room. |
| O'Mahen et al. [71] | i-C/BT GSH with telephone contact with therapist | NetmumsHWD which built on the postnatal iBA noted above, adapted to be modular and with increased support | 12 weeks | Mental health workers with undergraduate degrees with 1 year IAPT psychological therapies clinical qualification. Training and supervision with a clinical psychologist. | Included | Included as an optional module | Unclear | Included | Included | Additional modules focusing on being a good enough mother, sleep, and other perinatal specific content. Signposting to resources and a supervised web forum. |
| Pugh et al. [72] | i-C/BT GSH with email contact with therapist (telephone contact if required) | Maternal depression online, developed by adapting TA-ICBT for depression | 7 modules recommended one per week | Facilitated by doctoral students in clinical psychology with training and supervision from a registered psychologist | Included | Included | Included | Included | Unclear | Incorporated adaptations relevant to mothers of young infants, though no specific details provided. |
| Rondung et al. [73], Baylis et al. [74], Hildingsson and Rubertsson [75] | i-C/BT GSH with text and telephone contact with therapist | i-C/BT, inspired by the unified protocol for treatment of emotional disorders (UP), a face-to-face protocol, designed for applicability to all anxiety and unipolar mood disorders | 8 sessions recommended weekly | Guided by licensed clinical psychologists | Included | Included | Included | Included | Included | Adapted for the population regarding the content and order of the psychoeducation elements and FOB-specific examples. Additional module for postpartum follow-up focusing on childbirth in retrospect. |
| Shaw et al. [76, 77] | C/BT in person face-to-face | Manualised intervention for NICU parents | 3 – 4 sessions with one or two 45-to 55- minute sessions administered weekly | Clinical psychology graduate program students and a NICU social worker with training and supervision. | Included | Included | Included | Included | Included | Two additional sessions, adapted with permission from the creating opportunities for parent empowerment program to enhance the mother–infant relationship, also known as infant redefinition. |
| Suchan, et al. [78] | i-C/BT GSH with email contact with therapist (telephone contact if required) | Wellbeing course for new moms | 8 weeks | Master-level, registered social worker trained in the provision of i-CBT GSH | Included | Included | Included | Included | Included | Case stories were used that were relevant to new mothers and additional resources were available detailing common struggles experienced by new mums. |
| Trevillion et al. [79] | C/BT GSH workbook with either face-to-face or telephone guidance, plus usual care | Modified GSH, with usual care, for antenatal depression | An initial session plus eight 30-minute sessions and a final check-in session 6–8 weeks postdelivery | Psychological wellbeing practitioners experienced in delivering treatments based on GSH manuals, with clinical training and supervision | Included | Included | Unclear | Included | Included | Managing relationships in the perinatal period, including increasing social support. The development of maternal–fetal attachment and reflecting on how we learn to be parents. Preparing for parenthood. |
| Wozney et al. [80] | C/BT GSH with telephone sessions with therapist | The strongest families: managing our mood (MOM) | 12 sessions | Coaches were paraprofessionals who completed MOM coach training and received 1:1 supervision from an expert clinician throughout study | Included | Included | Included | Included | Included | A focus on child–mother interactions and on changing isolating and avoidance behaviors to break the cycle of loneliness that can come with postpartum depression. |
Note: CTS-R, revised cognitive therapy scale; TA-ICBT for depression, therapist-assisted internet-delivered CBT.
Abbreviations: BA, behavioral activation; C/BT, cognitive/behavioral therapy; GSH, guided self-help; i-C/BT, internet-based cognitive/behavioral therapy; IAPTs, improving access to psychological therapies; IBA, internet-based behavioral activation; NetmumsHWD, netmums helping with depression; NICU, neonatal intensive care unit; PND, postnatal depression.