Newsletter for Providers
February 2018
Anxiety and OCD
This provider issue of our newsletter focuses on perinatal anxiety, which includes perinatal OCD. Recent (small) studies have suggested that perinatal anxiety may in fact be more common than perinatal depression, although the general public is probably more familiar with perinatal depression and its symptoms. This month we focus on the latest research on OCD, including how hormones over the course of a woman's life cycle affect OCD's symptom expression and prevalence rate. We also provide a great list of resources for perinatal anxiety, including perinatal OCD.
You may have recently heard in the news of a new mother with unwanted intrusive thoughts who shared her concerns with her medical provider. She was forced against her will to go to the hospital only to be unceremoniously discharged 12 hours later with a few referrals.This preventable tragedy  should never have happened! It is up to medical providers to understand the symptoms of perinatal anxiety and OCD (which often includes unwanted thoughts of harm coming to the baby) so that they can provide supportive and appropriate treatment and referrals for perinatal women. 
Women with perinatal mood disorders currently underreport their symptoms, particularly when they involve intrusive thoughts. Once providers know what questions to ask and how to ask them, we will have come a long way in making it safe for women to ask for and receive the help that they so desperately need and deserve. 

We want to make sure you receive only the information you can use. You can choose which newsletter you receive--Parents, Providers, or both--by clicking the Update Profile link at the very bottom of this email.

We always welcome feedback on our newsletters!
In This Issue
Latest News 
Obsessive-Compulsive Disorder in the Perinatal Period
Terri Buysse

Obsessive-Compulsive Disorder is an anxiety disorder that often worsens or comes on rapidly during the perinatal period. It is found in 2 to 3% of the general population but at a much higher rate in the perinatal population. According to Chaudron et al., 29% of participants in their study had sufficient symptomatology for a diagnosis of postpartum (pp)OCD. It has not been determined whether ppOCD is a specific subtype of OCD, but clinical evidence suggests that is does present a distinctive clinical picture (McGuinness, 2011). Current research supports the idea that OCD symptoms worsen or present rapid onset during the perinatal period. In one study with 58 female subjects, 3.5% of women in the third trimester met criteria for OCD. Two of these women met criteria in the second trimester. The most common obsessions in descending order were contamination and symmetry/exactness and the most common compulsions were cleaning/washing and checking behaviors (MGH Center for Women's Health, 2009). Vasconcelos et al. found that risk factors predicting ppOCD from pregnancy included prolonged labor and edema.
Clinicians and researchers are finding links between the female reproductive cycle and the initiation or exacerbation of symptom severity in OCD (MGH Center for Women's Health, 2009). Of 46 subjects sampled, 22% had an onset of OCD symptoms the same year as the initiation of menarche, 2% had an onset of symptoms at pregnancy, 7% at postpartum, and 2% at menopause. Authors of this study hypothesize that the onset or worsening of symptoms present during the particularly vulnerable times of hormonal fluctuations including the premenstrual phase of the menstrual cycle and the perinatal period. They suggest increased monitoring of women during these vulnerable times when hormones are fluctuating.
OCD symptoms are correlated in 40 to 50% of women with postpartum-onset depression. The predominant symptom in this subgroup of women is intrusive harm-related obsessional thoughts inconsistent with a woman's identity and belief system. Women with OCD, particularly in the perinatal period, often experience shame that keeps them from treatment and symptom relief. They often fail to share their symptoms with providers even when asked, unless symptoms are normalized and fears addressed and quelled (MGH Center for Women's Health, 2009).
The Perinatal Obsessive Compulsive Scale (POCS) has been developed and validated to help clinicians detect perinatal OCD (Lord, 2011). This scale can also be used to facilitate conversations about this sensitive topic.
Chaudron, L., & Nirodi, N. (October 2010) Archives of Women's Mental Health, 13: 403-410.
MGH Center for Women's Health, (June 2009) Psychiatric Disorders During Pregnancy
McGuinness, M., Blissett, J., Jone, C., (January 2011) OCD in the perinatal period: Is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behavioral Cognitive Psychotherapy.
Vasconcelos, M.S., Sampaio, A.S. Hounie, A.G., et al. (February 2007) Prenatal, Perinatal and Postnatal Risk Factors in Obsessive-Compulsive Disorder. Biological Psychiatry. 3: 301-307.
Lord, C., Rieder, A. Hall, G.B.C., Soares, C.N.& Steiner, M. (December 2011) Piloting the Perinatal Obsessive-Compulsive Scale (POCS). Journal of Anxiety Disorders, 8: 1079-1084.
Perinatal Anxiety Resources for Clinicians

Books, Guides and Workbooks

The Pregnancy and Postpartum Anxiety Workbook
by Kevin Gyoerkoe PsyD, ACT, Laura Miller MD, Pamela Wiegartz PhD, ACT
This anxiety workbook offers proven-effective strategies drawn from cognitive behavioral therapy (CBT) for keeping anxious or obsessive thoughts at bay and getting back to productive and positive thinking.  Through a series of exercises and worksheets, this workbook includes skills for relaxing yourself when you feel stressed, as well as strategies for reducing the frequency and intensity of anxious feelings many pregnant women and mothers of infants face.
Postpartum Mood and Anxiety Disorders: A Clinician's Guide
by Cheryl Tatano Beck; Jeanne Watson Driscoll
Designed for clinicians delivering postpartum care, including clinicians, midwives, OB-GYN nurse practitioners, and women's health practitioners, this text overviews the six different mood and anxiety disorders that may present during a woman's postpartum year. Postpartum Mood and Anxiety Disorders focuses on assessment, screening tools, diagnosis, treatment, and implications for practice, and includes case studies to integrate the process.
Cognitive Behavioral Therapy for Perinatal Distress
by Amy Wenzel with Karen Kleiman

Countless studies have established the efficacy of cognitive behavioral therapy (CBT) for many manifestations of depression and anxiety. In Cognitive Behavioral Therapy for Perinatal Distress, Wenzel and Kleiman discuss the benefits of CBT for pregnant and postpartum women who suffer from emotional distress. The myths of CBT as rigid and intrusive are shattered as the authors describe its flexible application for perinatal women. This text teaches practitioners how to successfully integrate CBT structure and strategy into a supportive approach in working with this population. The examples used in this book will be familiar to postpartum specialists, making this an easily comprehensive and useful resource.
The Art of Holding in Therapy: An Essential Intervention for Postpartum Depression and Anxiety
by Karen Kleiman

First conceptualized by D.W. Winnicott, "holding" in this book refers to a therapist ' s capacity to respond to postpartum distress in a way that facilitates an immediate and successful therapeutic alliance. Readers will learn how to contain high levels of agitation, fear, and panic in a way that cultivates trust and the early stages of connectedness. Also addressed through vignettes are personality types that make holding difficult, styles of ineffective holding, and how to modify holding techniques to accommodate the individual woman. A must-read for postpartum professionals, the techniques learned in this book will help clients achieve meaningful and enduring recovery.
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood. 
by Karen Kleiman and Amy Wenzel

This book, geared toward both providers and parents, addresses intrusive thoughts--what they are, why they exist, and what you can do about them. 
Anxiety BC for Moms To Be and New Moms
A website for moms-to-be and new moms that provides psychoeducation, tools, and tips for navigating perinatal anxiety. 
International OCD foundation
Provides information about OCD and a searchable list of providers who specialize in OCD. Most content is not specific to perinatal OCD.

PASS, the perinatal anxiety screening scale
A printable version of the 31-question perinatal anxiety screening scale.
Using PASS, the perinatal anxiety screening scale.
Client handout about intrusive thoughts or "scary thoughts"
#SpeaktheSecret: campaign about scary thoughts
A long list of intrusive thoughts submitted by (anonymous) real women, intended to reduce the isolation stigma around intrusive thoughts. May not be appropriate to share with all clients.
NEW! Support Group Training Program

Perinatal Support Washington now provides support group training!  We use an integrated and intersectional community-based approach that supports the full spectrum of parenting. It is designed to support new parents, parents struggling with perinatal emotional complications like depression and anxiety, fathers, gender non-conforming and non-binary parents, marginalized parents, parents in recovery, infant/child loss, low income parents, incarcerated parents, and parents targeted by racism, Islamophobia, heterosexism and other oppressions.

Our training is usually two days long, and can be customized for your unique parenting group. You'll learn the following:
  • how to provide an evidence-informed model that incorporates cognitive behavioral therapy, motivational interviewing, mindfulness-based stress reduction and psychosocial education in a warm and accessible group model
  • group leadership skills to provide trauma-informed, empowering group environments through both didactic and experiential learning modalities
  • cultural messages and myths about parenthood that can undermine parental confidence, competence, and mental health
  • how to provide a population and culturally sensitive group model for diverse communities
  • how to include the values and soul of your community into your parenting group, and merge our curriculum with others, if desired.

This is a great way to bring training to your community. It is not exclusive to emotion-focused groups. It's for any parent group you may run--breastfeeding, parenting, mother-infant, and so on. 

For more information, email
Upcoming Events and Trainings

Consult Groups

PS-WA is partnering with local perinatal specialists to provide Clinical Consult Groups on perinatal mood and anxiety disorders. These consult groups offer a forum to meet with peers and colleagues to confidentially discuss clinic issues. They are suitable for all mental health providers.

The consult groups require a commitment of all 10 monthly consulting meetings. Cost is $75 per meeting.  20 CEUS provided by PS-WA at the completion of the year-long program based on participation: MAs, MSWs, MFTs.

BellinghamWe are now enrolling for the Bellingham consult group, led by Bellingham therapist  Michelle Anderson, LMHC . It starts March 14. Groups will meet the the second Wednesday of each month for 10 months.   For more information about the Bellingham group, see our Event page, or contact To register for the Bellingham group, click HERE

Seattle: Limited spots are available for the Seattle consult group, led by Leslie Butterfield. For more information about the Seattle group, contact

Warmline Training

Join our Warmline team! If you are you a mom or dad who has recovered from a perinatal mood or anxiety disorder, or a qualified therapist, you can help other parents as they deal with adjustments to parenthood, including perinatal mood and anxiety disorders. Our next Warmline training is February 24, 1-4pm, in the Seattle area. For more information, email
New Parent Support Group in Lynnwood!

Perinatal Support Washington is pleased to be partnering in Mothering the Mother, a new group for new parents in Snohomish County.  Led by Darla Greico, LMHCA, this group meets Saturdays from noon to 1:30 pm., at 16507 7th PL West in Lynnwood. For more information, see the Group page or call 425-341-3552.
Study Opportunity for New Moms

NEW Moms Connect Study. Do you know a mom who is pregnant with her first baby and due by May 15, 2018?  She can be part of a study that aims to help soon-to-be moms to manage stress, enjoy their babies, and increase their well-being. Participants attend  one of the free 8- week programs either before or after  the baby is born, and meet  with research staff four times to complete surveys and activities. Compensation of $420 if all four research meetings are completed. Must have income less than $45,000 and be less than 33 weeks pregnant to be eligible. To make referrals to the program, call 206-221-7049 or email
Climb Out of the Darkness 2018--Join us!

This year's Climb Out of the Darkness, an event that raises awareness about perinatal mood and anxiety disorders and raises funds for perinatal mental health, will be held June 23, 2018. Are you or your group or agency interested in teaming up with Perinatal Support Washington on a SEATTLE-area Climb? If you'd like to collaborate on a Climb in Seattle, please contact
Let Your Clients Know About Our  Warmline

Perinatal Support Washington has a toll-free support line for new parents. Leave a message, and a trained volunteer will return your call within 24 hours. The line is staffed by a parent who has experienced a perinatal mood and/or anxiety disorder and has recovered fully, or a licensed therapist with specialized training in perinatal mental health.  We provide warm, understanding, effective, and private support, as well as professional referrals to providers who can help. We also provide details about community support groups and resources and information in the community and online. 

NEW! DADS ON THE LINE! Would it feel more comfortable to talk with a dad who has been through his own perinatal mood or anxiety disorder, or has supported a partner who has? Call our Warmline and ask to talk with a dad. 
Apply for Our Provider List
We are working to broaden our database of providers who work with childbearing families experiencing emotional health complications. We seek qualified providers such as therapists, medication prescribers, doulas, IBCLCs, LMPS, and others. We use these provider lists as a referral resource for families who call our warm line or contact us for referrals in their area.

Our provider list is for highly qualified professionals who have specific training and experience working with perinatal mental health complication. Click HERE for detailed requirements and a link to the online application.
Giving to Perinatal Support Washington
Employee Giving
Are you a Microsoft or King County employee or spouse of one?  
Please consider supporting us through your respective workplace giving programs. For King County employees, our code is 9187. Our tax ID is 91-1448669. If you are looking for us, be sure to check our old and new name (Postpartum Support International of Washington) if you don't see us--we are there.

Make Sure You're Getting the Right Newsletter for You
PS-WA is always looking for ways to better provide our subscribers with the information they want and need. We now offer TWO separate newsletters to our community--one directed to parents and one directed to professionals! To start, everyone who has subscribed to our e-newsletter will receive both. If you would prefer to only receive one, please change your preferences by clicking "Update Profile" at the bottom of this email.

Our Parents Newsletter is full of helpful information, resources, community events, and inspiration for families to use to navigate PMADs and parenthood. If you're a provider, this is a great resource to send to your clients!

Our Professional Newsletter contains the most up-to-date research, news, resources, and training information to keep professionals in the know and up to speed.
Warm Line: 1-888-404-7763 (PPMD)

Support Education, Referral
(formerly Postpartum Support International of Washington)