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Objective Acceptance and Commitment Therapy (ACT) is a behavioral intervention demonstrating sustained improvements in anxiety in individuals with chronic anxiety and psychological distress. Because anxiety disorders are associated with the development of cardiovascular disease (CVD), we hypothesized that a novel 1-day ACT workshop would both lower anxiety and improve vascular function in persons with moderate/high anxiety. Methods In a randomized controlled study, 72 adults (age 33.9 ± 8.6 (SD) years) with baseline moderate/high anxiety completed a one-day ACT intervention (n = 44, age 33.9 ± 8.7 years) or control (n = 28, age 37.1 ± 10.1 years). Pre-specified secondary outcomes were measured over 12 weeks: aortic stiffness (carotid-femoral pulse wave velocity [cfPWV]), forearm vascular endothelial function (post-ischemic peak forearm blood flow [FBF] via plethysmography), and brachial artery flow-mediated dilation (FMD). Carotid artery stiffness (β-stiffness index), and inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) were also explored. Results Although the intervention had a significant and sustained effect on the primary outcome of anxiety as measured by the Beck Anxiety Inventory, the 1-day ACT workshop was not associated with improvement in vascular or inflammatory endpoints. The intervention was unexpectedly associated with increases in β-stiffness index that were also associated with changing trait anxiety. Conclusion Anxiety improvements did not translate into improvements in any of the vascular function outcomes. This may reflect a less-than-robust effect of the intervention on anxiety, failure in design to select those with vascular dysfunction, or not intervening on a relevant causal pathway. (Trial registration NCT02915874 at www.clinicaltrials.gov ).

There is a recent convergence of three trends that are transforming behavioral health care: 1) patient engagement and activation; 2) electronic capture of patient-reported outcomes integrated directly into the patients’ electronic health record to be used for measurement-based care; and 3) patient-facing health information technology, centering around patient portals, that empowed patients by providing them access to parts of their medical record. Though each component of this model is currently available; they have yet to achieve widespread standard of care. This paper will discuss general considerations to be explored when implementing electronic capture of patient-reported outcomes and multifunctional patient portals in the context of a general behavioral health clinic. First, it presents strategies for implementing electronic data capture of standard behavioral health measures including the process for selecting instruments, setting technical algorithms for standard patient selection, psychometric considerations, and workflow analysis. Electronic data capture can occur through electronic patient portals, about which there is extensive debate within behavioral health. This paper reviews recent research on allowing patients access to their mental health notes. It also presents some original research on providers’ views of note access and secure messaging. Finally, the paper makes recommendations for both future research and clinical practice. The field would benefit from expanding beyond the single focus on note reading and should explore the potential of patient portals as multicomponent Patient Centered Health Information Technology Homes. These homes can serve as an electronic bridge between clinic and home to help patients achieve their health and wellness goals. The overarching aim of this paper is to provide a vision of how this home might work -as well as its impact on clinical care for people suffering mental disorders.

Psychological inflexibility is a multifaceted construct reflecting a rigid dominance of psychological reactions over chosen values and contingencies in guiding action. Psychological inflexibility has been related to depressive and anxiety symptoms and has been studied as a target of treatment for different forms of psychopathology. This construct, however, remains understudied among some at-risk groups. To close this gap in knowledge, the current study examined cross-sectional relations between psychological inflexibility and (1) symptoms of depression among adults with migraines (n = 2936) and (2) symptoms of anxiety and depression among adults at-risk for cardiovascular disease (n = 921). Results indicate that psychological inflexibility significantly related to depressive and anxiety symptoms among these populations. Results are discussed in terms of treatment implications for such persons.

Background Mild traumatic brain injury (mTBI) is a signature wound of Veterans of operations in Iraq and Afghanistan (i.e., OIF/OEF/OND). Most Veterans with mTBI also experience stress-based psychopathology (e.g., depression, posttraumatic stress disorder) and chronic pain. This combination – referred to as polytrauma - results in detrimental long-term effects on social, occupational, and community reintegration. This study will compare the efficacy of a one-day Acceptance and Commitment Training plus Education, Resources, and Support (ACT+ERS) workshop to a one-day active control group (ERS) on symptoms of distress and social, occupational, and community reintegration. We will also examine mediators and moderators of treatment response. Methods This is an ongoing randomized clinical trial. 212 OIF/OEF/OND Veterans with polytrauma are being recruited. Veterans are randomly assigned to a one-day ACT+ERS or a one-day ERS workshop with two individualized booster sessions approximately two- and four-weeks post-workshop. Veterans complete assessments prior to the workshop and again at six weeks, three months, and six months post-workshop. Of note, workshops were converted to a virtual format due to the COVID-19 pandemic. Results The primary outcomes are symptoms of distress and reintegration; secondary outcomes are post-traumatic stress disorder symptoms and pain interference. Secondary analyses will assess whether changes in avoidance at three months mediate changes in distress and reintegration at six months. Conclusion Facilitating the psychological adjustment and reintegration of Veterans with polytrauma is critical. The results of this study will provide important information about the impact of a brief intervention for Veterans with these concerns.

Purpose Depression and burnout are prevalent among medical students and significantly impact functioning and quality of life. Thus, gaining a greater understanding of coping strategies that relate to depression and burnout can enhance the ability of medical schools to improve psychological wellbeing. The current study assesses how avoidance and decreased engagement in values-based behavior, key processes targeted in Acceptance and Commitment Therapy, relate to depression and burnout in medical students. Method: A survey was sent to second-, third-, and fourth-year medical students at a large Midwestern university. Respondents (N = 241) completed self-report measures of depression, burnout (encompassing emotional exhaustion, depersonalization, and personal accomplishment), avoidance, and values-based behavior. Associations between variables were examined using bivariate correlations and regression analyses. Results Nearly 25% of the sample was experiencing clinically significant depressive symptoms and 51% experiencing burnout. Greater avoidance and lower engagement in values-based behavior were associated with greater depressive symptoms, emotional exhaustion, and depersonalization. In contrast, lower avoidance and higher values-based behavior were associated with greater personal accomplishment. Conclusions Burnout and depression were associated with avoidance and decreased engagement in values-based behavior. Interventions aimed at targeting these difficulties and maladaptive coping strategies may offer an opportunity to enhance medical student well-being and mental health.

Childhood experiences, personality, and polyunsaturated essential fatty acid (PUFA) composition have all been shown to affect the likelihood of depressive symptoms. Few studies have addressed relationships between these factors in their influence on the occurrence or course of depressive symptoms. The following analysis was designed to do so. Subjects, 15-20 years old, had either begun antidepressant treatment within the preceding month (n = 88), or had never taken psychiatric medications (n = 92). Baseline assessments included a structured diagnostic interview, the self-completed Multiphasic Personality Questionnaire, and a determination of plasma PUFA phospholipid composition. Depressive symptom levels were assessed at baseline and again at 4, 8 and 12 months. Omega-3 composition and general childhood trauma scores were unrelated to each other but both correlated, in predicted directions, with negative emotionality. Low omega-3 composition and history of childhood trauma were associated with persistence of depressive symptoms during follow-up, largely through their effects on negative emotionality. Negative emotionality appears to comprise a final common pathway to depressive disorder through which the diverse risk factors of childhood adversity and low omega-3 composition are expressed.

Objective Persistent post-surgical pain is common among patients undergoing surgery, is detrimental to patients' quality of life, and can precipitate long-term opioid use. The purpose of this randomized controlled trial is to assess the effects of a behavioral intervention offered prior to surgery for patients at risk for poor post-surgical outcomes, including persistent pain and impaired functioning. Methods Described herein is an ongoing randomized, patient- and assessor-blind, attention-controlled multisite clinical trial. Four hundred and thirty Veterans indicated for total knee arthroplasty (TKA) with distress and/or pain will be recruited for this study. Participants will be randomly assigned to a one-day (~5 h) Acceptance and Commitment Therapy workshop or one-day education and attention control workshop. Approximately two weeks following their TKA surgery, patients receive an individualized booster session via phone. Following their TKA, patients complete assessments at 1 week, 6 weeks, 3 months, and 6 months. Results The primary outcomes are pain intensity and knee-specific functioning; secondary outcomes are symptoms of distress and coping skills. Mediation analyses will examine whether changes in symptoms of distress and coping skills have an impact on pain and functioning at 6 months in Veterans receiving ACT. This study is conducted mostly with older Veterans; therefore, results may not generalize to women and younger adults who are underrepresented in this veteran population. Conclusions The results of this study will provide the first evidence from a large-scale, patient- and assessor-blind controlled trial on the effectiveness of a brief behavioral intervention for the prevention of persistent post-surgical pain and dysfunction.

Background: Panic disorder (PD) and major depression frequently coexist but the nature of the relationship is controversial. Our aim was to determine if the risk for depression in a proband is influenced by the temporal sequence of comorbid PD and major depression in an affected family member. Methods: Of participants in a larger study of individuals who had a family, but no personal history of PD, 31 had a first-degree relative with comorbid PD and major depressive disorder (MDD). In 16, the onset of MDD preceded PD (HR-MDPD), and in 15, PD was established before the first depressive episode (HR-PDMD). Thirty-seven low-risk controls (LRC) described no first-degree relatives with psychiatric illness. Participants were assessed using the SADS-LA and provided family history data on first-degree relatives. Results: High-risk subjects whose first-degree relative had temporally primary depression had a 50% chance of having had a major depressive episode. Those with a first-degree relative with primary panic and secondary depression were at no greater risk of having had a depression than were normal controls (6.7% and 5.4%, respectively). Limitations: The use of the family history method has the intrinsic weakness of relying solely on proband knowledge. Conclusion: The temporal relationship between comorbid panic and depression may play an important role in determining the familial risk for depression in family members.