“Talk Therapy” Can Improve Outlook in Stroke

When we speak of “talk therapy” we usually mean Cognitive Behavioral Therapy (CBT), which combines two effective kinds of psychotherapy - cognitive therapy and behavior therapy.  CBT is a powerful tool for stopping emotional symptoms and improving troublesome behavior.  It usually involves repeated sessions in a group, with a psychotherapist.  But there’s another kind of “talk therapy” – Motivational Interviewing, or MI.  UK therapists have used it in stroke patients with some success; they’ve published their work in the journal Stroke.

411 consecutive patients admitted to hospital with stroke, who were free of severe cognitive or communication problems, were randomly allocated to usual care plus 4 individual 30- to 60-minute sessions of MI, or usual care alone.  The MI started within 4 weeks of the stroke; trained therapists encouraged patients to talk about their adjustment to stroke and to be realistic about the future.  Mailed questionnaires were used to monitor improvement, including the 28-item General Health Questionnaire (GHQ-28) to evaluate mood, and the Stroke Expectations Questionnaire.

At the 12-month follow-up point, 38% of patients in the ‘usual care’ group and 48% of patients in the MI group had ‘normal mood’, according to their GHQ-28 scores.  More importantly, 12.8% of the patients on ‘usual care’ and 6.5% of those having MI had died.  These two benefits of MI were statistically significant, i.e. they were not considered to have occurred by chance alone.

There were obvious weaknesses in this study.  For instance, data on the cause of deaths were not obtainable, so the relationship to MI therapy cannot be assured.  And there were no obvious effects of MI on activities of daily living or participation in social activities, which are normally related to ‘mood’.  Moreover, there was no quality-of-life measurement.  Nevertheless, the results showed a significant benefit of MI therapy.  Anything that improves 12-month mortality after a stroke is worth taking seriously.