Spotlight on the Green Health Psychology Lab: Advances in CBT for Women’s Health

Numerous studies continue to confirm that women’s health, particularly women’s mental health, remains under researched, underrepresented, and underfunded. The Green Health Psychology lab is trying to change that. Our research focuses on women and individuals assigned female at birth (AFAB) across the reproductive timeline. The menstrual cycle, the perinatal period (pregnancy and the postpartum), and the menopause transition are all considered a window of vulnerability for mental health difficulties. There is no doubt that a strong biological basis for this exists, with the common denominator of each of these critical times being hormonal changes/fluctuations. However, each of these windows of vulnerability in a woman’s life have unique psychological and social factors associated with them that also contribute to mental health difficulties. For instance, during the perinatal period, socially, every aspect of one’s life is changing (e.g., finances, relationships, parental leaves), which can contribute to uncertainty. Psychologically, beliefs and expectations play a huge role in one’s experience, while one’s identity and priorities are altering to incorporate the new experience of becoming a parent. Similarly, during peri-menopause (also known as the menopause transition), women aged 40-60 are often faced with continuing to care for children, empty nesting, or helping their adult children, while also caring for elderly parents with medical concerns, and juggling the demands that come with being at the peak of their career. Psychologically, this developmental time in life finds women re-evaluating life goals and identity as they age, including beliefs about self (e.g., self-worth, body image) that all contribute to functioning and well-being.

Utilizing the biopsychosocial model, our lab has developed CBT-based treatment protocols, tailored to meet the unique needs of perinatal and menopausal women and individuals AFAB with symptoms related to these reproductive-based time points. Evidence-based, non-pharmacological treatments are crucial for those who cannot, or choose not, to take medication, or for those who remain symptomatic despite medication use. A few recent and current studies from our lab are shared here.

Treating Anxiety Disorders during the Perinatal Period

Postpartum depression is widely recognized, well researched, and supported by effective psychological treatments. In contrast, anxiety disorders (ADs) during the perinatal period affect approximately 1 in 5 women, making them just as prevalent, if not more so, than postpartum depression. Despite this, ADs remain underrecognized and under researched, with far fewer empirically supported treatments available. In an effort to remedy this, our lab has developed an evidence-based treatment for ADs during the perinatal period namely, a 6-session CBT-protocol that has been evaluated with two rigorous randomized controlled trials (RCTs), the most recent including 170 participants with a confirmed AD, utilizing a gold standard semi-structured assessment. Recently, a PhD student from the lab developed a mindfulness-based cognitive therapy for women with ADs during the postpartum period that she is evaluating with an ongoing RCT, and another PhD student is building off our published case study, assessing the feasibility and acceptability of a cognitive processing therapy protocol we tailored to meet the unique needs of postpartum women with childbirth-related PTSD.

Proactive Perinatal Treatment Approaches

As of late, our lab has taken a proactive approach with mental health difficulties during the perinatal period, by targeting known mental health risk factors with specialized short-term treatments. Specifically, a 2025 PhD graduate, Dr. Melissa Furtado, identified intolerance of uncertainty as a risk factor for the development of ADs during the postpartum period during her master’s thesis. She subsequently developed and tested a 6-session CBT-based protocol utilizing an RCT design, aimed at intolerance of uncertainty (CBT-IU) during pregnancy for the prevention of postpartum ADs, with remarkable results. Further, we developed a half-day CBT-based sleep workshop for women in early pregnancy to not only improve sleep but prevent worsening of anxiety and depression. Results from this RCT revealed significant subjective and objective (actigraphy) improvements in sleep, anxiety, and depression in late pregnancy, that was maintained at three months postpartum. 

CBT for Menopause Symptoms

Another program of research within our lab focuses on treatments for common symptoms of menopause. Although the menopausal transition is a natural event experienced by women and individuals AFAB, many experience adverse physical (e.g., vasomotor-hot flashes, night sweats, sleep, sexual) and emotional (e.g., anxiety, depression) symptoms that cause significant distress and impairment in functioning (e.g., leaving the workforce). Our CBT for menopause symptoms (CBT-Meno) and CBT for sexual concerns during peri-menopause (CBT-SC-Peri) protocols are effective alternative and/or complimentary forms of treatment for those who cannot, or choose not to take medication, or for those who remain symptomatic despite medication use. The latter circumstance is unfortunately quite common, as half of the participants in our CBT for sexual concerns study were at a clinical level of symptoms at baseline despite using hormone therapy, and two thirds were taking a selective serotonin reuptake inhibitor (SSRI) medication     .

Moving Forward

In an effort to make our evidence-based protocols accessible we have published self-help books, with updated books and clinician guides being published in the new year. Despite evidence that our face-to-face protocols are effective, they remain inaccessible for many due to geography, cost, time, caregiving duties, stigma, and systemic barriers. These barriers disproportionately affect racialized, low-income, rural, immigrant, and other equity-seeking groups. Therapist-guided internet-delivered CBT (ICBT) may serve as a promising alternative as it preserves therapeutic elements while enabling remote, flexible, and lower-cost delivery. We are currently running an RCT examining a therapist-guided, internet-based CBT for menopause symptoms (ICBT-Meno) and hope to reach many more women and individuals AFAB to access the treatment they need.

• Resources

  Green, S.M., Frey, B.N., Donegan, E., & McCabe, R.E. (2019). Cognitive Behavioural Therapy for Anxiety and Depression During Pregnancy and Beyond: How to Manage Symptoms and Maximize Well-being. New York, NY: Routledge.

• Author Bio

  Dr. Green is an Associate Professor in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, and a Clinical and Health Psychologist within the Women's Health Concerns Clinic, St. Joseph's Healthcare, Hamilton. She is a proud Fellow of both the Canadian Association of Cognitive and Behavioural Therapies and the Canadian Psychological Association.