Promoting Attachment Through Healing

Intimate partner violence (IPV) is a significant and pervasive public health challenge and is associated with mental illnesses such as depression, anxiety and posttraumatic stress disorder (PTSD). Although the perinatal period may be a time of greater risk for experiencing IPV, and greater vulnerability to PTSD symptomatology, a lack of research exists pertaining to the identification/treatment of IPV-related PTSD symptoms during this period. Utilizing a mixed-methods approach, and employing a feminist, intersectional framework, the effectiveness of trauma-informed cognitive behavioural therapy (CBT) among pregnant survivors of IPV experiencing PTSD symptomatology on depression, anxiety, PTSD and maternal-infant attachment will be explored.

IPV is a pervasive public health problem \[1\], with estimates of approximately 50% of Canadian women experiencing IPV at least once during their lifetime \[2\]. Some studies suggest that the perinatal period is a time of higher risk for experiencing IPV \[3-4\]. Numerous studies have linked women's experience of IPV with mental health concerns such as depression, anxiety and PTSD \[5-8\] and rates of PTSD are higher for perinatal women compared to the general population \[9-10\]. Prevalence rates of PTSD among survivors of IPV range from 31-84% \[7,11\].

The perinatal period may relate to greater risk for re-triggering of PTSD, given the physical/emotional changes, and the intimate/invasive nature of perinatal care. Additionally, the medicalized processes involved may contribute to feelings of powerlessness and vulnerability, further compromising at-risk women \[9\]. PTSD can alter psychological functioning and is associated with depression \[12\], disordered eating, substance abuse, sexual risk exposures and re-victimization \[13\] and failure to engage in health promotion strategies such as exercise, diet and routine health care \[14\]; all of which may exacerbate obstetrical risk. Furthermore, mental illness and trauma have been associated with infant prematurity, low birth weight and childhood developmental delays \[15\] in addition to adverse effects on maternal functioning such as maternal-child attachment \[15\]. As such, there are enormous personal and societal costs associated with PTSD related to IPV for childbearing women.

Recently, a significant gap in the literature was identified pertaining to the identification and treatment of IPV-related PTSD of childbearing women \[16\]. There is a critical need for individualized, trauma-informed care to facilitate optimal maternal and child attachment outcomes \[16\]. Fortunately, effective PTSD treatments exist, such as CBT; however, research exploring CBT in pregnant populations is lacking \[17\]. As such, the purpose of this study is to explore the effectiveness of CBT for the treatment of IPV-related PTSD among antenatal women.

Eligibility Criteria:
Inclusion Criteria:

Women who received antenatal CBT treatment from the Perinatal Nurse Specialist at the Perinatal Mental Health Clinic (London Health Sciences Centre, London, ON, Canada) who are:

* English speaking
* Have symptoms consistent with PTSD, depression, and/or anxiety

Exclusion Criteria:

* Women will be excluded if there is, or if it anticipated that there will be involvement in child protection services under the Child and Family Services Act