Acceptance and Commitment Therapy for stroke survivors in the group setting: A feasibility and pilot study

Design: Feasbility study in a pre-post design with 6 months follow-up. Setting: Outpatient clinic. Germany. Participants: Nine stroke survivors with elevated symptoms of depression, anxiety or stress.Intervention: An English language group therapy manual (8 weekly sessions) based on Acceptance and Commitment Therapy was translated into German and adjusted by shortening sessions and simplifying contents. Two groups were facilitated.Main measures: Rates of recruitment, drop-out, attendance, homework and outcome completion. Treatment fidelity was evaluated in video-based ratings. Participants and therapists reported therapy acceptance (GTS). Participants rated psychopathological symptoms (DASS-21) and psychological flexibility (AAQ-ABI). Secondary outcomes included depression (PHQ-9) and anxiety symptoms (GAD-7), valued living (VQ), and self-as-context (SACS). All measures were translated to plain language.Results: All feasibility criteria were fulfilled except for treatment fidelity, which fell below the cut-off of 80% (76%). Participants’ and therapists’ therapy acceptance was adequate. Reliable change indices show a decrease of psychopathological symptoms for most participants after therapy (7/9; z = -1.3 to -4.8) and six months later (5/8; z = -1.5 to -4.8). Psychological flexibility changed significantly only in a minority (2/8; z = -1.3 to -1.8; and 2/7; z = -1.5 to -1.8). Conclusions: The adjusted group therapy is feasible, while unsufficient treamtent fidelity may be based on downscaled structuring by therapists. The therapy showed a consistent effect on psychopathology assessed with plain language measures. Effects on psychological flexibility may show a smaller effect size. Evaluation in larger samples and randomized controlled trials is indicated.