The creation of a ‘Psychological Wellbeing after Stroke’ group

Posted in Personal Perspective on 7th Jul 2015

18_ACNRMJ15-bioThe Psychological Wellbeing Group takes place weekly at the multidisciplinary team led, 24-bed Stroke Rehabilitation Unit, Beech Ward at Norwich Community Hospital.

The group was created to support and educate stroke survivors about adjustment, offering opportunities to share experiences of their journeys and to help normalise feelings related to adjustment to their illness and resulting disability, also providing patients with space to acknowledge and express their feelings.

NICE guidelines recommend setting up psychosocial education groups; based on findings from Croydon’s national stroke project, NICE further suggest that ‘people with stroke may want to access support in the form of meeting other people with stroke, or receiving information and advice’. This may include groups developed for people and their families; stroke education, psychological wellbeing, information giving or ‘telling your story’. Recommendations state ‘the role of such a group is to provide basic important stroke education (causes, physical and psychological effects and treatment approaches), describing local care pathways and what to expect. They suggest ‘resources and educational materials should be accessible for people with communication, visual and cognitive impairments, backed up with information people can take away from the group’ and ‘always ask for feedback from those who attend and act on it’.

The group steps include:

  • Introduction of group members, the facilitators and the psychology service for the stroke pathway, group session overview.
  • Ground rules – confidentiality, right to leave group and choice of participation.
  • Mindfulness exercise 1 – ‘feelings are like clouds’. Participants to engage and tune into feelings in the here and now. Patients to name three feelings and to record on a post-it note on a worksheet – facilitators support participants with this. They are encouraged to share with the group, following which discussion is encouraged and under guidance of the psychologist, feelings in the room are being explored.
  • Group members are asked if they have ever watched clouds or observed changing shapes and asked the question ‘what do clouds do?’ Answers include ‘change shape’, ‘rain on you’ and ‘have a silver lining’. These are set in context with feelings and participants are encouraged to view their feelings mindfully, i.e. to see them in their current shape and form, intensity and acuteness and then watch them drift away, change and disappear or turn into something else, just like clouds.
  • The psychologist guides them through the adjustment process graph, highlighting that patients in the room have coped with and mastered similar challenges.
  • Similarities and differences are reflected by the psychologist highlighting the shared experience aspect and encouraging the participants not to view themselves as isolated with the aftermath of this potentially traumatic life event.
  • Adjustment and rehabilitation process is compared to a rollercoaster ride.
  • If the group allows time and appears appropriate for this exercise, they are asked to describe ‘if you were a piece of fruit what would you be and why?’, allowing dialogue and participants to open up about themselves, supports laughter and light heartedness and gives the group a lighter, more uplifting moment.
  • The facilitators answer questions and deal with other issues.
  • Three-minute mindfulness exercise recorded by Dr Melanie Fennell.
  • Filling in feedback forms with co-facilitators.

The group content has been adapted slightly over the past 12 months due to patient feedback, which influences content and delivery frequently in order to mirror the patient’s voice. Quality is assessed constantly and is at the heart of the project. It also gives the MDT an indication of the participant’s needs and psychological mindset and is part of the psychology pathway and intervention for patients. Detailed results and analysis of the feedback from patients on their experience can be found in the full-length article.


Wordle cloud containing feelings patients have reported. The bigger the word, the more often it has been reported.


  • Useful
  • I can now understand more about my stroke and emotions
  • Helped to cope with the stroke
  • I enjoyed the group discussions
  • You share something so you don’t feel alone
  • I don’t think it was very enjoyable, it was quite painful, but cathartic
  • Small group helped me feeling comfortable to share my feelings & thoughts
  • Facilitator was very understanding of our feelings and journey
  • Coming to this group has done me very good
  • Nice to talk
  • It is useful to talk to others with similar experiences
  • We are all in the same boat
  • I have been to the group 4 times and it is always helpful
  • It is beneficial to the share experience
  • It is very nice to meet other people who have been affected by stroke
  • It has been very helpful
  • Meeting and sharing with others means you are not the only one
  • It helps to discuss with people in the same situation
  • Very beneficial to hear what happened to others
  • I hope I helped others by telling my story

Participants will have a copy of the ‘Feelings are like Clouds’ sheet, aiming to support patients to not feel trapped with certain feelings but instead see and notice them for what they are and then letting them go.


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Altieri M, Maestrini I, Mercurio A, Troisi P, Sgarlata E, Rea V, Di Piero V. Depression after minor stroke: prevalence and predictors. European journal of neurology : the official journal of the European Federation of Neurological Societies, 2012;19(3):517-21. Retrieved from

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Choi K.-S, Stewart R, & Dewey M. Participation in productive activities and depression among older Europeans: survey of Health, Ageing and Retirement in Europe (SHARE). International Journal of Geriatric Psychiatry, 2013;28(11):1157-65.

Fennell M. (2012). Mindfulness meditation. Available on

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NHS Improvement – Stroke (2013). Psychological care after stroke: Improving stroke services for people with cognitive and mood disorders. Accessed via:

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ACNR 2015;15(2):18-19.   Online 6 /07/15

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