The Feasibility and Acceptability of Dialectical Behaviour Therapy Groups for Perinatal Women with Mental Health Conditions Including Complex Post- Traumatic Stress Disorder
This mixed-methods study demonstrates that online Dialectical Behaviour Therapy groups are feasible and acceptable for perinatal women with complex mental health conditions, including C-PTSD, resulting in significant improvements in emotion regulation and positive experiences regarding therapeutic relationships and access.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
The period surrounding the birth of a child is often imagined as a time of pure joy, yet for many women, it is a season of profound vulnerability. During these months, from pregnancy through the first year of a baby's life, the brain and body undergo intense changes that can trigger or worsen mental health struggles. One in four women experiences significant emotional difficulties during this time. For some, these struggles are rooted in complex post-traumatic stress disorder, a condition that arises from repeated exposure to trauma, often in relationships. This condition makes it incredibly hard to manage strong emotions or feel safe with others. When a mother cannot regulate her own feelings, it can strain the delicate bond forming with her newborn, affecting the child's development as well. While therapies exist to help people learn to manage these overwhelming feelings, few have been tested specifically for new mothers who are navigating the unique pressures of early parenthood alongside deep emotional wounds.
Researchers at the University of Manchester and the Greater Manchester Mental Health NHS Foundation Trust set out to see if a specific type of therapy, known as dialectical behaviour therapy, could work for this group. This therapy teaches practical skills to help people understand and manage their emotions, tolerate distress without making things worse, and improve their relationships. The team wanted to know if delivering this therapy in an online group format would be feasible and acceptable for perinatal women, including those with complex trauma. They also wanted to see if the women felt better and if their connection with their babies improved after the course.
To find out, the researchers organized six online groups that ran continuously over a period of eighteen months. Forty-seven women with various mental health needs, including eight who met the criteria for complex post-traumatic stress disorder, joined these groups. The sessions were held via video call, lasting two hours each, and covered twelve weeks of material. The content was adapted specifically for mothers, using examples related to parenting and the relationship with a baby, rather than generic life scenarios. The women were asked to practice the skills they learned in their daily lives and complete homework assignments. The researchers tracked how many sessions the women attended and asked them to fill out questionnaires before and after the course to measure changes in their emotional well-being, their ability to regulate feelings, and the strength of their bond with their infants.
The results showed that the online format was workable and generally welcomed by the participants. On average, women attended nearly eight sessions, though only a small number completed the entire twelve-week program. This lower completion rate is common in mental health groups for this population, where the demands of caring for a newborn and managing complex emotional needs can make consistent attendance difficult. Despite the dropouts, the women who stayed engaged reported significant improvements. Their ability to manage emotions improved noticeably, a change that was statistically clear in the data. They also reported feeling less distressed overall. While the measures of their bond with their babies showed mixed numerical results, the women's own stories suggested they felt more capable and present in their parenting.
The interviews with the women and the clinicians who led the groups revealed why the therapy helped and where it stumbled. The women found the group to be a safe space where they felt understood and less alone. They particularly valued learning how to pause and observe their feelings before reacting, a skill that helped them interact more calmly with their babies. The group leaders noted that the online format made it easier for women to join from home, removing the barrier of travel, which is a major hurdle for new mothers. However, the online setting also had downsides. Some women found it hard to connect deeply with others through a screen, and the rolling nature of the groups—where new people could join at different times—sometimes caused confusion about where they stood in the course. Additionally, the technical language used in the therapy manuals was occasionally difficult to grasp, and the long sessions sometimes felt overwhelming when trying to focus on a baby at home.
The study concludes that online dialectical behaviour therapy groups are a promising and acceptable option for perinatal women, including those with complex trauma. The therapy appears to help women gain control over their emotions, which is a crucial step toward healing and building a secure relationship with their child. However, the researchers caution that the current format needs refinement to keep more women engaged throughout the full course. Suggestions include simplifying the language, offering printed materials instead of just digital ones, and perhaps mixing online sessions with occasional in-person meetings to strengthen the sense of connection. While the study does not prove that this therapy cures all perinatal mental health issues, it provides strong evidence that it is a valuable tool that can be delivered effectively to a population that desperately needs support. The findings suggest that with careful adjustments, this approach could become a standard part of care for mothers navigating the difficult intersection of trauma and new parenthood.
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