ACTion after stroke: Exploring the effects of an acceptance and commitment therapy group for adult stroke survivors and carers

The individual, familial, societal and economic impact of psychological distress following stroke is well established. Nevertheless, validated treatments to reduce psychological distress and enhance well-being in community-living stroke survivors is limited. Recently, Acceptance and Commitment Therapy (ACT) has demonstrated promising results for improving psychological wellbeing in a variety of presentations. However, there is a lack of research exploring ACT with adults who have survived a stroke. The current thesis examines the efficacy of a four-session ACT intervention that was delivered to both stroke survivors and their carers via a third-sector charity organisation. A quasi-experimental design was used with 69 participants assigned to either the ACT intervention or waiting list control group. Outcome variables captured levels of psychological distress, post-traumatic growth and quality of life at three time points (pre-intervention, post-intervention and two month follow-up) and were analysed using linear regression whilst controlling for baseline levels. A mediational analysis examining specific ACT processes – psychological flexibility and goal directed thinking - were also examined. Additionally, a one-hour focus group including seven individuals who completed the group was analysed by inductive thematic analysis to gain greater insight in to the personal experiences of the group. Group assignment predicted lower psychological distress in favour of the ACT group at post-intervention and at follow-up. There were no significant differences found for post-traumatic growth or quality of life. The mediational analyses suggest that the ACT intervention did not significantly alter levels of psychological flexibility, or goal directed thinking compared to the waiting list control group, and these measures did not appear to mediate the changes in psychological distress. The qualitative analysis supported the positive gains of the ACT group. The results are discussed in terms of developing ACT intervention for stroke survivors and carers