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Dr. Sarah (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.


Welcome everyone. Joining me again today is the co-founder of our joint practice Upshur Bren Psychology Group in Westchester, New York. Dr. Emily Upshur. Thank you for being here.

Dr. Emily (00:55):

Great to be here again.

Dr. Sarah (00:56):

Okay, so the question that we are going to be answering today, Emily, is coming from an expecting mom who’s written in and she says, I have a diagnosed anxiety disorder that I’ve been able to manage for the last several years. However, I just found out that I’m pregnant. While I’m very excited, I’m also apprehensive about the potential for postpartum anxiety or other issues during and after my pregnancy. Is there anything I can do now that might help with this? Thoughts on this initial thoughts?

Dr. Emily (01:27):

I mean, I think the first thing, my first reaction is I’m so glad you’re thinking about this already. Right? You’re sort of on top of it. You’re thinking about it, which is going to be your biggest protective factor. You’re already in line that this could be something on your radar. Something we talk a lot about in our practice is just setting yourself up with the right support systems. So perhaps you’ve been in treatment in the past and therapy, and that’s been helpful and that’s one approach to do. But I think we’re also sort of very open to a lot of other support systems. One thing I talk a lot with women about during pregnancy is postpartum support and setting those things up. Potentially a night nurse if sleep is a real big trigger for your anxiety, thinking through some of the symptoms and what the bigger picture issues are for you and plugging in those holes a little bit to round out a team that might be a little bit more supportive if you’re a little bit more vulnerable. It could be therapy, but it could also be a night nurse.

Dr. Sarah (02:29):

Or a postpartum doula. I actually love, I think that there’s a time and a place for all kinds of different services, but I think postpartum doulas are often really overlooked as a resource because what I love about postpartum doula is their focus is actually on the mother, not the baby or the mother baby dyad, rather than just, I take your baby and I support your baby at night or during the day while you get rest. I think that’s good too. And I think there’s definitely a use case for that for sure. But I think especially if someone who’s kind of worried about their own support and their own mental health or their own recovery postpartum, what I think people may not know about postpartum One, people might have heard of doulas, but they might not have heard of postpartum doulas. Postpartum doulas aren’t there for the birth.


They’re there after to care for the mother or the mother baby dyad. So the focus is really on helping support mom with breastfeeding or with taking care of the baby. I had a postpartum doula after both of my kids, and she would be up at night with the baby, but then she would bring, whenever my kids would wake up, she’d come in, support me through breastfeeding, and then she just came at night. In my case, some come during the day or come in different times, but instead of a night nurse, I had a postpartum doula and I could not have been happier with that choice for me. You got to kind of figure out how much you want, but I think that they’re lesser known or they’re lesser known about postpartum doula. So that’s just something to put on your radar and look and consider how that might fit into a support system in the postpartum period.

Dr. Emily (04:20):

Yeah, I mean, I think the most important part that you’re touching upon is giving you as the new mother or even as a pregnant expecting mom, this space and the mental space to say, what do I need? What are my vulnerabilities? What do I think? There’s of course our best laid plans, but what do I think are going to be some of my vulnerabilities? And what what you’re saying about a postpartum doula is they can plug many holes. It’s not just one, it’s not so myopic. It’s not so small or narrow. You’re able to say, you know what? I’d really love you to cook me a really healthy meal, and that can be really helpful. We talk a lot about physiological vulnerabilities for anxiety is your sleep hungry? You’re a little under the weather as things that are vulnerabilities. And so anything that can sort of attend to those and make those less of a stressor can really help prevent an anxiety disorder from spinning out and getting bigger.

Dr. Sarah (05:23):

And I think it’s important too to remember if you are someone who may have already beyond that anxiety spectrum, one of the things we have to remember about anxiety is it tends to be related to an overactive threat response, a sensitive moving into fight or flight, a hypervigilance or a hyperactivity of that sort of threat or fear or response. And one of the things that very naturally and appropriately and sort of biologically happens in pregnancy and in postpartum is there are structural changes to the brain. There are hormonal shifts in our biochemistry that actually importantly for the survival of our species, we’ve been designed for a mother’s brain to kind of move into a more sensitive threat response for a while, sometimes for as long as a year postpartum. And so if you have already a vulnerability to having kind of a high reactivity with your threat response and move into that anxiety or fear or threat space easily, it’s going to likely amplify to some degree in pregnancy or postpartum just from appropriate biological neurological changes.


So knowing that also can help because I think nothing is more frustrating or overwhelming than changes that you can’t anticipate, especially to your anxiety if you know, Hey, it’s appropriate and typical for me to have a spike in anxiety postpartum for everybody, but if I already run high on that anxiety spectrum, it could jump up to a really unmanageable level. And so that is why we want to really be mindful of, like you said, Emily, what can we do to bring your baseline down before you hit that natural shift in brain and hormone changes that come with the postpartum period so that when that does happen, it doesn’t push you up so high that things feel really unmanageable.

Dr. Emily (07:35):

Yeah, I mean, look, we really know that it’s a structural biological shift pregnancy, and I don’t think we emphasize that enough, to be honest. There’s a real biological shift, and so it is not only expected, but it’s a part of the natural of the developmental process of this. So I do think to this listener’s question, maybe you were in treatment in the past and it was effective. The good thing is it’s the same skillsets, right? It’s just sort of forming yourself up to them. Again, I always recommend having somebody not wait until you’re in crisis. So it’s a great idea to make a connection if you’ve had a previous therapist reach out to them. Again, you don’t have to be in weekly therapy, but it’s nice to rekindle that relationship. So it’s not I’m in a crisis, I need someone right now, I’m really feeling out of control, or I don’t feel like I have a handle on my coping skills or some of my strategies. I think it’s a great idea, even if you just have a few sessions to remember some of the skills and some of the resources that you have at your disposal.


And then that does sort of begin. We always talk about plugging you into a bigger treatment team. As psychologists, we often are the hub that holds together a treatment team. So that’s a great first step. We can then put our spiders out to other resources like psychiatrists or to your point, doulas or lactation consultants or those types of things.

Dr. Sarah (09:03):

Or your OB.

Dr. Emily (09:04):

Or your OB, exactly. And collaborate. But I do think that as psychologists or mental health professionals, our role is about being a little bit of that hub holder. So I do think it’s great if you’re worried about it, you’re thinking about it, there’s no harm in reaching out for some support, even if you’re like, I don’t know if I need it yet. I think that it’s okay to sort of kindle that those relationships or start a new one in that regard.

Dr. Sarah (09:32):

And so perhaps you had a therapist and you want to reach out to them, or maybe your therapist didn’t specialize in maternal mental health. You might want to consider finding somebody who specializes as well. If you go to Postpartum Support International, which is like psi.org, and I’ll link it in the show notes, but you can enter in your zip code and it will pull up a list of all of the clinical providers that have been trained in perinatal mental health that are in your area. So if they have an incredible directory, very robust and probably the PSI is like the gold standard first place to go. If you want to set up your support team or you want to get information on perinatal mood and anxiety disorders, they have tons of free new moms groups, they have new dads groups, they have groups in different languages.


They’re fantastic resource before you even have a kid. You can definitely go there. But I think there is something to be said for looking for a support team that has specialized training. Unless you have a very, very close relationship with your therapist, it’s totally fine to continue working with them. But some therapists might say, this isn’t my area, and either I’ll get consultations separately to make sure that I’m supporting you appropriately, or I’m going to refer you to someone who does because it’s a specialized skillset and training that goes into knowing the nuances of pm adss for sure.

Dr. Emily (11:04):

Absolutely. I think that we do have a lot of people that will reach out to us as specialists in this and as a consult to their therapist, you can stay with your therapist, but maybe they reach out to us for a few consultations and we can collaborate with their primary therapists around PS or those types of things that they might not be as familiar with. In addition, we also support psychiatry in perinatal mood and anxiety disorders. Reproductive psychiatrists are very specialized field, so connecting remaining with your primary therapist, maybe getting a consultation, but also having a knowledge that there are people that specialize in the safety of your baby and the safety of your mental health while pregnant with medication is also a great resource to have.

Dr. Sarah (11:52):

Yeah, I think it’s actually important that we say, because I think this might be something that people aren’t that aware of, but it is safe to take certain medications while you are pregnant for mental health purposes and seeing a reproductive psychiatrist who is specialized in providing medication management to mothers who are pregnant and postpartum safely is an option. A lot of people think, oh my God, I’m pregnant. I have to go off my antidepressant. I have to go off of my medication. And they just stop. And they’re not consulting with the therapist, sorry. They’re not consulting with a psychiatrist to do that. And that actually puts you at much greater risk of developing a perinatal mood and anxiety disorder or postpartum. It’s not to say you have to be on your medication during pregnancy, but you want to be working with somebody to help you do that. You don’t want to be changing your medication protocol on your own without consultation. That is very risky.

Dr. Emily (12:58):

Absolutely. And it does feel really good to have a team that really specializes and knows what they’re doing, that you can trust their recommendations and their choices, and you understand all of the risk benefit things, that there’s a lot of really safe options, and we don’t want you to think, oh, there’s no options out there.

Dr. Sarah (13:18):

Culture. So we covered some of the higher level clinical support systems. We covered how you can get, if you are on medicine, how you can safely continue to treat with medication anxiety or other mood disorders while pregnant and postpartum with the help of a psychiatrist. I also recognize that not everybody needs that high of a level of support, and maybe they’re wanting to think about more holistic things, more behavioral strategies, things that they can do while pregnant or as you’re getting closer to pregnancy or if you’re postpartum, what can people do on their own or within their relationships and family and friends and things like that to shore themselves up against the impact of anxiety?

Dr. Emily (14:16):

Yeah, I mean, I think we spoke about in the beginning there are skills that you’ve probably developed over the course of your life having an anxiety disorder that to be effective for you. So we always want to reemphasize those. I call this in parenting, I call it your A game parenting, but it’s the same for you if you have an anxiety disorder, if you know that exercise really helps to modulate your anxiety, we want to make sure that you’re prioritizing that. You want to make sure that you’re fitting that into your schedule, that that’s not flipping by the wayside that you’re getting that in every day. Those are the, or sleep, as we talked about earlier, and also communication, talking to your partner, this is on my radar. I need to really prioritize some of these coping skills that have helped me. If I fall off the wagon a little, maybe you could let me know, or if I’m spinning out a little in a way that’s a little bit not my norm recently, that’s a great conversation starter in a supportive way to start to do some of those things. So I think it’s about being sort of on a game of self-care in some ways, the things that to work for you, we really want to make sure those are prioritized.

Dr. Sarah (15:25):

And I think too just there are certain things that help us cope with anxiety that we want to be aware of the things that help us cope and make sure that we are prioritizing those. We also want to think about the things that kind of inhibit coping because a lot of times when we have anxiety, whether we’re aware of it or not, we often will sort of seek out things or people’s behaviors to rescue or turn off our anxiety. Seeking a lot of reassurance or having somebody help you avoid things that make you anxious or kind of eliciting other people to sort of turn off that anxiety for you. We call that accommodating in parenting when kids have anxiety. We talk a lot about how parents can accommodate their child’s anxiety and how that inadvertently ends up, not intentionally, but maintaining the anxiety because we keep rescuing them from experiencing the anxiety and they reduce their tolerance for anxiety or they don’t build up a greater tolerance for anxiety.


So it’s kind of counterintuitive, but the treatment for anxiety is not reducing anxiety. It’s increasing tolerance for anxiety. And so when we’re adults and we have a lot of anxiety, sometimes we pull other people into our lives to accommodate for us as well. And often if you’re a person who’s had anxiety your whole life, you may have been a child whose parents got pulled into accommodating a lot, and a lot of adults of anxiety may still be having their parents accommodate a lot of their anxiety. So understanding a more, when I say holistic, I don’t mean taking herbal remedies. I’m saying holistic as in look at the whole picture. Who is involved in the support of your healthy coping? Who is involved in the maintenance of your less healthy, healthy coping? And really doing an honest inventory of saying, am I constantly calling my friend and asking them to always tell me this is going to be okay?


Every time I feel worried, I say, can you make sure that I’m feeling okay? Tell me this is going to be all right. Or eliciting a lot of that reassurance. Am I always having my spouse drive me around because I’m nervous to drive? What are the things that we might be avoiding building a tolerance around? This is sort of regardless of if it’s generalized anxiety or if it’s a perinatal anxiety disorder, like postpartum anxiety. But I think oftentimes with anxiety, this is one of the things that we look at to support it kind of more holistically, can we involve the partner or the friends or the parents in understanding how sometimes when they rescue you from anxiety, they’re not actually helping you to learn to cope with and tolerate feeling anxious because anxiety is fair and comfortable, but it’s actually, it’s safe for you to feel this way. It’s often a false fire alarm.

Dr. Emily (18:31):

And I mean, I think that’s such an important point because I think, honestly, I think pregnancy seems like the exception. People are like, but I’m pregnant. I’m so vulnerable. You really should help me more in some ways. And so I think it’s even more important to keep that at the front of even your front burner. Am I asking too much? I can handle this on my, can I handle this on my own? And maybe pushing through that, and again, to your point, raising that tolerance and not sort of being bailed out, even in this very, very unique, very cool, exceptional phase of your life, you can still tolerate it. And so I think the question is keeping that at the front of your mind. I can do this on my own. Let me challenge myself a little. I can tolerate this. I don’t need to be rescued to your point or overly helped. And I think that that is a really important other side of that coin to address.

Dr. Sarah (19:24):

Yeah. Yeah. So my thoughts, this mom is first of all, congratulations and give yourself a lot of credit for the fact that you’re already thinking about this. I will say, I know how anxiety can sometimes make us worry about this. There’s a difference between being like I am forward thinking, I’m being realistic. I’m looking at the big picture. I’m zooming out and taking inventory, versus I am catastrophizing. I am ruminating on the future and all the possible things that could go wrong. Pay attention to the flavor. If you are getting stuck in the future and worrying a lot about the future or getting really stuck in the past and ruminating on the past, a very helpful strategy is to try to remind yourself. I say it’s helpful, it’s simple. It is not always easy, but to just try to say, oh, I got stuck in the future, or, oh, I’m getting stuck in the past.


Let me bring myself back to right now, do a quick grounding exercise. Where am I in this moment? Because right this moment is not, we have facts right now versus in the future sometimes we can be like, what if we don’t have those facts? They haven’t happened yet, so we don’t have to. It’s okay to go to the future, but you don’t want to get stuck there. You want to come back to now. I think that’s a very helpful thing with anxiety to remember. But I think if you are thinking about the future and you are not in a catastrophizing sort of hyper obsessive way, just thinking, Hey, I want to set myself up for success and I want to anticipate potential pitfalls or challenges that I might have, that’s great. And that’s going to help you think about a sort of individualized support plan that’s going to meet your needs, which I’m a very big fan of.


Actually have a mental health checklist. I should put it in the show notes. I’ll link it. It’s a free mental health postpartum checklist. I created it. I was like, we all get these birth plan checklists or hospitalist checklists and all these things. We put so much thought into our birth plan and our, what we’re going to bring to the hospital and all this stuff. And then we get home and we fall off a proverbial cliff in support and planning. And so I was like, if parents who are expecting can actually also make sure they’re creating a postpartum mental health checklist, who is the therapist that I might want to have on call or make sure I’ve already just reached out and said, Hey, I might want to check in with you. Or do I want to research some reproductive psychiatrists or do I want to find a postpartum doula?


Or do I want to make sure I’m thinking about what visitors, how I want to handle visitors after I come in the hospital or when I come home from the hospital? Because I always say, this is a hard thing too, but people don’t often realize how overwhelming it can be when you first get home and having all these people coming who want to see the baby and see you can be really overstimulating. And so it’s a lot easier to open things up later than it is to close down invitations that you’ve already given. So I always say keep it tighter than you think you might need, and then be willing to kind of invite people in as you see how you’re doing and how you’re feeling. All those things are things that I don’t know if we give enough weight to really supporting parents in advance to be thinking about. So I will definitely put a link to the maternal mental health postpartum checklist that I have in show notes. This was great. Thank you so much for coming and talking about this. Yeah,

Dr. Emily (23:23):

I love this. It’s a really important topic. So glad to be here.

Dr. Sarah (23:29):Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in this new series Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.

✨We want to hear from you! Go to https://drsarahbren.com/question to send us a question or a topic you want to hear us answer on Securely Attached – Beyond the Sessions! ✨

127. BTS: Is there anything I can do while I’m pregnant to make me less vulnerable to postpartum anxiety?