TOP TAKE-AWAY: Cognitive Behavioral Therapy (CBT) Strategies for Healing After Loss

The trauma experienced after a miscarriage can be overwhelming. Some women may develop distressing thoughts about themselves and their lives, or isolate themselves, pushing away family members and friends. One form of treatment that may be helpful is cognitive behavioral therapy, or CBT. This form of psychotherapy focuses on a client’s thoughts and behaviors, which can help women heal from their loss in a more effective way. For women who have experienced pregnancy loss, there are three effective strategies used in CBT that can be beneficial: behavioral activation, cognitive restructuring, and mindfulness and acceptance. 

Behavioral activation involves engaging in meaningful and enjoyable activities that provide a sense of accomplishment. Women who have experienced pregnancy loss may sometimes isolate themselves, often for fear of having to share the news of their loss. However, by isolating themselves, women may miss the positive social support that comes from interacting with others. In CBT, behavioral activation starts small, with activities that require no planning, before moving on to more complex and value-driven activities. Some of these activities might include traveling to visit family, or volunteering for a cause they are passionate about.

Cognitive restructuring for women who have experienced pregnancy loss involves identifying the thoughts and beliefs that these women have, evaluating their accuracy and usefulness, and modifying them to be more balanced and helpful. These women often have beliefs about themselves and their lives that cause emotional distress, such as the belief that they will never be a mother, or that they are to blame for their pregnancy loss. Cognitive restructuring involves asking questions about these beliefs to help women tease through the accuracy and helpfulness of such beliefs. For example, women may be asked to examine a situation where they felt they were judged by someone for their pregnancy loss, consider the other explanations for their behaviors, and decide for themselves what beliefs are more compassionate and balanced.

Mindfulness and acceptance is also an important factor for women who have experienced pregnancy loss. Women with pregnancy loss will often try to avoid their negative emotions or painful experiences. CBT asks these women to learn to accept their emotions, no matter how painful, and show them that they can still lead a quality life even with those feelings. By focusing on being mindful in the present, these women get out of “autopilot” and can catch the subtle changes or triggers that lead to their emotions. 

All three of these strategies are useful in some way to help women who have experienced pregnancy loss to accept their situation, address their emotional distress, and begin to participate in their lives again.

Wenzel, A. (2017). Cognitive behavioral therapy for pregnancy loss. Psychotherapy, 54(4), 400-405. https://doi.org/10.1037/pst0000132

TOP TAKE-AWAY: The Importance of Validation from Healthcare Professionals: Three Strategies for Engagement

Every woman has a unique reproductive journey, successful or otherwise.  When a pregnancy loss occurs, it is important for women to have their feelings validated by those around them, including their healthcare providers.  In many cases, healthcare professionals get it right -- they validate a woman’s experience and are sensitive to the wide range of emotions that can be triggered by a loss.  However, in some cases, healthcare professionals fail to recognize that not all women experience pregnancy loss in the same way.  Women's experiences with loss and grief are complex and not solely related to how long they were pregnant.  Because of this, it may be possible for a healthcare professional to underestimate the significant emotional trauma a woman may experience with an early loss.  Healthcare professionals serve as authority figures whose reactions can affect how women may view their own loss. Thus, it is important that they validate the full range of emotions that women may experience.  

A few ways to ensure women have their feelings validated include:

1. Treating her experience with sensitivity - This is a difficult situation for any woman and it is important to approach her with consideration and sensitivity.
   
   

2. Focusing on her perspective and feelings - However a woman views her pregnancy loss, she needs to feel as though her response is valid and justified and she has every right to feel how she does. The healthcare provider may not share the same view of the situation as the woman, but they must work to keep the focus on the woman’s individual perspective.
   
   

3. Allowing her to lead the conversation - It is essential to allow the patient to lead the conversation. This may feel counterintuitive, because healthcare providers have a lot of expert knowledge that they may want to share. However, it may be helpful to let the woman focus on what aspect of her experience she wants more information about, let her express how she feels, and let her be the one to ask the questions she wants answered. This allows the healthcare provider to tailor the information disseminated to what she needs and/or wants to hear.

When healthcare professionals take the time to take these steps, it can allow women to feel heard, understood, and strengthened.  As a result, this allows women who experienced pregnancy loss to tell their stories instead of feeling shame and guilt. Each woman has her own reproductive story, and as a result each woman deserves her story to be validated in order to feel comfortable enough to share it with others.

Corbet-Owen, C., & Kruger, L.-M. (2001). The health system and emotional care: Validating the many meanings of spontaneous pregnancy loss. Families, Systems, & Health, 19(4), 411–427. https://doi-org.holyfamily.idm.oclc.org/10.1037/h0089469

TOP TAKE-AWAY: PSYCHOTHERAPY: A TREATMENT FOR WOMEN AND THEIR PARTNERS WHO HAVE EXPERIENCED REPRODUCTIVE TRAUMA

Women who have experienced reproductive trauma struggle with having to go on with everyday life after their tremendous loss. They may find it extremely difficult to deal with their loss. They may also struggle with how their partner grieves and copes differently from them, which can cause problems in their relationship. Although pregnancy loss may be very difficult to get through, there is hope. One treatment that can help women and their partners to cope with their loss and strengthen their relationship is psychotherapy. Psychotherapy helps individuals change their behaviors and overcome problems that they face daily.

Every woman has her own unique reproductive story. I am sure at some point in your childhood, you played house pretending to be a mother, tucked your favorite stuffed animal into bed, or had your own baby doll that you took care of like it was your child. Most women have fantasized about their future as mothers; being able to nurture a happy and healthy baby. If a reproductive loss occurs, it can be extremely overwhelming and painful, causing women to realize how their reproductive stories have been in place for most of their lives.

TOP TAKE-AWAY: MANAGING FEELINGS AND EMOTIONS IN PREGNANCIES FOLLOWING LOSS

It is widely assumed that when a woman who has experienced a miscarriage becomes pregnant again, everything will be fine, but that is not always the case. Women must be able to resolve the trauma associated with their prior miscarriage(s) in order to fully engage in their new pregnancy. This article discussed five common strategies women who have experienced pregnancy loss often use to manage their emotions in subsequent pregnancies.

TOP TAKE-AWAY: GUIDELINES FOR DEALING WITH PREGNANCY LOSS IN THE EMERGENCY DEPARTMENT

Many women who have experienced pregnancy loss often state that nurses, doctors and other medical professionals appear insensitive or uninformed when it comes to discussing their pregnancy loss. It has been established in the research that how women are treated by medical professionals can significantly impact their grieving process. Therefore, it is important that women and their families experiencing pregnancy loss are receiving proper support, care and information from their medical team.

TOP TAKE-AWAY: BREAKING THE SILENCE IN THE WORKPLACE

For those of you who have experienced pregnancy loss, you are quite familiar with the silence that surrounds it. This is especially true in the workplace. Approximately 47% of women in the workplace have experienced a miscarriage and have grieved in silence because of the perception that society is not open to hearing womens’ stories of loss. This results in silence becoming a default response and women keeping their pregnancy a secret in the workplace in fear of being judged by their co-workers. Often times, when women share their experience of miscarriage at work, their co-workers do not know how to handle or respond to the situation - further enforcing the belief that women should not share their feelings of loss and grief.

TOP TAKE-AWAY: SOCIAL SUPPORT AS A PATHWAY TO HEALTHY COPING

After parents experience a miscarriage, they often struggle to cope. Many parents use passive coping, which can be maladaptive in the long term because it consists of self-blame, wishful thinking, and ignoring the situation.

Active coping is a more adaptive form of coping, because it involves problem solving, changing the situation, or changing something about the self in order to deal with the situation. However, active coping can be uncomfortable and even make parents feel worse in the moment. In order to actively cope, a person has to directly confront the situation, and that can make you feel sad, angry, or anxious in the moment. So, while it may be beneficial in the long-term, it can be very hard to do in the short-term.

IPL Story - Colleen

I always thought becoming pregnant was an easy thing to do. After I got married in February, I became pregnant right away this past summer after just our first time trying. A lot of my friends and family were also pregnant at this time so we were even more excited to announce our news!

I went to my first appointment around 4 weeks and got the confirmation that I was indeed pregnant. I felt great. I continued to play soccer, go for long runs, and live my normal life. I arrived to my 2nd appointment around week 9-10 thinking this is when I’d get my ultrasound. Little did I know, I was supposed to have scheduled my own ultrasound at the hospital weeks ago, soon after that first appointment. My doctor told me I needed to go and schedule that as soon as possible. Within the following week, I was on my way to hear my baby’s heart beat. When I arrived, I was a little nervous but then quickly talked myself out of it telling myself that this is a time I’m supposed to be excited, not worried.

SAY HELLO TO OUR FALL 2019 INTERNS!

We’ve been working on a lot of projects lately with the help of our Fall Interns, Sarah Montgomery (left) and Taeya Norris (right)! Sarah is a senior Neuroscience major who is investigating the relationship between pregnancy loss and symptoms of anxiety, depression, and PTSD. Taeya is a senior Psychology major, her project focuses on the coping methods used by women who have experienced involuntary pregnancy loss. Keep a look out for the interesting results from their work!

TOP-TAKE AWAY: AVOIDANCE AFTER RECURRENT MISCARRIAGE IS NORMAL, YOU’RE NOT ALONE

Recurrent miscarriages, where women experience multiple miscarriages, affect around 1% of women. While all miscarriages have a psychological impact, recurrent miscarriages may come with an additional layer of psychological distress. The frequency of miscarriage makes it more personal to women - they may feel like it’s their fault and that they will never have a successful pregnancy.

TOP-TAKEAWAY: HOW OTHERS CAN BE HELPFUL TO THOSE WHO HAVE EXPERIENCED PREGNANCY LOSS

After pregnancy loss, many women experience grief and distress, but they also experience silence. Some women report feeling hurt that their family and friends do not acknowledge their loss or seem to be avoiding them. Social support can be helpful in preventing depression following pregnancy loss - but it is important that those who are trying to be supportive are doing it in a helpful way.