Acceptance and Commitment Therapy (ACT) for OEF/OIF Veterans

The proposed study is a randomized controlled trial (RCT) of Acceptance and Commitment
Therapy (ACT) as compared to a control psychotherapy, Present Centered Therapy (PCT), for
individuals with distress and impairment who deployed as part of Operation Enduring Freedom
and/or Operation Iraqi Freedom (OEF/OIF). ACT was selected for study because it has a number
of advantages for this population. It is not tied to any particular symptom constellation,
so it can be applied to a variety of presenting concerns (Hayes, Luoma, et al., 2006; Öst,
2008, Powers et al., 2009), resulting in reduced training burden for clinicians and less
need for applying sequential treatments to address co-morbidities. ACT has good face
validity (i.e., "it makes sense") and conveys a compelling message to young Service Members
and Veterans. ACT asks individuals to move forward in accordance with one's values
regardless of limitations rather than struggling against those limitations. ACT appears to
be acceptable to patients (mean attrition of 15.4% in 13 RCTs (Öst, 2008). ACT is being
widely disseminated without adequate evidence of its effectiveness for this important
population.

Inclusion Criteria:

- Previous deployment to OEF or OIF

- Current distress and impairment [at least one Diagnostic and Statistical Manual
version IV (DSM-IV) anxiety or depressive disorder as determined by the Mini
International Neuropsychiatric Interview (MINI) or post-concussive symptoms (PCS) as
determined by a positive traumatic brain injury (TBI) screen with a score of 25 or
greater on the Rivermead with distress or impairment related to PCS].

- Capable of giving informed consent.

Exclusion Criteria:

- Cognitive impairment that would interfere with treatment. Potential participants will
be excluded if they screen positive for more than mild cognitive impairment on the
Montreal Cognitive Assessment (MoCA; excluded if score < 26).

- Severe psychopathology (psychosis, bipolar illness, urgent suicidality or
self-injurious behavior) or untreated substance dependence in the past month.

- Anticipated change in pharmacologic intervention. Patients may stay on their current
medications during the study but will be asked to refrain from beginning or altering
medication use during the study to the extent possible.

- Other psychotherapy focusing on the same target symptoms. Patients may attend
self-help groups or treatment for other types of problems (e.g., couples counseling)
but not other treatment for the same presenting problems.

- Anticipated deployment or other circumstance that would interfere with completion of
all study procedures.