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

Clin Rehabil. 2013 May;27(5):398-408. doi: 10.1177/0269215512462227. Epub 2012 Oct 11.


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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aphasia / etiology
  • Aphasia / psychology
  • Aphasia / rehabilitation*
  • Cognitive Behavioral Therapy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mood Disorders / etiology
  • Mood Disorders / therapy*
  • ROC Curve
  • Regression Analysis
  • Self Concept
  • Statistics, Nonparametric
  • Stroke / complications
  • Stroke / psychology
  • Stroke Rehabilitation*
  • Visual Analog Scale