A changed reality: Experience of an acceptance and commitment therapy (ACT) group after stroke
Open accessAbstract
Copious research on the utility of Acceptance and Commitment Therapy (ACT) in long-term conditions has demonstrated promising results. However, little research has been conducted on ACT within stroke, particularly studies that are qualitative in nature. The aim of this paper was to gain insight into stroke survivors' experiences of ACT and to explore what processes help facilitate adjustment in living with residual disability. Interviews with thirteen stroke survivors following their attendance at a stroke-adapted ACT group were analysed using a grounded theory approach. Stroke survivors varied in age, severity of stroke, limitations and duration since stroke. Interviews revealed a main difficulty of "accepting a changed reality" following stroke. Survivors' narratives regarding their experiences of ACT revealed insight into which processes helped facilitate movement towards accepting symptoms and a changed reality and into helpful and less helpful aspects of the intervention. Stroke survivors find ACT helpful in adjusting to stroke limitations. ACT appears to have potential as a psychological intervention for stroke survivors experiencing psychological distress. Amendments to the format of the intervention to enhance the impact of ACT impact are identified.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The text we found for this paper looks like another document, so the self-check wasn’t run.
Cites
Tong, A., Sainsbury, P., & Craig, J. (2007) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzm042 · Cited by 42,509 · see citing works
Constructing Grounded Theory. A Practical Guide Through Qualitative Analysis
Boyle, C., & Barker, A. (2006) · QMiP Bulletin · doi:10.53841/bpsqmip.2006.1.2.36 · Cited by 11,842 · see citing works
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 1× · see citing works
“…focus away from counterproductive experiential control strategies centred on trying not to have undesirable (yet inevitable) unpleasant thoughts, feelings and physical sensations, towards a more mindful, observational orientation about such experiences (Hayes, Luoma, Bond, Masuda & Lillis, 2006).”
The Neuropsychological Assessment
Ogden, J. A. (2005) · Oxford University Press eBooks · doi:10.1093/oso/9780195171358.003.0002 · Cited by 4,382 · see citing works
Transtheoretical therapy: Toward a more integrative model of change.
Prochaska, J. O., & DiClemente, C. C. (1982) · Psychotherapy: Theory, Research & Practice · doi:10.1037/h0088437 · Cited by 3,922 · see citing works
Adjustment to threatening events: A theory of cognitive adaptation.
Taylor, S. E. (1983) · American Psychologist · doi:10.1037/0003-066x.38.11.1161 · Cited by 3,065 · see citing works
(1998) · Medical Entomology and Zoology · Cited by 2,953 · see citing works
Downward comparison principles in social psychology
Wills, T. A. (1981) · Psychological Bulletin · doi:10.1037/0033-2909.90.2.245 · Cited by 2,705 · cited 2× · see citing works
“Social comparisons within the group may similarly have contributed to acceptance as most survivors reported positive comparisons enhanced their self-perceptions, selfesteem (Collins, 2000; Wills, 1981), and elicited optimism (Chambers & Windschitl, 2004).”
Evolving guidelines for publication of qualitative research studies in psychology and related fields
Elliott, R., Fischer, C. T., & Rennie, D. L. (1999) · British Journal of Clinical Psychology · doi:10.1348/014466599162782 · Cited by 2,491 · see citing works
A review of the literature on peer support in mental health services
Repper, J., & Carter, T. (2011) · Journal of Mental Health · doi:10.3109/09638237.2011.583947 · Cited by 1,103 · see citing works
The Dual Process Model of Coping with Bereavement: A Decade on
Stroebe, M., & Schut, H. (2010) · OMEGA - Journal of Death and Dying · doi:10.2190/om.61.4.b · Cited by 981 · see citing works
Ayerbe, L., Ayis, S., Wolfe, C. D. A., & Rudd, A. G. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.107664 · Cited by 980 · cited 1× · see citing works
“…cognitive functioning (Lezak, Howieson, Loring, Hannay & Fischer, 2004; Toole, Bhadelia, Williamson & Veltkamp, 2004), alongside secondary consequences of social isolation, reduced psychological wellbeing and a generalised sense of loss (Ayerbe, Ayis, Wolfe & Rudd, 2013; Campbell-Burton et al .”
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104449 · Cited by 800 · see citing works
Tomaka, J., Thompson, S. E., & Palacios, R. (2006) · Journal of Aging and Health · doi:10.1177/0898264305280993 · Cited by 726 · see citing works
Health Psychology: Psychological Adjustment to Chronic Disease
Stanton, A. L., Revenson, T. A., & Tennen, H. A. (2006) · Annual Review of Psychology · doi:10.1146/annurev.psych.58.110405.085615 · Cited by 688 · see citing works
Gillies, J., & Neimeyer, R. A. (2006) · Journal of Constructivist Psychology · doi:10.1080/10720530500311182 · Cited by 678 · see citing works
Assessing posttraumatic cognitive processes: the Event Related Rumination Inventory
Cann, A., Calhoun, L. G., Tedeschi, R. G., Triplett, K. N., Vishnevsky, T., & Lindstrom, C. M. (2011) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2010.529901 · Cited by 662 · see citing works
Chambers, J. R., & Windschitl, P. D. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.5.813 · Cited by 547 · see citing works
Facilitating Posttraumatic Growth
(1999) · doi:10.4324/9781410602268 · Cited by 446 · see citing works
Frequency of Anxiety after Stroke: A Systematic Review and Meta-Analysis of Observational Studies
Burton, C. A. C., Murray, J., Holmes, J., Astin, F., Greenwood, D., & Knapp, P. (2013) · International Journal of Stroke · doi:10.1111/j.1747-4949.2012.00906.x · Cited by 427 · see citing works
Ischaemic stroke in young adults: risk factors and long-term consequences
Maaijwee, N. A. M. M., Rutten-Jacobs, L. C. A., Schaapsmeerders, P., van Dijk, E. J., & de Leeuw, F.-E. (2014) · Nature Reviews Neurology · doi:10.1038/nrneurol.2014.72 · Cited by 377 · see citing works
Newton, J. N., Briggs, A. D. M., Murray, C. J. L., Dicker, D., Foreman, K. J., Wang, H., Naghavi, M., Forouzanfar, M. H., Ohno, S. L., Barber, R. M., et al. (2015) · The Lancet · doi:10.1016/s0140-6736(15)00195-6 · Cited by 347 · see citing works
Posttraumatic Growth in Clinical Practice
Calhoun, L. G., & Tedeschi, R. G. (2012) · Routledge eBooks · doi:10.4324/9780203629048 · Cited by 328 · see citing works
Positive Outcomes Following Bereavement: Paths to Posttraumatic Growth
Calhoun, L. G., Tedeschi, R. G., Cann, A., & Hanks, E. A. (2010) · Psychologica Belgica · doi:10.5334/pb-50-1-2-125 · Cited by 272 · see citing works
Hann, K. E. J., & McCracken, L. M. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.10.001 · Cited by 259 · see citing works
Acceptance and denial: implications for people adapting to chronic illness: literature review
Telford, K., Kralik, D., & Koch, T. (2006) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2006.03942.x · Cited by 246 · see citing works
Long-term Mortality After Stroke Among Adults Aged 18 to 50 Years
Rutten‐Jacobs, L. C. A., Arntz, R. M., Maaijwee, N. A. M., Schoonderwaldt, H. C., Dorresteijn, L. D. A., van Dijk, E. J., & de Leeuw, F. (2013) · JAMA · doi:10.1001/jama.2013.842 · Cited by 238 · see citing works
Feros, D. L., Lane, L., Ciarrochi, J., & Blackledge, J. T. (2013) · Psycho-Oncology · doi:10.1002/pon.2083 · Cited by 216 · cited 1× · see citing works
“…psychotherapeutic intervention for improving well-being and function for patients experiencing a range of chronic conditions including cancer (Feros, Lane, Ciarrochi & Blackledge , 2013), pain (Hann & McCracken, 2014), and neurological conditions such as multiple sclerosis (Carrigan & Dysch,…”
Change in identity and self-concept: a new theoretical approach to recovery following a stroke
Ellis-Hill, C. S., & Horn, S. (2000) · Clinical Rehabilitation · doi:10.1191/026921500671231410 · Cited by 191 · see citing works
Revised coping theory and the process of bereavement.
Folkman, S. (2001) · American Psychological Association eBooks · doi:10.1037/10436-024 · Cited by 186 · see citing works
Collins, R. L. (2000) · Springer eBooks · doi:10.1007/978-1-4615-4237-7_9 · Cited by 173 · see citing works
Medical and Psychosocial Aspects of Chronic Illness and Disability
Paterson, B. L., & Mercer, B. (2008) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2007.02255.x · Cited by 172 · see citing works
Reactions to invisible disability: The experiences of young women survivors of hemorrhagic stroke
Stone, S. D. (2005) · Disability and Rehabilitation · doi:10.1080/09638280400008990 · Cited by 168 · see citing works
Groce, N. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-803678-5.00114-4 · Cited by 164 · see citing works
Cognitive processing and posttraumatic growth after stroke.
Gangstad, B., Norman, P., & Barton, J. (2009) · Rehabilitation Psychology · doi:10.1037/a0014639 · Cited by 142 · see citing works
Kangas, M., & McDonald, S. (2011) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2010.540920 · Cited by 133 · see citing works
Effect of mood symptoms on recovery one year after stroke
Donnellan, C., Hickey, A., Hevey, D., & O'Neill, D. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2482 · Cited by 132 · see citing works
Social interaction plays a critical role in neurogenesis and recovery after stroke
Venna, V. R., Xu, Y., Doran, S. J., Patrizz, A., & McCullough, L. D. (2014) · Translational Psychiatry · doi:10.1038/tp.2013.128 · Cited by 120 · see citing works
Young adults’ experience of stroke: a qualitative review of the literature
Lawrence, M. (2010) · British Journal of Nursing · doi:10.12968/bjon.2010.19.4.46787 · Cited by 98 · see citing works
Peer support for stroke survivors: a case study
Kessler, D., Egan, M. Y., & Kubina, L.-A. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-256 · Cited by 87 · see citing works
Meaning and its measurement in psychosocial oncology
White, C. A. (2004) · Psycho-Oncology · doi:10.1002/pon.815 · Cited by 70 · see citing works
Visser, M. M., Heijenbrok-Kal, M. H., van‘t Spijker, A., Lannoo, E., Busschbach, J. J. V., & Ribbers, G. M. (2016) · Stroke · doi:10.1161/strokeaha.115.010961 · Cited by 60 · see citing works
Meaning perspective transformation following stroke: the process of change
Kessler, D., Dubouloz, C., Urbanowski, R., & Egan, M. Y. (2009) · Disability and Rehabilitation · doi:10.1080/09638280802509512 · Cited by 57 · see citing works
Traumatic brain injury and the construction of identity: A discursive approach
Cloute, K., Mitchell, A., & Yates, P. (2008) · Neuropsychological Rehabilitation · doi:10.1080/09602010701306989 · Cited by 54 · see citing works
Levack, W., Boland, P., Taylor, W. J., Siegert, R. J., Kayes, N. M., Fadyl, J. K., & McPherson, K. M. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-004630 · Cited by 53 · see citing works
Post-stroke emotional adjustment: A modified social cognitive transition model
Taylor, G. H., Todman, J., & Broomfield, N. M. (2011) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2011.598403 · Cited by 49 · see citing works
Post‐traumatic growth in stroke carers: A comparison of theories
Hallam, W., & Morris, R. C. (2013) · British Journal of Health Psychology · doi:10.1111/bjhp.12064 · Cited by 46 · see citing works
Self-citationStroke is a chronic disease with acute events
O’Neill, D. J., Horgan, F., Hickey, A., & McGee, H. M. (2008) · BMJ · doi:10.1136/bmj.39500.434086.1f · Cited by 40 · see citing works
Kalla, T., Downes, J. J., & de Broek, M. V. (2001) · Neuropsychological Rehabilitation · doi:10.1080/09602010042000141 · Cited by 40 · see citing works
A qualitative investigation of sense of self and continuity in younger adults with stroke
Hutton, L., & Ownsworth, T. (2019) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2017.1292922 · Cited by 27 · see citing works
Hjelmblink, F., Bernsten, C. B., Uvhagen, H., et al. (2007) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482620701296358 · Cited by 23 · see citing works
Progressive cognitive impairment after stroke
Toole, J. F., Bhadelia, R. A., Williamson, J. D., et al. (2004) · Journal of Stroke and Cerebrovascular Diseases · doi:10.1016/j.jstrokecerebrovasdis.2004.03.005 · Cited by 21 · see citing works
Group Psychotherapy and Related Helping Groups Today: An Overview
Scheidlinger, S. (2004) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.2004.58.3.265 · Cited by 20 · see citing works
Neuropsychological Rehabilitation
Yi, A., & Belkonen, S. (2018) · Springer eBooks · doi:10.1007/978-3-319-57111-9_1096 · Cited by 18 · see citing works
Exploring social and leisure participation among stroke survivors: Part two
Amarshi, F., Artero, L., & Reid, D. (2006) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2006.13.5.21376 · Cited by 12 · see citing works
Living with Parkinson’s disease in the community: improving assessments and interventions
Ambrosio, L., Sánchez, M. V. N., & Portillo, M. C. (2014) · Primary Health Care · doi:10.7748/phc.24.10.26.e915 · Cited by 8 · see citing works
Evaluating a transdiagnostic acceptance and commitment therapy psychoeducation intervention
Cartwright, J., & Hooper, N. (2017) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x17000125 · Cited by 7 · cited 1× · see citing works
“The intervention was based on a mental health version of ACT described in more detail in Cartwright & Hooper (2017), adapted for stroke in collaboration with stroke survivors and carers.”
Identifying Denial in Stroke Patients
Christensen, J. M., Cook, E. A., & Martin, B. C. (1997) · Clinical Nursing Research · doi:10.1177/105477389700600109 · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Han, A., & Kim, T. H. (2022) · Journal of Medical Internet Research · doi:10.2196/39727 · Cited by 50 · see citing works
“…and committed action to living in alignment with values may improve QoL and decrease psychological distress by helping those who receive the therapy better manage uncomfortable or negative emotions, thoughts, and experiences; accept them without judgment; and move forward to valued living [54,55].”
Sathananthan, N., Dimech-Betancourt, B., Morris, E., Vicendese, D., Knox, L., Gillanders, D., Das Nair, R., & Wong, D. (2022) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2021.1971094 · Cited by 31 · see citing works
Reyes, A. T. (2022) · Issues in Mental Health Nursing · doi:10.1080/01612840.2021.1953652 · Cited by 21 · see citing works
Sathananthan, N., Morris, E., Gillanders, D., das Nair, R., Knox, L., & Wong, D. (2025) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2024.2359992 · Cited by 14 · see citing works
“Similar benefits have been reported following other group rehabilitation programs (Large et al., 2020; Tulip et al., 2020; Withiel et al., 2020) and group connection following ABI is linked to psychological growth particularly when there is a strong sense of belonging or identification with other…”
Han, A. (2023) · Rehabilitation Counseling Bulletin · doi:10.1177/00343552211043257 · Cited by 14 · see citing works
Gladwyn-Khan, M., & Morris, R. (2023) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246582200042x · Cited by 13 · see citing works
Self-citationHan, A., Wilroy, J. D., & Yuen, H. K. (2023) · Clinical Psychologist · doi:10.1080/13284207.2022.2163158 · Cited by 12 · see citing works
Interventions targeting psychosocial adaptation in people with stroke: A scoping review
Zhang, Q., Chen, S., Zhang, Y., Ni, J., Huang, J., Wu, Y., & Li, M. (2023) · Patient Education and Counseling · doi:10.1016/j.pec.2023.107751 · Cited by 7 · see citing works
Storey, A., Nash, E., Dempsey, H., McIvor, K., & Zarotti, N. (2025) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2025.2457666 · Cited by 4 · see citing works
“…pain management group found that ACT led to greater openness towards thoughts and acceptance of living with chronic pain (Aymerich et al., 2022), and similar findings were observed following ACT groups for people living with multiple sclerosis (Ben-Zion, 2016) and stroke (Large et al., 2020).”
Ooi, J., & Steverson, T. (2023) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x23000260 · Cited by 2 · see citing works
“Emerging evidence indicates that ACT may also be an efficacious treatment approach for post-stroke adjustment difficulties (Graham et al ., 2015; Large et al ., 2019; Majumdar and Morris, 2019, Niu et al ., 2022; Rauwenhoff et al ., 2023).”
BackgroundRauwenhoff, J. C., Bol, Y., Peeters, F., & van Heugten, C. M. (2024) · Clinical Rehabilitation · doi:10.1177/02692155231218813 · Cited by 2 · see citing works
“17 Key strengths of the BrainACT intervention are the experiential nature of the intervention, the sim-pli fi ed materials of the workbook and homework, which were experienced as clear, and the structured nature of the protocol with help of the bus of life metaphor.”
Background
- Authors
- Large, R., Samuel, V., & Morris, R.
- Affiliations
- Cardiff University (GB)
- Corresponding author
- Morris, Reg
- Venue
- Neuropsychological Rehabilitation
- Publisher
- Informa UK Limited
- Published
- 2019-03-29
- Volume
- 30
- Issue
- 8
- Pages
- 1477-1496
- ISSN
- 0960-2011 (ISSN-L)
- 1464-0694
- OpenAlex
- W2925342522
- Cited by
- 37
- References
- 58
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 8
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- green
- pearl.plymouth.ac.uk
- Locations
- Neuropsychological Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- PEARL (University of Plymouth) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- acceptance and commitment therapy, stroke survivors, stroke rehabilitation, psychological adjustment, psychological distress, group therapy, residual disability, lived experience
- MeSH terms
- Stroke Rehabilitation, Psychological Distress, Adaptation, Psychological, Aged, Aged, 80 and over, Female, Humans, Male, Psychotherapy, Group, Patient Satisfaction, Process Assessment, Health Care, Survivors, Stroke, Qualitative Research, Acceptance and Commitment Therapy
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 ›
Are you an author, or do you see a problem with this page? Request a review
