Gladwyn-Khan Misbah, Morris Reg
Cardiff University and Cardiff & Vale UHB, Cardiff, UK.
Behav Cogn Psychother. 2023 Jan;51(1):87-104. doi: 10.1017/S135246582200042X. Epub 2022 Oct 10.
Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration.
To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke.
The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention.
Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores.
ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
心理困扰在中风后很常见，并会影响康复。然而，基于证据的心理治疗方法却很少。本研究评估一种基于阅读疗法的改善方法。
研究一本基于接受与承诺疗法（ACT）的中风特异性自我管理书籍，作为一种由治疗师支持的中风后心理困扰干预措施。
设计为单病例、随机非同期多基线设计（MBD）。16名中风幸存者，8名男性和8名女性（平均年龄60.6岁），参与了一个分为三个阶段的MBD：A（随机时长基线期）；B（干预期）；以及随访期（3周时）。在基线期，参与者仅接受治疗师的联系。在阅读疗法干预中，参与者每两周接受一次治疗师的支持。每周完成心理困扰的主要测量指标（一般健康问卷-12；GHQ-12）和生活质量（生活满意度量表；SWLS）。在干预前后完成情绪、幸福感和疾病影响的次要测量指标。
综合全组意向性分析对每个主要测量指标均具有统计学意义，且效应量中等（GHQ-12和SWLS分别为0.6和0.3）。个体意向性分析表明，大多数个体呈现出积极变化。所有次要测量指标在干预前后均显示出显著改善。81%的参与者报告这本书有帮助，81%的人还发现基于ACT的部分有帮助。相对风险计算表明，认为这本书有帮助与GHQ-12和SWLS评分的改善相关。
在治疗师支持下，基于ACT的阅读疗法是一种有前景的中风后心理问题干预措施。
