After a stroke, the focus of recovery and rehabilitation is often centered around the improvement of physical function. For example, increasing muscle strength, decreasing spasticity, maximizing range of motion, and regaining the ability to walk are often at the forefront of a survivor’s recovery focus. However, psychological care after stroke is a vital, although often overlooked, piece of the rehab puzzle.

When stroke patients do not receive adequate support for mental health, it can hinder recovery and reduce motivation to pursue rehabilitation. Treating stroke patients holistically takes into account mental and social factors rather than just the physical symptoms of stroke, leading to improved outcomes. In this article we will discuss the importance of psychological care for stroke survivors, treatment options, and how to advocate for this care.

The Need for Psychological Care After Stroke

In this comprehensive report, some of the top medical providers in the UK highlight the importance of psychological care after stroke. These providers cite that 35-60% of survivors experience cognitive impairment and around 1/3 are affected by depression after stroke. For this reason, psychological care after stroke deserves just as much attention as physical care.

A stroke is a life-threatening condition that often leaves significant aftermath. The secondary effects of stroke can include decreased mobility, impaired speech and cognition, difficulty eating, and the inability to perform daily tasks independently. For this reason, stroke can have a devastating impact on a survivor’s life and overall independence.

This reduced independence can lead to inhibited social involvement, decreased enjoyment of beloved hobbies, and feelings of grief related to these major life changes. When we pause to review the widespread effect of stroke symptoms, it becomes more clear why post-stroke depression is the most common psychiatric disorder after stroke.

Stroke-Related Cognitive and Behavior Changes

In addition to the psychological and emotional distress that can accompany stroke, many survivors experience cognitive and behavior changes. A stroke results in tissue damage within the brain and, depending on the area(s) affected, can lead to specific changes in processing, reasoning, and behaviors.

For example, a stroke affecting the frontal lobe can result in impulsivity, reduced empathy, and poor social skills. Additionally, intense mood swings and emotional lability are two common behavior changes experienced by stroke survivors. These changes can be confusing and frustrating for both survivors and caregivers as they navigate the recovery journey after stroke.

In more extreme cases, anger and aggression may be noted in stroke survivors. These psychological and behavior changes may be due to a combination of changes in the brain as well as the complex emotions experienced in the wake of a stroke. While aggression often subsides after the acute stage of stroke recovery, this can sometimes persist and become unsafe for the survivor and caregiver alike.

The Virtuous Cycle of Psychological Care

When stroke patients receive psychological care during the early stages of recovery, this can help improve levels of confidence, motivation, and well-being. Then, the benefits of psychological care create a virtuous cycle for the stroke survivor. Unlike a vicious cycle where negative events reinforce themselves, a virtuous cycle occurs when positive events reinforce themselves.

Here’s what the virtuous cycle of psychological care after stroke could look like:

• More psychological care results in more positive mood and confidence
• Positive mood and confidence motivate more action towards recovery, which results in greater physical improvements
• Physical improvements further boost confidence and positive mood, enhancing the cycle

As you can see, there is much to gain from psychological care after stroke. If you’re interested in a holistic approach to recovery, there are several types of psychological care you can consider, which we will review next.

Seeking Psychological Care After Stroke

If you would like to seek psychological care for yourself or a loved one, talk to your doctor or medical team. Your doctor may refer you to a psychiatrist or other health specialist to provide you with appropriate care. This process will look different for everyone since individual needs, available resources, and health insurance/processes vary from patient to patient. The important part is to ask and get the conversation started.

Here are some options for psychological care after stroke:

• Psychotherapy. This is often referred to as “talk therapy” and involves sitting down and speaking with a trained therapist. Psychotherapy can help with a variety of psychiatric disorders including post-stroke depression. If therapy is started early, it may even help prevent post-stroke depression altogether.
• Positive psychology. While traditional psychology focuses on mental illness, positive psychology focuses on mental wellness. This method concentrates on creating states of happiness, meaning, and fulfillment by using exercises that help retrain the brain. The book Healing & Happiness After Stroke touches on positive psychology for stroke survivors.
• Mindfulness. This includes the practice of living in the present moment rather than worrying about the past or future. Mindfulness can be a valuable addition to a daily routine after stroke as it can help reduce feelings of anxiety and depression. If you are unsure how to begin, there are apps that help with mindfulness, such as Headspace.
• Cognitive behavior therapy (CBT). This form of psychotherapy is based on the idea that our emotions are caused by our thoughts. By challenging negative self-talk, it can help you improve your psychological wellbeing.

In addition to these treatments, there are many other types of psychological care available. This includes art therapy, music therapy, and participation in stroke support groups to listen and learn from other stroke survivors. Experiment with different treatments until you find one that’s right for you.

If your health insurance doesn’t cover mental healthcare, then it might be worth exploring private practice psychological care after stroke. While private practice is more expensive, you may consider it an investment in your long-term health. Adequate care during the early stages of recovery can negate the need for even more expensive health care in the long run by teaching you effective coping strategies.

Along with the psychological interventions we have discussed, some survivors may require medication to help reduce the psychological effects of stroke. This can be a valuable addition to your recovery plan and might include antidepressant or anti-anxiety medications. It is important to talk with your doctor to determine the best interventions to address your specific needs and goals.

Improving Psychological Care After Stroke

The aftermath of a stroke can take a devastating toll on survivors’ psychological and physical health. This involves cognitive changes, emotional lability, and psychological conditions such as post-stroke depression. For this reason, early psychological care is essential after stroke to help survivors navigate these major changes and promote improved mental health and self-efficacy.

Modalities like talk therapy, positive psychology, and other methods of psychological care can help improve your confidence, mood, and overall quality of life. Since every survivor is different and has unique needs after stroke, it is important to find the right mix of treatments to best suit your specific journey. This can help create a virtuous cycle and encourage you to continue pursuing recovery.

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