Simko, Kinga Mercedesz
(2025)
Acceptance and Commitment Therapy for the management of postpartum psychological difficulties: a hermeneutic single-case efficacy design series.
DClinPsy thesis, University of Nottingham.
Abstract
Introduction: Perinatal mental health difficulties (PMHDs) affect 10-20% of women in the United Kingdom (Bauer et al., 2014). PMHDs are the leading cause of maternal morbidity and mortality among women of reproductive age (Oates, 2003; Russell et al., 2017) and can contribute to poorer maternal physical and mental health, quality of life and functioning, and poorer caregiver-infant bond, all of which can consequently negatively impact infant development (Gentile, 2017; Hoffmann et al., 2017; Junge et al., 2017; Stein et al., 2014). Various psychological approaches have been utilised to support the perinatal population (NICE, 2020), but the evidence base is limited. Some have suggested that higher psychological flexibility (PF) can promote parental self-regulation (Fonseca et al., 2020) and is associated with reduced depression, anxiety, and trauma symptomatology in the perinatal population, as well as better parental adjustment, attachment, and responsiveness (Ashton, 2024; Byrne et al., 2021; Evans et al., 2012; Monteiro et al., 2019). Due to its explicit focus on enhancing PF, Acceptance and Commitment Therapy (ACT; Hayes et al., 1999) has been proposed as a viable alternative to support perinatal women. Studies have shown that ACT is effective in various parallel populations (e.g., physical health difficulties and weight and body image-related challenges). However, to date, its effectiveness and change mechanisms have not been evaluated in perinatal samples. The current study aims to fill this gap.
Methods: A hermeneutic single case efficacy design (HSCED) series was conducted to investigate whether and how changes occurred for participants over a 10-week remote ACT intervention. Three clients with self-reported psychological distress were recruited from a community perinatal mental health team in the Midlands. Clients participated in 10 weeks of ACT and completed various quantitative and qualitative measures pre- and post-intervention, as well as throughout therapy. Data were compiled into rich case records for each participant, which were subject to critical analysis by three independent adjudicators, who were asked to determine outcomes and identify putative change mechanisms for each client
Results: Two clients improved, whilst one remained unchanged, based on reliable changes on qualitative measures as well as quantitative data. Where changes occurred, judges mainly attributed these to ACT-specific processes, namely experiential acceptance, cognitive defusion, and mindfulness. The therapeutic relationship and some extra-therapeutic influences (e.g., medication, life events, social support, time) also contributed to changes, albeit to a lesser extent.
Discussion/Conclusion: ACT appeared to be an effective intervention for two of the three clients studied in this case series. However, due to the intertwined nature of specific and common factors, it is possible that the therapeutic relationship created a setting in which the intervention could be effective. Future research should further clarify the role of the behavioural components of ACT on therapeutic outcomes (namely, values and committed action), further examine ACT’s applicability and necessary adaptations for neurodivergent clients, and continue building practice-based evidence through further replications.
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