1. A PSYCHOLOGICAL WELL-BEING GROUP FOR STROKE PATIENTS
Birgit Gurr Consultant Clinical Psychologist Stroke Service Poole Hospital Foundation Trust
A psychological well-being group was introduced at the Poole Stroke
Rehabilitation Unit.
Positive psychology and cognitive-behavioural therapy were applied to
support patients’ adjustments following a stroke, to optimise emotional and
cognitive functioning and to provide a service development opportunity.
The psychological well-being group is a suitable intervention to reduce
psychological distress and to optimise adjustment to residual stroke
problems. The group format allows experienced patients to introduce new
participants to the themes of the discussions and to the relaxation practice.
This enhances relationships, autonomy and personal growth which are
variables of a psychological well-being model.
The work with elderly patients in a hospital setting can be challenging due to
the variety of health and social needs. Therefore, a group like this provides
an opportunity to engage patients empathically and to optimise
psychological functioning and coping.
Qualitative Feedback: What was most important to you during the group sessions?
Procedures
The Psychological Well-Being Group (PWBG) is an open group. New participants join the group while others may be discharged. The group meets weekly for one and a half hours. The first hour follows a positive cognitive-behavioural therapy model which is followed by half an hour of mindfulness relaxation practice. Stroke patients who are undergoing intensive rehabilitation are automatically considered for participation in the PWBG. Patients who are medically unwell or unwilling to participate are excluded from the group.
The outcomes of 20 stroke patients were evaluated for this survey (13 male, 7 female). The mean age was 73 years, ranging from 37 to 91 years.
Psychological distress was measured using the Hospital Anxiety and Depression Scale. The ability to learn the relaxation exercise was self-rated by participants using an analogue scale. Patients completed a non-standardised evaluation form before discharge from their rehabilitation programme.
Hospital Anxiety and Depression Scale – Mean Outcomes
Self-report relaxation scores before and after each relaxation practice – Mean Outcomes
Results
Anxiety and depression scores decreased significantly by the end of patients’ participation in the group (p=0.02).
Analysis of the analogue relaxation scores showed significant improvements of relaxation ability up to session four (session one p=0.00, session two p=0.00, session three p=0.01, session four p=0.05; score 100=max relaxation).
The number of weeks patients participated in the group was highly variable. Most patients took part two to three times.
Patients’ qualitative feedback showed that eleven patients found the intervention very worthwhile and five found it worthwhile. The themed discussions and the relaxation components were rated as equally important and useful. Some participants applied the techniques independently during moments of distress and many planned to continue with elements of the programme following discharge from hospital.
Statistical analysis of the HADS should be interpreted with caution due to the small sample size and the lack of control for a range of variables.
Psychological Well-Being Model (Carol Ryff)
Personal growth
Self-acceptance
Autonomy
Environmental
mastery
Positive relationship
Purpose
in life
Psychological
Well-Being
Learning how to deal with worries
Relaxation: it’s wonderful!
Asking questions and listening to advice from other people
Being taught how to relax
Learning to teach the body with the power of the mind
Listening to how other people feel
Coping with my pain
Hope