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Recovering from a stroke: A narrative review on post-stroke anxiety treatment and management

Samantha N. Furbee1*
  • 1 University of Central Florida, College of Education and Human Performance, School of Teaching, Learning, and Leadership, United States

Purpose Aphasia, an acquired language disorder, is a common sequela after a stroke or head injury. It is estimated that 180,000 people are losing the ability to understand or express speech, each year (NAA, 2016). Unlike the general public, individuals with aphasia have difficulty with expression and comprehension which makes communicating or interacting with others difficult. There are recent studies that report the disruption of communication (e.g., limitations when exchanging ideas, feelings, concepts and events) often makes persons with aphasia anxious (Cahana-Amitay, 2011). Being that there are many variations of anxiety disorders such as general anxiety disorder (GAD), panic disorder, social phobia, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD),they are categorically different. These disorders all share similar characteristics such as irrational fear, apprehension, difficulty or distress in daily tasks. The aforementioned likely cause’s individuals to have cognitive, physical or behavioral effects on daily life. As such, early aphasia and anxiety research found when individuals are speaking and they have increased attention or are more focused on their content of speech, they report feeling more anxious and self-conscious about their performance (Christenfield & Creager, 1996). In 2007, the Department of Health reported that stroke is a leading cause of adult disability and as of yet, the most common mental health disorder is anxiety (Levine, 2003). A recent systematic review (Campbell Burton, Murray, Holmes, Astin, Greenwood, & Knapp, 2013) estimates anxiety prevalence in about 20 percent of stroke survivors. In comparison to the reported 1 in 5 stroke survivors living with an anxiety disorder (Centers for Disease Control and Prevention, 2005), the lifetime prevalence of anxiety disorders affects nearly 28.8 percent of the adult population (National Institute of Mental Health, 2016). These estimates suggest that Speech-Language Pathologist (SLPs) should develop skill sets to identify and provide appropriate interventions for aphasia victims, specifically with anxiety disorders. Method In this study the initial search strategy generated 1,096 articles. Following the review of the title and abstract, a total of 145 articles were identified that met the suggested inclusion criteria of the study. Each article was read and evaluated, the articles that were relevant underwent appraisal. Only 88 of these articles sought to explore aphasia patients with anxiety, and 37 identified treatments in persons with aphasia. A key finding in the search was to present how these variables relate to recovery or rehabilitation and quality of life. Although there are varying interventions used to treat anxiety after stroke (Campbell Burton, 2011), this study identified a few that currently utilized such as guided self-help, applied relaxation and cognitive behavior therapy (National Institute for Health & Clinical Excellence, 2011). Thus, it is proposed that during initial intake sessions clinicians should identify patient’s moods through a visual analogue mood scale, which is currently used to identify depression post-stroke (Stern, 1997). Currently, recent studies examine the comorbidity of anxiety and depression in aphasic patients, therefore, this review isolated anxiety so that conclusions can be drawn for clinical rehabilitation. Results In a review of nearly 100 studies published between 1985 and 2001, (Naylor, 2002) it was determined that caregivers have a negative influence on patients during the transition from hospital setting into traditional home settings. Education and effective planning is needed before patients are discharged to alleviate abandoned or worried emotions and thoughts. Additionally, caregivers with signs of declining health themselves should be provided community-based organizations for emotional support (Levine, 1998) since the type of care they provide is physically and emotionally demanding. It is supported that non-pharmacological and pharmacological interventions aid in the recovery process. For non-pharmacological interventions this included sensory intervention, social contact, behavioral therapy, combination therapy (individualized and group treatment), and caregiver education. The main benefits in non-pharmacological interventions are that they address goals and procedures, improve spoken language in either individual or group sessions, and alter intervention length, frequency, and duration of sessions (Carthery-Goulart, da Costa da Silveira, Machado, Mansur, de Mattos Pimenta Parente, Senaha, & Nitrini, 2013). If psychological treatments have not alleviated the anxiety symptoms in the recovery process, pharmacological treatment is prescribed by a psychiatrist to alter the level of neurotransmitters in the brain. Benzodiazepines are a psychoactive drug used to treat anxiety on a short term basis, such as acute anxiety which includes diazepam/lorazepam, alprazolam and oxazepam. Buspirone is an anti-anxiety medicine that treats symptoms such as fear, tensions, irritability, dizziness, pounding heartbeat, and other physical symptoms. Longer term medicines for anxiety include some antidepressant medications such as sertraline, paroxetine and venlafaxine (Stroke Association, 2016). Lastly, being that persons with aphasia and those with untreated mental health problems may find it difficult to concentrate, maintain motivation, and keep up with treatment plans and routines affecting how they think or feel (Stroke Foundation, 2016), integrating goal setting methods were included to facilitate motivation and persistence to reach quality of life. Approach oriented goals, SMARTER goal setting, solution focused therapy (SFT), and approach / avoidance behaviors were identified as techniques in order to help individuals reach their hopes and dreams. Conclusion This review was determined to find the optimal treatment intensity for aphasia patients with an anxiety disorder. The current research suggests that intensive treatment, pharmacological treatment, goals, and behavior promotes neurological changes underpinning recovery from stroke which is an essential component of rehabilitation. Additionally, within cognitive psychology, models of learning in healthy humans propose that distributed training promotes optimum long-term learning and retention of trained skills and behaviors (Dignam, Rodriguez & Copland, 2016). Although there are important distinctions between anxieties in non-aphasic persons and aphasic persons, it is recommended that identifying commonalities in neurological disorders and psychological disorders may help reform models of rehabilitation. The current review avoided assumptions that a single treatment is superior for all patients. In additions, it considered treatment approaches given previous dosage-controlled studies of treatment intensity in anxiety during aphasia rehabilitation. Further empirical investigation is required to establish the true effect of treatment for anxiety in aphasic patients to determine how these two bodies of research translate to language recovery and quality of life in aphasia.

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References

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Keywords: Aphasia, Anxiety, goal setting, therapy, Quality of Life, caregiver anxiety, pharmacological therapy, Nonpharmacological therapies;, Rehabilitation, Solution Focused Therapy, aphasia rehabilitation, Anxiety disorder

Conference: 54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016.

Presentation Type:

Citation: Furbee SN (2016). Recovering from a stroke: A narrative review on post-stroke anxiety treatment and management. Front. Psychol. Conference Abstract: 54th Annual Academy of Aphasia Meeting. doi: 10.3389/conf.fpsyg.2016.68.00108

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Received: 30 Apr 2016; Published Online: 15 Aug 2016.

* Correspondence: Ms. Samantha N Furbee, University of Central Florida, College of Education and Human Performance, School of Teaching, Learning, and Leadership, Orlando, FL, 32816, United States, snfurbee@knights.ucf.edu