Mindfulness-based cognitive therapy (MBCT) for stroke survivors : an application of a novel intervention / by Amy K. Moustgaard. --

Abstract

Stroke can affect neurological, cognitive, and emotional functioning and have a negative impact on overall quality of life (QoL). Published research in the area of psychological intervention for stroke patients suggests that therapy directed toward managing depression and anxiety can result in general improvement in emotional health and QoL. The purpose of this study was four-fold: (1) to adapt and implement Mindfulness Based Cognitive Therapy (MBCT) for stroke survivors; (2) to evaluate the psychometric properties of generic and stroke-specific measures; (3) to evaluate the effectiveness of MBCT on aspects of quality of life, emotional factors, and adjustment for participants, as well as caregiver burden; and (4) to determine the predictors of success. Participants (n = 23) completed questionnaires on initial assessment, after the 9-week MBCT Program, and at 3-month follow-up. Questionnaires included the Beck Anxiety Inventory (BAI), Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory - II (BDIII), Short Form-36 General Health Survey (SF-36), Stroke Specific Quality of Life Scale (SSQoL), and the Mental Adjustment to Stroke Scale (MASS). Overall, findings indicate that MBCT lends itself to be adapted to clinical groups. Psychometric analysis of measures used showed moderate to strong internal consistency (a = .57 - .95), significant convergent and divergent validity, and adequate responsiveness with moderate to large efkct sizes (0.32-1.43) on the non-physical indices. Independent t-test analyses showed significant improvement (p < .05) in participant scores (n = 8) on the BAI, BDI-II, HADS, and QoL indices when compared with dropout control scores (n = 4) in the initial control arm (Phase I). Phase II repeated measures analysis of variance for all completers (n = 21) reflected significant change from baseline to program completion, with maintained improvements at follow-up in all domains, including those related to anxiety [see dissertation] A decrease in scores on the MASS helplessness/hopelessness subscale significantly correlated with improvement in emotional constructs. MBCT may be useful in the treatment and prevention of depression and anxiety and may improve QoL and facilitate adjustment to changes secondary to stroke. Randomized controlled multi-center trials will be required to provide further evidence.