A Pilot Randomized Controlled Trial Testing the Feasibility and Acceptability of Helping Ease Anxiety and Depression after Stroke (HEADS: UP): An Online Mindfulness-Based Intervention for Stroke Survivors

Objectives
The purpose of this study was to assess feasibility and acceptability of a stroke-specific mindfulness-based
intervention called Helping Ease Anxiety and Depression after Stroke (HEADS: UP).
Method
This study was a mixed-methods pilot randomized controlled trial comparing HEADS: UP to treatment as usual
(TAU). HEADS: UP is a 9-week mindfulness intervention for stroke survivors. UK (United Kingdon)-based stroke survivors
were recruited and attended HEADS: UP Online. Psychological functioning outcomes measures and other data were collected
online at pre-intervention (Week 0), post-intervention (Week 9), and follow-up (months 3 and 6). Participants were
randomized 1:1 to either HEADS: UP or TAU.
Results
Sixty-two participants completed baseline questionnaires and were randomized to HEADS: UP (n = 30) or TAU
(n = 32). Retention rates were as follows: HEADS: UP (n = 25, 83.30%) versus TAU (n = 25, 78.10%) at post-intervention,
HEADS: UP (n = 24, 80%) versus TAU (n = 26, 81.30%) at 3-month follow-up, and HEADS: UP (n = 20, 66.70%) versus
TAU (n = 25, 78.10%) at 6-month follow-up. The mean age for HEADS: UP was 56.0 years versus 56.80 for TAU. The
HEADS: UP group was 30% male, while the TAU group was 56% male. Depression Anxiety Stress Scales (DASS)-21 total
mean score for HEADS: UP improved in the direction of expected effect (baseline 46.20, SD (standard deviation) = 24.00;
post-intervention 24.00, SD = 16.10) indicating recovery versus no reliable change for TAU (baseline 36.10, SD = 18.70;
post-intervention 31.60, SD = 20.40). HEADS: UP and TAU scores continued to improve over time. Between-group effect
sizes (Cohen’s d) at post-intervention were large for BAI (Beck Anxiety Inventory) (d = 0.91), DASS-21 total (d = 0.89),
and BDI (Beck Depression Inventory)-II (d = 0.86), highlighting the potential of HEADS: UP for improving depression and
anxiety symptoms. At the six-month follow-up, the attrition rate was higher in the HEADS: UP group (33.30%) compared
with TAU (21.90%).
Conclusions
HEADS: UP is feasible and acceptable and has potential to improve depression and anxiety symptoms for
stroke survivors.
Preregistration
ClinicalTrials.gov: NCT04985838.

https://doi.org/10.1007/s12671-025-02595-8