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Behaviour Activation Therapy for people with aphasia with low mood or mild depression post-stroke: delegated delivery


1st supervisor: Professor Katerina Hilari

2nd supervisor: Dr Shirley Thomas  (External)

3rd supervisor: Dr Sarah Northcott

Research centre

Language and Communication Science

Project description

Stroke and aphasia can have a profound impact on people’s lives. Depression is a common sequel of stroke (~ 33%); it is associated with worse rehabilitation outcomes, increased carer strain, increased healthcare utilisation, and higher mortality. The psychological needs of people with aphasia are even greater with rates of depression in this group up to 62%. A Cochrane systematic review has indicated that there is insufficient evidence for the effectiveness of psychological therapies for treating post-stroke depression. There is a pressing need to systematically evaluate interventions that aim to improve mood for people with stroke and for people with aphasia in particular.

The proposed PhD: One intervention, behavioural activation therapy (BAT), delivered by Assistant Psychologists has been shown to be effective for people with aphasia in a multicentre randomised controlled trial (n=105): mood was significantly better at 6 months follow up in those who received BAT compared to usual care (CALM study).  Yet, the Stroke Association’s report ‘Feeling overwhelmed’ highlights that over half of stroke units in England still have no access to psychology services.  This is an important barrier in the implementation of this intervention in clinical practice.  The proposed study will explore the feasibility of an alternative workforce delivering BAT for people with aphasia: rehabilitation workers / Speech and Language Therapy assistants (SLTAs). The study will comprise three phases. In phase 1, the student will carry out a systematic review of BATs in adult neurological populations to identify core components and map them on a theoretical framework; and consult with rehabilitation workers / SLTAs (two focus groups, n=10-12) re their needs in terms of delivering BAT. Based on this, in phase 2, the CALM BAT training and resources will be adjusted and the rehabilitation workers / SLTAs will be trained. Phase 3 will comprise a feasibility study, where n=30 people with aphasia and low mood or mild depression (screened with validated tool) will be randomised to either BAT or usual care and feasibility and potential outcomes for a definitive trial will be evaluated.  This project will lay the foundations for a large scale trial, which can form the basis of an NIHR application.

Supervisory Team: KH and SN are SLTs with extensive experience of working with people with aphasia and they currently run two feasibility RCTs on psychological interventions for people with aphasia. ST is a Psychologist: she led the CALM study and recently completed an NIHR HTA funded feasibility RCT testing BAT with a generic stroke population with positive results.  In addition to the named supervisors the candidate will be able to draw on the expertise of the wider LCS aphasia team. There will be synergies with the Mental Health team at SHS /City and with Division of Rehabilitation & Ageing at Nottingham University.

Potential for a field of strong candidates: LCS has a strong track record of recruiting excellent PhD candidates, including PhD students who have undertaken work related to this proposal.  This proposal may be of interest to recent SLT graduates, to current RAs involved in our aphasia research and to students who are completing our MScs in Speech Language and Communication or Speech and Language Therapy. It will also be of interest to Psychology graduates and Mental Health Nurses.

If you would like to have an informal discussion please contact K.Hilari@city.ac.uk.