Sharing thoughts and feelings may enhance recovery in stroke survivors

Stroke survivors who were uncomfortable sharing their thoughts and feelings about their condition and future had slower physical and cognitive recovery after their stroke, according to a preliminary study to be presented at the American Stroke Association's International Stroke Conference 2026. The meeting is in New Orleans, Feb. 4-6, 2026, and is a world premier global event dedicated to advancing stroke and brain health science.

When trying to cope with major stress and trauma, a lot of people benefit from having a supportive social environment where they can talk about what they are going through. However, when stroke survivors feel uncomfortable sharing their thoughts/feelings because they think talking about it will make others uncomfortable or that others won't want to hear their concerns, these constraints on sharing can be harmful for their health."

E. Alison Holman, Ph.D., lead study author, professor of nursing in the Sue & Bill Gross School of Nursing, University of California Irvine

Researchers investigated whether social constraints on sharing feelings and emotions predicted loneliness and functional and cognitive disability one year after a stroke. The analysis included more than 700 participants in the STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study, conducted at 28 U.S. sites. STRONG has already revealed that one-year recovery after a stroke is worse if there was a higher level of stress and trauma in a person's life before their stroke, if they experienced post-traumatic stress symptoms while still hospitalized after the stroke or if they had certain genetic variations.

In the current study, researchers assessed participants' perception of social constraints at 3 months after their stroke, after the initial healing period. Stroke survivors identified a person they regularly depend on, often a family member serving as a caregiver, and answered two questions about their interactions with this person: "In the past week, how often did you get the feeling that he or she didn't want to hear about your feelings about your stroke or your fears about future health problems?"; and "How often have you felt as though you had to keep your feelings about your stroke or your fears about future health problems to yourself because they made him or her feel uncomfortable or upset?"

The analysis found that one year after the stroke, people who felt less able to openly share their feelings at 90 days were more likely to experience several challenges:

• They felt lonelier, reporting they felt more left out, isolated or without companionship in the past week.
• They had more difficulty with everyday activities, such as feeding or bathing (they needed more help overall).
• They experienced greater problems with thinking skills, including memory, attention and language.

"The level of social constraint after 90 days was just as effective at predicting overall disability and physical function one year later as the initial severity of the stroke," Holman said. "For many stroke-focused health care professionals, the severity of the stroke is the gold standard for understanding how well or poorly a person will be doing down the road."

She encouraged other stroke researchers to inquire about what's going on in patients' social environment early after a stroke to understand if it may influence recovery and to provide support.

For caregivers, Holman encourages, "making room, a safe space, for people to talk about their stroke, let them talk about their feelings and what they're going through so they can process what has happened and what's going on. However, don't try to force it because not everyone needs to verbalize their emotions. Providing a safe place for them to share, if needed, is the key."

The researchers noted that if these results are confirmed in future studies, interventions could be designed to help stroke survivors face fewer social challenges.

American Stroke Association volunteer expert, Amytis Towfighi, M.D., FAHA, said, "While social support is increasingly recognized as beneficial after stroke, less is known about how social constraints affect recovery. This study is one of the first to assess their influence on long-term psychological, cognitive and functional outcomes. The findings offer valuable insights that can inform interventions to improve post-stroke recovery." Towfighi is also a professor of neurology and population and public health sciences at the Keck School of Medicine of USC and director, neurological services at the Los Angeles County Department of Health Services.

Study details, background and design:

• The study included 763 participants (average age of 63 years; 41.2% women; 69.4% self-reported white adults) who enrolled in the trial while hospitalized after a mild to moderate stroke.
• Participants were part of the STRONG (Stroke, sTress, RehabilitatiON, and Genetics) study, which was a detailed multi-center study examining the first year of recovery after a stroke, conducted at 28 U.S. sites between 2016 and 2021.
• Researchers assessed participants during their first hospitalization and again at 3-, 6- and 12-months post-stroke. At one year, physical and cognitive function were assessed using the modified Rankin Scale and the results of the Montreal Cognitive Assessment administered during a telephone call.
• Loneliness was rated using three items from the UCLA Loneliness Scale. This was assessed at every follow-up, at 3, 6, and 12 months post-stroke. The UCLA Loneliness Scale rated patients' level of loneliness on a 5-point scale from "never" to "all the time," so higher scores mean more frequent feelings of being lonely.
• At 90 days, the degree of discomfort expressed by the stroke survivors in relation to their concerns was rated using two items from the Social Constraints Scale.
• After controlling for age, gender, race, stroke severity and stress 2-10 days after the stroke, researchers analyzed the association between more social constraints at 3 months with loneliness and recovery levels at one year.

Patient Perspective: Why social support matters after stroke

Dipika Aggarwal, a neurologist from Kansas City, Missouri, was living a full life when a stroke in 2019 turned everything upside down. At just 38, she went from thriving in her career to months in intensive rehab, followed by isolation during the COVID lockdown. "I lost my professional life, my engagement ended and there was no guarantee I'd ever work again," she recalls. "My mental health got so bad that I started thinking about ending my life. I didn't even realize I was experiencing post-stroke depression."

Aggarwal says it took months before she felt comfortable talking about her stroke. When she finally opened up, first to family, then publicly on social media, it changed everything.

"Sharing my story helped me heal. It gave me hope to hear from others and feel less alone," said Aggarwal, who now volunteers for the American Stroke Association, a division of the American Heart Association. "The social, financial and psychological aspects of recovery are huge, and we don't talk about them enough. My advice to other stroke survivors: don't keep things hush-hush. Seek support, allow yourself to be vulnerable and connect with people who understand what you're going through."