Psychological therapy with communication supports

5.20 People with aphasia and mood concerns with a clinical diagnosis of depression and/or anxiety should be offered psychological therapy with communication supports by a psychologist or other appropriately qualified mental health practitioner.

References:  Allida et al., 2020: Cochrane review (participants without aphasia only); Baker et al., 2024 Qual; Kneebone et al., 2016: Narrative review; Ryan et al., 2021: Systematic review of 10 studies (5 RCTs, 4 pre-post studies and 1 SCED); Thomas et al., 2019: RCT; Thomas et al., 2013: RCT; Tjokrowijoto et al., 2023 SCED

NHMRC Level of Evidence: IV

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 5.19). Those with mild/moderate symptoms should be offered psychological therapy by an appropriately trained and qualified health professional, such as a psychologist or other health professional under the supervision of a psychologist (Kneebone, 2016).  Therapies may include modified cognitive-behavioural therapy and behavioural activation (Allida et al., 2020; Baker et al., 2024; Ryan et al., 2021; Thomas et al., 2013; Thomas et al. 2019; Tjokrowijoto et al., 2023).

For people with severe/persistent depressive and/or anxiety symptoms, health professionals including speech pathologists should identify problems, offer support to the client and their family, and triage the person to an appropriately trained and qualified health professional (i.e. (neuro)psychologist, psychiatrist, and/or medical practitioner - Kneebone, 2016).

In all cases, the health professional should be competent in supporting communication for adults with aphasia. Aphasia-friendly information and supported communication strategies should be used when providing any interventions, including medication management. Ongoing support for people with severe/persistent symptoms may continue to be required once symptoms have subsided (Kneebone, 2016). 

References:  

1. Allida, S., Cox, K. L., Hsieh, C. F., Lang, H., House, A., & Hackett, M. L. (2020). Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke. The Cochrane Database of Systematic Reviews, 1(1), CD003437. DOI: 10.1002/14651858.CD003437.pub4
2. Baker, C. (2024). Aphasia Depression and Psychological Therapy (ADaPT): Perspectives of people with post-stroke aphasia on participating in a modified Cognitive Behavioral Therapy. Healthcare (Basel) 12(7), 771.
3. Ryan, B.J., Clunne, S.M., Baker, C.J., Shiggins, C., Rose, M.L. Kneebone, I.I.(2021). A systematic review of non-drug interventions to prevent and treat anxiety in people with aphasia after stroke. Disability and Rehabilitation, 44 (18), 1-10. DOI: 10.1080/09638288.2021.1925752
4. 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
5. Tjokrowijoto, P., Thomas, S., Kneebone, I., Ryan, B., & Stolwyk, R. (2024). Aphasia, Depression, and Psychological Therapy (ADaPT): A single case design evaluation of a modified Cognitive Behavioural Therapy to treat depressive symptoms in stroke survivors with aphasia. Neuropsychological Rehabilitation, 1–45. Print. DOI: 10.1080/09602011.2024.2331840