Changes in Personality and Mood
Changes in personality and mood after stroke are common. Impulsiveness, apathy, pseudobulbar affect, anger, frustration and depression can affect a stroke survivor’s quality of life. But these challenges can be overcome by working closely with your health care team.
Impulsiveness
This is characterized as the inability to think ahead or understand consequences. Impulsiveness is more commonly experienced by survivors with right-side or front lobe stroke.
Apathy
Some survivors experience apathy. They may appear to not care about anything and lack interest and drive. This is not the same as depression. It's important to get people with apathy active, moving and involved again. Encourage them by giving them a choice of what to do or where to go, but make it clear they have to do something. This condition may require an evaluation by a neuropsychologist to determine best course for treatment if the condition doesn't improve.
Pseudobulbar Affect (PBA)
PBA is characterized by a mismatch or exaggeration of feelings and expression, like laughing at a funeral or crying at a joke.
Anxiety
Anxiety occurs when a person experiences feeling of worry, nervousness or unease. Anxiety affects about 20 percent of survivors.
Delirium
Delirium is a common yet underrecognized complication following stroke, affecting about 25% of stroke survivors. Characterized by an intense onset of altered level of consciousness with fluctuation with orientation, memory, thought, or behavior.
It's not uncommon for survivors to experience all three conditions. The good news is that treatment is available. For depression and anxiety, one of the best treatments is counseling or therapy with a licensed mental health practitioner. Medications and cognitive behavioral therapy may help PBA.
Caregivers should encourage their loved ones to get assessed for changes. If they're reluctant to see a mental health professional for therapy, they might be willing to increase their social support by becoming active in a support group, or seeking guidance from a pastor, priest or rabbi or other faith counselor.
Some therapeutic approaches that can help with these changes include:
Solution Focused Therapy
Is future-focused and goal-directed, and centers on solutions instead of the problems that bring people to therapy. It’s also called Solution Focused Brief Therapy and Solution Building Practice Therapy.
Problem Solving Therapy
Is a brief psychological intervention or “talking therapy” that’s typically four to eight sessions. Problems are identified through collaboration, and the therapist teaches the person a structured approach to solving them.
Cognitive Behavioral Therapy
Focuses on examining the relationships between thoughts, feelings and behavior. By exploring thought patterns that lead to self-destructive actions and the beliefs that direct them. The therapist and individual actively work together toward recovery, by exploring better problem solving and changes in behavior patterns. This type of therapy is the gold standard for psychotherapy.
Acceptance and Commitment Therapy
Also known as Attitude and Commitment Therapy, teaches people to use acceptance and mindfulness strategies combined with goal setting, commitment and behavioral change to better control discomfort and anxiety.
Interpersonal Therapy
Focuses on interpersonal relationships by improving the way the depressed person communicates and relates. Techniques help the person identify emotions and their sources, express emotions in a healthy way and deal with emotional baggage from past relationships. Coping, communication and decision-making skills are gradually improved through a number of therapeutic techniques.
Mindfulness Therapy
Mindfulness based interventions (MBI), also called Mindfulness-Based Cognitive Therapy and Mindfulness-based stress reduction, helps those who suffer repeated bouts of depression and stress reduction. It combines the ideas of cognitive therapy with meditative practices and attitudes based on cultivating mindfulness, a non-judgmental awareness of the experiences of the present moment.
