One-Day Acceptance and Commitment Training Intervention in Primary Care Patients
| Status: | Completed |
|---|---|
| Conditions: | High Blood Pressure (Hypertension), High Cholesterol, Psychiatric |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 4/21/2016 |
| Start Date: | August 2012 |
| End Date: | December 2013 |
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.
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.
Initial Assessment:
- 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.
Treatment:
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.
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.
Initial Assessment:
- 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.
Treatment:
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.
Inclusion Criteria:
- The subject population is people ages 18-75 who have vascular risk factors
(hypertension, diabetes mellitus or impaired fasting glucose, dyslipidemia, or
obesity) and symptoms of depression or anxiety. Symptoms of depression and anxiety
will be operationally defined as a score of >= 10 on the Patient Health Questionnaire
(PHQ-8;depression) or GAD-7 (anxiety). All participants must be English speaking.
Exclusion Criteria:
- Patients with a primary psychotic disorder (e.g. schizophrenia).
- Patients with current alcohol or illicit drug dependence/abuse disorders.
- Patients who have started a new medication in previous 4 weeks or plan on starting a
new medication in the next 4 weeks.
- Patients expressing active suicidal ideation.
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