Effect on Cognitive Behavioral Therapy Combined With Transcranial Direct Current Stimulation on Anxiety and Depression in Stroke Patients With Dysphagia

Abstract

Background: This study aimed to investigate the association between cognitive behavioural therapy (CBT) combined with transcranial direct current stimulation (tDCS) on negative mood states, such as anxiety and depression, in patients with post-stroke dysphagia through a retrospective review of medical records.

Methods: A retrospective study was conducted using medical records of patients with post-stroke dysphagia who were hospitalised at The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University between January 2022 and June 2025. Sample size matching was performed using the nearest neighbour matching method in propensity score matching on the basis of data extracted from medical records, ultimately including 348 study subjects for analysis. Based on the treatment regimens documented in the medical records, 174 patients in the combination group received CBT combined with tDCS, and 174 patients in the control group received tDCS alone. Basic rehabilitation measures were consistent between the two groups as per clinical protocols. Both groups completed a continuous 4-week treatment course as recorded in the medical charts. Data on the grading of the water swallowing test, surface electromyography parameters, the Stigma Scale for Chronic Illness (SSCI) score, the Herth Hope Index (HHI) score, the Self-Rating Anxiety Scale (SAS) score and the Self-Rating Depression Scale (SDS) score were extracted from the medical records at baseline (within 48 h before treatment initiation) and after the 4-week treatment period. 

Results: Following the 4-week treatment period, the overall distribution of water swallowing test grades documented in the medical records for the combination group was superior to that for the control group (p < 0.05). At baseline, no statistically significant differences were found in the surface electromyography parameters (average and maximum amplitudes) retrieved from the records between the two groups (p > 0.05). After the 4-week treatment period, the recorded values for average and maximum amplitudes in the combination group were significantly higher than those in the control group (p < 0.05). At baseline, no statistically significant differences were observed in various stigma scale scores extracted from the records between the two groups (p > 0.05). After the treatment period, the scores for internalised stigma and the total SSCI score in the combination group were significantly lower than those in the control group (p < 0.05). At baseline, no statistically significant differences were noted in any dimension scores of HHI between the two groups (p > 0.05). After the treatment period, the scores for positive attitude toward reality and the future, positive actions taken and maintaining close relationships with others and the total HHI score were all markedly higher in the combination group than in the control group (p < 0.05). At baseline, no statistically significant differences were observed in the SAS and SDS scores between the two groups (p > 0.05). After the treatment period, the SAS and SDS scores in the combination group were evidently lower than those in the control group (p < 0.05).

Conclusions: The combination of CBT and tDCS was associated with improved swallowing function; reduced stigma, depression and anxiety; and increased hope levels in patients with post-stroke dysphagia.