Search

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 ).

In patients with migraine, depression is associated with poorer medical prognosis, decreased quality of life, and increased risk of suicidality and disability; yet, behavioral interventions have rarely been investigated. The current study compared the efficacy of two 1-day (5- to 6-h) interventions for co-occurring migraine and depression: (1) acceptance and commitment therapy plus migraine education (ACT-ED), and (2) support plus migraine education (S-ED). One hundred and thirty-six patients with comorbid depression and migraine were randomized to a treatment. One hundred and three (76%) completed the ACT-ED (N = 56) or S-ED (N = 47) workshop. Primary outcomes were depression diagnosis and symptoms. Secondary outcomes were anxiety symptoms, headache-related disability and general functioning, and quality of life. Assessments were completed at baseline and 3 and 6 months following the workshop. At the 6-month follow-up, on categorical outcomes, a significantly greater number of people in the ACT-ED condition no longer met criteria for a major depressive episode and exhibited a > 50% drop in symptoms on the Hamilton Rating Scale of Depression. Similarly, though, weaker results were found when examining depressive symptoms dimensionally. On secondary outcomes, people in the ACT-ED condition exhibited significantly greater improvements in anxiety, headache-related disability, and quality of social relationships, compared to S-ED, No differences between groups were observed in general functioning. A 1-day (5- to 6-h) ACT workshop can deliver substantial and lasting benefits to depressed migraineurs, over and above those provided by group support and education. This approach is an attractive alternative to weekly psychotherapy. Clinicaltrials.gov # NCT02108678 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13311-019-00818-0) contains supplementary material, which is available to authorized users.

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.

High levels of pain, significant anxiety, or depressive symptoms before surgery put patients at elevated risk for chronic pain and prolonged opioid use following surgery. The purpose of this preliminary study was to assess the efficacy of a 1-day Acceptance and Commitment Therapy (ACT) workshop in “at-risk” veterans for the prevention of chronic pain and opioid use following orthopedic surgery. In a randomized controlled trial, 88 at-risk veterans undergoing orthopedic surgery were assigned to treatment as usual (TAU; n = 44) or TAU plus a 1-day ACT workshop (n = 44). Pain levels and opioid use were assessed up to 3 months following surgery. Pain acceptance and values-based behavior were assessed at baseline and 3-month follow-up. Participants who completed the ACT workshop reached pain and opioid cessation sooner than those in TAU. Postoperative complications exhibited a moderating effect on these outcomes, such that the effects of ACT were greater in patients without complications. Increases in pain acceptance and values-based behavior, processes targeted in ACT, were related to better outcomes. These promising results merit further investigation in a larger clinical trial. Providing an intervention before surgery for at-risk veterans has the potential to change clinical practice from a focus on management of postoperative pain to prevention of chronic pain in at-risk individuals. Perspective This pilot study compared the effects of a 1-day preventive behavioral intervention (ACT) to TAU in at-risk veterans undergoing orthopedic surgery. Three months following the intervention, veterans receiving ACT exhibited quicker cessation of pain and opioid use. Focusing on preoperative pain management may help prevent chronic postsurgical pain.

OBJECTIVE: The objective of the current research was to test the efficacy of a group-based Acceptance and Commitment Therapy (ACT) intervention for partner aggression, compared with a support and discussion control group, in a clinical sample of adults. METHOD: One hundred one participants (mean age = 31; 68% female; 18% minority) who endorsed recently engaging in at least 2 acts of partner aggression were randomly assigned to receive ACT or a support-and-discussion control condition. Both interventions consisted of 12 weekly 2-hr sessions. Assessments at pretreatment, during treatment, posttreatment, and 3 and 6 months after treatment measured psychological aggression (Multidimensional Measure Emotional Abuse Scale [MMEA]), physical aggression (Conflict Tactics Scales [CTS-2]), experiential avoidance (Avoidance and Action Questionnaire [AAQ]), and emotion dysregulation (Difficulties in Emotion Regulation Scale [DERS]). RESULTS: Results of growth curve modeling analyses demonstrated that participants in the ACT group had significantly greater declines in psychological and physical aggression from pre- to posttreatment and from pretreatment to follow-up and that 6-month treatment outcomes were partially mediated by levels of experiential avoidance and emotion dysregulation at posttreatment. CONCLUSIONS: The results of this first trial of ACT for aggressive behavior indicate that the ACT group significantly reduced both physical and psychological aggression and that these changes were significantly greater than those of the control group, suggesting that an ACT approach to aggression may serve as an efficacious treatment for aggression. (PsycINFO Database Record (c) 2014 APA, all rights reserved). Language: en

Psychological distress, often manifesting as depression and anxiety, is a risk factor for vascular disease [1]. These states also contribute to withdrawal and avoidance behaviors, which impede health promotion [2]. Effective treatments that target these syndromes and related health behaviors are needed for this broad group of distressed patients at risk of vascular disease, who comprise a considerable portion of clinic visits [3]. Acceptance and Commitment Therapy (ACT) is an empirically-supported behavioral therapy that aims to enhance psychological flexibility through use of acceptance, mindfulness, and behavioral change strategies. When presented as a brief intervention, ACT has produced positive long-term outcomes in those with co-morbidity [4, 5]. We developed a one-day ACT plus education (ACT-IM) group workshop and compared it to treatment as usual (TAU) for individuals at risk of vascular disease with clinically significant anxiety or depressive symptoms. We hypothesized this one-day intervention would improve quality of life, depression, and anxiety over six months. Individuals, ages 18–75, at risk of vascular disease (hypertension, diabetes mellitus or impaired fasting glucose, dyslipidemia, or obesity) were screened as outlined in the CONSORT Diagram (Figure 1). Of 142/827 screened scored ≥10 on either the Patient Health Questionnaire-8 or the GAD-7 without exclusion criteria: 1) brain injury; 2) past month medication changes; 3) schizophrenia or bipolar disorder, 4) current substance abuse; and 5) active suicidal ideation. Of those consented for this IRB-approved study at the University of Iowa, 30 were randomly assigned (2:1) to ACT-IM and 14 to TAU. Figure 1 Participant flow chart for the treatment trial. As a general measure of well-being, our a priori primary outcome was Quality of Life as measured with the World Health Organization Quality of Life-BREF (WHOQOL-BREF) [6]. Our a priori secondary outcomes included the clinician-rated Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HRSA). We also explored self-report measures with relevant Inventory of Depression and Anxiety Symptoms (IDAS) subscales [7]. An 11-item subscale of the Experiencing Questionnaire (EQ) measured psychological flexibility/decentering [8]. Each 6-hour ACT-IM workshop involved 7–10 participants and emphasized three topics: education (cardiovascular risk factors, diet and lifestyle recommendations, and self-monitoring), acceptance (new ways of managing troubling thoughts, feelings, and sensations), and behavioral change (how to recognize ineffective patterns, set goals, and commit to action). The intervention was manualized and participants received a corresponding workbook. The TAU group received any treatment in the community rather than through the protocol. Linear mixed models for a treatment-by-time interaction assessed the effect of treatment on primary and secondary outcomes for all randomized participants (intention-to-treat). The fixed effects were treatment status (ACT-IM versus TAU) and time (baseline, 12-, and 24 weeks). In analogous models, psychological flexibility (EQ) was assessed as a potential mediator on HRSD. Twenty six participants completed the ACT-IM intervention and 14 completed TAU. The mean age in both groups was 45. A majority of the participants were female (69% ACT-IM, 64% TAU), Caucasian (69% ACT-IM, 86% TAU), had completed college (69% ACT-IM, 71% TAU), and were working (85% ACT-IM, 71% TAU). Nearly half of those assigned to ACT-IM and 64% of those in the TAU condition were taking antidepressant medications at intake. There were no significant differences between the ACT-IM and TAU groups on any variables. All four WHOQOL-BREF (physical, social, psychological, environment) domains significantly changed from baseline through the 24-week follow-up with ACT-IM, but only for the psychological domain with TAU. The treatment-by-time interactions were not significant (Physical p=0.17; Psychological p=0.67; Social p =0.18; Environmental p=0.33). A significant overall group-by-time interaction on HRSD was observed (p

Objective To determine whether a 1-day behavioral intervention, aimed at enhancing psychological flexibility, improves headache outcomes of migraine patients with comorbid depression. Background Migraine is often comorbid with depression, with each disorder increasing the risk for onset and exacerbation of the other. Managing psychological triggers, such as stress and depression, may result in greater success of headache management. Method Sixty patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 38) or to treatment as usual (TAU; N = 22). Patients completed a daily headache diary prior to, and for 3 months following, the intervention. Clinical variables examined included headache frequency/severity, medication use, disability, and visit to a health care professional. Comparisons were made between baseline findings and findings at the 3-month follow up. Results Participants assigned to the ACT-ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability. In contrast, the TAU group did not exhibit improvements. The difference in headache outcomes between ACT-ED and TAU was not statistically significant over time (ie, the treatment by time interaction was nonsignificant). These results complement those of a previous report showing effects of ACT-ED vs TAU on depression and disability. Conclusion A 1-day ACT-ED workshop targeting psychological flexibility may convey benefit for patients with comorbid migraine and depression. These pilot study findings merit further investigation using a more rigorously designed large-scale trial.

Migraine is a complex neurological disorder that substantially impairs a person’s functioning and is often comorbid with depression. Currently, little is known about psychological coping strategies that may underlie disability and depression in patients with migraine. This study examines concurrent relations between depression and disability on the one hand and pain acceptance and values-based action on the other hand in patients with migraine. Ninety-three patients with migraine and depressive symptoms—being evaluated for a larger project examining the impact of a behavioral intervention on depression in patients with migraine—completed measures of depression, disability, pain acceptance, and values-based action. Using multiple regression analyses, the contributions of pain acceptance and values-based action to depression and disability were assessed. Low pain acceptance was strongly associated with depression and disability (r s 2 = .15–.37) in these patients. Low pain acceptance also explained unique variance in disability, beyond that of depression. Values-based action related modestly to depression and disability (r s 2 = .02–.07). Pain acceptance can contribute to our understanding of psychological health and functioning. An important next step would be to examine whether targeting acceptance in treatment of patients with migraine would lead to improvements in their mental health and functioning.

Migraine is a common and disabling disorder that is highly comorbid with depression. The comorbidity of depression and migraine is a major health concern as it results in poorer prognosis and quality of life. Yet, effective treatments have rarely been investigated.45 patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 31) or to Wait List/Treatment as Usual (WL/TAU; N = 14). Assessment of depressive symptoms, general functioning, and migraine related disability were completed at baseline and 2-, 6-, and 12 weeks after the workshop.At the 3-month follow up, participants in the ACT-ED condition exhibited significantly greater improvements in depressive symptoms, general functioning, and migraine-related disability than patients in the WL/TAU group.A 1-day ACT-ED workshop is a promising approach to the treatment for depression and disability in migraineurs that merits further investigation.

The ability of brain-damaged and hospitalized control Ss to discriminate brief temporal durations was investigated. Durations of .250, .300, and .350 sec. were employed, with .300 sec. as the standard stimulus. Each trial consisted of the presentation of the standard stimulus paired with either a .250 or .350 sec. comparison stimulus. The performances of brain-damaged and control Ss were compared as a function of stimulus modality and intra-pair interval. The stimuli were presented either auditorily or visually; the intra-pair interval was either 3 sec. or 12 sec. Each S performed under all four combinations of modality and intra-pair interval.