Link between post-stroke psychopathology and scope-of-action awareness
Open accessAbstract
Background: Epidemiological research has failed to confirm laterality of lesion site as a neurobiological source of post-stroke psychopathology. However, acquired communication disorders have proved to be a key risk factor for depression, apart from established parameters such as pre-stroke psychopathology and physical immobility. Objectives: The present work examines a new predictor of post-stroke psychopathology: psychological flexibility. This concept describes an accepting attitude toward irreversible loss following stroke while using remaining agency. Design: Overall, 70 individuals engaged in a cross-sectional study conducted in the subacute stage after an ischemic or hemorrhagic event, a period with elevated prevalence of mental-health problems (2 weeks to 6 months after stroke). Methods: Outcomes included standardized self-report and clinician-rated measures of depression, anxiety disorders, and general psychopathology (Beck Depression Inventory; Hospital Anxiety and Depression Scale; ICD-10 Symptom Rating; Hamilton Depression Rating Scale) alongside lack of psychological flexibility (Acceptance and Action Questionnaire II). The study design controlled for pre-stroke psychopathology and physical immobility (Barthel Index). Results: Partial correlation analyses revealed a significant medium-to-large association between the entire set of clinical outcomes and lack of psychological flexibility ( r ⩽ 0.62, p < 0.001). In moderator analyses, the magnitude of this association did not vary significantly with diagnosis of acquired communication disorders (i.e., aphasia, apraxia of speech or dysarthria; separately or combined). Conclusion: The current results demonstrate a substantial link between post-stroke psychopathology and psychological flexibility. This finding opens new avenues for research on depression and other mental-health problems in stroke survivors with and without acquired communication disorders. Registration: www.drks.de ; identifier: DRKS00031204
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Post-stroke anxiety and psychological flexibility affect quality of life and mental quality in stroke patients.
“There is a substantial association between post-stroke anxiety and psychological flexibility in stroke patients, which also affects their quality of life and mental quality (Lv et al. 2021;Stahl et al. 2024;Yuliana et al. 2023).”
From The Relationship Between Knowledge, Psychological Flexibility, Anxiety and Healthy Behaviour in Stroke Patients: A Chain Mediation Model. (2026) · cites this paper as Stahl et al. 2024
The Results (Table 2; page unavailable) report a significant association between lack of psychological flexibility and anxiety-disorder symptoms in stroke survivors. The Methods > Outcomes section lists measures of psychopathology and flexibility, but not quality of life or “mental quality”; the Discussion > Limitations also cautions that the correlational design cannot establish causality. Thus the source supports the association, not the claimed effects on quality of life or mental quality. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThere is a substantial association between post-stroke anxiety and psychological flexibility in stroke patients.
“There is a substantial association between post-stroke anxiety and psychological flexibility in stroke patients, which also affects their quality of life and mental quality (Lv et al. 2021;Stahl et al. 2024;Yuliana et al. 2023).”
From The Relationship Between Knowledge, Psychological Flexibility, Anxiety and Healthy Behaviour in Stroke Patients: A Chain Mediation Model. (2026) · cites this paper as Stahl et al. 2024
The Results report significant associations between lack of psychological flexibility and anxiety scores in 70 stroke survivors (HADS r = 0.47; ISR r = 0.34). That supports the quoted association. The citing sentence also says this affects quality of life and mental quality, but the passages from this paper do not establish those effects; its Discussion describes the study as correlational. (LLM, conf=0.86)
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Cites
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The empirical status of acceptance and commitment therapy: A review of meta-analyses
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“18 To date, only a few studies have investigated the association between mental-health problems and psychological flexibility in neurological conditions.”
BackgroundRumination, experiential avoidance, and dysfunctional thinking in eating disorders.
Rawal, A., Park, R. J., & Williams, J. M. G. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.05.009 · Cited by 223 · see citing works
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Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence
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Entwicklung des Fragebogens »ICD-10-Symptom-Rating« (ISR)
Tritt, K., von Heymann, F., Zaudig, M., Zacharias, I., Söllner, W., & Loew, T. (2008) · Zeitschrift für Psychosomatische Medizin und Psychotherapie · doi:10.13109/zptm.2008.54.4.409 · Cited by 123 · see citing works
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Psychologische Flexibilität messen: Der Fragebogen zu Akzeptanz und Handeln II
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“These studies point to a link between severity of depression and reduced psychological flexibility in individuals with mild traumatic brain injury, 19,20 spinal cord injury 21 as well as in mixed samples with stroke survivors and their relatives 22 or a wide spectrum of neurological syndromes such…”
BackgroundResultPatchwood, E., Foote, H., Vail, A., Cotterill, S., Hill, G., The WAterS PCPI Group, & Bowen, A. (2024) · Clinical Rehabilitation · doi:10.1177/02692155241239879 · Cited by 15 · cited 1× · see citing works
“In clinical practice, such tailored treatment seeks to promote psychological flexibility in stroke survivors 41 by adopting various methods proposed in the literature (e.g., setting new goals congruent with personal values).”
MethodMeasuring psychological flexibility and cognitive defusion in individuals with acquired brain injury
Rauwenhoff, J., Peeters, F., Bol, Y., & Van Heugten, C. (2021) · Brain Injury · doi:10.1080/02699052.2021.1972155 · Cited by 5 · see citing works
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Cited by
Sorted by citations
Ma, R., Qiao, M., Zhou, Y., Sun, W., Lv, Y., Zhou, X., Wang, Y., Wu, X., & Yu, R. (2026) · Journal of Clinical Nursing · doi:10.1111/jocn.17820 · Cited by 3 · see citing works
- Authors
- Stahl, B., Becker, K., Kocyigit, K., Denzler, P., & Röder, P.
- Affiliations
- MSB Medical School Berlin (DE)
- Median-Klinik Berlin-Kladow, Berlin, Germany
- Corresponding author
- Stahl, Benjamin
- Venue
- Therapeutic Advances in Neurological Disorders
- Publisher
- SAGE Publications
- Published
- 2024-01
- Volume
- 17
- Pages
- 17562864241282633-17562864241282633
- ISSN
- 1756-2856 (ISSN-L)
- 1756-2864
- PMC
- PMC11528591
- OpenAlex
- W4403754665
- Cited by
- 2
- References
- 13
- Citations by year
- 2025: 2
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Therapeutic Advances in Neurological Disorders (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- psychological flexibility, depression, anxiety disorders, acquired communication disorders, aphasia, apraxia of speech, dysarthria, stroke, Acceptance and Action Questionnaire, subacute stroke
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