Emotional wellbeing in stroke Dr Abi Methley & Dr Mary Delaney - PowerPoint PPT Presentation

Emotional wellbeing in stroke Dr Abi Methley & Dr Mary Delaney

Aims and Learning Outcomes  Understanding psychological reactions to stroke  Some practical ideas for managing psychological well being in stroke settings  A brief intervention to Acceptance and Commitment Therapy values based working.  Signposting to further information and resources  Self care – our own psychological wellbeing  Whistle stop tour!

 What are your hopes for today’s training?

Contents  The role of the MDT and Clinical Psychology in emotional reactions to stroke  Symptoms of psychological distress  Causes of psychological distress  Practical hints and tips  Signposting, resources, when to refer on.

Everybody’s business……  “If you want to heal the body, you must first heal the mind” Plato – 327-347 BC  We’re not just legs and arms and a mouth. We are human beings with a mixture of emotions. All these feelings, self esteem, self worth, confidence, identity, they’re all under attack after a stroke. You can feel vulnerable, frightened and you can lose yourself. Psychological support puts you back together again - especially psychological support from someone who’s been down that road before. The timing can’t be predicted. Sometimes it’s when you come out into your real world after hospital or it may be two - or more - years later when you discover that you will not make a ‘full’ recovery. It’s about reinvention and finding direction.  Harry Clarke , Counsellor at Connect who has aphasia

Experiences of a counsellor for people with stroke  Stroke survivor who works as a counsellor at Connect  https://www.youtube.com/watch?v=09nnQBToa_8

Stroke survivor experiences  “I wish I had known that mental problems can come on later on, like depression and fatigue. I was so frightened”  “They kept saying ‘you will get better’. Things got worse - tears, suicidal thoughts. They frightened me more than the stroke”

Barriers  E.g.  Time, confidence, training  Fear of Falling clinical examples  Supervision  Saving time in long run  Overall team time  Person centred approach  Normalising fear

Emotional distress  May reduce participation in rehabilitation  Can result in longer episodes of rehabilitation  Can effect a person’s overall ability to progress/adjust after stroke  If not addressed this can result in extra demands being placed on health care services  Can influence negatively mortality rates post-stroke  Doubles the risk of suicide

Stepped care model

Emotional reactions to stroke  Depression + apathy  Anxiety  Emotionalism  Post-traumatic Stress Disorder  Grief/Loss  Needs of carers and family members  Complex interplay of various factors, individualized person centered approach.

Emotional distress  Depressed/Low mood for the most of the day  Reduced pleasure in activities  Change in appetite (increase or decrease)  Sleep problems (decrease or increase in amount)  Agitation  Fatigue/Loss of Energy  Reduced motivation  Feelings of Worthlessness/Excessive or Inappropriate Guilt  Reduced ability to think or concentrate or indecisiveness  Recurrent thoughts of self-harm/death/suicide

 Fears/worries eg, falling, having another stroke, financial worries, how they or family will cope after the stroke.  Physical sensations eg heart-pounding, difficulty breathing, sweating etc  Inability to relax.  Avoidance of fearful places eg supermarket, social activities .  PTSD  Anger

Stages of recovery As cognitive deficits decrease, awareness increases. But increase in awareness/insight is often accompanied by an increase in anxiety and depression

Emotionalism  Involuntary, uncontrollable episodes of crying and/or laughing.  Episodes sometimes incongruent to reported mood…don’t match up to how person actually says they are feeling. E.g.Score okay on HADS.  Sometimes feels like an over-reaction.  Sudden and unpredictable.  Can last a few seconds…up to several minutes.  May happen several times per day.  May last over a year (1 in 10)  Distraction can be helpful. Comforting person can exacerbate symptoms

What can I do?  Managing expectations and endings  Active listening  Goal setting – Values based goals  Signposting to resources  Managing endings and expectations for rehabilitation

ACT Values A meaningful life STROKE Grief Struggle Suffering

ACT: Experiential avoidance  “ Headstuck! What is Experiential Avoidance ?”  https://www.youtube.com/watch?v=C-ZuqeyxULM

ACT Values exercises  90 th Birthday  What makes life worth living?

Active listening  Demonstrate that you are listening with your body language and by summarising what they have said so far  Give them time and space to talk  It may be better not to offer solutions straight away….listen to ensure you have the full story  Normalise their feelings in the light of their stroke “its common for people to feel like that after a stroke”  If someone is crying…allow them more time to speak and normalise their tearfulness (rather than try to stop it)  Sometimes doing ‘nothing’ is the most supportive thing you can do

Managing endings  Planning the ending from the assessment stage  Managing expectations  Dealing with plateaus  Avoiding feelings of abandonment  Ending letters – who do you write to? What is the content? What positive written feedback do you give your patients?  Realistic goal setting – guided failure?

Compassion focussed therapy  For people who suffer with high levels of shame and self- criticism  Helps people to feel more compassion towards themselves, with a positive impact on their ability to cope  Exercise: How would you treat a friend?

Self Care  Emotional distressing work at times  Who looks after us?  Self care  Team culture around self care  #149 Culture and GOB  Mindfulness  Practice what we preach !!!

Risk  Warning signs  Helplessness, hopelessness, worthlessness  Despair  Previous history  What/How to ask?  Will asking increase risk?

References and Resources  HEADSPACE app and Youtube videos – Mindfulness by Andy Puddicombe. Good introduction.  Mindfulnesss – http://www.breathworks- mindfulness.org.uk/mindfulness-for-health/long-term-health- conditions  Russ Harris – You tube videos, book: “The Happiness Trap”  Rebuilding your life after stroke by Reg Morris  Self care for the Real World by Nadia Narain

Thank you  Any questions or comments?