ACT + PPA

Behavior science and its applications to managing anxiety

Photo by Jenna Norman on Unsplash

I hesitated to share my postpartum anxiety (PPA) story because it’s deeply personal—and because it isn’t over. But if my story and the tools I’ve learned help even one person, it’ll be worth it. (And if it resonates with you, I’d love to hear from you!) Everyone’s experience with PPA is different. For me, it revolves around my son’s sleep—or lack thereof—and how that affects my own.

I had an incredibly easy pregnancy. It was so smooth that friends and colleagues envied my experience. Sure, there were constant bathroom trips and the occasional heartburn, but overall, I felt great. And I got the BEST sleep of my life during those nine months. Little did I know just how rude of an awakening I was going to get.

My husband and I prepared as much as we could for L’s arrival, our first child, but nothing prepared us for the complexities of baby sleep. I expected sleepless nights, sure—but I didn’t fully understand what that would mean. I thought, I pulled plenty of all-nighters in college; I’ll be fine. Spoiler: I was not fine. 😂😭

The newborn phase wasn’t too bad. I was recovering from a c-section, but my husband was incredibly supportive with wake-ups and feedings. L would nurse and go right back into his bassinet, easy as could be. But what I didn’t know was that the newborn sleepiness eventually wears off. I didn’t realize that as babies develop, their growing awareness of their surroundings can make sleep so much harder.

Looking back, there are so many things I wish I had known prior. I wish I had understood that baby sleep is ever-changing, that a good sleeper in one phase might struggle in the next. I wish I’d known how much their temperament impacts their sleep—and that L, by many definitions, would be categorized as “difficult.” I wish I’d known about failed transfers, the Moro reflex, false starts, regressions, split nights, connecting sleep cycles, missed sleepy cues, overtiredness, growth spurts, developmental leaps, low vs high sleep needs, sleep associations, caregiver preference, and all the other “fun” sleep considerations.

Most of all, I wish I’d known that these things are biologically normal. At the very least, I could have mentally prepared myself. But even with that knowledge, I don’t think I would have been emotionally prepared. I often found myself crying in frustration, only to feel guilty for being frustrated in the first place.

As a behavior analyst, I know how empowering it is to have proactive strategies in place when challenges arise. But in this area, I had none. I felt powerless, incompetent as a mom, and deeply disconnected from my pre-motherhood identity.

I love this tiny human so much. But sleep consumed my life. I obsessed over it, spending so much time scrolling through Facebook groups, Reddit threads, Google searches, baby app forums, and research articles in search of answers to control what I inevitably couldn’t, all while holding my son to sleep. I clenched my jaw before every transfer, bracing for the possibility of failure. Will this transfer work? How long will I have to try again? Will he sleep? Will I?

It wasn’t until my jaw started aching throughout the day that I realized how deeply this anxiety had taken root. In behavior analysis, we often talk about how internal experiences manifest in observable behaviors. For me, it was jaw clenching and obsessive reading about baby sleep. I even found myself snapping at door-to-door salesmen and at my dog when L’s successful naps were interrupted during the day. I knew it was time for a change.

We were clear about two things: we didn’t want to sleep train (e.g. CIO, etc.) and we didn’t want to co-sleep. We wanted to prioritize connection and responsiveness, while keeping L in his own safe sleep space. So I sought therapy to address my anxiety and learn how to better support both my baby and myself.

I was already familiar with ACT (Acceptance and Commitment Therapy) from working in the ABA field, but I hadn’t used it much in practice as a provider. Understanding how effective it can be, I wanted a therapist who had ACT as one of their core competencies so I could learn more about it and apply it to myself.

ACT is an evidence-based therapeutic approach rooted in behavior analysis. It is grounded in the principles of Relational Frame Theory (RFT), a behavioral account of human language and cognition. ACT focuses on increasing psychological flexibility—the ability to adapt to challenges, align behavior with values, and take meaningful action, even in the presence of difficult thoughts and emotions. By addressing behavior through a functional, contextual lens, ACT aligns with the core philosophy of behavior analysis while extending its application to internal experiences such as thoughts, feelings, and memories. Here’s how I’ve been learning to apply its six core processes to navigate my PPA:

1. Cognitive Defusion

Instead of being consumed by unhelpful thoughts, I practice distancing myself from them. When I catch myself thinking, He’s never going to sleep; I’ll be here all night, I remind myself: It’s just a thought, not a fact. Sometimes, I even say aloud, I’m noticing the thought that… to create space between myself and the worry.

2. Acceptance

This was a big one for me. I’m learning to make room for uncomfortable emotions instead of fighting them. When frustration bubbles up after multiple failed transfers, or when L struggles to resettle after a night wake, or when I realized 2 hours passed and I’m still not sleeping (etc., etc., etc.), I let myself acknowledge it without judgment: This is hard right now, and it’s okay to feel this way. Fighting emotions only drains more energy.

3. Present Moment Awareness

Anxiety often pulls me into “what if” spirals: What if he wakes up again? How will I function tomorrow? Instead, I bring my focus to the here and now—the rhythm of my baby’s breath, the feel of his sleep sack. Staying present and noticing what my senses are sensing grounds me.

4. Self-as-Context

Anxiety can feel all-consuming, but I remind myself: I am not my anxiety. I’m a person experiencing it. This reframe helps me see the bigger picture and not get lost in the feeling.

5. Values Clarification

When anxiety drives me to perfectionism, I pause to reflect on what truly matters: creating a calm, nurturing environment for my baby. Focusing on my values helps me make decisions rooted in love, not fear.

6. Committed Action

Even when it’s hard, I’m learning to take actions aligned with my values—like sticking to our bedtime routine. It’s not about getting it perfect; it’s about progress and consistency.

ACT has been a lifeline. It hasn’t erased my PPA, but it’s helping me manage it especially during sleep regressions when I feel that my anxiety is more intense (we’re experiencing one now as I write this). I’ve stopped clenching my jaw and replaced obsessive reading about sleep with writing for this Substack, reading thoughtful pieces on other topics, and focusing on growth as I learn more about this role L calls “Mama.” 🥺

If you’re struggling with PPA—or any kind of anxiety—know that you’re not alone. These tools aren’t a magic fix, but they can help you navigate the storm. And if any of this resonates with you, please let me know in the comments or send me a DM. 🫶

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Disclaimer:

These strategies are not a substitute for individualized professional medical, behavioral, or mental health advice. If challenges persist, consider seeking support from a behavior analyst (that’s me!), therapist, or other qualified professional.

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