Episode 8 The Pros and Cons of CBT for Birth Trauma

Birth Trauma Training for Birth Workers

In episode 8, I talk you through the pros and cons of using CBT for birth trauma and how it's less about the therapy approach you choose and more about the therapeutic fit.

The WHO recommends two main Psychological approaches for the treatment of Posttraumatic Stress Disorder (PTSD). One is Cognitive Behaviour Therapy (CBT) the other is Eye Movement Desensitisation & Reprocessing (EMDR).

Cognitive Behaviour works by working with someone's negative or 'stuck' thoughts about the trauma. This works on the idea that the brain doesn't realise that the threat of the trauma has passed, and/or what you want to do with information about the trauma. Imagine that somewhere in your birth experience (or watching someone's else's) you have the thought "this is it, I'm going to die". I remember in vivid detail after the birth of my first daughter being in so much pain, that I actually welcomed death. I remember being wheeled off to emergency surgery seeing my husband cradling our new baby and saying thinking "take care of her. This might be the last time I see you guys". I still well up with tears every single time I think, write, or speak about it, but part of the 'trick' to coping has been (a) realising I had that thought and (b) coaching my brain to realise that the threat has past, and I'm now in the present. Each time I'm able to do that, my heart rate lowers, my breathing rate reduces, my jaw relaxes and I can feel what it's like for my brain to back down, realising it's a memory and the actual threat has passed.

The goal of CBT then is to help people catch the negative thoughts that pop up automatically and thereby reduce the awful feelings. CBT posits that all feelings and sensations from trauma (e.g., heart racing, sweating, feeling pannicky, feeling rage, avoiding) all start with a single thought.

A large component (at least the way I work) is through writing – writing the event as it happened, in the past then in present and working with ‘hot spots’ – automatic negative thoughts. The goal is to work with thoughts and beliefs about the trauma so distress is reduced.

PROS of CBT

• Evidence based
• Longitudinal research
• WHO supported
• Medicare rebate supported (10 sessions in Australia)
• Skills learned translate well into other areas of life - confidence, parenting, anxiety, depression, fears and just getting yourself out of a funk.
• Easy to find a practitioner

CONS of CBT

• Potentially the ‘best’ we have but still doesn’t remedy all PTSD
• Gold standard CBT for PTSD is 20+ sessions, roughly 12 months of work
• Medicare will only rebate for 10 sessions, meaning client either has to fork over the rest of payment, wait until new calendar year, or find bulk-billing (there are no financial benefits for mental health workers to bulk-bill, unlike for GPs)
• Can potentially be interpreted as blaming (‘your thoughts are the problem’)
• Even imaginal exposure is too confronting for some
• Cognitive therapies are not great for people with low self-reflection