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Topics in Stroke Rehabilitation Volume 30, 2023 - Issue 4
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Review

Cognitive -behavioral therapy for managing depressive and anxiety symptoms after stroke: a systematic review and meta-analysis

Jessica Ahrensa Lawson Health Research Institute, Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada;b St. Joseph’s Health Care, Parkwood Institute, London, Ontario, CanadaORCID Iconhttps://orcid.org/0000-0003-2176-669XView further author information
ORCID Icon,
Richard Shaoa Lawson Health Research Institute, Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada;b St. Joseph’s Health Care, Parkwood Institute, London, Ontario, CanadaView further author information
,
Daymon Blackporta Lawson Health Research Institute, Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada;b St. Joseph’s Health Care, Parkwood Institute, London, Ontario, CanadaView further author information
,
Steven Macalusob St. Joseph’s Health Care, Parkwood Institute, London, Ontario, Canada;c Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, CanadaView further author information
,
Ricardo Vianab St. Joseph’s Health Care, Parkwood Institute, London, Ontario, Canada;c Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, CanadaView further author information
,
Robert Teasellb St. Joseph’s Health Care, Parkwood Institute, London, Ontario, Canada;c Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, CanadaView further author information
&
Swati Mehtaa Lawson Health Research Institute, Parkwood Research Institute, Parkwood Institute, London, Ontario, Canada;b St. Joseph’s Health Care, Parkwood Institute, London, Ontario, Canada;c Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, CanadaCorrespondence[email protected]
ORCID Iconhttps://orcid.org/0000-0002-5036-9055View further author information
ORCID Icon show all
Pages 368-383 | Received 01 Nov 2021, Accepted 27 Feb 2022, Published online: 30 Mar 2022
 
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ABSTRACT

Background

Post-stroke anxiety and depression can be disabling and result in impaired recovery. Cognitive-behavioral therapy (CBT) has been demonstrated to be effective for anxiety and depression; however, determining its efficacy among those with stroke is warranted. Our objectives to evaluate CBT for anxiety and depression post-stroke .

Methods

This review was registered with PROSPERO (REG# CRD42020186324). Medline, PsycInfo, and EMBR Cochrane were used to locate studies published before May 2020, using keywords such as stroke and CBT. A study was included if: (1) interventions were CBT-based, targeting anxiety and/or depression; (2) participants experienced a stroke at least 3 months previous; (3) participants were at least 18 years old. Standardized mean differences ± standard errors and 95% confidence intervals were calculated, and heterogeneity was determined. The Cochrane Risk of Bias tool was used.

Results

The search yielded 563 articles, of which 10 (N = 672) were included;6 were randomized controlled trials. Primary reasons for exclusion included: (1) wrong population (2) insufficient data provided for a meta-analysis; (3) wrongoutcomes. CBT showed large effects on reducing overall anxiety (SMD ± SE: 1.01 ± 0.32, p < .001) and depression (SMD ± SE: 0.95 ± 0.22, p < .000) symptoms at the end of the studies. CBT moderately maintained anxiety (SDM ± SE: 0.779 ± 0.348, p ˂.025) and depression (SDM ± SE: 0.622 ± 0.285, p ˂ .029) scores after 3-months. Limitations included small sample size, limited comparators, and lack of follow-up data.

Conclusion

The results of this meta-analysis provide substantial evidence for the use of CBTto manage post-stroke anxiety and depression.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Impact

  • There is limited evidence for the management of mood and anxiety symptoms post-stroke through community-based CBT programs.

  • The current paper provides an up-to-date synthesis of current literature for the effectiveness of CBT interventions among those post-stroke.

  • This paper highlights factors that may influence long term outcomes, such as group-based versus individual-based therapy, intervention duration, comparator group, and intervention leader.

  • Current gaps in literature are identified and recommendations for future research are provided, including having pharmacotherapy as a comparator, including a more representative sample of the population, and having longer term follow-ups.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

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