The Evolution of Self: Identity, Adjustment, and Psychological Flexibility After Stroke

Cole, Amber Rose Elizabeth (2025) The Evolution of Self: Identity, Adjustment, and Psychological Flexibility After Stroke. Doctoral thesis, University of East Anglia.

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Abstract

Aim: This thesis aimed to explore the experiences of stroke survivors to better understand the facilitating processes of self-identity reconciliation post-stroke and to assess the relationship between stroke severity, psychological flexibility and adjustment.

Methods: A systematic review and thematic synthesis of qualitative research capturing the subjective experience of stroke survivors regarding processes that support self identity reconciliation was completed. Additionally, a cross-sectional empirical study examined the relationships between stroke severity, psychological flexibility, and post-stroke adjustment.

Results: The review findings identified five overarching process themes reported by survivors as supporting self-identity reconciliation, namely: Acceptance, Accessing the Known Self, Reinvention, Reclaiming Agency, and Embracing Social Support. These encompassed personal, interpersonal and systemic elements that whilst distinct, were interconnected. The empirical paper found that poorer physical stroke severity was a unique predictor of increased helplessness-hopelessness, anxious preoccupation and fighting spirit, but not cognitive avoidance or fatalism. Cognitive stroke severity did not uniquely predict any indicator of adjustment. Whilst psychological flexibility uniquely predicted better adjustment except for the component indicating cognitive avoidance, it did not moderate the relationship between stroke severity and adjustment. Finally, higher helplessness hopelessness and anxious preoccupation, and lower fatalism, associated with worse depression and anxiety outcomes.

Conclusions: The identified processes supporting self-identity reconciliation provide insight into the relevance of therapeutic and conceptual approaches. The potential benefit of ACT in facilitating adjustment regardless of physical or cognitive disability is explored. Encouraging the engagement of the survivors' wider social network and ensuring the consideration of sociodemographic characteristics and intersectionality within the therapeutic context may support self-identity reconciliation and adjustment for survivors of stroke.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	21 Oct 2025 14:20
Last Modified:	21 Oct 2025 14:20
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100733
DOI:

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