Piloting the Attention Training Technique for Post-Stroke Emotionalism
Research type
Research Study
Full title
Applying the Metacognitive Model to Post-Stroke Emotionalism: A Multiphasic Case Series piloting the Attention Training Technique
IRAS ID
333045
Contact name
Adrian Wells
Contact email
Sponsor organisation
University of Manchester
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 3 months, 29 days
Research summary
There are around one million stroke survivors in the UK, many of which have emotional difficulties. One common difficulty is that people struggle to control their emotions. For example, they may start to cry even when they are not feeling sad. This is called Post-Stroke Emotionalism (PSE). People with PSE are often very embarrassed by it which has negative consequences for their recovery and mental health. There are few treatments to help PSE. Antidepressant medications are not very effective and there is no evidence for the effectiveness of psychological interventions. One psychological treatment that might help improve PSE symptoms is the Attention Training Technique (ATT). It could help people to disengage from the unhelpful thoughts and coping strategies that are believed to make PSE worse. The ATT is a listening exercise that helps people become unstuck from an unhelpful thinking pattern. A pattern of paying too much attention to themselves, their thoughts, and emotions. It helps people to recognise this pattern and become more in control of it. This study aims to explore if the ATT can improve PSE symptoms. It will teach the ATT to at least three people who have had a stroke at least six months ago, have PSE and are currently receiving support from a Community Neurorehabilitation service in the North West of England. Stroke survivors will also require the support of a carer/loved to record their symptoms on a daily basis. Stroke survivors will attend weekly appointments either at the community service site or via video-call for up to 15 weeks. There is also the option to complete an interview to discuss their experiences of learning the ATT with the researcher. This study hopes to be the first step in establishing evidence in support of a novel psychological intervention to help improve PSE symptoms.
Lay summary of study results: Background: Post-Stroke Emotionalism (PSE) is a common difficulty that can occur after stroke. It causes people to cry, unpredictably and uncontrollably, even when they are not feeling sad. People with PSE are often very embarrassed by it which has negative consequences for their recovery and mental health. There is currently very limited evidence for psychological interventions for PSE. A metacognitive intervention called the Attention Training Technique (ATT) may be effective in helping people to disengage from unhelpful thoughts and coping strategies that are believed to make PSE worse. The aim of this study was to pilot the ATT to help improve PSE symptoms.
Method: An A-B case-series design with follow-up was used across five stroke survivors. Between 5 and 12 weeks of baseline symptom monitoring (A) and between 3 and 10 weekly intervention sessions (B) was completed. The primary outcome was the frequency of post-stroke emotionalism symptoms, and a range of secondary outcomes were also measured pre-and post-intervention. Follow-up analyses were completed between 3 and 6-months post-intervention with most participants.
Results: Stable baselines were observed in most cases. Across all stroke survivors, ATT was associated with reductions in PSE symptom frequency. The majority of secondary outcomes also showed improvement. Follow-up data is still being analysed, and the full results will be published in due course.
Conclusion: This pilot case series provides preliminary evidence that ATT is associated with improvements in PSE. Replication and extension is required to confirm an intervention effect and explore potential mechanisms.REC name
East Midlands - Leicester Central Research Ethics Committee
REC reference
24/EM/0081
Date of REC Opinion
16 May 2024
REC opinion
Further Information Favourable Opinion