Internet-based CBT After Stroke Pilot

Not Applicable

Completed

Brief Summary: Mood disorders occur in 25-30% of stroke patients and are associated with lower quality of life, higher mortality, increased healthcare utilization, and higher costs. Cognitive behavioral therapy (CBT) interventions have been shown to both treat and prevent post-stroke mood disorders, thus having the ability to improve quality of life and reduce costs. This study aims to test the feasibility of internet-based CBT combined with a telephone/email based coaching service after stroke.

Recruitment & Eligibility

Inclusion Criteria

Age ≥18 years of age
Acute ischemic stroke within the past 3 months
Regular access to the internet, sufficient to allow a minimum of interactions with the internet daily, either through a personal smartphone or web-based internet browser.
Subject is willing and able to participate in internet-based cognitive behavioral therapy
Can participate in the program in English
Willingness and ability to sign informed consent by the patient
Symptoms of mild to moderately depressed mood, defined as a score of 5-19 on the Patient Health Questionnaire-9 at the time of study enrollment.

Exclusion Criteria

Severely depressed patients, defined by a score of 20+ on the Patient Health Questionnare-9 are excluded
Patients with an active bipolar disorder diagnosis are excluded
Patients with personality disorder diagnoses are excluded
Patients with active suicidality or past suicide attempts are excluded
History of schizophrenia or schizoaffective disorder
Active participation in face-to-face psychotherapy prior to stroke
Patients with a history of dementia are excluded
Patients with aphasia, defined as a score of 1 or greater on NIH Stroke Scale Item 9 are excluded.
Patients without regular internet access through a computer, tablet or smartphone are excluded.
Subjects requiring long-term inpatient nursing care are excluded. For patients enrolled as inpatients, individuals being discharged to both home and acute rehab are eligible. Individuals being discharged to a skilled nursing facility or hospice are excluded.
Expected life expectancy less than 6 months or other inability to comply with study follow-up.
Pregnant women and prisoners are excluded

Arm && Interventions

Group	Intervention	Description
Cognitive Behavioral Therapy (CBT) program	Cognitive behavioral therapy	-

Primary Outcome Measures

Name	Time	Method
Change in Depressive Symptoms Over Time	Baseline and 90 days	Subject's depressive symptoms will be quantified using the Patient Health Questionnaire 9. This assessment includes 9 close-ended questions with a scoring system ranging from 0 to 27. Scores greater than 10 are considered "positive" for depressive symptoms. We will compare the average PHQ-9 score at study enrollment to the PHQ-9 at 90 days to determine the reduction in depressive symptoms over time.

Secondary Outcome Measures

Name	Time	Method
Quality of Life Assessed by the EuroQOL-5D	90 days	EuroQOL-5D questionnaire that measures health related quality of life. The scale ranges from 1 to 100, with higher scores indicating better outcomes.