Track topics on Twitter Track topics that are important to you
The goal of this study is to 1) examine the feasibility and acceptability of a one-day Acceptance and Commitment Training + Illness Management (ACT-IM) intervention in patients with comorbid vascular disease risk factors and depression or anxiety; and 2) to evaluate the effectiveness of this brief group intervention(ACT-IM), compared to Treatment-As-Usual (TAU) on the mental health and functioning of patients with co-morbid mood/anxiety and vascular disease risk factors. Patients with vascular disease risk factors will be identified by physicians in Family Practice or Internal Medicine, through chart review, or through advertisements. Those with vascular risk factors will be screened and assessed for symptoms of depression or anxiety. Patients who are experiencing significant depressive or anxiety symptoms and are interested in the treatment arm of the study will be randomized to the ACT-IM intervention or to TAU. Assessments of the following will take place both before and after the intervention: depression, anxiety, functioning, illness self-management, blood vessel health, and blood.
There is no difference in the recruitment, consent, or enrollment process for the ACT-IM or the TAU group.
Patients with vascular disease risk factors will be identified by physicians in Family Practice or Internal Medicine, through chart review, or through advertisements. Those responding to advertisements or who have been referred by a physician will be invited to complete a screening phone call or to complete an on-line screening measure. Potentially eligible patients who were identified through chart review will first be sent a letter. This letter will be followed, at least one week later, by a phone call to assess for interest in the study and to provide information about the screening.
Participants who are eligible at screening will be contacted by the research team to discuss the study and answer any questions the patient may have. If the patient is interested in participating in the treatment arm of the study, an appointment will be scheduled for an in-person assessment.
At the in-person baseline assessment, participants will be provided with a detailed description of the study, consent will be obtained, and a 90-120 minute assessment will begin.
- vitals(height, weight, blood pressure, temperature, pules, respiration rate.
- blood draw(to test blood fat, sugars, and inflammation (lipid panel (LIPP), glucose (GLU), hemoglobin A1C (A1C), and hsCRP). For this blood draw we ask that the participant not consume alcohol for 24 hours preceding the visit. We ask that this be a 12 hour fasting blood draw. We also ask that the participant not take their medications the day of the draw, prescription or otherwise. Once the blood draw is complete, they made take any medications they have.
- Noninvasive measure of blood vessel health (finger plethysmography) using EndoPAT**.
- Interview: Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety
- Self Report measures
- Medical charts only to confirm the diagnosis of vascular disease, hypertension, diabetes, or obesity from the chart.
At the end of the assessment, participants will be randomly assigned, using a 2:1 ratio, to either ACT-IM or TAU.
Patients in the ACT-IM group will attend a 1-day group workshop. Each ACT-IM group will be held at the University of Iowa Hospitals and Clinics, include 8-12 patients, and last 6 hours. The ACT-IM group will be conducted by 2 psychologists and the IM portion will be completed by a physician with expertise in vascular disease-psychiatric comorbidity. Three broad areas will be covered: 1) Illness Management will cover the importance of physical and psychological self-care for the management of co-morbid depression/anxiety and vascular problems (e.g. fatigue, stress, poor nutrition management, and inadequate physical activity); 2) Behavioral Change Training will involve i) teaching patients how to recognize ineffective patterns of behavior and habits, ii) exploring and setting life goals and those related to mental and physical health, and iii) promoting effective and committed actions to achieve these goals despite the urge to do otherwise; 3) Mindfulness and Acceptance Training will emphasize new ways of managing troubling thoughts, feelings, and physical sensations (e.g., learning how to recognize, and develop cognitive distance from unhelpful thoughts such as "I can't take this anymore" and learning how to willingly face experiences that cannot be changed). In-session exercises and practice will be heavily emphasized during the group intervention. A manual with information about topics covered during the group will be distributed for home use. Lunch will be provided and breaks will be offered to minimize fatigue.
Two to four weeks after the intervention, the ACT-IM participants will be contacted by one of the PI's and asked to provide qualitative feedback about the workshop.
Follow up assessments will take place at 2-, 6-, 12-, and 24-weeks. The 2-week and 6-week follow-ups can be completed by phone or web and take 45-60 minutes.
The 12-week follow-up will include interview assessments of depression and anxiety and will be completed over the phone.
The 24-week assessment will replicate the baseline visit. Thus, it will be an in-person visit, lasting 90-120 minutes.
All interviews and interventions will be audio taped for: 1) assessment of treatment integrity (i.e., to ensure that therapists are following study procedures) and 2) for inter-rater reliability of the interview measures.
**At baseline and 6 month follow-up, participants will undergo non-invasive testing of endothelial cell function using the Endothelial Peripheral Arterial Tone (EndoPAT). The EndoPAT is a medical device based on noninvasive Peripheral Arterial Tone (PAT)signal technology. It measures endothelium-mediated changes in vascular tone using unique bio-sensors placed on the fingertips. These changes in arterial tone are elicited by creating a down-stream hyperemic response induced by a standard 5-minute occlusion of the feeding artery (using a standard blood pressure cuff). When the cuff is released, the surge of blood flow causes an endothelium-dependent Flow-Mediated Dilation (FMD). The dilation or reactive hyperemia is captured by EndoPAT as an increase in the PAT Signal amplitude. A post-occlusion to pre-occlusion ratio is automatically calculated by the EndoPAT software, thus providing the EndoScore. Measurements from the opposite arm are used to control for concurrent non-endothelial dependent changes in vascular tone. Participants will be asked to clip their index fingernails before the visit or a research assistant may clip their fingernails before the study using sterilized clippers. Fingernails may need to be clipped if they are too long for the probes.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Crossover Assignment, Masking: Single Blind (Subject), Primary Purpose: Treatment
Acceptance and Commitment Therapy plus Illness Management
University of Iowa Hospitals and Clinics
Active, not recruiting
University of Iowa
Published on BioPortfolio: 2014-08-27T04:00:43-0400
First, we will determine whether Acceptance and Commitment Therapy in combination with Contingency Management increases initial treatment response rates. Second, for patients who do not r...
The purpose of this study is to determine the effect of Acceptance and Commitment Therapy (ACT) in groups on functional level, emotional problems, and use of health care in patients with s...
The goal of this study is to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for individuals who engage in nonsuicidal self-injury(NSSI) and have comorbid anxiety. W...
This study will investigate the feasibility of running a randomised controlled trial (RCT) of a psychotherapy called "Acceptance and Commitment Therapy (ACT)", delivered in a self-help for...
Intervention study with uncontrolled design investigating the effects of smartphone delivered Acceptance and Commitment Therapy for longstanding pain in adolescents. Primary outcome is pai...
This study aimed to analyse published studies regarding the usefulness of Acceptance and Commitment Therapy in the treatment of oncological patients. A systematic review of the literature was conducte...
Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is characterized by preoccupation with fear of...
The management of suicidal crisis remains a major issue for clinicians, driving the development of new strategies to improve suicide prevention.
Acceptance and Commitment Therapy (ACT) has growing support for chronic pain. However, more accessible treatment delivery is needed. This study evaluated the feasibility of online ACT for patients wit...
Attentional biases have been observed in populations with psychological disorders, but have been under-investigated in populations with physical illnesses. This study investigated potential attentiona...
Contextually focused form of cognitive behavioral psychotherapy that uses MINDFULNESS and behavioral activation to increase patients' psychological flexibility in areas such as ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations.
Those disorders that have a disturbance in mood as their predominant feature.
Clinical management approach wherein immediate therapy is not provided but there is a period of observation during which periodic tests monitor patient and the progression of the illness. (Driffield T, Smith PC Med Decis Making. 2007 Mar-Apr;27(2):178-88)
A self-administered version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool containing modules on multiple mental health disorders including anxiety, alcohol, eating, and somatoform modules. The Patient Health Questionnaire (PHQ-9) is designed specifically for mood/depression scoring each of the 9 DSM-IV criteria based on the mood module from the original PRIME-MD. The Generalized Anxiety Disorder scale (GAD-7) scores 7 common anxiety symptoms.
A nondirective psychotherapy approach originated by Carl Rogers. The goals of therapy are to promote the client’s congruence, self awareness, and self acceptance. This approach views the client as naturally directed toward self actualization, and only needing facilitative conditions in order to promote this tendency.
Blood is a specialized bodily fluid that delivers necessary substances to the body's cells (in animals) – such as nutrients and oxygen – and transports waste products away from those same cells. In vertebrates, it is composed of blo...
Psychiatry is the study of mental disorders and their diagnosis, management and prevention. Conditions include schizophrenia, severe depression and panic disorders among others. There are pharmaceutical treatments as well as other therapies to help...
Anxiety is caused by stress. It is a natural reaction, and is beneficial in helping us deal with tense situations and pressure. It is deterimental when is becomes an excessive, irrational dread of everyday situations. The most common types of anxiety di...