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Telemedicine-delivered CBT feasible for treating poststroke anxiety

14 Aug 2020

Remote delivery of cognitive behavioural therapy (CBT) shows potential in the management of anxiety among stroke survivors, according to the results of a feasibility study.

Researchers recruited 27 adult community-based men and women (mean age, 65 years; 56 percent male) with anxiety who had experienced a minor stroke or transient ischaemic attack (TIA; median modified Rankin Scale score, 1). Participants were randomized to a telemedicine guided self-help CBT intervention (TASK-CBT; n=14) or relaxation therapy (TASK-Relax; n=13). All participants were invited to use a wrist-worn actigraphy sensor, which recorded actigraphy, light, and wrist temperature. The intervention lasted 20 weeks.

The TASK-CBT intervention was delivered remotely via telephone, treatment website, email, and mobile text. Participants had six weekly telephone sessions conducted by a stroke physician trained in CBT. They received an online task to practise between sessions and was prescribed one or more of the psycho-educational videos on the TASK-CBT treatment website.

On the other hand, participants in the TASK-Relax group received one introductory telephone session only. They were instructed to watch an introductory video and do relaxation tasks, such as performing a breathing exercise and listening to music or sounds for relaxation, among others.

About a half had a history of anxiety or depression and had modest/severe anxiety at baseline. Remote self-enrolment, electronic signature, intervention delivery, and automated follow-up were feasible. All participants in the TASK-CBT group completed all sessions (14/14).

Anxiety levels were lower in the TASK-CBT vs the TASK-Relax group at both weeks 6 and 20. Mean actigraphy sensor wearing-time was 33 days.

The preliminary data from the current study show that telemedicine-delivered CBT is a viable approach to treat anxiety after stroke/TIA and that wrist-worn actigraphy sensor is useful for collecting objective data, according to the researchers.

Overall, the study supports a larger definitive clinical trial, they added.

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