Engage & connect psychotherapy improves social reward responsivity and reduces postpartum depression

Postpartum depression (PPD) is common but undertreated, stressing the need for scalable psychotherapies. The reward system is a promising mechanism as PPD disrupts reward-supported behaviors: reduced motivation to engage in rewarding experiences (behavioral activation) and blunted pleasure during social interactions (social reward responsivity). Engage & Connect (E&C) is a simple and scalable psychotherapy, based on neuroscience literature. It aims to increase engagement in rewarding social experiences to restore reward-supported behaviors and reduce PPD.

In a one-arm pilot study, 38 women with PPD received 9-weeks of E&C. We tested whether E&C is feasible and acceptable. Using mixed-effects models, we tested whether E&C reduces PPD, mediated by improved reward-supported behaviors.

We found that E&C was feasible and acceptable (86% retention). PPD severity significantly reduced during E&C (EPDS change = 8.6 points (SD = 3.8); 83% remission, 73% clinical response). Further, significant improvement in reward-supported behaviors (behavioral activation, social reward responsivity) mediated PPD reduction. Finally, anxiety severity, perceived social support, and infant bonding improved during E&C.

Results provide preliminary evidence that E&C may be a promising scalable first-line psychotherapy for PPD, pending testing in a randomized controlled trial. E&C might reduce PPD by improving reward functions with long-term benefits for mothers and infants. Clinical Significance: This pilot study suggested that Engage & Connect (E&C) is feasible and acceptable, with reduction in PPD and improvements in behavioral activation, social reward responsivity, social support, and infant bonding. Further, improvements in behavioral activation and social reward responsivity mediated PPD reduction. Pending replication in a larger sample, E&C may be a promising scalable first-line psychotherapy that reduces PPD by enhancing behavioral activation and response to social rewards.