Abstract
Objective
To evaluate the effectiveness of individually tailored cognitive behavioral therapy
(CBT) for reducing depressive symptoms with or without anxiety poststroke.
Design
Multicenter, assessor-blinded, randomized controlled trial.
Setting
Ambulatory rehabilitation setting.
Participants
Patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D)
score >7 at least 3 months poststroke (N=61).
Interventions
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 Measures
HADS-D was the primary outcome, and measures of participation and quality of life
were secondary outcomes. Outcome measurements were performed at baseline, immediately
posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear
mixed models using group (CBT vs CCT) as the between-subjects factor and time (4 assessments)
as the within-subjects factor.
Results
Mixed model analyses showed a significant and persistent time effect for HADS-D (mean
difference, −4.6; 95% confidence interval, −5.7 to −3.6; P<.001) and for participation and quality of life in both groups. There was no significant
group × time effect for any of the outcome measures.
Conclusions
Our augmented CBT intervention was not superior to CCT for the treatment of mood disorders
after stroke. Future studies should determine whether both interventions are better
than natural history.
Keywords
List of abbreviations:
CBT (Cognitive behavioral therapy), CCT (Computerized cognitive training), CI (Confidence interval), HADS-D (Hospital Anxiety and Depression Scale-depression subscale)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: November 12, 2016
Footnotes
Supported by The Netherlands organization for health research and development, ZonMw (grant no. 89000004).
Dutch Trial Register Clinical Trial Registration No.: NTR2999.
Disclosures: A.C.H.G. declares financial relationships with Ipsen and Merz outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
