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  • Anne Nisenzon, PhD

Struck by Stroke: What to Expect and How to Cope

Updated: Oct 25, 2019

Stroke, depression, therapy, psychology, philadelphia

May is National Stroke Awareness Month. With nearly a million new cases of stroke each year in the United States, it is a leading cause of long-term disability and has broad reaching personal and professional costs. Anyone who has experienced a stroke or cares for a stroke survivor is well aware of the emotional and mental consequences a stroke can have. Depending on the location and severity of the stroke, recovery can differ vastly and comes with a lot of uncertainty. Grief is very common and understandable given the sudden loss of functioning that often accompanies a stroke. Anxiety and frustration also arise as you and your loved ones try to adjust to the roller coaster that comes with recovery. Knowing what to expect emotionally can help you cope through difficult moments in your rehabilitation, as well as know when it is time to get help.

The course of recovery after a stroke can vary from person to person. While the most rapid recovery usually occurs in the first 3-4 months, there can still be gains in physical and mental functioning for another couple of years after the stroke. Noticing and celebrating any steps in recovery, no matter how big or small, can help you stay motivated in therapy. Also realizing that progression is not always a straight line and there will likely be setbacks can help you keep going when you have a bad day or week.

While sadness, worry, and frustration are normal reactions after a stroke, it is important to take action when these issues become persistent and start to impact functioning. One common condition after stroke is depression, where you feel sad or numb most of the time, withdraw from family and friends, and don’t want to do anything, even activities you still can do. Severe anxiety, when worry gets in the way of everyday activities and can lead to feelings of panic, is another condition that can follow stroke. Depression and anxiety can impact your rehabilitation course and therefore should be addressed as soon as possible to bolster recovery. Seeing a therapist or talking to your doctor about medications can help you understand and manage these issues before they become a more interfering problem.

A lesser known condition that can happen in some stroke survivors is called pseudobulbar affect, where you have trouble controlling your emotions or may laugh or cry inappropriately. People experiencing this condition may feel embarrassed by their emotional expressions and therefore withdraw from social events or their loved ones. Understanding that these reactions are caused by an injury to the brain’s ability to regulate emotions may help you release self judgments that then contribute to depression or frustration. While there are currently limited medical interventions for pseudobulbar affect, certain psychological interventions such as relaxation training and mindfulness may help manage unwanted behaviors.

The road to recovery after a stroke is very challenging and taking a “all hands on deck” approach can help you rehabilitate optimally. Getting established with psychotherapy in addition to your other physical therapies can improve your coping tools, thereby keeping you strong and ready for each new hurdle you may face. May is also National Mental Health Awareness Month. Talk about how you’re feeling, ask for help, and prioritize your mental health to optimize your recovery after a stroke.

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