title: Augmented Cognitive Behavioral Therapy for Poststroke Depressive Symptoms: A Randomized Controlled Trial.
abstract: To evaluate the effectiveness of individually tailored cognitive behavioral therapy (CBT) for reducing depressive symptoms with or without anxiety poststroke.
  
  
  
  Multicenter, assessor-blinded, randomized controlled trial.
  
  
  
  Ambulatory rehabilitation setting.
  
  
  
  Patients who had a Hospital Anxiety and Depression Scale-depression subscale (HADS-D) score >7 at least 3 months poststroke (N=61).
  
  
  
  Participants were randomly allocated to either augmented CBT or computerized cognitive training (CCT). The CBT intervention was based on the principles of recognizing, registering, and altering negative thoughts and cognitions. CBT was augmented with goal-directed real-life activity training given by an occupational or movement therapist.
  
  
  
  HADS-D was the primary outcome, and measures of participation and quality of life were secondary outcomes. Outcome measurements were performed at baseline, immediately posttreatment, and at 4- and 8-month follow-up. Analysis was performed with linear mixed models using group (CBT vs CCT) as the between-subjects factor and time (4 assessments) as the within-subjects factor.
  
  
  
  Mixed model analyses showed a significant and persistent time effect for HADS-D (mean difference, -4.6; 95% confidence interval, -5.7 to -3.6; P<.001) and for participation and quality of life in both groups. There was no significant group × time effect for any of the outcome measures.
  
  
  
  Our augmented CBT intervention was not superior to CCT for the treatment of mood disorders after stroke. Future studies should determine whether both interventions are better than natural history.
authors.affiliation: Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: joyce.kootker@radboudumc.nl.
authors.forename: Joyce A
authors.initials: JA
authors.lastname: Kootker
authors.affiliation: Adelante Rehabilitation Center, Hoensbroek, The Netherlands; CAPHRI, Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Sascha M C
authors.initials: SM
authors.lastname: Rasquin
authors.affiliation: Groot Klimmendaal, Rehabilitation Center, Arnhem, The Netherlands.
authors.forename: Frederik C
authors.initials: FC
authors.lastname: Lem
authors.affiliation: School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: van Heugten
authors.affiliation: Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Klimmendaal Rehabilitation Center, Arnhem, The Netherlands.
authors.forename: Luciano
authors.initials: L
authors.lastname: Fasotti
authors.affiliation: Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.
authors.forename: Alexander C H
authors.initials: AC
authors.lastname: Geurts
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D020521:Stroke / Q000523:psychology*; D016896:Treatment Outcome
keywords: Anxiety; Depression; Psychology; Rehabilitation; Stroke