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Indiana University School of Medicine
Indiana University School of Medicine
Faculty Research Labs

Perinatal Traumatic Stress Lab

Reducing traumatic stress for pregnant and postpartum women at IU School of Medicine and IU Health

We are passionate about helping pregnant and postpartum individuals. For many women, the perinatal period can include new mental health concerns or existing symptoms getting worse. This can especially be true if they have a history of difficult experiences during childhood or other traumatic experiences, especially during the perinatal period. Ensuring well-being in pregnancy and the postpartum period is important for the parent's health, the child/children’s health and the health of the whole family. We offer parents opportunities to participate in ongoing treatment research studies and provide clinical services in our Perinatal Traumatic Stress Clinic.

Research

Ongoing Studies

We are currently recruiting pregnant women and postpartum women who delivered in the last 12 weeks that have a history of trauma exposure and/or posttraumatic stress disorder (PTSD).  In this study, we want to learn if we can help perinatal women move forward from past traumatic experiences using Narrative Exposure Therapy (NET). NET helps people share their stories with a therapist who helps them understand how the experiences affected them through free virtual individual therapy (6-8 sessions). Recruitment begins early September, and participants will be paid for completing questionnaires about their experiences.

To learn more, or to participate, please visit our study's website.

ClinicalTrials.gov Registration: NCT07175025
OSF Pre-Registration

We are currently gathering information on a measure designed to assess several difficult or stressful things that sometimes happen during pregnancy or postpartum. Participants are asked to indicate if various obstetric events happened to them (e.g., first trimester miscarriage, serious childbirth/postpartum complication), to describe briefly what happened, how often it happened, and how stressful/ traumatic the event was at the time.

Traumatic childbirth experiences are characterized by overwhelming negative emotions and distressing reactions, leading to short and/ or long-term negative effects on a person’s health and wellbeing. Traumatic birth experiences are extremely common with one in three and up to 45% of women reporting that their birth experience was traumatic. One of the biggest risk factors is poor communication with medical providers. To address this, our current study is aiming to reduce the trauma that can be associated with birth. Our ongoing study measures how the following interventions affect the birth experience:

  • Providing psychoeducation at multiple time points on birth options and how to handle birth trauma if it occurs 
  • Asking patients and providers if they considered birth to be traumatic and if there was a conversation to talk about it afterwards.
  • Standardizing the provider debrief after a potentially traumatic birth experience 
  • Assessing the birthing partner’s perception of the birth and if they personally experienced it as traumatic
  • Providing self-guided resources and mental health resources in the immediate postpartum period to be available if birth trauma is causing significant distress 
  • Assessing outcomes at 6-weeks postpartum, especially around PTSD and depressive symptoms as well as bonding with the baby 

Upcoming Projects

Mental illness is a leading cause of maternal mortality and a common complication during the perinatal period. Women with adverse pregnancy outcomes or extended inpatient stays face increased mental health risks. Specialized psychiatric care, including therapy and early screening, significantly improves outcomes like depression, anxiety, and suicidal ideation. Despite strong evidence, access to perinatal psychiatric services remains limited due to systemic and financial barriers. Collaborative care models have shown promise in improving access, quality, and cost-effectiveness. This project aims to establish a collaborative mental health care program at Riley Maternity Tower to support hospitalized perinatal patients experiencing medically complex conditions.

This project will pilot Written Exposure Therapy (WET) in a virtual format to treat postpartum PTSD (PPTSD) in individuals who experienced adverse pregnancy outcomes. Using the ORBIT model, we will refine WET to enhance PPTSD symptom reduction and improve maternal-infant bonding targeting emotional regulation, mindfulness, and breathing. The study will integrate health technology to monitor real-time emotional and behavioral data, aiming to increase accessibility and precision. This work will address critical gaps in maternal mental health care and lay the foundation for scalable, evidence-based interventions aligned with national priorities in reproductive and infant health.

Completed Studies

The research on trauma exposure and PTSD in rural pregnant individuals is extremely limited. No interventions for perinatal PTSD have ever been systematically studied in rural settings. We partnered with the Logansport Memorial Hospital Women's Health Center, an obstetrics clinic that serves rural-dwelling perinatal individuals in north central Indiana, to screen for trauma exposure and PTSD symptoms. Of the over 400 women screened, over half endorsed trauma exposure and about one in four trauma-exposed patients scored above clinical threshold for probable PTSD (≥3 on the PC-PTSD-5). This high amount of trauma and subsequent PTSD symptoms suggest more prevention, assessment, and treatment efforts are needed in rural areas. 

Funding: Indiana Clinical and Translational Sciences Institute, Indiana State Department of Health

There is often high dropout from treatment for PTSD, especially among those who have experienced chronic or multiple traumatic events. One increasingly popular PTSD treatment delivery model targeting treatment retention is intensive treatment delivery. Our study examined the feasibility, acceptability, and preliminary efficacy of intensively delivered NET to a highly traumatized sample (HI-NET). Our sample (N =8) participated in daily NET sessions for one week and completed assessments at baseline, 1-week post-treatment, and 1-, 3-, and 6-month follow-up timepoints. We found that HI-NET was feasible, with all participants attending all sessions. Participants reported that they liked the intervention and showed significant reductions in PTSD symptoms, depressive symptoms, the frequency and intensity of dissociative symptoms, and dysfunctional trauma-related cognitions. In conclusion, after only 6 daily sessions delivered across one week, participants experienced a significant decrease in PTSD symptoms that remained over time. HI-NET is feasible, acceptable, and efficacious, yet larger clinical trials with more diverse samples are needed. 

Publication: Miller, M.L., Ward, M. J., & Meyer, D. J. (2024). Intensive Narrative Exposure Therapy for Posttraumatic Stress Disorder: A one-week intervention. Violence and Victims. Dec 5:VV-2024-0057.R1. doi: 10.1891/VV-2024-0057.

PTSD symptoms are associated with poorer direct and downstream health outcomes for reproductive-aged individuals. There is limited literature targeting treatment of PTSD symptoms during reproductive time periods, especially the preconception period, yet effective and acceptable interventions are needed. We conducted an open pilot feasibility study of a 4-week virtual Acceptance and Commitment Therapy (ACT) psychotherapy group for trauma-exposed reproductive aged women (N =8, two cohorts)with PTSD. We found high levels of acceptability and feasibility, with most participants (87.5%) attending most sessions (≥ 75%). Participants showed clinically meaningful reduction in PTSD symptoms (≥10 points on PTSD Checklist for DSM-5 (PCL-5)) from baseline to post-intervention and follow-up. Our study was the first to look at a group intervention to reduce PTSD for individuals in the preconception period. Our protocol was acceptable, feasible, and efficacious, although there were challenges to consider for future tailoring. 

Funding: American Psychological Foundation’s 2019 Division 49 Group Psychotherapy Grant

Publication: Danson, L., Ward, M.J., Jiang, L.J., & Miller, M.L.(In press). Posttraumatic Stress Disorder in the preconception period: An open pilot feasibility study. Maternal Health, Neonatology and Perinatology

Team members

Research Team

Director
59677-Miller, Michelle

Michelle L. Miller, PhD

Assistant Professor of Psychiatry

Michelle Miller, PhD, is an assistant professor and licensed clinical psychologist in the IU School of Medicine Department of Psychiatry. She serves as the primary investigator of the Perinatal Traumatic Stress Lab at IU School of Medicine as well as the director of the IU School of Medicine Perinatal Traumatic Stress Clinic. Her research interests focus on how reducing perinatal traumatic stress may improve maternal mental and physical health outcomes, such as reducing perinatal complications and improving overall functioning, which can ultimately enhance family well-being across the lifespan.

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68254-Williams, Tiffany

Tiffany Williams, PhD

Assistant Professor of Psychiatry

Dr. Williams is an assistant professor and a licensed psychologist in the Department of Psychiatry in the IU School of Medicine. She specializes in mood, anxiety, trauma and other psychiatric disorders. Dr. Williams is the director of the Perinatal-Postpartum Mental Health Clinic (P2MHC), where she provides therapy to women and birthing persons experiencing perinatal and postpartum mental health conditions. In addition to her clinical work, Dr. Williams oversees a training clinic, offering clinical supervision to psychology interns and practicum students. Her research focuses on (1) adapting, evaluating and implementing evidence-based treatments for high-risk perinatal and postpartum populations, and (2) investigating social determinants of health and effects on Black women’s health and other marginalized groups.

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Clinical Psychology Postdoctoral Students

Clinical Psychology Interns

Clinical Psychology Practicum Students 

NEXT Study Therapists

  • Ashley Bocanegra
  • Emma Cleary, BA
  • Lindsey Fisher-Fox, BS
  • Melissa Liu, PhD
  • Mahogany Monette, MS
  • Sahiba Singh, MA
  • Allison Sylvester, BSN, RNC OB

Research Coordinators

Neva Brown

Neva Brown, BA

Lead Coordinator

Rubab Asad

Rubab Asad

LHSI Intern

Ellie Cornette

Ellie Cornett

UROP Intern

Rilyn Wonnell

Rilyn Wonnell

Former LHSI Intern

Lab Publications

Select publications:

  • Danson, L., Ward, M.J., Jiang, L.J., & Miller, M.L.(In press). Posttraumatic Stress Disorder in the preconception period: An open pilot feasibility study. Maternal Health, Neonatology and Perinatology.

  • Miller, M.L., Wasson, R., Jiang, L.J., Ward, M., Meyer, D., & Haas, D. (In press). Narrative Exposure Therapy: Expanding virtual treatment of Posttraumatic Stress Disorder to the postpartum period. Journal of Aggression, Maltreatment & Trauma.

  • Monette, M. A., Minor, K.S., Ward, M.J., & Miller, M.L. (In press). Unveiling the intersection: Dissociative and psychotic-like experiences among a trauma-exposed clinical sample including postpartum women. Psychological Trauma: Theory, Research, Practice, and Policy.

  • Williams, T. R., Sanders, S. M., Bass, J., Tookes-Williams, K., Popplewell, R., Hooper, V., & Garcia-Aguilera, C. (2025). Investigating the effects of age and racial identity on the relationship between Black women’s body image and psychological health. Women & Therapy, 1–23. https://doi.org/10.1080/02703149.2025.251501.

  • Miller, M.L., Ward, M. J., & Meyer, D. J. (2024). Intensive Narrative Exposure Therapy for Posttraumatic Stress Disorder: A one-week intervention. Violence and Victims.

  • Hinton-Froese, K.E., Powers, V.A., Richards, S.R., & Miller, M. L. (2024). Treating the trauma-based psychological sequelae of a COVID-19 related hospitalization: Two case studies of patients who experienced delirium. Cognitive and Behavioral Practice.

  • Miller, M.L., Dupree, J.C., Monette, M., Lau, E., & Peipert, A. (2024). Health Equity and Perinatal Mental Health. Current Psychiatry Reports, 26(9), 460-469.

  • Peipert, A., Ward, M. J., & Miller, M.L. (2024). Narrative Exposure Therapy for a traumatic birth experience with the non-birthing parent: A single case study. Cognitive and Behavioral Practice.

  • Williams, T. R., Bass, J., Swain, M., Jennings, D., Wyatt, W.*, Foster, S. (2024). Unpacking the stress of 2020: Black Americans cope with systemic trauma. Clinical Psychology & Psychotherapy, 31(1), e2944. https://doi.org/10.1002/cpp.2944.

  • Sanders, S. M., Williams, T. R., Gao, F. , Muwele, C. & Mitchell, T. (2024). The relationship between the imposter phenomenon and psychological distress in Black graduate students: Examining moderating effects of perceived social support. Journal of Black Psychology. https://doi.org/10.1177/00957984241309166.

  • Williams, T. R., Erving, C.L., Gao, F., Mitchell, T., Muwele, C., Martin, R., Blasingame, M., Jennings, D.* (2023). Do resilience and social support moderate the association between race-related stress on Black women’s reports of trauma symptoms? Race & Social Problems, 16(2), 198–210. https://doi.org/10.1007/s12552-023-09401-x.

  • Williams, T. R., Erving, C. L., Frierson, W., Gao, F., Bass, J., Martin, R., & Mitchell, T. (2023). Facilitating healing for Black Women experiencing gendered racism and traumatic stress: The moderation of psychosocial resource. Journal of Women’s Health & Development 6, 75-88. https://doi.org/10.26502/fjwhd.2644-288400110.

  • Williams, T. R., Autin, K., Jennings, D.*, Garcia, R.*, Herdt, M.*, Pugh, J.*, & Roberts, T.* (2023). Predicting decent work for US Black workers: Examining Psychology of Working Theory. Journal of Career Assessment, 31(4), 756-772. https://doi.org/10.1177/10690727221149456.

  • Williams, T. R., Walker, T., & Wyatt, W. L.* (2022). Conceptualizing racism through a systemic trauma lens: Impacts on Black college students. Journal of Psychotherapy Integration, 32(1), 49-63. https://doi.org/10.1037/int0000206.