An Analysis of Psycho-cognitive Factors in Relation to Postpartum Depression and Anxiety in Women with and without Changes in Body Weight

The aim of this study is firstly to analyze the differences in postpartum self-acceptance, patterns of beliefs (rationality) and perfectionism in women with and without changes in body weight and secondly to identify the relationships among self-acceptance, rationality, and perfectionism on the one hand and postpartum depression and anxiety on the other hand. The study involved 123 women, newly mothers, aged between 20 and 46 years, M = 32.29, SD = 6.56. The instruments used were Unconditional Self-Acceptance Questionnaire, Inventory of Ideas II, Frost Multidimensional Perfectionism Scale, Hamilton Depression Scale, and Inventory of State-Trait Anxiety. The results showed that the level of rationality and self-acceptance was lower in women with higher body weight, while the level of perfectionism was higher in same tier. At the same time, the results obtained by regression and mediation analyzes showed that self-acceptance is negatively associated with both depression and anxiety, rationality is also negatively associated with both depression and anxiety, and perfectionism mediates the relationship between rationality and depression, but not the relationship between rationality and anxiety. The conclusions of the study highlighted the women’s need for support to regain their pre-pregnancy emotional balance and well-being.

unhappy with their appearance may refuse to breastfeed (Brown, Rance, & Warren, 2015), exhibit unhealthy eating behaviors, and adhere to dangerous weight loss diets that can endanger their lives and that of the child (Ushama & Anna, 2011). Women with a high body weight tend to compare themselves to thin women and avoid social contacts in fear of being judged for their appearance. Physiological changes, psychological stress and social pressure to look good lead to increased feelings of inactivity and depression. Also, the negative evaluation of body size in pregnant women with excessive weight leads to decreased self-esteem and the formation of a pattern of irrational thoughts.
There are a number of theories that explain the effects of a negative body image, including the socio-cultural model. This model identifies social pressure as a force underlying the individual's need to conform to standards of appearance (Cusumano & Thompson, 1997). The media, the fashion industry and the clothing industry have direct effects on body image, which can lead to significant distress among women. Studies show that fashion magazines and the media portray the ideal body as having dimensions of 13-19% lower than healthy weight. These hard-to-reach standards, especially during pregnancy, prevent women from easily accepting their own bodies (Schumann et al., 2014).
Given the fact that the present study involved women in the postpartum period, with different body mass indices, we aim to test the differences that may occur in irrational thoughts (rationality), self-acceptance and perfectionism depending on body weight, assuming that women with a higher weight will have lower scores of rationality and self-acceptance and higher scores of perfectionism.
We therefore formulate the following hypotheses: H1. Higher weight women have a lower level of rationality.

H2. Higher weight women have a lower level of self-acceptance.
H3. Higher weight women have a higher level of perfectionism.

Self-acceptance and Its Relationship to Depression and Anxiety
Self-acceptance means self-satisfaction and involves both self-understanding and conscious observation of one's own strengths and weaknesses (Ryff, 1989). Self-acceptance is a central feature of mental health in Jahoda (1958), is self-actualization in Maslow (1968), is optimal functioning in Rogers (1957), is the maturity concept of Allport (1961), but also in Ellis's theory (1962). Ellis (1962) launched the concept of self-acceptance starting from the assumption that people are beings subject to errors and in order to make peace with themselves it is necessary to accept their own person, to accept themselves as people as who they are. People are able, through innate creativity, to build an emotional journey, which can sometimes lead to irrational behaviors. Greater flexibility can avoid potential significant consequences on the general health and level of functionality of the individual (Ellis, 2007). True self-acceptance means embracing what you are, without judgments, conditions or exceptions (Ellis, 1994). Morgado and colleagues (2014) argue that self-acceptance is the acceptance of all the attributes of the individual, whether positive or negative. Thus, the importance of accepting all facets of one's own person is emphasized. It is not enough to embrace only the positive aspects, that is, to have a high self-esteem. In order to integrate true self-acceptance, we must also embrace our own less desired or even negative aspects. In other words, let's fully appreciate ourselves. According to Kabat-Zinn (2005), individuals need to remember that they are worthy of appreciation, including self-esteem. The road to a healthy self does not seem to involve only self-acceptance, but unconditional self-acceptance. It's relatively easy to accept when we've done something great, such as winning an award or meeting a public figure. But the hallmark of unconditional self-acceptance is the acceptance of our shortcomings and our own mistakes and defects. According to Dryden (2014), unconditional self-acceptance is the understanding that the person "in herself" is different from his actions and qualities. She admits that she made mistakes and that she has flaws, but she does not let these factors define her. Women at risk for postpartum anxiety and depression, but without symptoms, have higher levels of self-acceptance and self-compassion (Monteiro et al., 2019). Self-acceptance is not self-esteem, as it does not refer to the feeling of being special, but of accepting one's own uniqueness. It involves, rather, acceptance of what is, with good and bad. Self-esteem refers to a person's subjective assessment of his or her value as a person (Donnellan et al., 2011;MacDonald, 2012). It is also known that self-esteem is not the expression of a person's talent or abilities. It is also not the way a person is evaluated by others, but the person's perception of how it is evaluated. In general, self-esteem is conceptualized as the feeling that someone is "good enough". Self-acceptance and self-respect, is opposed to excessive self-esteem and grandeur that characterize narcissistic individuals (Ackerman et al., 2010).
There is evidence that self-acceptance is not an automatic or default state. Many individuals do not accept themselves as they are in general, but only accept the positive parts, and for the rest they are evasive. Research results show that it is necessary to accept both defects and failures (Chamberlain & Haaga, 2001;David et al., 2002). And that can lead to unconditional self-esteem.
Reduced self-acceptance has been identified as the main predictor of symptoms of depression or anxiety (Boyraz & Waits, 2015;Edmondson & MacLeod, 2015;Risch et al., 2013). Moreover, the assumption of goals related to one's own interests and values has been associated with the complex process of self-acceptance, rather than the perception of progress towards these goals and values (Sansinenea et al., 2020). Thus, one can admit the possibility of a link between self-acceptance and patterns of ideas, as expressions of personal beliefs and thoughts. Therefore, it could be assumed that assuming goals related to body weight, from the perspective of one's own body attributes, can contribute to increasing one's own acceptance. The literature suggests a link between (irrational) patterns of ideas and self-acceptance. Different studies have revealed the importance of self-acceptance in maintaining or regaining mental health in clinical and non-clinical populations, in different life contexts. Thus, unconditional self-acceptance has a protective role in the case of depressive and anxious emotional reactions in situations of simulated public stress, followed by neutral, negative or positive feedback in clinically healthy people (Popov et al., 2016). It was also observed that self-acceptance positively affects the psychological well-being of students in the context of physical activities (Lapa, 2015). And in the particular situation derived from the immigrant status, evaluated as a www.scholink.org/ojs/index.php/asir Applied Science and Innovative Research Vol. 5, No. 3, 2021 21 Published by SCHOLINK INC.
factor of discrimination at work, it was proved the importance of a high level of self-acceptance in maintaining well-being (Ferná ndez et al., 2015).
On the other hand, self-acceptance is also involved in the recovery of individuals with clinical conditions, through cognitive-behavioral therapy (Kivity et al., 2016). In a randomized controlled study, positive changes were found regarding self-acceptance in the evaluation of emotion-centered therapy as a treatment for generalized anxiety disorder (Timulak et al., 2017). Xu and his team (2016) showed how self-acceptance significantly mediates the positive association between mindfulness and subjective well-being. A qualitative meta-analysis combined with a systematic literature review proved that self-acceptance is a criterion with a high effect size, relevant in recovery in eating disorders (de Vos et al., 2017). On the other hand, relevant data have been produced that attest to a low level of self-acceptance in women with breast cancer, which qualifies it as a direction of therapeutic intervention (Chen et al., 2017). Research on post-traumatic stress disorder (PTSD) and chronic childhood abuse has revealed changes in the level of self-acceptance assessed following therapeutic interventions through mindfulness (West et al., 2017).
In general, there are data showing that a high level of self-acceptance in daily life is a protective factor against distressing events (Chamberlain & Haaga, 2001;David et al., 2002). Empirical data suggest that when they can learn this "empirically validated philosophy of life", most people assimilate it. Thus, a person who thinks in rational terms will experience feelings of pleasure and satisfaction when his goals and desires are fulfilled and negative feelings of sadness (which is functional), not of depression (which is dysfunctional) when are exposed to adverse events. These latest feelings will be healthy, normal reactions to negative events, which will not prevent the person from achieving their goals (Chamberlain & Haaga, 2001). This is a pragmatic way to approximate rational attitude in real life and is as important as their content and achievement. Flexible, non-absolutist formulation of objectives promotes well-being even if it cannot be achieved.
Taking into account the above, we aim to test the associations between self-acceptance and depressive-anxiety symptoms among women who have just given birth, so we formulate the following hypotheses: H4. Self-acceptance is negatively associated with depression.
H5. Self-acceptance is negatively associated with anxiety.

Irrational Beliefs vs. Rationality and Their Relationship to Depression and Anxiety
Beck and Haigh (2014) defines beliefs as the generic label assigned to constructions related to cognitive schemas that include hypotheses, expectations, fears, evaluations, and rules, influencing memory and cognitive associations in general. Among their characteristics are the form -for example the imperative, the object -which can be one's own person or others, and the expression -which can take the form of a word, for example "must" (Beck & Haigh, 2014 by dimensions such as accessibility, conditionality, validity, attribution or absolute character. A derivative of faith is represented in the form of automatic thought (Beck, 1963). Beliefs can also be characterized by their degree of bias. Biased beliefs range from adaptive to maladaptive, from sub-clinical to clinical and from mild to extremely severe. A functional bias can become dysfunctional as a result of a situation in which biased vulnerability beliefs are applied to a situation perceived as similar to that vulnerability (Beck & Haigh, 2014).
The literature also contains relevant data regarding the relationship between the patterns of beliefs and ideas and the state of mental health. Personal identity is defined by a series of psychological attributes such as the memory of one's own experiences as a result of which thoughts and beliefs are developed, as persistent psychological traits (Noonan, 2005). is argued that the application of this perspective in the clinical field can complement current conceptualizations of major depressive disorders, social and generalized anxiety (Kneeland et al., 2016).
In essence, the subjective creation of meaning of the individual in relation to himself, others and social situations plays a decisive role in his life, and interventions to change the meaning can have important beneficial consequences that help individuals to prosper (Walton & Wilson, 2018).
Beliefs seem to influence the depressive-anxious experience by making it easier to deal with stressful situations (Warren & Hale, 2020) and are a way to change and create meaning and identity in psychosocial contexts that require changes or adjustments, as is the maternity period (Zhou & Xu, 2019). Taking into account all this, we aim to verify the existence of associations between irrational thoughts (measured as the level of rationality) and depressive-anxious symptoms among women who have just given birth, thus establishing the following hypotheses: H6. Rationality is negatively associated with depression.

H7. Rationality is negatively associated with anxiety.
It should be mentioned that we used the variable rationality to the antipode with irrational ideas.

Depression-anxiety Symptoms
In the context of the irrational thinking model that can lead to psycho-behavioral disorders, Ellis (1962Ellis ( , 2002 identified perfectionism as a fundamental irrational belief, the expression of the importance of perfect performance -for example, "I must be perfect in everything I do in order to perform". Irrational beliefs are considered to be self-sabotaging, due to excessive expectations about oneself, unlikely to be met (Ellis, 1962). In general, cognitive-behavioral explanations are based on the concept that perfectionism is derived from dysfunctional thinking patterns (Andrews et al., 2014;Beck, 1976;Shafran et al., 2002). Slade and Owens (1998) developed the model of the dual process of perfectionism starting from the principles of Skinner's (1969) consolidation theory. The model proposes explanations for both the adaptive dimension and the maladaptive dimension of perfectionism. Thus, adaptive perfectionism is obtained by pursuing positive results -success, which works as a positive reinforcement, while maladaptive perfectionism is based on the function of avoiding negative consequences -failure, which works as a negative reinforcement. According to Slade and Owens (1998), adaptive perfectionists tend to set realistic standards, which they are satisfied with when they succeed, and therefore remain optimistic about their future success. In contrast, maladaptive perfectionists are more likely to set unattainable goals, which puts them in a position to almost never experience feelings of satisfaction for the goals achieved, due to the fear of failure in the future. In other words, adaptive perfectionists are driven by the pursuit of an ideal self, while maladaptive perfectionists are motivated by a desire to avoid the fearful self (Slade & Owens, 1998).
Numerous studies have shown that the different dimensions of perfectionism are significantly related to irrational cognitions (Andrews et al., 2014;Flett et al., 1991;Lo & Abbott, 2013). Thus,  research shows significant positive correlations between irrational thinking and other-oriented perfectionism and socially-oriented perfectionism, two of the three dimensions of perfectionism. There are studies that have evaluated specific irrational beliefs and fears specific to perfectionism, such as fear of failure, fear of negative evaluation, high expectations of self, and low self-worth (Ellis, 2002;Flett et al., 1991;. These results support the hypothesis that perfectionism derives from the cognitive constructs of irrational thinking.
Starting from Beck's (1976) cognitive model, which emphasizes the role of negative automatic thoughts present in situations of emotional suffering, a number of studies have demonstrated the association between perfectionist cognitions and emotional suffering (Flett et al., 1998(Flett et al., , 2002(Flett et al., , 2007. Thus, perfectionists seem to be driven by automatic thoughts centered on perfectionist themes, such as reaching high standards. Therefore, perfectionists with a high level of perfectionist cognition are more likely to experience a negative effect (e.g., depression in relation to the perception of failure to meet the expected standard or anxiety in relation to fear of failure to meet expected standards). Flett and colleagues (2002) found positive correlations between cognitions related to perfectionism and depression/anxiety. These results suggest that ruminating on perfection increases the likelihood of experiencing distress, confirming that the frequency of cognitions about perfectionism is associated with high levels of negative affectivity and deficits in cognitive self-regulation.
In conclusion, the research results suggest that a key variable associated with perfectionism is perfectionism-oriented cognitions, although the relationships between perfectionism and automatic irrational thoughts still remain moderate. This leads to the assumption that the relationship between irrational thoughts and depressive-anxious symptoms can be mediated by perfectionism, in the sense that irrational thoughts lead to the development of perfectionism, which in turn is associated with depression and anxiety. Therefore, we introduced in the study model the concept of perfectionism, assuming that: H8. Perfectionism mediates the relationship between rationality and depression.
H9. Perfectionism mediates the relationship between rationality and anxiety.

Participants and Procedure
The study involved 123 women, newly mothers, aged between 20 and 46 years, M = 32.29, SD = 6.56.
Data were collected in the first three months after birth. To obtain the sample, women were invited by e-mail to participate in the study, through a set of questions offered via the Internet. The eligibility criteria were the following: age over 18 years, Romanian citizenship, confirmation of the status of mother with one or more children, the last of which is at most three months old. Out of the total number

Instruments
Self-acceptance was measured with the Unconditional Self-Acceptance Questionnaire (USAQ) (David, 2007). The questionnaire includes 20 items that reflect the different aspects of this multi-faceted concept, central to rational-emotional and behavioral theory. Scores are offered on a six-step Likert scale where 1 -never and 6 -most of the time. The total score reflects the level of unconditional acceptance of one's own person. High scores indicate high unconditional self-acceptance, while low scores indicate low unconditional self-acceptance. Possible scores range from 20 (minimum score) to 140 (maximum score). Item example: "The feeling of my worth depends largely on the result of the comparison with other people." Rationality was measured (as opposed to irrational thoughts) with the Inventory of Ideas II (David, 2007 concern for mistake, personal standard, parental expectations, critical opinion of parents, insecurity (doubt) in action, organization. In the present study, perfectionism was analyzed as a global variable.
The answers are given on a five-step Likert scale, where 1 -to a small extent and 5 -to a large extent.
Possible values are between 35 and 175 points, where the high score means high levels of perfectionism. Examples of items: "If I make a mistake at work/school I am a loser", "If I do not set very high standards, I will probably end up like being nobody".

Depression was measured with the Hamilton Depression Scale (HRSD) from the Clinical Evaluation
System, Romanian version (David, 2007). It was developed in 1960 and revised in 1967 by Max Hamilton and is one of the first instruments created to assess the severity of depressive symptoms (Hamilton, 1967).
HRSD contains 17 items that measure the intensity of symptoms characteristic of depressive disorders, being a good indicator of the overall intensity of depressive syndrome. Scores are offered on a five-step Likert scale where 0 -never and 4 -most of the time. It is generally accepted that scores below 7 indicate the absence of depression, between 7-17 mild depression, between 18-24 moderate depression and over 25 severe depression. The scale includes items for evaluating the cognitive components (example of item: "Feelings of guilt"), behavioral but especially somatic components (example of item: "Anxiety at the somatic level"), evaluation based on observations on the patient's current condition, supplemented with specific questions (some standard questions are offered for each item).

Anxiety was measured with the Inventory of State-Trait Anxiety (STAI) from the Clinical Assessment
System, the Romanian version (Spielberger, 2010), which aims to measure by self-administration the presence and severity of current anxiety symptoms and a generalized tendency to be anxious. Both the adult and children's versions are available. The adult version was used in this study. The instrument comprises two subscales. The state anxiety scale (A-state) assesses the current state of anxiety, assessing how respondents feel "right now", using items that measure subjective feelings of restraint, tension, nervousness, anxiety and activation/excitation of the autonomic nervous system. Example of a representative item "I'm tense." The Trait Anxiety Scale (A-Trait) assesses relatively stable aspects of "predisposition to anxiety", including general states of calm, confidence and security. Example of a representative item "I would like to be happy as others seem to be." In the present study we used A-state with 20 items. Scores are offered on a five-step Likert scale where 0 -never and 4 -most of the time.

Descriptive Statistics
Mean scores, standard deviations, internal consistency coefficients and correlations between variables are presented in Table 1.

H1. Higher weight women have a lower level of rationality.
H2. Higher weight women have a lower level of self-acceptance.

H3. Higher weight women have a higher level of perfectionism.
For testing the first three hypotheses, three one-way ANOVA analyzes of variance were performed, the criterion being the weight index quantified by 1 -normal weight, 2 -overweight and 3 -obesity.   To accurately identify the differences between the three weight groups, the Bonferroni post-hoc test for multiple comparisons was performed. It is observed that in terms of rationality, there is a significant difference between women with normal weight and those with obesity, MD = 14.08, CI95% (6.87, 21.29), p < .05. Regarding self-acceptance, the significant differences are between women with normal weight and those with obesity, MD = 16.52, CI95% (8.57,24.48), p < .05 and lower between those with normal weight and overweight, MD = 9.36 , CI95% (1.16,17.55), p < .05, and in terms of perfectionism, significant differences are observed between women with normal weight and those with obesity, MD = -43.08, CI95% (-59.05, -27.11), p < .05 and between overweight and obese, MD = -26.71, CI95% (-45.07, -8.35), p < .05.
Taking into account these results, we can say that hypotheses H1, H2 and H3 are supported by the analyzed data. By testing these hypotheses, the following analyzes become all the more justified because they explain to some extent the low levels of rationality and self-acceptance among women with high body weight, as well as the high levels of perfectionism.

Relationships between self-acceptance and depression/anxiety
H4. Self-acceptance is negatively associated with depression.

H5. Self-acceptance is negatively associated with anxiety.
To test these hypotheses, two simple linear regression analyzes were performed having self-acceptance as predictor and alternatively, depression and anxiety as dependent variables. It is observed that self-acceptance is responsible for 49% of the variation of depression, the regression equation being statistically significant, F(1, 121) = 116.05, p < .01. Self-acceptance is significantly and negatively associated with depression, β = -.70, p < .01. At the same time, self-acceptance is responsible for 22% of the anxiety variation, the regression equation being statistically significant, F(1, 121) = 33.79, p < .01. Self-acceptance is significantly and negatively associated with anxiety, β = -.47, p < .01.

Relationships between rationality and depression/anxiety
H6. Rationality is negatively associated with depression.

H7. Rationality is negatively associated with anxiety.
To test these hypotheses, two simple linear regression analyzes were performed having rationality as predictor and alternatively, depression and anxiety as dependent variables. H8. Perfectionism mediates the relationship between rationality and depression.

Discussion
The present study aimed to analyze the differences between a number of cognitive variables depending on the level of body weight in postpartum women, as well as the set of relationships that are established between these variables and mental health. Self-acceptance, patterns of ideas (rationality), perfectionism, depression and anxiety were taken into account.
First of all, the differences in terms of rationality, self-acceptance and perfectionism were analyzed according to the body weight of the participants, noting that there are marked differences among them.
Thus, the level of rationality and self-acceptance was lower in women with higher body weight, while the level of perfectionism was higher in same tier. These results show the extent to which body perception affects women's thinking and feelings in the postpartum period, when social pressure and multiple roles intervene on their well-being.
The results obtained through regression and mediation analyzes showed that self-acceptance is negatively associated with both depression and anxiety, rationality is also negatively associated with both depression and anxiety, and perfectionism mediates the relationship between rationality and depression, but not the relationship between rationality and anxiety.
Our measurements took place three months after birth, when women begin to re-find their "functions" inside family. Beyond the priority role of mother of the baby, the role of mother of the other children returns to the center of attention, where it exists, and also the role of wife and the role of attractive woman. This "return" to pre-pregnancy life is accompanied by emotional feelings as strong as those related to pregnancy. Women usually want to return to their previous physical shape, to have a slim and harmonious body, to be liked by those around them. Against a background of weight gain, sometimes extremely high, self-acceptance may decrease markedly, and patterns of irrational ideas can reach alarming levels, thus leading to low rationality. All these constitute the fertile ground for the development of depressive-anxious symptoms, with the deterioration of the woman's well-being and of the entire family context.
The strong association between rationality and depression/anxiety, as well as between self-acceptance and depression/anxiety can be alarm signals that must be addressed as soon as possible so that the mental health of women after birth will not deteriorate irreversibly.
Perfectionism, strongly fueled by the pattern of irrational thoughts, is significantly associated with depression, but not with anxiety. The woman can consider that the right solution to solve the unhappy situation in which she finds herself is to give up the fight, to any means to become again what she was before. The multitude of dysfunctional thoughts she faces turns into a maladaptive perfectionism that leads to toxic comparisons, the woman often positioning herself on the lower places of an "unattainable" ranking of "beauty". Although studies that looked at postpartum depression and anxiety looked less at the psycho-cognitive factors associated with them, there are a limited number of studies that have yielded similar results to ours. Thus, Wittkowski et al. (2016) showed that postpartum depression is not associated with antenatal socio-demographic and contextual factors, but rather with women's irrational beliefs and the perfectionism fueled by these beliefs. Sweeney and Fingerhut (2013), in a study involving 46 pregnant women, showed that low levels of self-acceptance, but not perfectionism, are associated with depressive symptoms.
In the context of the present study, the low level of rationality and self-acceptance, as well as the high level of perfectionism have as a starting point the weight level, so we can argue that body perception is very important in tracing women's beliefs, attitudes and behaviors and also in the manifestation of depressive-anxious symptoms not only during pregnancy, but also postpartum.

Limitations and future research directions
The present study was attended by women, mostly from Bucharest and Ilfov with a great probability of adherence to urban culture, in which the physical appearance and social customs regarding their own image are possibly different from those in other geographical areas of the country, in smaller cities or in rural localities. It is an aspect that could be a direction for future research, by including a more diverse sample from a geographical and cultural point of view.
Also, the number of participants was relatively small, leading to the assumption that increasing the sample size could reduce the sampling error. For reasons related to the internal regulations of the medical facilities, self-reporting questionnaires distributed online this time were used for data collection, which makes possible the existence of a self-reporting bias. In our future studies we will take into account another set of variables that can more accurately explain the variation of depressive-anxious symptoms, but we will also ensure that a more rigorous data collection will be done, possibly at different times.

Practical implications
The postpartum period represents for the woman who has just become a mother a period marked by multiple changes and reconfigurations of her whole life. The appearance of the newly born child in the family, the change in the rhythm of activities, the new responsibilities related to motherhood in general, all these predispose to significant pressures. To these are often added pressures of a psycho-cognitive nature such as thoughts and concerns about the child's health, parental effectiveness or the resumption of pre-pregnancy social roles. During this period, the woman wants to become attractive again, to regain her original shape, to erase any traces left by pregnancy on her body. As long as the shape and size of the body remain "dissatisfying" for the woman, she will be prone to manifest minor or major mental disorders, culminating in depression and anxiety.
In the postpartum period, we recommend that women create an existential equilibrium, an optimal balance between mother's life and wife's life, by trying to cover as much of the responsibilities of these roles as possible. This is not an easy task because she often takes care of the baby, breastfeeds her and generally organizes the time according to the baby's rhythm. Thus, the woman needs sustained support from the family, and if this support is difficult to obtain, we recommend looking for it in specialized support groups. These groups, moderated by psychologists, can come to support the new mothers to help them resume their pre-pregnancy lifestyle. The purpose of these groups is to normalize the seemingly dramatic situation that women believe they are going through, to diminish dysfunctional patterns of ideas, to increase rationality and self-acceptance, and to diminish maladaptive perfectionism.
Women must be supported to return to a normal, complete and meaningful life in order to maintain their emotional balance and to minimize the impairment of their well-being. Motherhood must be perceived as a goal of a woman's existence in itself, with good and bad, with costs and benefits.
Women can be helped to learn what are the best ways to regain their pre-pregnancy forms, which is the most appropriate diet for their lifestyle, how to combine daily responsibilities with moments strictly for themselves (walks, mindfulness, relaxation).
At the same time, when depressive-anxious symptoms are strong, intervention programs based on cognitive-behavioral techniques can be developed to reduce irrational patterns of ideas, to increase self-acceptance and self-compassion and to reduce perfectionism.