Treating the Maternal Stress Response in Group Therapy

Perinatal women undergo various levels of increased stress during pregnancy, birth and the postpartum. The first year of parenting an infant adds additional demands on the mother to cope with infant feeding and sleep patterns. Mothers in this therapy group reported increased depressive, anxious and body dysmorphic symptoms since the birth of their one-year-old infants. Half of the members reported increased marital discord. The major goal of therapy in this group is to alter the neurological pathways of the mothers from over activated sympathetic and limbic system functioning to increased parasympathetic and whole-brain functioning through creativity, movement, empathy and play and reduce mental health symptoms.

Exposure to stressors increases the production of vasopressin to activate the hypothalamus-pituitary-adrenal (HPA) axis, enabling a fight, flight or freeze response. “Physiological and anatomical processes responsible for individual adaptation may enhance survival, but the susceptibility of these systems to change also leaves these same systems vulnerable to modifications that in a later context may be maladaptive (Carter, 2003, p. 383)”.  The health risks associated with chronic HPA axis reactivity include transgenerational vulnerabilities, including those seen in African-Americans as a result of structural racism (Kuzawa, 2008).

Oxytocin is similar to vasopressin in structure, but it’s function in reproduction and lactation is antagonistic to vasopressin. Research has shown that oxytocin can decrease the reactivity of the HPA axis in mother rodents, and produce increased nurturing behavior toward their young, having long-lasting positive effects on developmental outcomes (Carter, 2003).  In this group, we co-create a safe and nurturing space, inducing the release of oxytocin through social connection during experiential psychotherapy sessions. Porges argues that safety is a prerequisite to birth, nurse and care for infants and to elicit the social engagement system (2003).  Following is an example of one of our experiential processes designed to utilize nature, art and sharing to promote restoration and resiliency.

           Two dyads from my Creative Mothers therapy group participated in the experiential. The group meets evenings on the eastside of Austin in a studio that is nestled into a garden with meandering borders, wildflowers and perennials under the shade of old oaks. The garden has been a resource for our group over the course of our meetings, and the clients have consistently expressed a sense of peace from its presence. Thus, the idea of “allowing nature to become the guide for mothers to find inner peace” emerged over the course of my work with them. I was delighted to discover similar ideas in the international literature on nature therapy to support my hypothesis. According to Berger and McLeod (2006), nature becomes a therapeutic partner free from the power and control of the therapist. Ecopsychology, a growing subfield in clinical psychology, seeks to find evidence and therapeutic frameworks for the long-held belief that nature heals the psyche.

I gave the following instructions: Go out to the garden and see what draws your interest. Stay with your connection to that object or being for a period of about five minutes and notice yourself in relation to that object: how you feel, what information you receive from “being with” that object or being.

I observed my group members seeking inspiration in the garden, wandering and lingering until they each discovered an object or being on which (or with whom) to focus. With wide-eyed curiosity, acute observation and/or symbiotic relation, group members seemed to join with their surroundings in a manner that appeared embodied in nature. Squatting , stooping and reclining were common physical positions. Watching them, I felt a sense of wonder emerge from within myself as well as radiating connection to the groups’ process.

I gathered each dyad together at the end of the brief session with nature and we walked together back into our studio. Oil Pastels and textured paper were provided with the following second set of instructions: Record your sense of the experience you had in nature with an image. After the image is complete, ask what the object or being represents, what message it has for you. Write this message on your paper.

            During this part of the task, group members drew while in a sitting position on their yoga mats. Their work seemed intrinsic, focused and absorbing, much like Csikszentmihalyi’s Flow (1990). My goal was to facilitate the interaction with nature from a non-verbal sensory experience to creative visual form and verbal expression.  Group members produced individualized images and messages that included insights that were resilient and full of hope. Here are some examples:       From a bee hovering over a detailed purple drawing of a Larkspur flower: “I’m too busy to bother you.” The client reported that she was typically afraid of bees. Then she wrote, “Everything doesn’t have to have meaning. Sometimes things are just beautiful. Enjoy it; life is short”.

From a grouping of Bachelor Button Flowers, each at various stages in the life cycle: “Sisterhood: sacred feminine; gratitude in motherhood and life; baby@birth; nurturing; embracing change; branching out”

            From the canopy of a Wisteria vine: “No matter how lost you feel, your source will find you again. In fact, it already has.”

From the bees visiting a group of white flowers: “Just bee…focus, yet seems effortless…pair, duo, team…easier and more fun when in harmony”

Each member then shared their drawing and words with the group, as well as keynote aspects of their nature experiential. Sharing during the session provided an opportunity for each member to be witnessed by the group with her insights from connection with nature, and it offered observers an opportunity to learn from other members’ insights.

To further integrate and embody the lessons from nature, I loosely guided a ten-minute movement to classical guitar music using the words that group members had harvested from their interaction with nature. While observing their movement, which started low on their mats and rose to standing, I inserted guiding words to assist and encourage expansion of movement. The mothers rose at various paces to a standing position, mostly with their eyes closed. Swaying was the most common rhythms of movement, but I also saw some undulating mimicking birthing rhythms, as well as floating. One member found stasis (stillness) once she ascended to her full height, her hands branched out at hip level. Eventually, each person ended her dance in a resting pose, accessing support from the ground.


The cumulative response of nature interaction and sharing insights with the group was calming, as evidenced in movement patters. The rocking, swaying movements observed in the final (movement) phase of the experiential are indicative of vagal nerve activation. “Rocking provides an efficient and direct influence on the vagus by stimulating vagal afferent pathways via the baroreceptors. Moreover, activation of the social engagement system dampens the neural circuits, including the limbic structures that produce fight, flight or freeze behaviors (Porges, 2003).” In effect, the safety established in the group as well as the social connection among group members contribute to the inhibition of sympathetic response of the HPA through neuroception.

The decision to extend the experiential beyond the drawing and sharing component of the nature interaction was based on my clinical judgment at the time. I had witnessed hope and excitement when group members shared their insights.   Had we not continued with the amplification through dance, I would not have gathered additional evidence of peaceful embodiment from my clients’ movement.   Moreover, the clients would not have had the opportunity to “put it in their body”, or embody their resilient insights from nature. My rationale is that amplification of resiliency pathways provides greater access to the same neurological resources in the future. When timely and appropriate, interventions such as these may buffer effects of chronic stress over the course of a single organism’s lifespan that may counteract earlier risk exposures and protect their offspring from vulnerability.




Berger, R. & McLeod, J. (2006) Incorporating nature into therapy: a framework for             practice . Journal of Systemic Therapies, 56 (2), 80-94.

Carter, C. S. (2003). Developmental Consequences of Oxytocin. Physiology &            Behaviour ,79, 383-397.

Csikszentmihalyi, M. (1990). Flow: The Psychology of Optimal Experience. New          York: Harper & Row.

Kazawa, C.W. and Sweet, E. (2008). Epigenetics and the embodiment of race:          developmental origins of US racial disparities in cardiovascular health .        American Journal of Human Biology 21, 2-15.

Porges, S.W. (2003) Social engagement and attachment: a phylogenic perspective.            Annals of New York Academy of Sciences 1008, 31-47.



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Illysa Foster

Illysa is a psychotherapist, midwife, educator, dancer and author. She currently provides psychotherapy in Austin and San Marcos, Texas to individuals, groups, couples and mother-baby dyads. Also a lecturer at Texas State University, Illysa helps students prepare to provide services for children and families. Licensed as a psychological associate under the supervision of Dr. Joellen Peters, Illysa offers somatic, depth and creative arts therapies to integrate the mind/body and soul.

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