Background: While cognitive behavioural therapy (CBT) has shown effectiveness in treating depression among the general population, very little research has examined the use of CBT tailored specifically to the communication needs of stroke survivors with aphasia.
Aims: To investigate the feasibility and preliminary efficacy of a modified CBT intervention to treat symptoms of depression in individuals with post-stroke aphasia.
Methods: An ABA withdrawal/reversal single case design with concurrent multiple baselines was repeated across ten participants (4 female) with post-stroke aphasia and self-reported depression. Participants were randomly assigned a baseline length (2.5, 4.5, or 6.5 weeks), then completed 10 individual intervention sessions and a 4-week follow-up. Treatment consisted of behavioural and cognitive strategies to address depression, delivered by a clinical neuropsychologist. The primary outcome was subjective ratings of depression. Secondary outcomes were observable symptoms of depression and anxiety rated by a close other. Data were analysed visually and statistically controlling for baseline trend. Feasibility was addressed by analysing recruitment and retention rates, and adaptations. An independent rater reviewed video recordings of treatment sessions and completed fidelity ratings.
Results: During the intervention phase, five participants reported a decrease in depression ratings. Most of these participants sustained their improvement throughout the withdrawal phase, and three additional participants also showed improvement during the withdrawal phase. Close others reported a reduction in depressive and anxiety symptoms for eight participants, and this improvement was sustained for most participants. Fidelity ratings ranged from acceptable to excellent.
Conclusion: Modified CBT appears feasible and potentially efficacious for reducing symptoms of depression in people with aphasia. A randomised controlled trial is necessary to confirm these findings. Additional treatment sessions may be needed to ensure all components can be thoroughly covered. We noted discrepancies between self-rating and close other ratings of mood, and both should be retained in future studies.