The efficacy of therapist-supported acceptance and commitment therapy-based bibliotherapy for psychological distress after stroke: a single-case multiple-baseline study

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="S135246582200042X_as1"> <jats:title>Background:</jats:title> <jats:p>Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration.</jats:p> </jats:sec> <jats:sec id="S135246582200042X_as2"> <jats:title>Aims:</jats:title> <jats:p>To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke.</jats:p> </jats:sec> <jats:sec id="S135246582200042X_as3"> <jats:title>Method:</jats:title> <jats:p>The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention.</jats:p> </jats:sec> <jats:sec id="S135246582200042X_as4"> <jats:title>Results:</jats:title> <jats:p>Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre–post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores.</jats:p> </jats:sec> <jats:sec id="S135246582200042X_as5"> <jats:title>Conclusions:</jats:title> <jats:p>ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.</jats:p> </jats:sec>