Archives of Women's Mental Health

, Volume 17, Issue 4, pp 327–337 | Cite as

Internet therapy for postpartum depression: a case illustration of emailed therapeutic assistance

  • Nicole E. Pugh
  • Heather D. Hadjistavropoulos
  • Chantalle M. Fuchs
Case Report


Postpartum depression (PPD) afflicts up to 15 % of Canadian women following childbirth. Minimal research has focused on therapist-assisted internet-delivered cognitive behavior therapy (ICBT) for PPD. The purpose of this paper was to illustrate this novel treatment approach that was offered to a woman afflicted with PPD. A first-time mother participated in therapist-assisted ICBT for PPD. She completed the seven-module intervention in 12 weeks, sent seven emails to her therapist, and received 13 therapeutic emails. Therapeutic exchanges are presented. Treatment progress, therapeutic alliance, and treatment satisfaction were assessed. Symptom reduction was observed on all measures at post-treatment. Treatment satisfaction and a strong therapeutic alliance were also reported. The case will expand clinician understanding in therapist-assisted ICBT for PPD and may serve to stimulate clinician interest. Future research directions stemming from this case are presented.


Internet-delivered cognitive behavior therapy Postpartum depression Therapist assistance Case study 



The authors acknowledge the client for participating in the program and Marcie Nugent and Max Ivanov for their involvement in the development and management of the Online Therapy Unit for Service Education and Research, University of Regina. We also acknowledge Swinburne University’s National eTherapy Centre in Australia for licensing their existing therapist-assisted ICBT program that was utilized in this case study. This work was supported by funding provided by the Canadian Institutes of Health Research (reference number 101526) and Saskatchewan Health Research Foundation.

Conflict of interest

The authors declare that they have no conflict of interest.


The views expressed in the submitted article are that of the authors’ and not an official position of the institution or funders.


  1. Abidin RR (ed) (1995) Parenting stress index: professional manual, 3rd edn. Psychological Assessment Resources, Odessa, FLGoogle Scholar
  2. Affonso DD, De AK, Horowitz JA, Mayberry LJ (2000) An international study exploring levels of postpartum depressive symptomatology. JPsychosomal Res 49:207–216CrossRefGoogle Scholar
  3. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th ed., text rev. Washington, DC: AuthorGoogle Scholar
  4. Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N (2010) Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS ONE 5:e13196. doi: 10.1371/journal.pone.0013196 PubMedCentralPubMedCrossRefGoogle Scholar
  5. Barak A, Klein B, Proudfoot JG (2009) Defining internet-supported therapeutic interventions. Ann Behav Med 38:4–17. doi: 10.1007/s12160-009-9130-7 PubMedCrossRefGoogle Scholar
  6. Bassler M, Potratz B, Krauthauser H (1995) Der helping alliance questionnaire (HAQ) von Luborsky. [The helping alliance questionnaire (HAQ) by Luborsky]. Psychotherapeutics 40:23–32Google Scholar
  7. Chalmers B, Dzakpasu S, Heaman M, Kaczorowski J (2008) The Canadian maternity experiences survey: an overview of findings. JOGC 30:217–228PubMedGoogle Scholar
  8. Christensen H, Griffiths KM, Farrer L (2009) Adherence in internet interventions for anxiety and depression: systematic review. J Med Internet Res 11:e13. doi: 10.2196/jmir.1194 PubMedCentralPubMedCrossRefGoogle Scholar
  9. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786PubMedCrossRefGoogle Scholar
  10. Cuijpers P, Donker T, van Straten A, Andersson G (2010) Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med 40:1943–1957. doi: 10.1017/S0033291710000772 PubMedCrossRefGoogle Scholar
  11. Dyck KG, Hardy C (2013) Enhancing access to psychologically informed mental health services in rural and northern communities. Can Psychol 54:30–37CrossRefGoogle Scholar
  12. Gibson J, McKenzie-McHarg K, Shakespear J, Price J, Gray R (2009) A systematic review of studies validating the Edinburgh postnatal depression scale in antepartum and postpartum women. Acta Psychiatr Scand 119:350–364. doi: 10.1111/j.1600-0447.2009.01363.x PubMedCrossRefGoogle Scholar
  13. Glaze R, Cox JL (1991) Validation of a computerised version of the 10-item (self-rating) Edinburgh Postnatal Depression Scale. J Affect Disord 22:73–77PubMedCrossRefGoogle Scholar
  14. Goodman JH (2009) Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36:60–70PubMedCrossRefGoogle Scholar
  15. Hadjistavropoulos HD, Thompson M, Ivanov M et al (2011) Lessons learned in developing a therapist-assisted internet cognitive behavior therapy service. Prof Psych Res Pract 42:463–471. doi: 10.1037/a0026176 CrossRefGoogle Scholar
  16. Johansson R, Andersson G (2012) Internet-based psychological treatments for depression. Expert Rev Neurother 12:861–870PubMedCrossRefGoogle Scholar
  17. Kendall-Tackett KA (ed) (2010) Depression in new mothers: causes, consequences, and treatment alternatives, 2nd edn. Routledge, Milton Park, Abingdon UKGoogle Scholar
  18. Kersting A, Kroker K, Schlicht S, Wagner B (2011) Internet-based treatment after pregnancy loss: concept and case study. J Psychosom Obstet Gynecol 32:72–78CrossRefGoogle Scholar
  19. Klein B, Richards, JC (2001) A brief internet-based treatment for panic disorder. Behav Cog Psychother 27:113–117Google Scholar
  20. Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther 33:335–343PubMedCrossRefGoogle Scholar
  21. Luborsky L, Barber JP, Siqueland L et al (1996) The revised helping alliance questionnaire (HAq-II). Am J Psychother 5:260–271Google Scholar
  22. Maloni JA, Przeworski A, Damato EG (2013) Web recruitment and internet use and preferences reported by women with postpartum depression after pregnancy complications. Arch Psychiatr Nurs 27:90–95. doi: 10.1016/j.apnu.2012.12.001 PubMedCrossRefGoogle Scholar
  23. Martins C, Gaffan EA (2000) Effects of early maternal depression on patterns of infant–mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry 41:737PubMedCrossRefGoogle Scholar
  24. Matthey S (2004) Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale: a brief report. J Affect Disord 78:269–272. doi: 10.1016/S0165-0327(02)00313-0 PubMedCrossRefGoogle Scholar
  25. Milgrom J, Martin PR, Nergi L (1999) Treating postnatal depression: a psychological approach for health care practitioners, 2nd edn. Wiley, West Sussex, EnglandGoogle Scholar
  26. Miller RL, Pallant JF, Negri LM (2006) Anxiety and stress in the postpartum: is there more to postnatal distress than depression? BMC Psychiatry 6:12–22. doi: 10.1186/1471-244X-6-12 PubMedCentralPubMedCrossRefGoogle Scholar
  27. O’Mahen HA, Woodford J, McGinley J et al (2013) Internet-based behavioral activation – treatment for postnatal depression (Netmums): a randomized controlled trial. J Affect Disord Adv Online Publ. doi: 10.1016/j.bbr.2011.03.031 Google Scholar
  28. Paxling B, Lundgren S, Norman A et al (2013) Therapist behaviours in internet-delivered cognitive behaviour therapy: analyses of e-mail correspondence in the treatment of generalized anxiety disorder. Behav Cog Psychother 41:280–289. doi: 10.1017/S1352465812000240 CrossRefGoogle Scholar
  29. Roccaforte WH, Burke WJ, Bayer BL, Wenge SP (1992) Validation of a telephone version of the mini-mental state examination. J Am Geriatr 40:697–702Google Scholar
  30. Ruwaard J, Broeksteeg J, Schrieken B, Emmelkamp P, Lange A (2010) Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: a randomized controlled trial with a three-year follow up. J Anxiety Disord 24:387–396. doi:  10.1016/j.janxdis.2010.01.010
  31. Salonen AH, Pridham KF, Brown RL, Kaunonen M (2013) Impact of an internet-based intervention on Finnish mothers' perceptions of parenting satisfaction, infant centrality and depressive symptoms during the postpartum year. Midwifery Adv Online Publ. doi: 10.1016/j.midw.2013.02.009 Google Scholar
  32. Shandley K, Klein B, Kyrois M, Austin D, Cierchomski L, Murray G (2011) Training postgraduate psychology students to deliver psychological services online. Aust Psychol 42:120–125CrossRefGoogle Scholar
  33. Sheeber LB, Seeley JR, Feil EG, Davis B, Kosty DB, Lewinsohn PM, Sorensen E (2012) Development and pilot evaluation of an internet-facilitated cognitive–behavioral intervention for maternal depression. J Consult Clin Psychol 80:739–749. doi: 10.1037/a0028820 PubMedCentralPubMedCrossRefGoogle Scholar
  34. Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:34–57Google Scholar
  35. Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V (2007) Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 37:319–328. doi: 10.1017/S0033291706008944 PubMedCrossRefGoogle Scholar
  36. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65:805–815PubMedCentralPubMedCrossRefGoogle Scholar
  37. Xie R, He G, Koszycki D, Walker M, Wen SW (2009) Prenatal social support, postnatal social support, and postpartum depression. Ann Epidemiol 19:637–643. doi: 10.1016/j.annepidem.2009.03.008 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2014

Authors and Affiliations

  • Nicole E. Pugh
    • 1
  • Heather D. Hadjistavropoulos
    • 1
  • Chantalle M. Fuchs
    • 1
  1. 1.Department of PsychologyUniversity of ReginaReginaCanada

Personalised recommendations