Postpartum anxiety is probably the most common beast in my office. There are certainly differing shapes that this big, furry, gnarly-clawed beast takes — general anxiety, panic, OCD for example — but usually the annoying, mean, and seemingly relentless monster has a big “A” stamped on his forehead. And this monster is ferocious at times, making it impossible for moms to sleep, eat, breathe, and think clearly. He is on a serious mission, no doubt. Sometimes he is so big and impending that I get a sense of his foul breath from my chair. Even though it is not me who he is chasing, I get a glimpse of what it must feel like to be the mom who is living in his humongous shadow. Not good.
And the moms who come into my office in an effort to get the heck out of this guy’s path have no idea of how on earth to do this … or if it’s even possible. For these moms, this snaggletoothed misery called postpartum anxiety is all that they can see. He makes it this way because he seems to know exactly how to get back into their line of sight when they begin to turn away.
Annoying, to say the least.
So, I thought I’d take a minute to explain, from my chair, what goes into getting postpartum anxiety off your back. So that, if you don’t already, you have a sense of how you might overpower him. The truth is that he is actually not as strong and lethal as he looks. I know he feels strong and invincible — he is really, really skilled at that — but the truth is that he does melt when you throw the right kind of water on him.
When I work with moms who are in battle with postpartum anxiety, I break the treatment down into four parts:
- Looking at treating the symptoms and managing crises
- Understanding the role that thoughts play in anxiety
- Understanding the non-biological causes of the anxiety
- Learning to tolerate anxiety and distress when it occurs
If you want to stick with the monster metaphor, the four things look like this:
- Treating his bite
- Understanding the role that your fear in him plays in his strength
- Understanding why he is pestering YOU of all people
- Learning how to be okay even when he is knocking at your door
- Treating his bite (or treating the symptoms): First and foremost, we have got to stop the bleeding, right? If a mom is anxious all of the time and, because of this, unable to meet her body’s basic needs, if she is suffering from panic attacks, or if she is having the intrusive thoughts of postpartum OCD, we need to take care of the brain so that it can be healthier. For many moms, this will involve medicine because, truthfully, when these things happen it lets us know that your brain is sick and needs to become more resilient. SSRI medication (like Zoloft) and benzodiazepines (like Klonopin) are usually very, very helpful in this (and also known to be safe for breastfeeding moms, by the way). We also know that things like sleep, healthy nutrition (especially protein because amino acids- found in proteins are building blocks to Serotonin, the feel good hormone in the brain), water, and oxygen are important in brain health. So I always have conversations with my moms about how to make sure that they are getting these things. Help at night and/or other strategies for sleep as well as protein-based snacks and water in her diaper bag, car, bedside table, and desk at work are imperative. As is learning how to breathe effectively. Did you know that when we are anxious, we are usually breathing in our chest and actually only using about a third of our lung capacity? Think hyperventilation to the extreme. In order for our brains to settle rather than react, they need enough oxygen to do so. The moms who I see get a lesson or 20 on how to take a deep diaphragmatic (or belly) breath because this will literally change their physiological reactions to stress. Exercise also helps the brain to be strong, as it has been shown to lower cortisol levels in folks who do it.
- Understanding the role that your fear of this monster plays in his strength (or understanding the role that thoughts play in postpartum anxiety): Anxiety, like monsters, loves when you are afraid. Anxiety gets more power from this fear; it seems to increase tremendously when you are afraid of being anxious, afraid of having a panic attack, or afraid of the power that your intrusive thoughts have. This is the basis for cognitive- behavioral therapy (CBT) and there is a huge amount of research on the positive effects that CBT has on pregnant and postpartum moms who are anxious. In my office, I use cognitive therapy components often, teaching moms how to identify negative thoughts (such as the “shoulds”, all or nothing thinking, catastrophic thinking, discounting the positives, overestimating the threat, “what-if” thinking, and overgeneralization) and helping them learn to replace these thoughts with something more useful (and true). What these moms find is that when they take away the nourishment for that big bad monster, he begins to get weaker. He may still be there when all is said and done, but more times than not he is shaking at the knees. There is a great book, by the way, that helps moms to use these techniques called The Pregnancy and Postpartum Workbook, by Pamela Weigartz and Kevin Gyoerkoe.
- Understanding why he is pestering YOU of all people (or understanding the non-biological causes of the anxiety): We know that anxiety is a physiological response to a stressful event and that symptoms like elevated heart rate, shallow breathing, dizziness, and sweaty palms are all physical responses to hormones (like cortisol) that are released in the limbic brain. But what, exactly, is triggering this brain reaction? Sometimes there seems to be no apparent cause. Often moms will say that “on paper everything is going well” and anxiety (that darned monster) just lingers anyway. Usually, though, there is something that is being triggered that causes the brain to assume that there is reason to panic. Does your crying baby remind you of a time when your needs were not met? Does the reality of being responsible for a baby stir up memories of needing to be overly responsible as a child? Do you hold expectations of yourself in motherhood that are unrealistic and provided by people and books rather than yourself? Has the shift in becoming a mom created identity changes that feel unfamiliar (and therefore disconcerting) to you? Once we understand why we feel so anxious, we can begin the process of validating and empathizing with ourselves because of course we would be feeling anxious given many of the triggers that motherhood initiates. Once you get why that big guy is following YOU around, you just might be able to forgive him a bit. Want him to stay? Definitely not, but understand his crush? Perhaps.
- Learning how to be okay when he is knocking at your door (or learning to tolerate postpartum anxiety and distress when it occurs). The truth is, folks, that if those of us who treat postpartum depression and anxiety told moms that we were curing them of their anxiety we would be setting them up for disappointment. Being a mom is overwhelming and it is, at a certain level, entirely normal and appropriate for moms to be anxious from time to time. What is not normal or appropriate is for moms to be anxious all the time or for anxiety to interfere with daily life. When this happens, it tells us that there is something else going on outside of the normal strains of being a mama. For moms who suffer from an anxiety disorder, any level of anxiety becomes distressing because they have learned that anxiety is dangerous. So, we need to teach moms how to know that they will be okay even WHEN they feel this way. This does not mean, by the way, that moms need to ignore the anxiety, push it away, or pretend it’s not there; this would be no more possible (or helpful) than telling your ears not to hear the loud banging at the back door. But what I do focus on in my office is helping moms learn to acknowledge their anxiety at the lowest level that it exists, give themselves a big huge hug around the fact that they are feeling anxious (usually for very good reason.. even if it is just the fact that they are caring for a little tiny person) rather than judge themselves for it, and then take super duper good care of themselves in that moment so that their anxiety rests there (take some deep breaths, eat something protein-based, go for a walk, call a friend, take a break etc). We actually don’t need to fix anxiety every time it comes up… but what we can do is acknowledge it, understand it, and then be really, really kind to ourselves.
None of this is easy. Often, it takes an army to fight off this unrelenting beast. But it is possible, even when it feels like it is not.
~ Kate Kripke, LCSW