Dialectical Behaviour Therapy (DBT) adapted for the perinatal period
Research type
Research Study
Full title
A mixed-methods investigation into an online Dialectical Behaviour Therapy (DBT) skills group adapted for the perinatal period.
IRAS ID
355600
Contact name
Nicole Stokoe
Contact email
Sponsor organisation
Royal Holloway, University of London
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
The perinatal period is when somebody is pregnant or has given birth in the last 12-24 months. This is a time of higher mental health risk, with challenges in managing emotions. Healthcare guidelines recommend that therapists should adapt existing therapies to the needs of perinatal individuals.
Dialectical Behaviour Therapy (DBT) is a helpful therapy to manage emotions and includes skills groups. These groups aim to develop
people’s skills in relationships, distress management, emotion management and people's ability to be present in the moment. Research shows this to be useful in improving emotion management and mental health overall. Recent research has looked at how these groups can be changed to fit the perinatal period, but there is not much information on what specifically about these perinatal skills groups is important.This research will look at data to see if we can run DBT groups in perinatal services and whether it is useful to people. This will include data from questionnaires, group attendance and interviews with service-users who have taken part in the group.
Lay Summary:
Quantitative component: A mixed-methods feasibility study of a transdiagnostic online DBT-informed skills group adapted for the perinatal period
Many new parents and pregnant people struggle with their mental health. Some feel sad, worried or find it hard to cope with all the changes that happen when they have a baby. In England, there are NHS mental health teams that specialise in supporting mothers and birthing parents with these kinds of challenges. Some teams offer therapeutic groups to teach practical emotion coping skills. These skills help parents to develop moment-to-moment awareness of their thoughts and feelings, find ways of coping when emotions feel overwhelming, and practice new ways of asking for what they need. The groups hold babies in mind, by covering topics like bonding with baby, coping when baby is upset or crying, and maintaining relationships with partners, family and friends.
These types of groups have been found to be helpful for lots of different people experiencing a range of problems. However, there are huge changes to a person’s body, lifestyle, identity, and relationships during pregnancy and the first two years of parenting, so we cannot assume what works for people at other times of life will work for new parents and pregnant people too. There is not yet strong evidence about how well these types of groups work for mothers who are struggling with their mental health, or the best way to study these groups. This study was a step towards building that evidence.
The quantitative component of this study took place across four NHS teams to test whether it was practical to research one of these groups. Twenty-seven new or expectant mothers took part, 14 who went to the group, and 13 who were receiving other care from the same services but had not been to the group. We asked everyone to fill-out questionnaires about their mood, worries, and overall wellbeing before and after the group. Those who went to the group also filled in questionnaires about their relationships, how they coped with difficult emotions and distressing situations, and how able they felt to live in-the-moment. We asked clinicians who ran the group for their views about what worked well and what could be improved.
We found that on average mothers came to most of the group sessions, which suggested they may have found the group worthwhile. However, many mothers did not fill-in all the questionnaires, which made it difficult to know whether the group had helped. The questionnaires that asked about coping with emotions showed the most promising results. All the mothers who completed these showed meaningful improvements after the group, and clinicians also thought the emotion coping skills were the ones mothers used most. Clinicians told us that completing so many questionnaires felt time-consuming for parents, and that some questionnaires did not feel relevant to them.
The quantitative component of this study identified several things that would need to change before a larger study could be run. These included making sure that every parent who goes to the group is offered the same number of sessions and is taught the same skills. We also recommended that future studies reduce the number of questionnaires parents are asked to complete, and we found out which questionnaires were the least helpful so that these could be left out or replaced in the future.
The findings from the quantitative component of this study will help NHS services and future researchers to collect stronger evidence, which we hope will eventually lead to improvements in care for new and pregnant mothers who are struggling with their mental health.Qualitative component: The mechanisms of change of an online, perinatal dialectical behaviour therapy skills group – the perspective of service-users
Women and birthing people are more vulnerable to mental health difficulties in the perinatal period. Emotion dysregulation means having difficulty managing emotions, such as feeling overwhelmed, reacting very strongly, or struggling to calm down once upset. Difficulties with managing emotions is increasingly recognised as an important factor across mental health problems and has been linked with psychological distress and difficulties in relationships during the perinatal period. Dialectical behaviour therapy (DBT) is a well-established therapy for supporting people who struggle with emotion regulation. There is growing evidence that DBT-skills groups may be helpful for people during the perinatal period. However, little research has explored the perspectives of attendees of these groups. There is also no research exploring how acceptable, or how suitable and satisfactory, these groups are when delivered online, or how they bring about change. Therefore, the qualitative component of this study aimed to:
• Explore how an online DBT-skills group adapted for the perinatal period may influence psychological change.
• Understand how acceptable this online perinatal DBT skills group was to service-users.
We interviewed nine women and birthing people online about their experiences of the group. We analysed the results using constructivist grounded theory, an approach where findings are developed from participants’ experiences, recognising that meaning is shaped by both participants and researchers. This process helped to develop a framework that suggested how change may occur.
We identified five main themes. Firstly, participants described many factors that affected their ability to engage with the group, including physical health difficulties, caring responsibilities, and life pressures. The online format helped some people attend but also made it harder to concentrate. Secondly, participants described the group as a safe space, where they felt understood and validated by facilitators and other group members. This helped them to open up and try new strategies. Thirdly, participants highlighted the importance of practising and adapting the skills, which they felt played a key role in improvements to their mental health. Fourthly, participants described feeling more like themselves as a parent, with increased calmness and confidence. Finally, participants noticed positive changes within their families, including feeling more connected and responsive to their babies and experiencing a calmer family environment.
In summary, qualitative participants found the group acceptable and meaningful. An important process of change appeared to be improved emotion regulation, supported by the group feeling safe and regular use of DBT skills. This change was felt to extend to the wider family. While the qualitative component of this study was small and focused on one area, the findings suggest that online, perinatally adapted DBT-skills groups may offer a promising and accessible way of providing preventative, family-focused mental health support.REC name
London - Stanmore Research Ethics Committee
REC reference
25/LO/0355
Date of REC Opinion
12 May 2025
REC opinion
Favourable Opinion