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). [View resources link]

We then investigated the feasibility, acceptability, and preliminary efficacy of peer-led groups supported by a hub of expert training and support. Our program is called a Peer-led Hub and Spoke Community Aphasia Program. We found that: the program was highly acceptable to group members with aphasia and their family members/significant others

  • the program was feasible to run
  • for some participants, communication-related quality of life improved after attending the program
  • all participants were highly positive about the program.

Resources coming soon

Current Community Aphasia Group Trials

Our next projects are:

1. Peer-led Hub and Spoke Community Aphasia Program

Aim: To examine if the Peer-led Hub and Spoke Community Aphasia Program can be successfully embedded into a community health/rehabilitation service (Led by Dr Lucette Lanyon ….link to her website).

Progress: Lucy to update - Active

We are currently recruiting participants to this study (Feb 2024), further details and participant information sheet are available here.

Ethics approval number: 97132.
This research project is a collaboration between La Trobe University and Grampians Health, Ballarat and has been funded through the Stroke Foundation Australia and La Trobe University.

We are currently recruiting participants for this project. (Jan 2024)
Further details on the Hub-and-Spoke Peer-Led Community Aphasia Group project are available here

2. Group facilitation education and training

Aim: To develop and examine the feasibility, acceptability, and preliminary efficacy of a group facilitation education and training program for speech pathologists and people with aphasia/community volunteers (Led by PhD student Kathryn Pettigrove - link to website.)

Progress: Katherine for update

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.

Can a brief early intervention prevent depression and help people live with aphasia a year after stroke? (ASK project)

Below are resources developed for the ASK study. All resources are for therapists who wish to deliver the interventions.

The first set of downloadable Intervention Program manuals are for the therapist to read before delivering the intervention. The ASK program was developed as an experimental intervention to prevent depression and improve the wellbeing of people with aphasia following stroke. The Secondary Stroke Prevention program was developed as an attention control program in this study.

The second set of downloadable Training Manuals are the 8 workbooks that the therapist uses with the person with aphasia and their family member. Each workbook is in an aphasia-friendly format and can be used to support and guide the conversation with the person with aphasia and their family member. For optimum effectiveness, aphasia therapists are encouraged to use supported conversation techniques, motivational interviewing and further relevant elaboration and information when discussing these topics.

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