Post-Stroke Anxiety and Depression: The Association with Psychological Flexibility and Consideration of Time Since Stroke on Treatment Outcomes

Blyth, Ellis (2025) Post-Stroke Anxiety and Depression: The Association with Psychological Flexibility and Consideration of Time Since Stroke on Treatment Outcomes. Doctoral thesis, University of East Anglia.

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Abstract

Background: Mood difficulties are prevalent in stroke survivors. Acceptance and Commitment Therapy (ACT) is a psychological intervention with a growing evidence base with stroke survivors. Psychological flexibility is a key process in ACT to support individuals manage mood difficulties. Clinical guidelines in the United Kingdom do not recommend when to provide psychological intervention for post-stroke mood difficulties. The impact of time since stroke on intervention outcomes is under-researched.

Method: A systematic review was conducted to synthesize research on psychological interventions for post-stroke depression and anxiety to explore the impact of time since stroke. A cross-sectional study recruited 206 stroke survivors, measuring impacts of stroke, psychological flexibility, depression, and anxiety. This study explored the associations between indicators of stroke impact and mood, and whether psychological flexibility moderates this relationship.

Results: A narrative synthesis of 15 studies found a greater frequency of significant improvement in depression and anxiety in intervention groups compared to controls at an earlier time since stroke. Only four studies included anxiety as an outcome. The empirical study found that psychological flexibility did not moderate the relationships between impacts of stroke, and mood. Psychological flexibility predicted depression and anxiety with a large and moderate effect size respectively.

Conclusions: Interventions were more frequently effective when provided earlier after stroke, but more evidence is needed. It is recommended that intervention randomised controlled trials for post-stroke mood routinely report time since stroke and consider recruitment of specific ranges. Psychological flexibility does not moderate the relationships between stroke impacts and mood but does predict depression and anxiety. Further research is required on psychological flexibility and mood in stroke survivors, and how it can be developed therapeutically.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	28 Oct 2025 09:03
Last Modified:	28 Oct 2025 09:03
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100807
DOI:

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