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Early Talk Therapy May Help Stroke Patients Bounce Back
Date:6/24/2011

By Steven Reinberg
HealthDay Reporter

THURSDAY, June 23 (HealthDay News) -- After suffering a stroke, patients who talk with a therapist about their hopes and fears about the future are less depressed and live longer than patients who don't, British researchers say.

In fact, 48 percent of the people who participated in these motivational interviews within the first month after a stroke were not depressed a year later, compared to 37.7 of the patients who were not involved in talk therapy.

In addition, only 6.5 percent of those involved in talk therapy died within the year, compared with 12.8 percent of patients who didn't receive the therapy, the investigators found.

"The talk-based intervention is based on helping people to adjust to the consequences of their stroke so they are less likely to be depressed," said lead researcher Caroline Watkins, a professor of stroke and elder care at the University of Central Lancashire.

Depression is common after a stroke, affecting about 40 to 50 percent of patients. Of these, about 20 percent will suffer major depression. Depression, which can lead to apathy, social withdrawal and even suicide, is one of the biggest obstacles to physical and mental recovery after a stroke, researchers say.

Watkins believes their approach is unique. "Psychological interventions haven't been shown to be effective, although it seems like a sensible thing," she said. "This is the first time a talk-based therapy has been shown to be effective.

One reason, the researchers noted, is that the therapy began a month after the stroke, earlier than other trials of psychological counseling. They speculated that with later interventions, depression had already set in and may have interfered with recovery. Early therapy, Watkins has said, can help people set realistic expectations "and avoid some of the misery of life after stroke."

The report was published in the July issue of Stroke.

For the study, the researchers randomly assigned half of 411 stroke patients to see a therapist for up to four 30- to 60-minute sessions and the other half to no visits with a therapist. All of the patients received standard stroke care, the study authors noted.

During the sessions, patients were asked to talk about their future, what obstacles they thought they would have to overcome in recovery and how confident they were about solving them.

In addition, the patients were encouraged to come up with their own solutions to the problems they were going to face, Watkins explained. "It's not just talking to people in any old way," she said.

Patients with severe communication problems were excluded from the study because it would have been difficult for them to take part in talk-based therapy, Watkins added.

After a year, the patients responded to a questionnaire to see how well they were doing.

Watkins noted that the study was done only in one hospital and only with a specific therapy. Whether this approach would be useful in other hospitals or with other types of talk therapy isn't clear, she noted.

She and the other researchers also pointed out that although a larger number of patients in the control group died within the year -- suggesting a strong link between mood and death following a stroke -- further research needed to be done to examine the cause of the deaths.

Intriguingly, the therapists were not clinical psychologists, but two nurses and two people with psychology degrees. They were trained and supervised by a clinical psychologist, suggesting that other health care settings could do the same at a low cost.

Commenting on the research, Dr. Larry B. Goldstein, a professor of medicine and director of the Duke Stroke Center at Duke University Medical Center, said that "this is a promising initial study."

However, it was limited to a selected group of patients from a single hospital. "The study will need to be replicated and the generalizability of the findings established with testing in a broader range of study sites," he said.

More information

For more information on stroke, visit the U.S. National Library of Medicine.

SOURCES: Caroline Watkins, Ph.D., professor of stroke and elder care, University of Central Lancashire, U.K.; Larry B. Goldstein, M.D., professor of medicine, director, Duke Stroke Center, Duke University Medical Center, Durham, N.C.; July 2011, Stroke


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