Language as a stressor in aphasia

Abstract

Background Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. Aim The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. Main Contribution Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term “linguistic anxiety.” Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to “linguistic anxiety.” Conclusion Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer’s disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom “linguistic anxiety” might be at work when they have trouble finding words.

Neuroscience of Aphasia Recovery: the Concept of Neural Multifunctionality

“…Consider, for example, the use of visual cues in therapy, the utility of which rests, at the very least, on engagement of neural mechanisms of visual attention. However, the availability of such attentional resources can be altered by the emotional state of the aphasic individual, who, if anxious, can show heightened psychophysiologic stress responses that would compete with the attention resources required for successful task performance [98]. Such changes may implicate biomarkers of the hypothalamic-pituitary-adrenal (HPA) axis [99], which, in turn, can influence limbic structures subserving memory-based or learning-related language performance [8••].…”

Aphasia and the neuropsychobiology of stress

“…Such ambiguities will only dissolve after further studies are designed and executed. When more is known about stress and its role in aphasia, then more specific behavioral, pharmacologic, and counselling interventions could be developed (Cahana-Amitay et al, 2011;Dubay et al, 2011;Laures-Gore, 2012;Laures-Gore, Hamilton, et al 2007). …”

“…These results demonstrate an intriguing pattern of speech and language in response to stress: People are able to speak and communicate under stress, sometimes quite well, but their retrieval of linguistic information may be slowed as indicated by increased pause time. Other researchers have examined the influence of stress on vocal pitch (Giddens, Barron, ByrdCraven, Clark, & Winter, 2013), filled and unfilled pauses (Christenfeld & Creager, 1996;STRESS AND APHASIA 695 Hofmann, Moore, Gutner, & Weeks, 2012), syntactic complexity and discourse organization (Cahana-Amitay et al 2011), and measures of verbal complexity (Saslow et al, 2014). Application of some of these same measures to research on individuals with aphasia could prove valuable in determining how stress affects already disordered speech and language processes.…”

“…The most pervasive hypothesis is that speaking is a stressor for some individuals with aphasia (e.g., Cahana-Amitay et al, 2011); however, the types of tasks that serve as stressors for adults with aphasia have not been determined. In a meta-analysis of over 200 laboratory studies, Dickerson and Kemeny (2004) highlight the situational factors that most consistently elicit a stressinduced cortisol response.…”

Performance-based measurement of participation for people with aphasia: using an iPhone application to measure talking time in everyday life

“…People who suffer a stroke have poorer quality of life if they have concomitant aphasia, even when other variables such as physical disability are accounted for (Hilari, 2011). Evidence shows that the presence of aphasia results in poor psychosocial well-being, including decreased quality of life Ross & Wertz, 2003), increased incidence of depression (Code & Herrmann, 2003), anxiety (Cahana-Amitay et al, 2011) and social isolation (Brown, Worrall, Davidson & Howe, 2011;Dalemans, de Witte, Wade & van den Heuval, 2010;. People with aphasia may also be disadvantaged in that they may not have equity of access to health information and health services (Brady, Fredrick & Williams, 2013;Rose, Worrall, McKenna, Hickson & Hoffmann, 2009).…”