Training Better Baby-bonding For Expectant Mothers

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Teaching expectant mothers to bond with their babies

Up to one-third of mothers do not form strong bonds with their newborns, causing intense emotional distress for both mother and child. Now, researchers have discovered that they can train expectant mothers at risk to better recognize and regulate their emotions, potentially reducing their risk for postpartum depression.

“People generally have an automatic tendency to see the positive or negative in any situation. In previous studies we saw that certain expectant mothers tended to perceive mostly negative emotions in relation to babies. This took several forms,”

said researcher Dr. Anne Bjertrup.

In some instances, a pregnant woman would gaze at a baby and mistakenly believe it was distressed or unhappy when it was not. In other instances where the infant was distressed, the women were unable to cope emotionally. Therefore, the researchers needed to determine whether they could be trained to prevent this negative bias and their own reactions during motherhood.

Computer-based Cognitive Training

The proof-of-concept study included 45 pregnant women from Copenhagen hospitals. Having suffered from depression in the past, 23 of them were at high risk for postpartum depression and may not have bonded with their infant. The remaining 22 had no history of depression and were classified as minimal risk.

Visual representation of the study setup
Visual representation of the study setup. Credit: Dr. Anne Bjertrup

All were assessed at the beginning of the study to see how they responded to various baby emotions. Following a two-week period of computer-based cognitive training sessions designed to assist them in managing challenging emotions, the high-risk women underwent another evaluation.

“With the at-risk women we were trying to communicate different things. For example, to make the worried expectant mothers focus on how a baby really expressed itself not just what she thought she saw, and then to respond appropriately. We tried to make sure that the women could accurately recognize the emotion a baby was showing, and we got them to visualize how to properly respond to these emotions,”

Anne Bjertrup, of the Psychiatric Center Copenhagen-NEAD Center said.

Modified Reaction to Emotional Stimuli

After the training, women in the high-risk group were significantly better at recognizing happy babies; the women were themselves able to show more happy facial expressions and reacted less to signs of infant distress.

“We found that participants’ perceptions of infant facial expressions shifted significantly after the training. For example, before the training, they viewed ambiguous baby facial expressions as slightly negative. After the training, this perception became positive, marking a 5% shift towards a positive perception on our rating scale,”

Dr. Bjertrup said.

Six months after childbirth, those who improved the most in recognizing happy baby expressions displayed reduced signs of depression. Six months after giving birth, those who improved the most in recognizing happy baby expressions displayed reduced signs of depression.

Reducing Postpartum Depression Risk

The results suggest that if expectant mothers can be trained to be more sensitive to happy facial expressions and give them back control of their emotional response to infant distress, then it may be possible to reduce the risk of postpartum depression. This benefits the mother and contributes to the infant’s emotional development.

“This is a preliminary study, so we need to interpret these results cautiously. We are currently undertaking a bigger trial, which will include a control group. Nevertheless, these initial results are promising. We’re among the first groups anywhere to really explore how we can use emotional cognitive processes to prevent this significant mental illness and mother-infant bonding problem,”

said Dr. Bjertrup.

There are approximately 4 million births per year in the EU alone, which means that well over a million mothers and infants will have attachment issues. Lack of bonding can have devastating effects on mother and infant, as well as on families.

Later in life, it may be difficult for children to develop secure attachments, although this also depends on what occurs in childhood.

A mother may have difficulty bonding for a variety of reasons, including hormonal changes, tension, or past traumas. This can result in feelings of humiliation or inadequacy, causing many mothers to deny their difficulties. Many respond by emotionally withdrawing, resulting in a vicious cycle of estrangement.

“It’s important to recognize that bonding challenges, outside of PostPartum Depression or other mental illnesses, can stem from various factors. Not experiencing immediate bonding feelings as one might expect doesn’t inherently signal an issue. A mother might not have immediate bonding feelings yet can still respond sensitively and appropriately to her infant’s emotions and cues,”

Dr. Bjertrup added.

Abstract

Negatively biased cognitive response to infant stimuli during pregnancy is associated with increased postpartum depression (PPD) risk. This proof-of-concept study aimed to investigate the feasibility and effects of a two-week affective cognitive training intervention on cognitive responses to emotional infant stimuli for pregnant participants at risk of PPD. Forty-three participants were included: 23 ​at high risk and 22 ​at low risk of PPD. Cognitive response to emotional infant stimuli was assessed at baseline, immediately after the intervention and at a two-week follow-up for the intervention group (n ​= ​16) and twice over two weeks for the comparison group. The intervention was feasible, as 80% completed all sessions and gave positive feedback. The intervention group showed increased sensitivity to happy infant faces (p-values < 0.02, d ​> ​0.1), more infant-directed facial expressions (p ​< ​0.001, d ​= ​0.6), greater attention toward infant stimuli (p ​= ​0.04, d ​= ​0.2), and reduced negative reactivity to infant distress (p ​= ​0.01, d ​= ​2.6). The increased sensitivity to happy infant faces correlated with fewer depressive symptoms six months after birth (r = −0.59, p = 0.03). Interpretation of the results is limited by the lack of a high-risk control group and small sample size. Randomised controlled trials are now warranted to investigate whether the effects of prenatal affective cognitive training on affective cognitive response to infant stimuli confer reduced risk of PPD.

Reference:
  1. Bjertrup, Anne & Hvass Petersen, Tue & Beier, Nynne & Kofoed, Jeanne & Horgen, Ingeborg & Kjærbye-Thygesen, Anette & Kirkegaard, Thomas & Miskowiak, Kamilla. (2023). Prenatal affective cognitive training: A proof-of-concept study. Neuroscience Applied. 2. 101135. 10.1016/j.nsa.2023.101135