Psychotherapy for PPD: 5 approaches compared

If you have been told that therapy might help with postpartum depression, the next question is often: which kind?

The word "therapy" covers a significant range of different approaches, each with its own underlying theory, its own techniques and its own evidence base. They are not interchangeable. And while any good therapist will adapt their approach to the individual, knowing roughly what each involves helps you ask better questions and make a more informed choice about what you are agreeing to.

These are the five approaches most frequently used for postpartum depression, compared honestly.

1. Cognitive behavioural therapy (CBT)

What it is: CBT works on the relationship between thoughts, feelings and behaviours. The premise is that the way you interpret events shapes how you feel about them. Depression and anxiety tend to involve predictable patterns of inaccurate thinking, called cognitive distortions, that maintain the low mood. CBT helps you identify those patterns and develop more accurate, less catastrophic responses.

What it involves: Structured sessions, thought records, behavioural experiments and homework between sessions. It is an active therapy. The therapist teaches skills and you practise them.

The evidence: CBT has the strongest and most consistent evidence base of any psychological therapy for postpartum depression. A 2015 Cochrane review of eighteen RCTs found CBT significantly more effective than standard care. NICE guidelines recommend it as a first-line treatment for perinatal depression.

Best suited to: Mothers whose primary experience is negative or catastrophic thinking about themselves as parents, their baby's safety or the future. Also effective for postpartum anxiety.

Limitations: Requires active engagement and homework. Less suited to mothers who need to process traumatic birth experiences or complex relational history.

2. Interpersonal therapy (IPT)

What it is: IPT focuses on the relationship between interpersonal difficulties and mood. For new mothers specifically, the relevant themes tend to be role transitions (the shift from previous identity to motherhood), grief (for the life before, or for the birth experience that was hoped for), and relationship conflicts that have emerged or intensified after having a child.

What it involves: Structured sessions focused on one or two key interpersonal problem areas. Less homework than CBT. More conversational in format.

The evidence: A 2017 meta-analysis in Archives of Women's Mental Health found IPT equally effective to CBT for postpartum depression, with particularly strong outcomes where role transition and relationship issues were the dominant presenting concerns.

Best suited to: Mothers whose depression is strongly connected to the adjustment to motherhood, changes in the partnership, grief about how things have gone or conflict with family.

Limitations: Does not directly address thinking patterns. Less skills-based than CBT.

3. EMDR (Eye Movement Desensitisation and Reprocessing)

What it is: EMDR was originally developed for trauma and PTSD. It uses bilateral stimulation (typically eye movements guided by the therapist) to help the brain process and integrate memories or experiences that have become stuck.

What it involves: Sessions that target specific distressing memories or experiences rather than general mood management. Less structured conversationally. The bilateral stimulation component is unique to this approach.

The evidence: EMDR has a strong evidence base for PTSD and is increasingly used for birth trauma and postpartum PTSD. A 2021 review in Journal of Trauma and Dissociation found EMDR effective for perinatal trauma presentations. NICE recommends it for PTSD, which overlaps significantly with birth trauma symptoms.

Best suited to: Mothers whose postpartum difficulties are rooted in a traumatic birth experience, a previous traumatic loss or a difficult childhood that has been reactivated by becoming a mother.

Limitations: Not the primary approach for postpartum depression without a trauma component. Requires a trained EMDR practitioner, which narrows availability.

4. Acceptance and Commitment Therapy (ACT)

What it is: ACT is a newer development from the CBT family that focuses less on changing difficult thoughts and more on changing your relationship to them. The goal is to reduce the control that difficult thoughts and feelings have over your behaviour, and to move toward actions that are consistent with your values even when internal experience is difficult.

What it involves: Mindfulness practices, values clarification, metaphors and exercises that help you hold difficult thoughts and feelings without being controlled by them.

The evidence: A 2020 review in Mindfulness found ACT effective for perinatal anxiety and depression, with particular benefits for mothers who had not responded fully to CBT.

Best suited to: Mothers who find that challenging negative thoughts directly does not feel helpful, or whose distress is more about the relationship with difficult experience than the specific content of thoughts.

Limitations: Less session-by-session structure than CBT. Some find the metaphor-heavy approach less intuitive.

5. Dialectical Behaviour Therapy (DBT)

What it is: DBT was developed by Marsha Linehan for emotional dysregulation, particularly where intense emotional experiences feel unmanageable or produce impulsive responses. It combines CBT techniques with mindfulness and focuses explicitly on distress tolerance, emotion regulation and interpersonal effectiveness.

What it involves: Skills training in four areas: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. Usually delivered both in individual therapy and in group skills training.

The evidence: DBT is most strongly evidenced for borderline personality disorder but is increasingly used for postpartum presentations involving significant emotional dysregulation, intense rage or severe anxiety. Research in Behaviour Research and Therapy (2019) supports its use in broader emotion dysregulation presentations.

Best suited to: Mothers experiencing very intense emotional swings, significant postpartum rage, overwhelming anxiety or patterns of self-destructive responses to distress.

Limitations: Typically requires commitment to both individual therapy and group skills training. Less available than CBT.

At a glance

"The curious paradox is that when I accept myself just as I am, then I can change." - Carl Rogers

If CBT specifically is what you are considering, CBT for postpartum depression: how it works and what to expect goes into that approach in more practical detail. And for help with finding the right practitioner for any of these approaches, how to find a therapist who actually understands postpartum depression covers that process step by step.

Emergency support: Samaritans 116 123 (UK). 988 Suicide and Crisis Lifeline (US). PSI: postpartum.net.

Further reading: Karen Kleiman & Valerie Raskin, This isn't what I expected (2013). NHS NICE guidelines: nice.org.uk. Marsha Linehan, DBT skills training manual (2014).