Perinatal compassion focused therapy (P-CFT) for mothers with mental health difficulties: A study protocol for a multisite and mixed methods feasibility and acceptability study

Leah A Millard-Brewer^1,2Debbie M Smith^1,2Ming Wai Wan^1,2Anja Wittkowski^1,2*

• ¹Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
• ²Perinatal Mental Health and Parenting (PRIME) Research Unit, Greater Manchester Mental Health National Health Service (NHS) Foundation Trust, Manchester, United Kingdom

Introduction: Mental health difficulties are a common complication affecting 1 in 5 women during the perinatal period (from conception up to two years after childbirth). As well as affecting the wellbeing of the mother, perinatal mental health difficulties can contribute to adverse long-term outcomes for the infant by disrupting the mother-infant relationship. Effective interventions are needed to enhance maternal and infant wellbeing during the perinatal period. Perinatal compassion focused therapy (P-CFT) is a promising intervention that has been adapted for perinatal mental health difficulties, and which may also help enhance the mother-infant relationship through its focus on generating compassionate and empathic cognitions of self and others. While CFT is in use in perinatal clinical settings, few studies exist that explore its potential benefits. The aims of this study were to explore the feasibility of recruitment, to determine the suitability of the outcome measures, to assess the acceptability of P-CFT through qualitative evaluation, and to explore the effects of P-CFT on compassion-based outcomes, wellbeing, and parent-infant interactions. Methods: The multisite feasibility and acceptability study will adopt a single pre-post, quasi-experimental study design comprising three components using a sample of service users attending P-CFT groups. Component 1 is a feasibility study measuring maternal self-report questionnaire outcomes (e.g., self-compassion, postpartum bonding) at baseline, post-intervention and six-month follow-up, and recruitment and retention rates. Component 2 will evaluate mother-infant interactions through the coding of video observations from baseline to post-intervention. Component 3 will entail qualitative semi-structured interviews to explore the acceptability of the intervention. Data will be analysed using statistical methods of analysis for quantitative data (Component 1 and Component 2) and reflexive thematic analysis for qualitative data (Component 3). Discussion: To the authors' knowledge, this study will be the first multisite feasibility and acceptability study of perinatal compassion focused therapy offered to mothers and birthing parents in specialist perinatal mental health services in England's National Health Service (NHS). This study will identify any necessary refinements for future studies and considerations for good practice in this specific population and clinical setting, as well as the intervention itself.