Testing a Positive Psychology-based Intervention for Couples Coping With Stroke

Stroke survivors and spousal caregivers face significant challenges, yet interventions to
support couples after stroke are largely lacking. Depressive symptoms post-stroke occur in
30-50% of survivors and partner caregivers, and have significant consequences on function and
quality of life. Further, mood and psychosocial well-being are reciprocal in couples, meaning
if one partner is depressed, the other is more likely to be depressed. Sustaining well-being
in both partners is important for continued engagement in rehabilitation and re-integration
into the community, yet existing interventions are aimed at the individual rather than the
couple. This study will address this gap by testing an innovative dyadic (couples-based)
intervention using a new approach based on positive psychology that focuses on the strengths
in the relationship in order to foster resilience in the couple. Using a randomized waitlist
control design, this pilot study aims to determine whether an 8-week dyadic positive
psychology-based intervention (PPI) can improve mood and subjective well-being as assessed by
established outcome measures in 24 couples coping with stroke. The intervention consists of
self-administered PPI activities, such as expressing gratitude and practicing acts of
kindness, which participants complete individually and as a couple. Two potential pathways
will be explored for the PPI: (a) enhanced quality of interactions as couples deal with daily
life demands and (b) improvements in mood that are "contagious" among couples. If found
effective, couples with greater well-being may be better emotionally equipped to cope with
the sequelae of stroke by reducing stress and depressive symptoms, and increasing
participation in meaningful activities and quality of life.

Inclusion Criteria:

- Couples consist of one partner who had an ischemic or hemorrhagic stroke > 6 months
ago and a cohabiting partner (> 1 year) who self-identifies as the caregiver and is
willing to enroll in the study;

- Either one or both partner(s) report depressive symptoms as assessed by the PROMIS-D
(no formal diagnosis is required).

Exclusion Criteria:

- the caregiver has had a stroke or other major neurological condition;

- either partner is unable to understand the printed English instructions;

- either partner scores <19 (the established cut-off for mild cognitive impairment) on
the Montreal Cognitive Assessment (MoCA), a validated screening instrument for
cognitive performance.