Acceptance and commitment therapy (ACT) for post-stroke adjustment difficulties via telerehabilitation in a working-age man

Adjustment difficulties following a stroke are common and associated with poorer outcomes. Current systematic reviews suggest insufficient evidence for the efficacy of psychological interventions for post-stroke anxiety and/or depression. However, a recent randomised controlled trial (Majumdar and Morris, 2019) of group-based acceptance and commitment therapy (ACT) showed promise in reducing depression and increasing hopefulness and perceived health status in stroke survivors. The present case study describes the assessment, formulation, treatment and outcomes of post-stroke adjustment difficulties in a working-aged man using ACT delivered via telerehabilitation. At the end of treatment (six sessions over 2 months), the client no longer met clinical cut-off for psychological distress and depression. Furthermore, reported levels of psychological flexibility were comparable to non-clinical norms. These gains were maintained at 3- and 6-month follow-up. Outcomes from this case study support emerging evidence indicating that ACT may be an efficacious intervention for post-stroke adjustment difficulties, even when delivered via telerehabilitation. Further research investigating the mediating and moderating effects of different cognitive behavioural processes such as values and acceptance on psychological adjustment to stroke is recommended

The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10) in post-acute patients with stroke

Objective: To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores. Setting: A post-acute stroke rehabilitation ward in the East of England. Participants: A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia. Main measures: Alongside the CORE-10, the Patient Health Questionnaire – 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures. Results: To assess reliability, the internal consistency and test–retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test–retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach’s alpha) for the CORE-10 was .80, and test–retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported. Conclusions: This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke

A clinical psychology service in stroke rehabilitation: A review of five years of referrals and an evaluation of a matched care model

This article presents a review of five years of referrals to a clinical psychology service in stroke rehabilitation and evaluates the efficacy of a matched care approach for triaging referrals. Analysis showed that where referrals were triaged to one of three levels, those allocated to the highest level of priority were seen sooner and for more sessions. Where pre and post assessment across psychological intervention was undertaken, average improvement in mood showed medium to large effect sizes. The utility of a matched care model as well as service improvements based on this review are discussed

Post-stroke emotionalism; diagnosis, pathophysiology, and treatment

Background: Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect. Aim and Methods: This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment. Results: Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke–Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions. Conclusions: More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field

An evaluation of an open group for depressed mood on a stroke rehabilitation ward: three years of clinical data

Purpose: An open group intervention for stroke inpatients, based on Acceptance and Commitment Therapy, is evaluated using retrospective clinical service data. Materials and methods: Participants were included unless severely unwell or unable to provide informed consent. 117 participants attended at least two sessions in a non-controlled, repeated measures design. Two session protocols were delivered on alternating weeks by an Assistant Psychologist and Trainee Psychologist, covering values, committed action, and acceptance. Participants rated their mood each session using the Depression Intensity Scale Circles (DISCs). Results: Attended sessions ranged from 1 to 11 (Md: 2). Significant reductions in DISCs scores with medium effect sizes were found among those scoring above the cut-off for depression at baseline, Χ2(3) = 20.87, p < .001. The likelihood of scoring below the cut-off for depression did not change between participants’ first and last sessions, X2(1, N = 117) = 1.36, p = .24. The number of sessions attended did not predict outcome, rs(117) = .09, p = .33. Conclusions: Design limitations prevented inferences of clinical effectiveness, but the group met several clinical utility criteria by providing a flexible intervention on a rehabilitation ward with competing demands. We highlight the importance of contrasting findings of clinical trials with data from clinical services

Relationships among moral reasoning, empathy and distorted cognitions in men with ID and a history of criminal offending

Eighty men, spread equally across 4 groups, were recruited, including men with and without intellectual disabilities. The men were either criminal offenders or nonoffenders. Participants completed measures of moral reasoning, empathy, and distorted cognitions. The results indicated that the moral reasoning abilities of offenders with intellectual disabilities were developmentally delayed but were still more mature than those of nonoffenders with intellectual disabilities. Offenders without intellectual disabilities had less mature moral reasoning abilities than nonoffenders without intellectual disabilities. The differences may be partially accounted for by intellectual ability. The results also indicated that the relationship between empathy and distorted cognitions was mediated by moral reasoning. The findings have implications for the use of psychological interventions with offenders with intellectual disabilities

The relationships between moral reasoning, empathy and distorted cognitions amongst men with and without intellectual disabilities who have a history of criminal offending: A comparison study

Eighty men, spread equally across 4 groups, were recruited, including men with and without intellectual disabilities. The men were either criminal offenders or nonoffenders. Participants completed measures of moral reasoning, empathy, and distorted cognitions. The results indicated that the moral reasoning abilities of offenders with intellectual disabilities were developmentally delayed but were still more mature than those of nonoffenders with intellectual disabilities. Offenders without intellectual disabilities had less mature moral reasoning abilities than nonoffenders without intellectual disabilities. The differences may be partially accounted for by intellectual ability. The results also indicated that the relationship between empathy and distorted cognitions was mediated by moral reasoning. The findings have implications for the use of psychological interventions with offenders with intellectual disabilities