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Section 2
6 Tools for Treating Depression after a Stroke

Question 2 | Test | Table of Contents

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In the last section, we discussed reflex crying and four recommendations for family and friends of a patient who has suffered a stroke.

In this section, we will discuss six suggestions for getting up when you’re feeling down

I have found, probably like you, that few men and women who survive a stroke escape a sense of emotional upheaval, though the intensity and length of time of this upheaval varies.  As you know, feelings of sadness, guilt, impatience, helplessness, loss, depression, love, and dislike may coincide with one another, and this kind of inner conflict may cause a feeling of confusion in the stroke survivor.

Larry, age 55, came to see me about six months after his stroke.  Because of the stroke, Larry now had to use a wheelchair.  The adjustment had been difficult for him, but he had gradually become more independent.  However, despite his physical adjustments, Larry told me that his mental and emotional states had changed drastically since his stroke. 

Larry stated, "I used to be everyone’s favorite uncle.  I would joke around, tell stories.  My brothers’ kids were always happy to see me.  But ever since the stroke, I’ve been feeling, I dunno, down. I have trouble doing chores around the house and I can’t do a lot of what I liked to do, like playing golf with my friends or backyard football with my nephews, so it’s hard to get my mind off stuff."

I stated to Larry, "While the pain of your losses will probably not go away quickly, there are ways to change how you think and to cope more effectively with your challenges."  To help him change his thoughts and coping methods, I provided Larry with the following six suggestions for getting up when you’re feeling down.  Evaluate if playing this section be beneficial for your Larry in your next session.

6 Suggestions for Getting Up when you’re Feeling Down

♦ #1. Celebrate your victories.  I stated to Larry, "Every gain is hard won.  Pause to celebrate when you accomplish something you couldn’t do the week before, even if it was something you could do with ease before your stroke.  Just as someone’s who is 40 wouldn’t expect to be judged by the same criteria as when they were 20, don’t compare current Larry to pre-stroke Larry.  You’re playing by a different set of rules, and what’s important is to notice how much you’ve gained since the stroke, not what you lost."

♦ #2.  Be determined.  I stated, "If you really want to accomplish something, like being able to play with your nephews, it may help to think about the persistence principle: trying is better than not trying at all.  While you probably can’t play a full game of football in a wheelchair, with determination you can learn to adapt, such as switching to catch or basketball related games, like HORSE."

#3.  Anger can be harnessed. Along with Celebrate your victories and Be determined, suggestion #3 is Anger can be harnessed.  I informed Larry that one of his confused emotions may be anger, and that anger, while potentially painful and destructive, can also be used as fuel to ignite determination to survive.  I stated to Larry, "Look for signs of anger such as impatience, uncooperativeness, sarcasm, hyperawareness, and bitterness, and turn its power to your advantage."

♦ #4. Judge whether you can control a situation.  I stated, "If you feel you have some control over a situation, you’ll be less likely to dwell on the problem and become depressed.  You are more likely to take action and think constructively if you believe you have the power to influence the outcome with your choices.  If your family or friends are helping you, let it be just that: helping you accomplish a task how you want it done, not them doing the task for you."

♦ #5. Break up large tasks into more manageable basic components.  I stated to Larry, "Sometimes you may not be able to take on a project or goal all at once the way you used to, but that doesn’t mean it’s now impossible.  Try taking it one step at a time, so you don’t get worn out or overwhelmed."

♦ #6. Most stress comes from what you tell yourself. Along with Celebrate your victories, Be determined, Anger can be harnessed, Judge whether you can control a situation, and Break up large tasks into more manageable basic components, #6 is Most stress comes from what you tell yourself. 

I stated to Larry, "How you talk to yourself about your challenges can be a great source of stress, or a great help, depending on if the self-talk is constructive.  I have found with many depressed clients that the most difficult time of the day is when they wake up and have the whole day ahead of them.  You may want to set a little time aside in the morning to set goals for the day, thinking of them as opportunities to test and improve your abilities instead of strains upon them."

I stated to Larry that as he became more comfortable with his changed circumstances, he would better be able to find new ways of doing things and new activities for entertainment, and he would likely return more and more to what he considered his "normal self."

Think of your Larry.  Could he or she benefit from hearing this section in your next session?

In this section, we discussed six suggestions for getting up when you’re feeling down.

In the next section, we will discuss differences between right-brain and left-brain injury as a result of stroke.  In addition, we will discuss the time orientation strategies technique at the end of the section.

Depression After Stroke

- Rehabilitation Outcomes Research Center. Depression After Stroke. Department of Veterans Affairs.

What are six suggestions for getting up when you’re feeling down?
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Section 3
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