ACT-based change processes as predictors of post-stroke depression among stroke survivors

Evidence is needed about contextual-behavioural change processes that could be targeted by Acceptance and Commitment Therapy-based (ACT-based) interventions for specific populations and contexts, including those designed to help stroke survivors avoid or reduce depression. In this study, an online questionnaire survey with measures of depression (PHQ-9), psychological flexibility (AAQ-ABI), cognitive fusion (CFQ), valued living (VLQ), and stroke impact (SF-SIS) was completed by 81 stroke survivors (aged 29-85 years, 58.0% female, 49.4% post-ischaemic stroke, and 27.2% post-haemorrhagic stroke). Hierarchical linear regression and mediation analyses were used to test hypothesized associations between stroke impact, psychological flexibility, cognitive fusion, valued living, and depression. The results showed that cognitive fusion, stroke impact, gender, and ethnicity predicted depression independently of other factors, accounting for 60.2% of the variance in depression. Cognitive fusion almost entirely mediated the initially significant independent association between psychological flexibility and depression. The findings support the value of ACT-based interventions for stroke survivors and suggest that cognitive de-fusion is a change process that could be specifically targeted to avoid or reduce depression. Cognitive de-fusion may have a positive impact on depression because it helps with rebuilding personal identity following stroke.