Aphasic stroke patients' mood lifted by behavioral therapy

Who cares about lifting their mood? Did they have better recovery? Don't you know to look at endpoints, not intermediate steps? What about the proven research that shows anti-depressants promote better recovery, less damage?
http://www.clinicalpsychiatrynews.com/news/neurology/single-article/aphasic-stroke-patients-mood-lifted-by-behavioral-therapy/15aed1fa5f73f594565866c7351c64f5.html

People with aphasia and low mood after a stroke can benefit from behavioral therapy, the results of a multicenter, randomized controlled trial suggested.

In the Communication and Low Mood (CALM) study, patients who were in the behavioral therapy group reported better mood, as measured by the 21-item hospital version of the Stroke Aphasic Depression Questionnaire (SADQ) at both 3 and 6 months’ follow-up. Mean SADQ scores in the behavioral therapy versus the usual care arm were 16.9 and 19.2 at 3 months (P less than .05) and 17.4 and 21.9 at 6 months (P = .002), with a lower score indicating a better level of mood.

Depression is estimated to affect up to a third of patients after a stroke and can have detrimental effects on patients’ rehabilitation. It can cause psychological distress for patients and caregivers and is linked to higher mortality.

"People with aphasia may be particularly susceptible to depression, but they are often excluded from research," Dr. Shirley Thomas said at the annual European Stroke Conference.

Dr. Thomas of the Institute of Work, Health, and Organisations at the University of Nottingham (England) noted that few studies have looked at the use of psychological interventions for depression after a stroke. The studies that have been conducted have typically excluded people with aphasia because the interventions are often talk based and require good communication skills.

"Behavioral therapy is quite a practical and concrete approach that doesn’t require intact communication skills," Dr. Thomas said. She explained that it "is based on a behavior model of depression, the idea being that people develop depression because they are not getting positive reward and reinforcement from their environment." This "fits" with having aphasia following a stroke, she commented.

The aim of the CALM study, therefore, was to compare usual care alone with usual care plus the addition of a behavioral intervention to address low mood in patients with aphasia.

A total of 511 patients who had aphasia after a stroke were screened for signs of depression, with 105 identified as having "low mood" and consenting to participate in the trial. The mean age of the enrolled patients was 67 years and 63% were men. The trial began a median of 9 months after a stroke.

The behavioral therapy involved one-on-one sessions between a patient and a psychologist in the patient’s home, with up to 20 sessions occurring over a period of 3 months. Each session lasted for 1 hour and included patient education, which involved asking patients how they spent their time, identifying mood-lifting activities, scheduling these activities into each week, helping patients break down large tasks into graded steps, and giving people tasks to complete before the next session. Therapy was tailored to patients’ needs and guided by a manual specifically designed for the trial, which outlined all the various methods that could be used.

Two main instruments were used to assess patients’ mood in the trial: the SADQ and the ‘sad’ item of the Visual Analog Mood Scales (VAMS). Other measures used included the Visual Analog Self-Esteem Scale (VASES) and the Nottingham Leisure Questionnaire (NLQ).