After a person has a stroke, a neurological condition in which the blood supply to a part of the brain becomes disrupted, she may experience emotional changes. For example, the U.S. Department of Health and Human Services noted that up to one-third of patients who survive having a stroke suffer from post-stroke depression. Patients with post-stroke depression may experience social withdrawal, trouble sleeping, fatigue and lethargy. Changes in eating patterns may occur, which result in either weight gain or weight loss. Other symptoms of post-stroke depression include irritability and suicidal thoughts.
Patients with post-stroke depression may take antidepressants or attend psychological therapy to cope with their symptoms. With psychological intervention, studies have looked at different techniques that may be more effective with stroke patients. In 2009, a study funded by the National Institute of Nursing Research investigated the efficacy of an intervention called Living Well with Stroke on post-stroke depression. That study included more than 100 stroke survivors, who either received the counseling intervention or usual post-stroke care; patients receiving the Living Well with Stroke intervention had nine counseling sessions, which occurred over two months, with a stroke rehabilitation nurse who taught problem-solving skills and help improve mood. The press release from the National Institutes of Health reported that immediately after treatment, 47 percent of patients in the intervention no longer met the criteria for depression compared to 19 percent of the control group; one year later; 48 percent of the intervention group no longer met criteria, compared to 27 percent of the control group.
In a new study published in the journal Stroke: Journal of the American Heart Association, researchers looked at whether a type of therapy called motivational interviewing would help with post-stroke depression. Maryland's Department of Health and Mental Hygiene defined motivational interviewing as “a directive, client-centered counseling style of eliciting behavior change by helping clients to explore and resolve ambivalence.” A mental health professional conducting motivational interviewing uses several different strategies to evoke behavioral changes in the patient. For example, the mental health professional may use open-ended questions, reflective listening, decision balancing and affirmations.
The study published in Stroke included 411 patients who were on a stroke unit, with more than half of the participants being men. Half of the participants were assigned to the motivational interviewing intervention, in which they received therapy with either a nurse or an individual with a psychology degree. The participants in this intervention attended 4 sessions that lasted 30 to 60 minutes; the therapy began two to four weeks after they had had the stroke. Assessment of mood was done before the intervention and again at 12 months. The press release from the American Heart Association reported that after one year, 48 percent of the participants in the motivational interviewing group had a normal mood, compared to 37.7 percent of participants who did not receive any therapy. The researchers also looked at the death rate of participants: 6.5 percent of participants in the intervention passed away, compared to 12.8 percent in the non-therapy group; they did not investigate what the cause of death was in each patient who passed away.
References
National Institute of Neurological Disorders and Stroke. Post-Stroke Rehabilitation Fact Sheet. National Institutes of Health, 2011. Web. 13 July 2011
http://www.ninds.nih.gov/disorders/stroke/poststrokerehab.htm
U.S Department of Health and Human Services. A Brief Behavioral Intervention Can Reduce Depression in Stroke Survivors. NIH News, 6 August 2009. Web. 13 July 2011.
http://www.nih.gov/news/health/aug2009/ninr-06.htm
Department of Health and Mental Hygiene. Motivational Interviewing. State of Maryland. Web. 13 July 2011
http://fha.maryland.gov/pdf/ohpetup/MI_resource.pdf
Guided Self-Change Clinic. Motivational Interviewing Strategies and Techniques: Rationales and Examples. Nova Southeastern University, 2008. Web. 13 July 2011
http://www.nova.edu/gsc/forms/mi_rationale_techniques.pdf
The 12-Month Effects of Early Motivational Interviewing After Acute Stroke http://stroke.ahajournals.org/content/42/7/1956
Reviewed July 13, 2011
by Michele Blacksberg R.N.
Edited by Alison Stanton