DBT vs CBT for Perinatal Depression: Emotion Regulation vs Cognitive Reframing

Perinatal depression can include classic depression symptoms, such as persistent sadness, irritability, fatigue, feelings of guilt or worthlessness, anxiety, and changes in sleep or appetite. It also encompasses issues specific to the early days of child rearing, such as difficulty bonding with the baby.

A review by the National Institute of Health found that perinatal depression is quite common, occurring in 26.3% of women studied in the period around childbirth. Self-reported depression (27.4%) was much higher than diagnoses from clinical interviews (17%), but even the interview-based figure shows perinatal depression to be a common occurrence.

Both CBT and DBT have been shown to be effective in treating perinatal depression (though DBT hasn’t been studied as extensively in this context). A review by the NIH found that CBT was effective in treating perinatal depression in both the short and long-term, whether it was used by itself or in addition to other therapies. It was also shown to treat perinatal short and long-term perinatal anxiety and short-term perinatal stress.

A similar review showed that DBT held promise in treating perinatal depression, but studies tended to be limited in that most only used some of DBT’s four modes, making it difficult to draw comprehensive conclusions. However, DBT has proven powerful in treating depression in broader populations.

While CBT and DBT have certain similar elements, they approach mental health from different starting points. CBT examines negative thought patterns, which lead to unhelpful behaviors. Patients are prompted to question their negative beliefs and self-talk, and to effectively reprogram themselves from their thoughts to their actions.

DBT therapists help clients identify emotional states and triggers, and teaches practical techniques for handling flare ups of unwanted feelings and challenging situations.

The approach a therapist takes with a client dealing with perinatal depression will depend on the particulars of the client’s issues, and both CBT and DBT can provide an effective path forward. 

CBT Techniques

• Cognitive Restructuring: This concept involves identifying negative, distorted thoughts (e.g., “I’m not ready to be a mother”) and interrogating their accuracy. Patients learn to replace them with more realistic, compassionate, and balanced thoughts, which helps reduce feelings of guilt, shame, or hopelessness.
• Behavioral Activation: Depression often leads to avoidance and withdrawal, which worsen symptoms. Behavioral activation encourages scheduling small, meaningful activities (e.g., taking a walk, calling a friend) to increase positive experiences and a sense of accomplishment.
• Problem-Solving: New mothers often face overwhelming challenges, such as feeding, sleep deprivation, or relationship stress. CBT teaches structured problem-solving steps to help break problems into manageable parts and develop actionable solutions.
• Thought Logs/Journaling: Clients are asked to track their thoughts, feelings, and situations that trigger distress. This practice helps them identify patterns and become more aware of how their thoughts influence their emotions and behaviors.
• Goal Setting: Therapists help clients set realistic, achievable goals that align with their values (e.g., bonding with the baby, self-care routines). Reaching these goals boosts self-efficacy and helps reverse the sense of helplessness common in perinatal depression.

DBT Techniques

• Mindfulness: Mindfulness teaches patients to observe their thoughts and emotions without judgment and to stay present in the moment. This can reduce rumination and anxiety, helping new mothers respond to stressors (e.g., crying baby, sleep deprivation) with more calm and clarity.
• Emotion Regulation: DBT’s emotion regulation skills help individuals understand and manage intense emotions by identifying what triggers them and choosing healthier ways to respond. For perinatal depression, an application of this approach could mean learning how to reduce emotional overwhelm when feeling inadequate or exhausted.
• Distress Tolerance: DBT offers tools to cope with emotional crises without making things worse—such as using cold water, breathing exercises, or distraction. These skills are crucial for moments when distress feels unmanageable, like during postpartum anxiety spikes or moments of panic.
• Interpersonal Effectiveness: New mothers often struggle to express their needs or set boundaries with family or partners. Interpersonal effectiveness skills help them communicate clearly, ask for help, and maintain healthy relationships while respecting both their own and others' needs.
• Radical Acceptance: Radical acceptance involves fully acknowledging difficult situations or feelings without trying to fight or deny them. In perinatal depression, this might mean accepting the hardships of early motherhood while still working toward change, reducing self-blame and emotional suffering.

Perinatal depression is a common issue that can be managed with appropriate counseling and techniques. By learning to manage depression and other challenges during the pressurized environment of pregnancy and infancy, clients can develop resilience that will last with them for years to come. The mental and emotional management abilities they gain through CBT or DBT can pay dividends as the client embarks on parenthood.

• Dialectical Behavioral Therapy Live Cohort Certification Waitlist
• Introduction to Dialectical Behavioral Therapy (DBT)
• What is Maternal Mental Health? An Introduction to the Basics

Blog Posts & Podcasts

• Mindfulness Over Molecules: DBT Strategies to Counteract Low Serotonin and Emotional Dysregulation
• Emotion Regulation in DBT Family Therapy: Breaking Cycles of Invalidation
• CBT vs. DBT: Evidence-Based Choices for Anxiety and Depression Treatment
• What is DBT & How Does it Work?
• Unveiling Maternal Mental Health Truths
  

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