Positive psychology intervention could improve quality of life after stroke

Researchers at University of Utah Health are testing whether an eight-week program based on positive psychology techniques can improve the mood and well-being of people who have had a stroke and those who care for them. The ReStoreD (Resilience in Stroke survivor-care partner Dyads) clinical trial involves both the stroke survivor and their spouse or care partner. Together, the couple takes part in planned activities that can be done at home.

The study will recruit 200 couples in which one partner has had a stroke within the past three months to three years. The couple must have lived together for at least six months and may live anywhere in the U.S.

"This approach is different from others that address pathology or things that are wrong," says Alexandra Terrill, Ph.D., leader of the new clinical trial and associate professor of occupational and recreational therapies at U of U Health. "Instead, we're taking a 'building what's strong' approach."

In the eight-week program, couples coping with stroke learn and practice goal setting, communication strategies, and positive psychology activities, such as expressing gratitude, finding meaning, and fostering connections. As a part of each module, participants view educational videos or read materials to learn about topics, such as resilience, coping, and well-being, that relate to adjusting to life after stroke. Then, they carry out activities related to the week's theme.

Activities can be as simple as writing a thank you note, performing a good deed, or reflecting on an enjoyable experience.

"We're very good at prescribing blood pressure medicines and anti-thrombotics to help prevent the next stroke," says Jennifer Majersik, M.D., a neurologist and stroke specialist at U of U Health who is a collaborator on the study. "But stroke survivors need something beyond just a pill to really help them reintegrate into their family lives and the community."

Promising results

In pilot studies with 34 couples, the researchers found that the intervention lessened depression and improved resilience in stroke survivors, maintaining these changes for at least three months after the program ended. Resilience is having the ability to adapt and cope when faced with challenges. Findings were more mixed for care partners, but those who had depressive symptoms and lower resilience also saw improvements. The studies' results were based on self-report questionnaires and standardized measures.

The new trial seeks to confirm these results on a larger scale and provide additional evidence that the behavioral intervention lowers emotional distress in both partners. The trial will also examine effects on relationship quality, stroke-related stress, and engagement in meaningful activities.

"There is a common assumption that feeling depressed or anxious is to be expected after sustaining a stroke and that mental health issues will resolve spontaneously once a person returns home," Terrill says. "Unfortunately, this is often not the case."

Stroke is a leading cause of long-term disability, affecting nearly 800,000 people in the U.S. every year. The life-changing event can alter speech, movement, or cognition, causing a stroke survivor to lose their independence. As a result, 30% to 50% of people coping with stroke, along with their partners, experience depression or emotional distress.

Positive psychology could be a relatively simple, cost-effective solution to this problem, Terrill says. She is a clinical psychologist with specialized training in rehabilitation. More broadly, she researches the role of relationships and positive psychology in managing chronic conditions. If successful, the novel approach being tested in ReStoreD could become a sustainable and accessible means to improve recovery and quality of life.

"I've seen it affect patients and their partners in a positive way," Majersik says. "It's shown me that we can continue to bend the curve of stroke recovery, not just by medicines or technology but also by using what I consider to be pretty simple tools. And that matters."

Provided by University of Utah Health Sciences