Augmented cognitive behavioral therapy for post stroke depressive symptoms: a randomized controlled trial

Publication date: Available online 12 November 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Joyce A. Kootker, Sascha MC. Rasquin, Frederik C. Lem, Caroline M. van Heugten, Luciano Fasotti, Alexander C. Geurts
ObjectiveTo evaluate the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety post stroke.DesignMulti-center, assessor-blinded, randomized controlled trial.SettingSix ambulatory rehabilitation settings in The Netherlands.ParticipantsPatients who had a Hospital Anxiety and Depression Scale – subscale Depression (HADS-D) score > 7 at least three months post stroke.InterventionsSixty-one participants were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist.Main outcome measuresHADS–D was the primary outcome and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, directly post treatment, and at four and eight months follow-up. Analysis was performed with linear mixed models using group (CBT vs CCT) as between-subjects factor and time (4 assessments) as within-subjects factor.ResultsMixed model analyses showed a significant and persistent time effect for HADS–D (MD:-4.6, 95%CI=-5.7;-3.75, p<0.00) as well as for participation and quality of life in both groups. There was no significant group x time effect for any of the outcome measures.ConclusionsOur augmented CBT intervention was not superior to computerized cognitive training for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better compared to natural history.



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