1. Molly Lineberger Wake Forest University

2. Serious & pervasive mood disorder Persistent feelings of hopelessness, guilt, sadness, or worthlessness Effects 7% Americans per year Lasts ≥ two weeks (American Psychiatric Association, 2013) Body aches, irritability, sleeplessness, fatigue Thoughts of suicide & suicide attempts Impairment mild to severe

3. Twice as prevalent in women as men Before puberty, equally occurring in girls & boys Higher incidence in women after puberty possibly related to lifelong changes in hormone levels Menstrual cycle changes Pregnancy Miscarriage Postpartum period Perimenopause Menopause (Depression Fact Sheet, n.d.)

4. Wake Forest University Z. Smith Reynolds Library PsychInfo and PubMed data bases Key terms: “depression,” “women,” and “CBT” Limits: articles published 2003 – 2013 PsychInfo: 119 hits PubMed: 8 hits

5. Effective treatment for depression (Butler, Chapman, Forman, & Beck, 2006) Can be modified to meet needs of women in various life situations, ie pregnancy or after childbirth (O’Mahen et al., 2012). In classical design, CBT administered over 16 sessions, in practice, number can vary (Austin et al, 2008). BehaviorsFeelings Thoughts

6. Poor, black urban Pregnant or with a child < 6 months Home visitation program 6 group manual-guided sessions CBT improved depression in 84% of participants Control group – improved depression in 41% Child-care, transportation, meal provided for each session (Tandon, Perry, Mendleson, Kemp, & Leis, 2011)

7. 124 women trying to conceive for 2 years randomized to Fluoxetine – prescribed for 90 days Control CBT – 2 - hour group weekly sessions for 10 weeks CBT adapted for infertile women - “a novel amalgamation” 1 st three sessions – gynecologist explained cause of infertility for each patient Resolution of Depression by end of 10 – week study: Fluoxetine 50% Control 10% CBT 79% Authors cited CBT as superior to fluoxetine (Faramarzi et al., 2008)

8. Pregnant women with mild to moderate depression CBT 6 weekly 2 hour group sessions Manual-based Preventing stress, low mood Context: pregnancy & caring for infant Control group Booklet Information regarding stress triggers, strategies How to access local postnatal support Results: CBT not superior to control intervention (Austin et al, 2008)

9. Rural Utah 16 depressed middle-aged women 10 one-hour manualized CBT sessions Participants went to 1 of 2 offices with video equipment Internet power points Online measures of progress Online modules Real time video conferencing Symptoms improved and continued to improve 3 & 6 months post therapy (Openshaw, Pfister, Silverblatt, & Moen, 2011)

10. CBT can be an effective treatment Studies show that it is not always the most highly effective i.e. CBT not more effective than booklet (Austin et al, 2008) More effective when designed to meet specific needs of women in various life situations Delivery (Tandon, Perry, Mendleson, Kemp, & Leis, 2011) Content (Faramarzi et al., 2008) More studies should be done with larger populations of women

11. Feasible in rural communities where counselors are not geographically close Patients who access therapy on a home computer are able to do it on their own time Viable option for women reluctant to go to psychological clinic More convenient for mothers of young children (Openshaw et al., 2012)

12.  Alder, J., Fink, N., Bitzer, J., Hösli, I., & Holzgreve, W. (2007). Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 20(3), 189–209. doi:10.1080/14767050701209560  American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.  Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive behaviour therapy, 38(4), 196–205. doi:10.1080/16506070903318960  Austin, M.-P., Frilingos, M., Lumley, J., Hadzi-Pavlovic, D., Roncolato, W., Acland, S., … Parker, G. (2008). Brief antenatal cognitive behaviour therapy group intervention for the prevention of postnatal depression and anxiety: A randomised controlled trial. Journal of Affective Disorders, 105(1-3), 35–44. doi:10.1016/j.jad.2007.04.001  Burns, A., O’Mahen, H., Baxter, H., Bennert, K., Wiles, N., Ramchandani, P., … Evans, J. (2013). A pilot randomised controlled trial of cognitive behavioural therapy for antenatal depression. BMC Psychiatry, 13.  Cherry, K. (2013). What is cognitive behavior therapy? Retrieved from http://psychology.about.com/od/psychotherapy/a/cbt.htm

13.  Cho, H. J., Kwon, J. H., & Lee, J. J. (2008). Antenatal cognitive-behavioral therapy for prevention of postpartum depression: a pilot study. Yonsei medical journal, 49(4), 553–562. doi:10.3349/ymj. 2008.49.4.553  Cramer, H., Salisbury, C., Conrad, J., Eldred, J., & Araya, R. (2011). Group cognitive behavioural therapy for women with depression: pilot and feasibility study for a randomised controlled trial using mixed methods. BMC psychiatry, 11, 82. doi:10.1186/1471-244X-11-82  Definition of perinatal.(n.d.). Retrieved from http://www.medterms.com/script/main/art.asp?articlekey=7898  Depression fact sheet. (n.d.). Retrieved from http://www.womenshealth.gov/publications/our- publications/fact-sheet/depression.html  Faramarzi, M., Alipor, A., Esmaelzadeh, S., Kheirkhah, F., Poladi, K., & Pash, H. (2008). Treatment of depression and anxiety in infertile women: Cognitive behavioral therapy versus fluoxetine. Journal of Affective Disorders, 108(1-2), 159–164. doi:10.1016/j.jad.2007.09.002  Kersting, A., Kroker, K., Schlicht, S., Baust, K., & Wagner, B. (2011). Efficacy of cognitive behavioral internet-based therapy in parents after the loss of a child during pregnancy: Pilot data from a randomized controlled trial. Archives of Women’s Mental Health, 14(6), 465–477. doi:10.1007/s00737-011-0240-4

14.  O’Mahen, H., Fedock, G., Henshaw, E., Himle, J. A., Forman, J., & Flynn, H. A. (2012). Modifying CBT for perinatal depression: What do women want?: A qualitative study. Cognitive and Behavioral Practice, 19(2), 359–371. doi:10.1016/j.cbpra.2011.05.005  Openshaw, D. K., Morrow, J., Law, D., Moen, D., Johnson, C., & Talley, S. (2012). Examining the satisfaction of women residing in rural Utah who received therapy for depression through teletherapy. Journal of Rural Mental Health, 36(2), 38–45. doi:10.1037/h0095814  Openshaw, D. K., Pfister, R., Silverblatt, H., & Moen, D. (2011). Providing mental health services to women diagnosed with depression in rural Utah communities: Using Technologically Assisted Psychotherapeutic Intervention as the delivery medium. Rural Mental Health, 35(1), 23-31.  Siddique, J., Chung, J. Y., Brown, C. H., & Miranda, J. (2012). Comparative effectiveness of medication versus cognitive-behavioral therapy in a randomized controlled trial of low- income young minority women with depression. Journal of Consulting and Clinical Psychology, 80(6), 995–1006. doi:10.1037/a0030452  Tandon, S. D., Perry, D. F., Mendelson, T., Kemp, K., & Leis, J. A. (2011). Preventing perinatal depression in low-income home visiting clients: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(5), 707–712. doi:10.1037/a0024895