Associate Prof. David Andrewes
Psychology Department, The University of Melbourne
Beyond Blue Victorian Centre of Excellence
Project completion year
The incidence of post stroke depression (PSD) is approximately 25%. Psychological therapy studies for these patients have produced mixed, but largely negative results and demonstrate the difficulty of working with patients with limited emotional and cognitive resources. This study investigated the potential of using Interpersonal Therapy (IPT), by examining the limitations of PSD patients in their ability to take advantage of positive mood induction to increase mood and enhance interpersonal attitudes. Forty-two PSD patients and 43 rheumatic/orthopaedic control patients were presented with either positive or neutral emotionally evocative verbal and non-verbal film conditions and were assessed for related cognitive and emotional processing deficits. Patients were also assessed on a series of cartoons and jokes as an independent measure of humour.
Key findings /Main outcomes
Positive mood induction significantly improved depression, mood and attitudes towards interpersonal relationships irrespective of cognitive and emotional processing deficits. The non-verbal material was effective for all patients but more marked for the left PSD group. The right PSD group showed a greater response to the verbal jokes but demonstrated the least understanding of them. These results show the potential of incorporating positive mood induction within therapeutic programs such as IPT and suggest that IPT could be a worthwhile therapy to use within this patient group.
This study demonstrated that depression, attitudes towards interpersonal relationships and mood in PSD patients and rheumatic/orthopaedic patients can be enhanced using positive mood induction. This technique could therefore successfully be incorporated into psychotherapy such as IPT with benefit to these patients. While the effects of this positive mood induction are no doubt transient, the value of the technique lies in the finding that the use of humour within a longer therapeutic program may provide more lasting changes in depression. Despite the incidence of major depression following stroke being around 25%, there is little evidence of how a therapeutic approach might be tailored to the limited cognitive and emotional resources that are available to these patients. This study represents the first step towards this goal.
Implications for practice, policy and partnerships
We believe that the publication of this research will encourage therapists to work on improving interpersonal relationships in depressed stroke patients, which will enhance partner support and ultimately reduce depression. Our continuing work in this area is therefore aimed at progressing one step further towards implementing a program that teaches depressed stroke patients to recognize emotions and learn to apply suitable strategies aimed at improving the quality of interpersonal relationships. Workable strategies for use in this area would significantly benefit such a therapeutic approach to reduce depression and have great potential to facilitate pathways of care for people with PSD and for their carers. If interpersonal relationships can be improved and depression relieved after a stroke then there will then be more scope for further progress in other areas of rehabilitation and less demand by both the stroke sufferer and his/her primary care giver on the already overloaded mental health system.