Cognitive Behavioral Intervention for Post-Stroke Depression

In This Article

Abstract

Background Post-Stroke Depression with or without Anxiety (PSDA) is a common disorder in the chronic phase of stroke. Neuropsychiatric problems, such as PSDA, have a negative impact on social reintegration and quality of life. Currently, there is no evidence-based treatment available for reducing PSDA symptoms. In the recent literature on depression in the general population it has been shown that depression complaints can diminish by cognitive behavioural therapy (CBT). In the current study, the effectiveness of augmented, activation-based and individually tailored CBT on the reduction of depression and anxiety will be investigated in patients with PSDA. Additionally, the effects on various secondary outcome measures, such as quality of life, goal attainment and societal participation will be evaluated. This study is embedded in a consortium of 4 interrelated studies on quality of life after stroke (Restore4Stroke).

Methods/design A multi-centre, assessor-blind, randomized controlled trial is conducted. A sample of 106 PSDA patients, as assessed with the Hospital Anxiety and Depression Scale (HADS depression subscale >7), will be recruited and randomly allocated to either an experimental or a control group. The experimental intervention consists of an augmented CBT intervention. The intervention is based on CBT principles of recognizing, registering, and altering negative thoughts and cognitions so that mood, and emotional symptoms are improved. CBT is augmented with direct in-vivo activation offered by occupational or movement therapists. Patients in the control group will receive a computerized cognitive training intervention. Outcomes will be assessed at baseline, immediately post intervention, and at 6 and 12 months follow up.

Discussion This study is the first randomized clinical trial that evaluates the (maintenance of) effects of augmented CBT on post-stroke depression with or without anxiety symptoms. Together with three other projects, the Restore4Stroke PSDA trial will provide novel information about the (treatment of) emotional problems and quality of life after stroke.

Trial registration Trial registration number: Dutch Trial Register NTR2999

Table 1. Content of successive phases of the augmented Cognitive Behavioural Therapy
Phase	Content
1. Introduction	Building rapport; discussing grief; psycho-education about the relationship between mood and behaviour.
2. Goal setting	Active goal setting with OT/MT.
3. CBT principles	Recognising and registration of 'hidden cognitions'.
4. CBT	Challenging and altering 'negative cognitions'.
5. Relapse prevention	Building a relapse-prevention plan with taught techniques.

Table 2. Outcome measures
	Tests
Primary outcome measure
Depression and Anxiety	Hospital Anxiety and Depression Scale (HADS)
Secondary outcome measures
Quality of Life
General	Stroke Specific quality of Life (SSQoL-12)
	EuroQuality of Life (EQ6D)
Domain specific	User-P
	Life Satisfaction questions
Post-stroke depression	Post Stroke Depression Rating Scale (PSDRS)
Goal attainment	Goal Attainment Scale (GAS)
Participation in therapy	Pittsburgh Rehabilitation Participation Scale (PRPS)
Coping strategy	Utrecht Proactive Coping Competence scale (UPCC)
Caregiver outcome measures
Domain specific quality of life	Hospital Anxiety and Depression Scale (HADS)
Subjective strain	Caregiver Strain Index (CSI)
Emotional burden	Involvement Evaluation Questionnaire (IEQ)