Language as a stressor in aphasia

Abstract

Background: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians, and researchers would agree that language might be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce.

Aim: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a programme for future study. In doing so we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation.

Main Contribution: Post stroke emotional changes in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term “linguistic anxiety”. Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to “linguistic anxiety”.

Conclusions: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post-traumatic stress disorder, or even with healthy ageing persons, in whom “linguistic anxiety” might be at work when they have trouble finding words.

Keywords:

• Aphasia
• Anxiety
• Language
• Stress

Acknowledgments

Our thanks to Mira Goral, Jacqueline Laures-Gore, Kristine Lundgren, Loraine Obler, and Carole Palumbo for their insightful comments on this manuscript. We would also like to thank Danny Kaloupek and our anonymous reviewers for their extremely valuable comments. Support for this research was provided by the National Institutes of Health, NIDCD grant 5P30DC005207, Boston University, Department of Neurology, Harold Goodglass Aphasia Research Center and VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, and NIA grant 2R01AG14345 Boston University, Department of Neurology, Language in the Ageing Brain, VA Healthcare System, 150 South Huntington Avenue, Boston, MA 02130.

Notes

ⁱGoral and Kempler (2008), who performed a treatment study examining changes in patterns of verb production in chronic aphasia, used the number of verbs and nouns per text, and the verb–noun ratio as outcome measures. These measures might be particularly useful, since the task they used to elicit discourse samples in their study is similar to the one Laures-Gore, Heim, et al. (2007) used in that it required the patient to talk about his job before the stroke.

ⁱⁱInterestingly, in a recent study assessing cognitive and emotional functionality in neurologically intact elderly participants over a period of 6 months, the occurrence of filled pauses (“ums”) in phone interviews has been found to be a reliable marker for monitoring changes in mood and executive functions over time (Penard et al., 2009).