The efficacy of therapist-supported acceptance and commitment therapy-based bibliotherapy for psychological distress after stroke: a single-case multiple-baseline study
Open accessAbstract
BACKGROUND: Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration. AIMS: To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke. METHOD: The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention. RESULTS: Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores. CONCLUSIONS: ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
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Most prior studies of ACT for acquired brain injury did not include an active control intervention with a comparable duration and intensity.
“However, most studies did not include an active control intervention with a comparable duration and intensity [11,13 -15]”
From Acceptance and commitment therapy for people with depressive and anxiety symptoms following acquired brain injury: Results of the BrainACT randomized controlled trial. (2024) · cites this paper as [15]
The Introduction (page unavailable) says the control intervention in one prior ACT study of traumatic brain injury lacked equivalence to ACT. The Limitations and future research section (page unavailable) calls for randomized control conditions in the authors’ own study. These passages support a concern about controls, but do not establish that most prior studies lacked an active control comparable in both duration and intensity. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNone of the prior studies of ACT for acquired brain injury had a follow-up period longer than three months.
“and none of these studies had a follow-up period longer than three months.”
From Acceptance and commitment therapy for people with depressive and anxiety symptoms following acquired brain injury: Results of the BrainACT randomized controlled trial. (2024) · cites this paper as [15]
The Study procedure and Follow-up sections report a three-week follow-up for this study. The Introduction discusses earlier ACT studies involving acquired brain injury, but our copy does not give their follow-up durations. It therefore does not establish that none had follow-up longer than three months. (LLM, conf=0.77)
Experimental — accuracy not yet measuredSeveral studies found improvements regarding anxiety and depressive symptoms with ACT for people with acquired brain injury.
“all studies found improvements regarding anxiety and depressive symptoms [11 -15].”
Our results are similar to those from previous studies that reported significant improvements in anxiety and depressive symptomatology in people with ABI following ACT interventions.
“Our results are similar to those from previous studies that reported significant improvements in anxiety and depressive symptomatology in people with ABI following ACT interventions [11 -15].”
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Cited by
Sorted by citations
Rauwenhoff, J. C. C., Bol, Y., Peeters, F., Smits, P., Duits, A., Wijenberg, M., Blok, A., & van Heugten, C. M. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.111933 · Cited by 9 · see citing works
- Authors
- Gladwyn-Khan, M., & Morris, R.
- Affiliations
- Cardiff University (GB)
- Corresponding author
- Morris, Reg
- ORCID
- Morris, Reg
- Venue
- Behavioural and Cognitive Psychotherapy
- Publisher
- Cambridge University Press (CUP)
- Published
- 2022-10-10
- Volume
- 51
- Issue
- 1
- Pages
- 87-104
- ISSN
- 1352-4658 (ISSN-L)
- 1469-1833
- OpenAlex
- W4303986329
- Cited by
- 13
- References
- 85
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 5 · 2023: 3
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Behavioural and Cognitive Psychotherapy (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- Funders
- Stroke Association
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
- Keywords
- acceptance and commitment therapy, bibliotherapy, stroke, psychological distress, stroke survivors, quality of life, mood, well-being, disease impact
- MeSH terms
- Psychological Distress, Humans, Middle Aged, Quality of Life, Stroke, Acceptance and Commitment Therapy
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