The role of rational emotive behavioral therapy (REBT) is not adequately assessed as a potential aid in the hallmark process of shifting identities and the common occurrences of emotional distress experienced during matrescence. This paper examines if REBT theory and interventions have the potential to assist new mothers in navigating and embracing both identity shifts and anxiety throughout the perinatal period. In reviewing literature on perinatal anxiety, the psychological aspects of shifting identity in matrescene, the REBT method of cognitive restructuring, and its philosophy of unconditional self-acceptance, this paper seeks to provide insight on whether REBT theory and its applications can assist in creating a more optimal psychological environment throughout the process of becoming a mother.
In an effort to better understand how REBT strategies may play a role in alleviating postnatal anxiety, we first define the associated terms and identify the psychological and neurological changes that this process activates. Matrescence, initially conceived as an anthropological concept (Raphael, 1975), has more recently been applied to psychology and defined as the transition into motherhood through preconception, pregnancy and birth, surrogacy or adoption, to the postnatal period and beyond (Athan & Reel, 2015). A staggering one in five mothers experience postpartum depression, more than half of new mothers experience the “baby blues” (Tucker, 2022, p. 12), and experiencing anxiety throughout matrescence is even more common (Barnett, 2023, p. 77; Kleiman, 2022, p. 47). Similar to generalized anxiety disorder, anxiety throughout matrescence can include physical manifestations such as nausea and sleep problems, as well as constant worrying, panic (Kleiman, 2022, p. 47), and invasive ruminating thoughts (Kleinman & Wenzel, 2020).
Although there isn’t unanimous agreement on what mediates anxiety throughout matrescence, there is evidence that neurological shifts, precipitated by hormonal changes make new mothers more vulnerable to psychological distress (Daws & Rementeria, 2021, p. 97). This includes a massive loss of grey matter from neurological pruning that occurs to create a hyper-vigilance in order for mothers to be able to predict danger (Daws & Rementeria, 2021, pp. 97-98). However, the stresses that threaten modern mothers the most are often not catastrophic events that require short periods of hyper-vigilance as evolution has prepared for but rather chronic, and often invisible problems such as poverty and hunger leaving some mothers under constant duress which can disrupt their most fundamental maternal habits (Tucker, 2022, p. 171). Therefore, the brain of a new mother reorients itself towards a tendency to catastrophize, which REBT is specifically suited to address (Bernard, 2013, p. 29).
Similar to any other developmental push, throughout matrescence mothers experience an acceleration in multiple domains: bio-psycho-social-cultural-spiritual (Athan & Reel, 2015) which serves as a catalyst for a shift in their identity. Van Gennep refers to this identity shift as a rite of passage in which a woman undergoes phases of separation, marginality and reincorporation during pregnancy as she exchanges one social status for another (Winson, 2017, p. 144). Rubin describes this evolution of identity as a process that involves examining self-image, undergoing mimicry, roleplay, and fantasy to then introject, project and reject external methods of motherhood. Rubin’s theory posits that “when these decisions have been made, the woman can be said to have identified with the role that she had previously been mimicking.” (Winson, 2017, p. 145).
Understanding the development of a mother’s identity in matrescence is critical because it not only impacts her, but also her early relationship with her child. Rogan highlights the potential downside of this phenomenon during the perinatal period, “when feeling overwhelmed, unprepared, and unsure of their identity, women become drained and experience strong senses of loss and aloneness.” (Rogan et al., 1997, p. 883). Further, Rubin’s theory explains that the process of taking on the identity of a mother is not complete without a period of grief and letting go of former identity (Winson, 2017, pp. 144-146). Rubin proposes that if there is not some degree of resolution of the two lifestyles, then there is marked depression in role taking. Valentine stipulates that the four developmental tasks that her research presents as commonly occuring during pregnancy must be mastered, otherwise postpartum adjustment and parenting abilities are negatively impacted (Valentine, 1982). When the maternal motivation system comes online and continues to be activated by consistent engagement with the baby (Conaboy, 2022), this is a recognized as a reflection of "the intention to mother, committing to new life circumstances" and falls under the larger core category of ‘Expansion of Self' (Athan & Miller 2005, p. 26; Barlow & Cairns, 1997).
Given the common experience of shifting identity and anxiety in the perinatal period and the potential negative implications on the early mother-child relationship, it's imperative to consider how REBT theory and strategies, more specifically cognitive restructuring and the philosophy of unconditional self-acceptance, might aid in this potent transition. REBT’s elegant solution involves getting to the root of disturbances to prompt cognitive restructuring and profound philosophical change (Ellis, 1986). REBT maintains that irrational beliefs mediate the relationship between environmental events and emotional distress and accordingly uses cognitive restructuring as a psychotherapeutic technique intended to alter maladaptive belief systems, thereby reducing emotional distress (Ellis, 1982), with the “ABCDE’’ model being the cornerstone of REBT (David, Szentagotai, Kallay, & Macavei, 2005).
A 2021 study found that irrational beliefs, rooted in rumination and catastrophizing, caused an increase in anxiety in mothers. This study tested the effects of an eight-session REBT-based emotion regulation program on cognitive changes and negative emotions among mothers of premature infants in the neonatal intensive care unit. These mothers experienced emotional distress related to facing trauma in the midst of an identity change and their corresponding rumination and self-blame (Choi, Lee, & Shin, 2021). A birth experience can be traumatic when cultural expectations around birth aren’t achieved, there is a negative perception of personal performance, or complications arise during delivery (Simpson & Catling, 2016). The participating mothers used the “ABCDE” model to change their irrational beliefs to healthy, rational beliefs and then repeatedly expressed and practiced coping statements, which helped reduce anxiety. REBT theory and interventions were found to be effective for reducing maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression in participating mothers due to its focus on disputing irrational beliefs and cultivating rational, valid, efficient, and self-critical cognition (Choi et al., 2021).
Anton and David (2015) conducted a study using classic restructuring techniques focused on irrational beliefs to assess the efficacy of this REBT intervention to work as a preventive measure for anxiety, negative emotionality, and depression in pregnant women. This technique was applied to irrational beliefs related to demandingness, catastrophizing/awfulizing, frustration intolerance, global evaluation/self-downing associated to various activating events: participants physical health (pregnancy comes with many physical changes that can be overwhelming for some women), the moment of giving birth, fears related to the baby and his health, the marital relationship, and participants body image (Anton & David, 2015, p.7). The results of the study showed significant differences in negative emotionality and anxiety which were maintained through to the postpartum period. Specifically, the REBT group intervention led to lower anxiety levels. Thus, the REBT model of cognitive restructuring can work as a preventive intervention for anxiety and negative emotionality in pregnant women (Anton & David, 2015).
Similar to cognitive restructuring, the REBT philosophy and core therapeutic goal of unconditional self-acceptance, can potentially be applied to alleviating emotional distress during matrescence. It’s typical for new mothers to be bombarded with thoughts stemming from comparing themselves to others (Clements & Nixon, 2022), and not feeling adequate or in control (Barnett, 2023, p. 76; Kleinman & Wenzel, 2020) leaving them stuck in a negative thought pattern where rumination causes a downward spiral (Athan & Miller, 2005, p. 19). In the most advanced industrialized societies with the least robust family policies including the United States, this effect is compounded by the “rosy view” of parenthood that presents unrealistic expectations on new mothers (Athan, 2020, p. 451).
Adopting unconditional self-acceptance alongside cognitive restructuring may reduce anxiety stemming from societal expectations of motherhood and internalized self-comparisons. This core REBT philosophy emphasizes accepting oneself despite flaws and imperfections, rather than basing self-worth on achievements or external validation (Chamberlain & Haaga, 2001). REBT stands apart from most of the other cognitive therapies with its philosophical emphasis including the importance of unconditional self-acceptance, unconditional other-acceptance, and unconditional life-acceptance (Ellis & Ellis, 2019, p. 140). One can maintain emotional stability and well-being in life when one consistently acquires these three important basic philosophies (Ellis & Ellis, 2019, p. 26-27). Chamberlain and Haaga (2021) found that people who were more unconditionally self-accepting tended to be lower in depression and anxiety and higher in happiness or general well-being.
In conclusion, there is compelling evidence to support the potential for REBT theory and interventions to aid in the process of shifting identities and alleviating anxiety in the developmental process of matrescence. However, the available literature warrants more empirical evidence and further research to establish a clear connection between addressing psychological discomfort in the perinatal period with the application of REBT. A case can be made for the use of REBT strategies to alleviate anxiety and to create a more easeful shift in identity for new mothers based on the capacity of these strategies to reconcile their new with their former identities through cognitive restructuring and the embracing of the philosophy of unconditional self-acceptance. Perhaps most importantly, REBT interventions are proven to be effective and long-lasting (Ellis & Ellis, 2019). Therefore, a need exists to further examine and unlock the potential of applying REBT theories and interventions in the treatment of perinatal women.
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