Home Mind & Brain Modified Cognitive Behavioural Therapy Shows Promise for Stroke Survivors with Aphasia and Depression

Modified Cognitive Behavioural Therapy Shows Promise for Stroke Survivors with Aphasia and Depression

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A recent study evaluating modified cognitive behavioural therapy (CBT) has shown promising results in treating depressive symptoms among stroke survivors with aphasia. Researchers from a number of institutions, including Monash University and the University of Technology Sydney, conducted the study, which emphasises the potential of specialised psychological interventions in addressing the complex needs of this vulnerable population.

The findings were published in the journal Neuropsychological Rehabilitation.

Depression affects approximately one-third of stroke survivors, significantly impacting their quality of life and social functioning. The condition is often exacerbated in individuals with aphasia, a communication disorder resulting from stroke that affects their ability to speak, understand, read, and write. Traditional psychological interventions, such as CBT, which focus on the “here and now” and problem-solving skills, are well-established for treating depression in the general population. But the cognitive and communicative impairments of stroke survivors with aphasia pose unique challenges that necessitate tailored interventions.

The study used a single-case experimental design with multiple baselines and a follow-up period of four weeks. The ABA withdrawal/reversal was used. It involved ten stroke survivors with aphasia who reported depressive symptoms. Following 10 individual therapy sessions with a clinical neuropsychologist, participants underwent a four-week post-intervention period.

The intervention was adapted to accommodate the cognitive and communicative challenges of the participants. It included behavioural techniques like activity scheduling and cognitive strategies such as thought modification. The primary outcome measure was self-rated depression, with secondary outcomes including observer-rated symptoms of depression and anxiety.

The findings revealed that the modified CBT was both feasible and potentially efficacious. Three participants reported a decrease in depression levels during the intervention, which was sustained for two participants. Four others showed improvement during the follow-up phase. Others of the participants also reported sustained improvements in both depressive and anxiety symptoms for six and seven participants, respectively.

Independent fidelity assessments showed that the intervention was carried out with enough skill and adherence, suggesting that this kind of customised approach can work well for stroke survivors with different levels of aphasia.

Detailed vignettes of participants highlighted the diverse experiences and outcomes of the intervention. For instance, participant JJ, a retired mental health professional with mild anomic aphasia, exhibited substantial improvements in subjective depression ratings during the baseline phase, with further gains observed during follow-up. Her progress was facilitated by her psychological-mindedness and prior experience with behavioural activation.

Another participant, II, who had moderate Wernicke’s aphasia, showed median-level improvement in mood from baseline to intervention, with gains maintained throughout the follow-up period. His wife played a crucial role in assisting with therapy tasks, which underscores the importance of involving close others in the therapeutic process.

The study’s results align with existing literature that supports the adaptation of CBT for individuals with cognitive impairments due to brain injury. The observed improvements in depressive symptoms and the feasibility of delivering modified CBT highlight the intervention’s potential in clinical practice. However, the study also faced challenges, such as the need for more flexible session numbers and the difficulty of addressing core beliefs and values in participants with severe aphasia.

The study underscores the importance of personalised treatment plans that consider individual circumstances and involve close others to support the therapy process. The use of digital tools and telehealth, particularly relevant during the Covid pandemic, also emerged as effective strategies for delivering CBT to this population.

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