Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia

OBJECTIVE The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. DESIGN A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. SETTING Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. SUBJECTS Of 511 people with aphasia identified, 105 had low mood and were recruited. INTERVENTIONS Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. MAIN MEASURES Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales 'sad' item, and Visual Analogue Self-Esteem Scale. RESULTS Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue 'sad' (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. CONCLUSIONS Behavioural therapy seemed to improve the mood of people with aphasia.