Understanding and Addressing the Individualized Emotional Impact of Aphasia: A Framework for Speech-Language Pathologists

Abstract

Emotion plays an integral role in communication and has long been considered relevant to aphasia rehabilitation. Speech-language pathologists (SLPs), however, may sometimes wonder how or whether to address emotional responses. The purpose of this article was to (1) present a framework that clinicians can use to understand individualized emotional responses in aphasia and (2) discuss examples of how the framework informs practical strategies that SLPs can use to provide emotional support to people with aphasia (PWA). Drawing upon a cognitive–motivational–relational theory of emotions perspective combined with emerging research in aphasia, I show that emotion impacts and is impacted by both language processing and social participation, but this impact should be interpreted in light of individual variability. Personal characteristics, environmental conditions, and cognitive appraisal, considered within a specific cultural context, help account for individualized emotional responses. SLPs should consider interactions among emotional response, language processing, and social participation in aphasia while recognizing each person's unique perception of the situation and resources to cope with it. Additionally, the presented framework provides insights about how SLPs could offer emotional support to PWA. Specific examples related to harnessing situational demands to improve communication, employing active listening, facilitating reappraisal, and strengthening social support are discussed.

Keywords

aphasia - emotion - stress - mood - stroke

Disclosure

The author is a salaried employee of Brigham Young University where some of the research described in this paper was conducted.

Publication History

Article published online:
22 November 2023

• References

• American Psychological Association. (n.d.). Emotion. In: APA Dictionary of Psychology. Accessed May 9, 2023 at: https://dictionary.apa.org/emotions
• American Speech-Language-Hearing Association. (2016). Scope of Practice in Speech-Language Pathology [Scope of Practice]. Accessed October 9, 2023 at: www.asha.org/policy/
• Ashaie, S. A., & Castro, N. (2022). Complexity of participation post-stroke: longitudinal assessment of community participation, positive affect, social support and functional independence. Journal of Rehabilitation Medicine, 54, jrm00335
• Baker, C., Worrall, L., Rose, M., Ryan, B., Baker, C., Worrall, L., Rose, M., Ryan, B., Baker, C., & Worrall, L. (2019). 'It was really dark': the experiences and preferences of people with aphasia to manage mood changes and depression with aphasia to manage mood changes and depression. Aphasiology, 34(1), 19–46
• Bakhtiyari, J., Khatoonabadi, S. A. R., Dadgar, H., Bakhtiari, B. M., Khosravizadeh, P., & Shaygannejad, V. (2015). Comparison of emotional and non-emotional word repetitions in patients with aphasia. Advanced Biomedical Research, 4(1), 164
• Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). Guilford Publications. Accessed May 9, 2023 at: http://ebookcentral.proquest.com/lib/byu/detail.action?docID=735600
• Beck, K., & Kulzer, J. (2018). Teaching counseling microskills to audiology students: recommendations from professional counseling educators. Seminars in Hearing, 39(01), 091–106
• Biorn-Hansen, V. (1957). Social and emotional aspects of aphasia. The Journal of Speech and Hearing Disorders, 22(1), 53–59
• Blackett, D. S. (2021). The effects of emotional stimuli on language processing in aging adults and people with aphasia. The Ohio State University
• Bloom, R. L., Borod, J. C., Obler, L. K., & Gerstman, L. J. (1992). Impact of emotional content on discourse production in patients with unilateral brain damage. Brain and Language, 42(2), 153–164
• Bloom, R. L., Borod, J. C., Obler, L. K., & Gerstman, L. J. (1993). Suppression and facilitation of pragmatic performance: effects of emotional content on discourse following right and left brain damage. Journal of Speech and Hearing Research, 36(6), 1227–1235
• Bloom, R. L., Borod, J. C., Santschi-Haywood, C., Pick, L. H., & Obler, L. K. (1996). Left and right hemispheric contributions to discourse coherence and cohesion. The International Journal of Neuroscience, 88(1-2), 125–140
• Borod, J. C., Rorie, K. D., Pick, L. H., Bloom, R. L., Andelman, F., Campbell, A. L., Obler, L. K., Tweedy, J. R., Welkowitz, J., & Sliwinski, M. (2000). Verbal pragmatics following unilateral stroke: emotional content and valence. Neuropsychology, 14(1), 112–124
• Brown, K., Worrall, L. E., Davidson, B., & Howe, T. (2012). Living successfully with aphasia: a qualitative meta-analysis of the perspectives of individuals with aphasia, family members, and speech-language pathologists. International Journal of Speech-Language Pathology, 14(2), 141–155
• Bryan, J. L., Young, C. M., Lucas, S., & Quist, M. C. (2018). Should I say thank you? Gratitude encourages cognitive reappraisal and buffers the negative impact of ambivalence over emotional expression on depression. Personality and Individual Differences, 120, 253–258
• Buchanan, T. W., Laures-Gore, J. S., & Duff, M. C. (2014). Acute stress reduces speech fluency. Biological Psychology, 97(1), 60–66
• Cahana-Amitay, D., Oveis, A. C., Sayers, J. T., Pineles, S. L., Spiro, A., III, & Albert, M. L. (2015). Biomarkers of "Linguistic Anxiety" in aphasia: a proof-of-concept case study. Clinical Linguistics & Phonetics, 29(5), 401–413
• Calhoun, L. G., & Tedeschi, R. G. (2004). Posttraumatic growth: the positive lessons of loss. In R. A. Neimeyer (Ed.), Meaning Reconstruction & The Experience of Loss (pp. 157–172). American Psychological Association. https://doi.org/10.1037/10397-008
• Chun, C.-A., Moos, R. H., & Cronkite, R. C. (2006). Culture: a fundamental context for the stress and coping paradigm. In: P. T. P. Wong & L. C. J. Wong (Eds.), Handbook of Multicultural Perspectives on Stress and Coping (pp. 29–53). Springer US
• Code, C., Hemsley, G., & Herrmann, M. (1999). The emotional impact of aphasia. Seminars in Speech and Language, 20(1), 19–31
• Code, C., & Herrmann, M. (2003). The relevance of emotional and psychosocial factors in aphasia to rehabilitation. Neuropsychological Rehabilitation, 13(1-2), 109–132
• Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357
• DeCaro, M. S., Thomas, R. D., Albert, N. B., & Beilock, S. L. (2011). Choking under pressure: multiple routes to skill failure. Journal of Experimental Psychology. General, 140(3), 390–406
• DuBay, M. F., Laures-Gore, J. S., Matheny, K., & Romski, M. A. (2011). Coping resources in individuals with aphasia. Aphasiology, 25(9), 1016–1029
• Efthymiopoulou, E., Kasselimis, D. S., Ghika, A., Kyrozis, A., Peppas, C., Evdokimidis, I., Petrides, M., & Potagas, C. (2017). The effect of cortical and subcortical lesions on spontaneous expression of memory-encoded and emotionally infused information: evidence for a role of the ventral stream. Neuropsychologia, 101, 115–120
• Ekman, P., & Friesen, W. V. (1971). Constants across cultures in the face and emotion. Journal of Personality and Social Psychology, 17(2), 124–129
• Ford, B. Q., Karnilowicz, H. R., & Mauss, I. B. (2017). Understanding reappraisal as a multicomponent process: the psychological health benefits of attempting to use reappraisal depend on reappraisal success. Emotion (Washington, D.C.), 17(6), 905–911
• Harmon, T. G. (2020). Everyday communication challenges in aphasia: descriptions of experiences and coping strategies. Aphasiology, 34(10), 1270–1290
• Harmon, T. G., Jacks, A., Haley, K. L., & Bailliard, A. (2019). Dual-task effects on story retell for participants with moderate, mild, or no aphasia: quantitative and qualitative findings. Journal of Speech, Language, and Hearing Research: JSLHR, 62(6), 1890–1905
• Harmon, T. G., Jacks, A., Haley, K. L., & Bailliard, A. (2020). How responsiveness from a communication partner affects story retell in aphasia: quantitative and qualitative findings. American Journal of Speech-Language Pathology, 29(1), 142–156
• Harmon, T. G., Johnson, A., Ward, V., & Nissen, S. L. (2023a). Physiological arousal, attentiveness, emotion, and word retrieval in aphasia: effects and relationships. American Journal of Speech-Language Pathology, 1–11. Doi: 10.1044/2023_AJSLP-22-00305
• Harmon, T. G., Nielsen, C., Loveridge, C., & Williams, C. (2022). Effects of positive and negative emotions on picture naming for people with mild-to-moderate aphasia: a preliminary investigation. Journal of Speech, Language, and Hearing Research: JSLHR, 65(3), 1025–1043
• Helm-Estabrooks, N., Ramsberger, G., Ruggiero, A., & Nicholas, M. (1989). Boston Assessment of Severe Aphasia. Accessed May 9, 2023 at: https://www.proedinc.com/Products/8955/basa-boston-assessment-of-severe-aphasia.aspx
• Hilari, K., Northcott, S., Roy, P., Marshall, J., Wiggins, R. D., Chataway, J., & Ames, D. (2010). Psychological distress after stroke and aphasia: the first six months. Clinical Rehabilitation, 24(2), 181–190
• Holahan, C. J., & Moos, R. H. (1985). Life stress and health: personality, coping, and family support in stress resistance. Journal of Personality and Social Psychology, 49(3), 739–747
• Hughlings Jackson, J. (1874). On the nature of the duality of the brain. Medical Press and Circular, 1, 80–86
• Hunting Pompon, R. (2021). Basic counseling skills: Working with people with aphasia and their families. Perspectives of the ASHA Special Interest Groups, 6(5), 1003–1014
• Jagosh, J., Donald Boudreau, J., Steinert, Y., Macdonald, M. E., & Ingram, L. (2011). The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship. Patient Education and Counseling, 85(3), 369–374
• Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., Threats, T., & Sharp, S. (2008). Counting what counts: a framework for capturing real-life outcomes of aphasia intervention. Aphasiology, 22(3), 258–280
• Kreindler, A., Mihailescu, L., & Fradis, A. (1980). Speech fluency in aphasics. Brain and Language, 9(2), 199–205
• Kuperman, V., Estes, Z., Brysbaert, M., & Warriner, A. B. (2014). Emotion and language: valence and arousal affect word recognition. Journal of Experimental Psychology. General, 143(3), 1065–1081
• Lang, P. J., Bradley, M. M., & Cuthbert, B. N. (1990). Emotion, attention, and the startle reflex. Psychological Review, 97(3), 377–395
• Laures-Gore, J. S., & Buchanan, T. W. (2015). Aphasia and the neuropsychobiology of stress. Journal of Clinical and Experimental Neuropsychology, 37(7), 688–700
• Laures-Gore, J., Cahana-Amitay, D., & Buchanan, T. W. (2019). Diurnal cortisol dynamics, perceived stress, and language production in aphasia. Journal of Speech, Language, and Hearing Research: JSLHR, 62(5), 1416–1426
• Laures-Gore, J. S., Dotson, V. M., & Belagaje, S. (2020). Depression in Poststroke Aphasia (pp. 1–13)
• Laures-Gore, J. S., DuBay, M. F., Duff, M. C., & Buchanan, T. W. (2010). Identifying behavioral measures of stress in individuals with aphasia. Journal of Speech, Language, and Hearing Research: JSLHR, 53(5), 1394–1400
• Laures-Gore, J. S., Hamilton, A., & Matheny, K. (2007). Coping resources, perceived stress, and recent life experiences in individuals with aphasia. Journal of Medical Speech-Language Pathology, 15(4), 423–431
• Laures-Gore, J. S., Lambert, P. L., Kruger, A. C., Love, J., & Davis, D. E., Jr. (2018). Spirituality and post-stroke aphasia recovery. Journal of Religion and Health, 57(5), 1876–1888
• Laures-Gore, J., & Rice, K. G. (2019). The simple aphasia stress scale. Journal of Speech, Language, and Hearing Research: JSLHR, 62(8), 2855–2859
• Lazarus, R. S. (1991). Emotion and Adaptation. Oxford University Press
• Le Dorze, G., Salois-Bellerose, É., Alepins, M., Croteau, C., & Hallé, M.-C. (2014). A description of the personal and environmental determinants of participation several years post-stroke according to the views of people who have aphasia. Aphasiology, 28(4), 421–439
• Levasseur, M., Richard, L., Gauvin, L., & Raymond, E. (2010). Inventory and analysis of definitions of social participation found in the aging literature: proposed taxonomy of social activities. Social Science & Medicine, 71(12), 2141–2149
• Manning, M., MacFarlane, A., Hickey, A., & Franklin, S. (2019). Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: a systematic review and thematic synthesis. PLoS One, 14(3), e0214200
• Manning, M., MacFarlane, A., Hickey, A., Galvin, R., & Franklin, S. (2022). Regulating emotional responses to aphasia to re-engage in life: a qualitative interview study. International Journal of Language & Communication Disorders, 57(2), 352–365
• Matthews, G., Wohleber, R. W., & Lin, J. (2019). Stress, Skilled Performance, and Expertise. In: The Oxford Handbook of Expertise (Issue May, pp. 489–524). Doi: 10.1093/oxfordhb/9780198795872.013.22
• Mauss, I. B., Cook, C. L., Cheng, J. Y. J., & Gross, J. J. (2007). Individual differences in cognitive reappraisal: experiential and physiological responses to an anger provocation. International Journal of Psychophysiology, 66(2), 116–124
• Mccullough, M. E., Emmons, R. A., & Tsang, J.-A. (2002). The grateful disposition: a conceptual and empirical topography. Journal of Personality and Social Psychology, 82(1), 112–127
• Moss, B., Northcott, S., Behn, N., Monnelly, K., Marshall, J., Thomas, S., Simpson, A., Goldsmith, K., McVicker, S., Flood, C., & Hilari, K. (2021). 'Emotion is of the essence. … Number one priority': a nested qualitative study exploring psychosocial adjustment to stroke and aphasia. International Journal of Language & Communication Disorders, 56(3), 594–608
• Nielen, M. M. A., Heslenfeld, D. J., Heinen, K., Van Strien, J. W., Witter, M. P., Jonker, C., & Veltman, D. J. (2009). Distinct brain systems underlie the processing of valence and arousal of affective pictures. Brain and Cognition, 71(3), 387–396
• Northcott, S., Simpson, A., Moss, B., Ahmed, N., & Hilari, K. (2017). How do speech-and-language therapists address the psychosocial well-being of people with aphasia? Results of a UK online survey. International Journal of Language & Communication Disorders, 52(3), 356–373
• Northcott, S., Simpson, A., Moss, B., Ahmed, N., & Hilari, K. (2018). Supporting people with aphasia to 'settle into a new way to be': Speech and language therapists' views on providing psychosocial support. International Journal of Language & Communication Disorders, 53(1), 16–29
• Olness, G. S. (2006). Genre, verb, and coherence in picture-elicited discourse of adults with aphasia. Aphasiology, 20(2–4), 175–187
• Ramsberger, G. (1996). Repetition of emotional and nonemotional words in aphasia. Journal of Medical Speech-Language Pathology, 4(1), 1–12
• Sandberg, C. W., Nadermann, K., Parker, L., Kubat, A. M., & Conyers, L. M. (2021). Counseling in aphasia: information and strategies for speech-language pathologists. American Journal of Speech-Language Pathology, 30(6), 2337–2349
• Schaffer, K. M., Evans, W. S., Dutcher, C. D., Philburn, C., & Henry, M. L. (2021). Embedding aphasia-modified cognitive behavioral therapy in script training for primary progressive aphasia: a single-case pilot study. American Journal of Speech-Language Pathology, 30(5), 2053–2068
• Schwen Blackett, D., & Harnish, S. M. (2022). A scoping review on the effects of emotional stimuli on language processing in people with aphasia. Journal of Speech, Language, and Hearing Research: JSLHR, 65(11), 4327–4345
• Simmons-Mackie, N., Worrall, L., Murray, L. L., Enderby, P., Rose, M. L., Paek, E. J., Klippi, A., & The Aphasia United Best Practices Working Group. (2017). The top ten: best practice recommendations for aphasia. Aphasiology, 31(2), 131–151
• Swinburn, K., Porter, G., & Howard, D. (2005). Comprehensive Aphasia Test. Psychology Press
• Tse, A. C. Y., Wong, A. W. K., Whitehill, T. L., Ma, E. P. M., & Masters, R. S. W. (2014). Analogy instruction and speech performance under psychological stress. Journal of Voice, 28(2), 196–202
• vanOyen Witvliet, C., Knoll, R. W., Hinman, N. G., & DeYoung, P. A. (2010). Compassion-focused reappraisal, benefit-focused reappraisal, and rumination after an interpersonal offense: emotion-regulation implications for subjective emotion, linguistic responses, and physiology. The Journal of Positive Psychology, 5(3), 226–242
• Watkins, P. C., Uhder, J., & Pichinevskiy, S. (2015). Grateful recounting enhances subjective well-being: the importance of grateful processing. The Journal of Positive Psychology, 10(2), 91–98
• Wilce, J. M. (2009). Language and Emotion (Issue Vol. 25). Cambridge University Press; eBook Comprehensive Academic Collection (EBSCOhost). Accessed May 9, 2023 at: https://lib.byu.edu/remoteauth/?url=https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip&db=e025xna&AN=313172&site=ehost-live&scope=site
• Wood, A. M., Joseph, S., & Maltby, J. (2008). Gratitude uniquely predicts satisfaction with life: Incremental validity above the domains and facets of the five factor model. Personality and Individual Differences, 45(1), 49–54