An integration of third wave cognitive behavioural interventions following stroke: A case study

Abstract

Many individuals with stroke experience difficulty resuming their pre-injury lifestyle, that which may lead to feelings of discouragement, shame, and self-criticism. Self-criticism has been associated with heightened risk of depression and anxiety. Therefore, managing self-criticism may be a key component in psychotherapeutic interventions; however, this is yet to be evaluated in the context of stroke. A case study is presented of "Pamela", a forty-eight-year-old woman who experienced an aneurysm located in the right posterior communicating artery eighteen months prior to therapy. She was initially referred for an assessment of memory functioning and cognitive rehabilitation. However, it became apparent that her subjective cognitive concerns were not consistent with the likely site of neurological damage, and that her high levels of anxiety were exacerbating her functional impairments in daily life. This had resulted in the use of avoidance as a safety strategy, and an overall reduction in her activity and social participation. Following a comprehensive assessment of cognitive functioning and feedback (five sessions), therapy adopted an integrated cognitive behavioural/ compassion-focused approach aimed at enhancing self-acceptance and compassion, and reducing avoidance and psychological distress. After ten sessions of psychotherapy, Pamela reported a clinically significant reduction in emotional distress, fewer avoidance behaviours, and an increase in self-compassion. At the three-month follow-up Pamela's improvement in emotional status was maintained, despite an increase in avoidance behaviours to almost pre-treatment levels.