Suitable psychological therapies delivered with communication supports

5.19 For people with aphasia experiencing difficulties with coping and adjustment, suitable psychological therapies delivered with communication supports can be facilitated by a range of trained clinicians, including speech pathologists, to prevent the development of ongoing mood problems.

References: Attard et al., 2018: Pre-post study; Baker et al., 2018: Systematic review of 45 studies; Golding et al., 2018: RCT; Hilari et al., 2021: RCT; Kneebone, 2016: Narrative review; Northcott et al., 2021: RCT; Thomas et al., 2013: RCT; Thomas et al., 2019: RCT; Visser et al., 2016: RCT

NHMRC Level of Evidence: II

Rationale: The severity of depressive/anxiety symptoms after stroke varies and can impact the type of therapy that should be offered and by whom (Kneebone, 2016 – see also statement 5.20). For those without depressive symptoms, and/or with less severe mood concerns such as difficulties with coping and adjustment, a range of psychological therapies may be useful in preventing the development of more severe and/or ongoing mood problems for people with aphasia (Baker et al., 2018). Psychological therapies to prevent mood problems may include:

●   behavioural activation (Thomas et al., 2013; Thomas et al., 2019);
●   problem solving therapy (Visser et al. 2016);
●   relaxation therapy (Golding et al., 2018);
●   solution focused brief therapy (Northcott et al., 2021);
●   community aphasia groups (Attard et al., 2018); and
●   peer befriending (Hilari et al., 2021).

In addition to mental health professionals, other appropriately trained clinicians including speech pathologists may deliver these treatments for people with aphasia (Baker et al., 2018; Kneebone, 2016). Aphasia-friendly information and supported communication strategies should be used to support delivery of treatments. Close monitoring of mood problems is required so that more severe problems are flagged at an early stage and higher-intensity treatment can be provided if needed (Kneebone, 2016). 

References:

1. Attard, M.C., Loupis, Y., Togher, L., & Rose, M.L, (2018). The efficacy of an inter-disciplinary community aphasia group for living well with aphasia. Aphasiology, 32(2), 105-138. DOI: 10.1080/02687038.2017.1381877
2. Baker, C., Worrall, L., Rose, M., Hudson, K., Ryan, B., & O’Byrne, L. (2018). A systematic review of rehabilitation interventions to prevent and treat depression in post-stroke aphasia. Disability and Rehabilitation, 40(16), 1870–1892. https://doi.org/10.1080/09638288.2017.1315181
3. Golding, K., Fife-Schaw, C., & Kneebone, I. (2018). A pilot randomized controlled trial of self-help relaxation to reduce post-stroke depression. Clinical Rehabilitation, 32(6), 747-751. DOI: 10.1177/0269215517741947 
4. Kneebone, I. (2016). Stepped psychological care after stroke. Disability and Rehabilitation, 38(18), 1836-1843. DOI: 10.3109/09638288.2015.1107764
5. Northcott, S., Thomas, S., James, K., Simpson, A., Shashivadan, H., Barnard, R., Hilari, K. (2021). Solution Focused Brief Therapy in Post-Stroke Aphasia (SOFIA): feasibility and acceptability results of a feasibility randomised wait-list controlled trial. BMJ Open, 11(8), e050308–e050308. https://doi.org/10.1136/bmjopen-2021-050308
6. Thomas, S.A., Walker, M.F., Macniven, J.A., Haworth, H., & Lincoln, N.B. (2013). Communication and Low Mood (CALM): A randomized controlled trial of behavioural therapy for stroke patients with aphasia. Clinical Rehabilitation, 27(5), 398-408. DOI:  10.1177/0269215512462227 
7. Thomas, S.A., Drummond, A.E.R., Lincoln, N.B., Palmer, R.L., Das Nair, R., Latimer, N.R., Hackney, G.L., Mandefield, L., Walters, S.J., Hatton, R.D., Cooper, C.L., Chater, T.F., England, T.J., Callaghan, P., Coates, E., Sutherland, K.E., Eshtan, S.J., & Topcu, G. (2019). Behavioural activation therapy for post-stroke depression: The BEADS feasibility RCT. Health Technology Assessment. 23(47), 1-176. DOI: 10.3310/hta23470
8. Visser, M.M., Heijenbrok-Kal, M.H. Van ‘t Spijker, A., Lannoo, E., Busschbach, J.J.V., & Ribbers, G.M. (2016). Problem-solving therapy during outpatient stroke rehabilitation improves coping and health-related quality of life: Randomised controlled trial. Stroke, 47(1), 135-142. DOI: 10.1161/STROKEAHA.115.010961.