Augmented Cognitive Behavioral Therapy for Poststroke Depressive Symptoms: A Randomized Controlled Trial
Open accessAbstract
Objective To evaluate the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety poststroke.Design Multicenter, assessor-blinded, randomized controlled trial.Setting Ambulatory rehabilitation setting.Participants Patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D) score >7 at least 3 months poststroke (N=61).Interventions Participants were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist.Main outcome measures HADS-D was the primary outcome, and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, immediately posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear mixed models using group (CBT vs CCT) as the between-subjects factor and time (4 assessments) as the within-subjects factor.Results Mixed model analyses showed a significant and persistent time effect for HADS-D (mean difference, -4.6; 95% confidence interval, -5.7 to -3.6; P<.001) and for participation and quality of life in both groups. There was no significant group × time effect for any of the outcome measures.Conclusions Our augmented CBT intervention was not superior to CCT for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better than natural history.
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Cognitive behavioural therapy is widely used for treating depression and anxiety, but there is no strong evidence for its post-stroke effectiveness, and research into its effectiveness following traumatic brain injury is inconclusive.
“Cognitive behavioural therapy is widely used for treating depression and anxiety, but there is no strong evidence for its post-stroke effectiveness [10, 11], and research into its effectiveness following TBI is inconclusive [12–15].”
There is evidence that ACT is cost-effective over comparators for several other patient populations.
“There is evidence that ACT is cost-effective over comparators for several other patient populations (20–23).”
From Trial-based economic evaluation of the BrainACT study: acceptance and commitment therapy for anxiety and/or depressive symptoms after acquired brain injury. (2025) · cites this paper as [23]
The Conclusions report symptom improvement after augmented CBT and computerized cognitive training in patients after stroke, but do not address cost-effectiveness. A search of our copy for ACT, acceptance and commitment therapy, and economic comparisons found no passage about cost-effectiveness in other patient populations. (LLM, conf=0.78)
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- Authors
- Kootker, J. A., Rasquin, S. M. C., Lem, F. C., van Heugten, C. M., Fasotti, L., & Geurts, A. C. H.
- Affiliations
- Radboud University Nijmegen (NL)
- Maastricht University Medical Centre (NL)
- Corresponding author
- Kootker, Joyce A.
- Venue
- Archives of Physical Medicine and Rehabilitation
- Publisher
- Elsevier BV
- Published
- 2017-04
- Volume
- 98
- Issue
- 4
- Pages
- 687-694
- ISSN
- 0003-9993 (ISSN-L)
- OpenAlex
- W2549828709
- Cited by
- 53
- References
- 38
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 6 · 2023: 8 · 2022: 9 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 2
- FWCI
- 3.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Physical Medicine and Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- cognitive behavioral therapy, post-stroke depression, stroke, computerized cognitive training, anxiety, mood disorders, participation, quality of life, occupational therapy, movement therapy, outpatient rehabilitation
- MeSH terms
- Adult, Aged, Anxiety, Depression, Female, Humans, Male, Middle Aged, Netherlands, Psychiatric Status Rating Scales, Quality of Life, Cognitive Behavioral Therapy, Treatment Outcome, Stroke
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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