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

Abstract Importance: Postpartum depression (PPD) is common, undertreated, and debilitating for women and infants. There is an urgent need for scalable treatments for PPD. Women with PPD experience disruptions in reward-supported behaviors - reduced behavioral activation and social reward responsivity. Thus, the reward system is a promising target for psychotherapy. Objective: Engage & Connect (E&C) is a novel neuroscience-informed psychotherapy that increases engagement in rewarding social experiences to restore reward-supported behaviors and reduce PPD. We tested whether E&C reduces depression severity and is feasible and acceptable for women with PPD. We also examined whether improved reward-supported behaviors are mediators of response to E&C. Design: A pilot one-arm study of women with postpartum depression from November 17, 2022 to January 26, 2024 in a large healthcare system. Setting: Women were recruited from Weill Cornell Medicine/NewYork Presbyterian Hospital and New York City communities to this remote study. Participants: 38 women, up to 1-year post delivery, with PPD. Intervention: Engage & Connect (E&C) is a 9-week remote intervention, delivered by community therapists. It aims to reduce depression by increasing engagement in rewarding social activities. Main Outcomes and Measures: Our primary outcome was PPD severity, measured with the EPDS. Secondary outcomes included social reward responsivity (ACIPS) and behavioral activation (BADS) – candidate mediators of EPDS reduction. Additional secondary outcomes were perceived social support (MSSPS) and infant-mother bonding (PBQ). Semi-structured interviews and retention rates measured acceptability. Results: Among 38 women (Mean Age=34.7 [SD=3.69]; 71% White, 18% Asian, 3% Black, 5% other, 10% Hispanic), E&C was feasible and acceptable (86% retention). Our primary outcome, PPD severity, significantly reduced during E&C (EPDS change=8.6 points (SD=3.8); 83% remission, 73% response). Further, we observed significant improvement in behavioral activation and social reward responsivity, that mediated EPDS reduction (ACIPS [ACME] = -.052; BADS [ACME]= -.18). Finally, we also found improvements in perceived social support and infant bonding. Conclusions and Relevance: E&C may be a promising scalable first-line psychotherapy for PPD that reduces PPD by improving reward system functions and lead to long-term benefits for mothers and infants. Trial Registration: ClinicalTrials.gov Identifier: NCT05585164