Understanding the influences of self-compassion and psychological flexibility on life satisfaction and depression after stroke.

Review Objectives Older adulthood, often defined as being over the age of 65, is associated with several specific challenges which can significantly impact mental wellbeing, and older adults experience high rates of depression and anxiety. Third-wave Cognitive Behavioural Therapy (CBT) refers to a group of psychological interventions which may be particularly suited to this population. This review therefore aimed to synthesise the existing literature on the use of these therapies with older adults. Method Online databases (SCOPUS, PsycINFO, Medline, Cochrane Library, ProQuest, WhiteRose and OpenGrey) were searched to identify studies examining the efficacy/effectiveness of third-wave CBTs in decreasing depression/anxiety, or increasing wellbeing, in older adults. Risk of Bias (RoB) in eligible studies was examined, followed by a narrative synthesis of the studies and their results. Results The database searches and forward/backward citation searching yielded 14 studies from an initial pool of 752. Overall RoB in the studies was moderate. There was variance in effect sizes, which ranged from statistically non-significant and trivial (d = 0.06) to statistically significant and large (d = 1.20), although effect sizes were primarily small (42%). Three of the four large effect sizes were in studies of Mindfulness-Based Stress Reduction (MBSR), as were the only studies at low RoB. Three of five case reports found reliable/clinically significant changes. Conclusions Third-wave CBTs have a mostly small effectiveness for older adults. MBSR may facilitate larger changes in mood than other third-wave CBTs. The current literature base is small and at moderate RoB; as such, further research is much needed. Empirical Objectives Stroke survivors commonly report decreased psychological wellbeing. This study aimed to investigate whether physical/cognitive stroke severity is associated with psychological wellbeing, and if self-compassion and/or psychological flexibility moderate this relationship. Method A cross-sectional, quantitative, online survey design was used. Stroke survivors completed measures of stroke severity, self-compassion, psychological flexibility, and depression/life satisfaction. Correlational and moderation analyses were conducted to assess the associations between these variables. Results There was an association between physical/cognitive stroke severity and levels of depression (physical; b = -.055, p <.001, cognitive; b = -.087, p <.001) and life satisfaction (physical; b = .016, p <.001, cognitive; b = -.087, p = .010). Psychological flexibility was associated with depression (b = .261, p <.001) and life satisfaction (b = -.041, p <.001). Selfcompassion was associated with depression only (b = -1.025, p = .049). The only significant moderation effect was that of self-compassion on the association between cognitive stroke severity and life satisfaction (p = 0.10, change R 2 = 0.19). Conclusions These findings suggest that more severe post-stroke difficulties are associated with higher levels of depression and lower levels of life satisfaction. Such associations are generally not moderated by psychological flexibility or self-compassion. Those who are more psychologically flexible or (to a lesser extent) self-compassionate are also less depressed, and those who are more psychologically flexible are also more satisfied with life. However, causality in these associations could not be assessed in this cross-sectional study.