There is substantial research supporting cognitive-behavioral therapy (CBT) for depression during pregnancy and the postpartum period. Systematic reviews and meta-analyses have identified CBT as effective for both the prevention and treatment of perinatal depression (e.g., Nillni et al. 2018; Sokol 2015). However, CBT interventions can range in format (e.g., group or in-person), delivery mechanism (e.g., licensed mental health provider, digital delivery), number of sessions, and content included. 

There is a need to better understand mechanisms of action for cognitive behavioral therapies and to understand what approaches work best for whom within the perinatal population.

Waqas and colleagues (2023) recently published a systematic review and meta-regression analysis that addressed exactly these gaps in knowledge by:

  1. Assessing the effectiveness of CBT interventions for the prevention and treatment of perinatal depression (PND),
  2. Exploring the settings in which the interventions work best,
  3. Exploring the individual level and intervention level factors driving PND’s prognosis among women undergoing CBT, and
  4. Exploring the active ingredients of CBT interventions for PND.

A total of 56 studies covering 59 interventions were included in the review, and interventions were delivered individually (n=24), in a group format (n=25) and digitally (n=10). Overall, the included CBT-based interventions had a strong effect size in improving perinatal depressive symptoms. Other key findings included:

Intervention-Level Moderators:

  • Treatment interventions had significantly higher effect sizes than prevention interventions for perinatal depressive symptoms.
  • Interventions offered as stand-alone programs performed better than those integrated into healthcare settings.
  • Effect sizes did not differ according to delivery format (i.e., electronic delivery, face-to-face in groups, or face-to face individually).
  • Delivery agents with varying backgrounds and credentials were effective, although interventions delivered electronically and through mental health specialists had slightly higher, yet statistically not significant, effect sizes than others (i.e., non-specialists).

Participant-Level Moderators:

  • Higher effect sizes were associated with interventions recruiting perinatal women with older age.
  • Smaller effect sizes were found among samples with a greater proportion of women belonging to racial minority groups, low-income levels, lower educational levels, and recurrent episodes of depression.
  • Interventions delivered during the postpartum period had slightly higher effect sizes than those delivered in during pregnancy or both time periods, although this difference was not statistically significant.

Active Ingredient Moderators:

  • The dose of the intervention was inversely associated with effect size. In other words, briefer interventions were more effective than longer interventions.
  • Using more behavioral ingredients (e.g., problem-solving, relaxation, emotional regulation and stress management, decision-making) in CBT interventions was associated with greater effect sizes.
  • Interventions utilizing the identification of affect and self-awareness strategies yielded larger effect sizes than interventions without these components included.

These findings can help guide intervention developers and practitioners in more effectively addressing symptoms of depression in perinatal individuals. It is encouraging to learn that interventions were effective across different delivery formats (individual, group, and electronic) and could be delivered effectively by specialists and non-specialists. Such findings indicate that a wide range of delivery options may be effective and could be leveraged to expand access to effective treatments. Furthermore, longer durations of CBT interventions may not necessarily be more effective than shorter ones; thus, brief CBT may be an effective and more scalable option. In addition, we learned that interventions should consider including multiple behavioral ingredients to maximize intervention benefits.

This review also points to areas where further work is needed. For example, the authors found that there were smaller reductions in PND symptoms among younger perinatal women, those with lower educational or economic levels, and those belonging to minority ethnic groups. The authors note how these findings highlight the importance of considering contextual factors affecting health and wellbeing of perinatal individuals in certain communities, and how more research is needed to optimize intervention effectiveness for these groups.

Rachel Vanderkruik, PhD, MSc


Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clin Psychol Rev. 2018 Dec;66:136-148. doi: 10.1016/j.cpr.2018.06.004. Epub 2018 Jun 9. PMID: 29935979; PMCID: PMC6637409.

Sockol LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015 May 15;177:7-21. doi: 10.1016/j.jad.2015.01.052. Epub 2015 Feb 2. PMID: 25743368.

Waqas A, Zafar SW, Akhtar P, Naveed S, Rahman A (2023). Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis. Cambridge Prisms: Global Mental Health, 10, e22, 1–14.

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