Optimising mental health and wellbeing in aphasia

People with aphasia are highly susceptible to mental health concerns with up to 44% experiencing anxiety and 56% experiencing depression at any one time after stroke.

Failure to provide appropriate psychological management of these concerns not only causes avoidable suffering and poorer rehabilitation outcomes, it also impacts on the Australian healthcare system and economy due to associated increased length of hospital stays and greater use of healthcare in the community.

Stroke Foundation audits of rehabilitation services since 2008 show that the mental health needs of Australian stroke survivors with aphasia are consistently neglected.

We aim to bridge these gaps by investigating:

  • modified cognitive behaviour therapy (CBT) to manage mental health in people with aphasia
  • provision of peer led community aphasia support and
  • stepped psychological care.

Modified cognitive behaviour therapy to manage mental health in aphasia

Behavioural activation may be effective in managing mood but further research is warranted, including the exploration of other psychological therapies that have potential to treat mood disorder in aphasia after stroke.

Chief Investigator (CI) Kneebone has already demonstrated the potential of relaxation training as a first line treatment for anxiety and depression in those without aphasia post-stroke. However, to date Cognitive Behaviour Therapy (CBT), one of the most effective of psychological therapies, is yet to be proven in people with aphasia after stroke. A CBT modified for those with stroke (CBT-S) has been proposed by CI Kneebone, but so far it remains untested.

Project aim

To establish the feasibility of a modified CBT to manage mental health in aphasia.

Moving toward peer-led community aphasia support services

People with stroke-related aphasia have difficulty engaging with general stroke groups. Those who try are frequently dissatisfied and often stop attending. Specific community support services can address the negative impacts of chronic aphasia, but fewer than 1% of Australians with aphasia have access. Peer-led groups with professional consultative support in a hub-and-spoke model may offer a feasible and cost-effective solution.

Chief Investigator (CI) Rose’s research has determined:

  • range, scope, and frequency of current practices in community-level aphasia support services
  • components of clinically effective services
  • enablers and barriers to development and maintenance of aphasia support services
  • consumer needs. In Phase I research we established effects of two models of community aphasia support (Speech Pathologist-led and joint Social Work- and Speech Pathologist-led).

We now need to investigate the feasibility and effects of peer-led groups supported by a hub of expert training and support.

Project aims

  1. To investigate the feasibility of a peer-led aphasia group program.
  2. To investigate the efficacy of peer-led community aphasia programs in a hub-and-spoke model

Progress

This project has commenced and we are currently seeking ethics approval.

Participants

We are seeking people with aphasia more than six months after stroke who are living in the community to join our first peer-led group.

Please contact us for more details.

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Stepped psychological care for people with aphasia: a feasibility study

To address scarcity of resources Chief Investigator (CI) Kneebone proposed a multidisciplinary framework for stepped psychological care after stroke. Such models are based on increasing levels of tailored intervention, at levels according to need. CI Rose, Associate Investigator (AI) Worrall, and Postdoctoral fellows Ryan and Baker have adapted and described stepped psychological care for depression in aphasia based on evidence from interventions.

Most current evidence supports level one and two interventions, such as relaxation therapy and motivational interviewing. However, the efficacy of delivery by rehabilitation stroke professionals as a systematic and packaged service has not been evaluated.

Project aim

To determine requirements for a study to establish the effectiveness of level one and two stepped care for mental health in aphasia.

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