Why did we do the study?

Around one third of people who have a stroke will have aphasia, a language disability, which can affect talking, understanding, speaking and writing. It is common for people with aphasia to lose confidence and become anxious or low in mood. There is not enough research evidence for interventions that might help people with aphasia to improve their mood. Many mental health services find it difficult to offer therapy to people with aphasia, as psychological ‘talking therapies’ typically rely on complex language. People with severe aphasia find it particularly difficult to access psychological therapies.

Aims of the research

We wanted to see if it was possible to adapt a psychological therapy for people with aphasia. We wanted to include people with different kinds of aphasia, including people with severe aphasia who can say very few words. The therapy we tested is called Solution Focused Brief Therapy. This approach explores a person’s resources and expertise to enable them to move forwards. It also listens to their distress, and their experiences of living with the aphasia.

To work out if an intervention is effective, the ‘gold standard’ is a large randomised controlled trial, where half the people receive the therapy, and half do not. The groups are then compared. Before it is reasonable to fund a large-scale trial, it is useful to carry out a smaller ‘feasibility’ study. This is what we did in the SOFIA Trial (Solution Focused brief therapy In post-stroke Aphasia). We had four research questions: (1) how do people with aphasia find this therapy?; (2) do people want to take part in this research?; (3) do people like the research design and the questionnaires? (4) can Speech and Language Therapists to deliver this therapy, and if so, what training and support do they need?

Methods

We used a wait-list design. Half the participants received the therapy straight away over a 3-month period; half the participants waited for 6 months. Participants were offered up to 6 therapy sessions, delivered by Speech and Language Therapists. All the participants completed questionnaires about their wellbeing, mood and participation at the start of the project, and then 3 and 6 months later. We compared the groups at 6 months to see if there was any difference between them. The ‘wait-list’ group then received the therapy and completed questionnaires 9 months after starting in the project. We also invited all the participants to do in-depth interviews exploring their experiences of the study. In addition, we interviewed the therapists, and the NHS sites who were helping us to find people. We recruited people who were at least 6 months post stroke.

Results

1. How do people with aphasia find the therapy?

Twenty-nine participants wanted to receive all 6 sessions; 1 participant received 5 sessions; 2 withdrew due to illness or timing.  In the post-therapy interviews, participants were positive about the therapy, and considered it suitable for people with aphasia. There were five things they liked about the therapy: being able to talk about their hopes for the future; noticing their own personal qualities and achievements; being able to tell someone how they felt; companionship and having an enjoyable time; and the connection they felt with the therapist. Participants described feeling better in themselves, feeling more confident to talk in different situations, positive changes in their relationships with family and friends, increased independence (e.g. putting the rubbish out, using a purse one-handed) and increased confidence to participate (e.g. using public transport, going out to restaurants). Some people were content at the start of the project; they liked the companionship and were not seeking to make changes. A few participants were disappointed that their aphasia had not improved.

2. Do people with aphasia want to take part in this study?

Our target was to recruit 32 people with aphasia in 13 months. Our NHS sites worked hard with us to enable us to meet this target. We were proud to be able to recruit people with severe aphasia (44%). We hoped at least 70% of our participants would complete questionnaires 6 months after the start of the project. In fact, 97% of participants did so.

3. Do people like the research design and the questionnaires?

Our participants told us that they liked the Research Assistants coming to their home to help them complete the questionnaires. Some found being asked questions about their life therapeutic. Everyone answered the questions: there were almost no ‘missing’ answers, which suggests these questionnaires worked reasonably well.

Not everyone liked or understood the wait-list design. However, they were pleased to be offered the therapy, albeit after a wait of 6 months.

4. Can Speech and Language Therapists offer this therapy?

All three Speech and Language Therapists working for the study felt it was appropriate for Speech and Language Therapists to deliver this therapy. They also said it was essential to receive training at the start of the study, and regular supervision throughout. They valued being able to ask for advice after a session if they had concerns about a participant.

Clinical outcomes

Our study was too small to say for certain whether this therapy is effective. There is modest evidence that the intervention is associated with improvements in mood and wellbeing, although the numbers are small. Overall, simply taking part in the study was beneficial to people’s mood, even while waiting for the intervention. There is some evidence that people who had low wellbeing or average wellbeing at the start of the study benefited more from the therapy than people who had high wellbeing at the start.

Future implications

Our study demonstrated that it is possible to adapt a psychological therapy so that it works well for people with aphasia, including people with severe aphasia. We also demonstrated that our research design worked well: it was possible to recruit people with aphasia into our trial, and they reported that taking part was a positive experience. These promising results suggest it is worth exploring this therapy approach in future research. More generally, we found that people with aphasia valued being offered a psychological therapy. This suggests that people with aphasia should have equitable access to appropriate mental health support.