primary care

Brief Acceptance and Commitment Therapy (ACT) interventions are well-suited to facilitate timely access to effective treatment for patients experiencing common mental health concerns. This study piloted a 4-session virtual ACT group for primary care patients experiencing symptoms of depression and anxiety (n = 21). Changes in symptoms of depression and anxiety, psychological flexibility, and quality of life (QoL) were examined at post-treatment and at 1- and 3-month follow-up. At a group level, there were significant reductions in symptoms of depression for all time points and symptoms of anxiety were significantly reduced at 1- and 3-month follow-up. Measures of psychological flexibility and QoL were significantly improved at 1- and 3-month follow-up. Reliable change index scores revealed high proportions of individual improvement for depression and anxiety symptoms (56–83% across time points). Proportions of reliable change ranged from 25 to 50% for measures of psychological flexibility and QoL at 1- and 3-month follow-up. Overall, these results are comparable with previously reported rates of improvement for empirically supported treatments and provide preliminary evidence for the effectiveness of this brief ACT intervention delivered in a community setting.

Mental health service scalability needs to be improved to meet the growing global demand. The scalability of Focused Acceptance and Commitment Therapy (fACT), a popular evidence-based brief behavioural intervention used in primary care contexts, could be improved through the development and implementation of a digital tool that supports practitioners to overcome service-delivery problems within their practice context.

Through semi-structured in-depth interviews with 12 fACT practitioners, we examined the service-delivery problems that they face within the New Zealand primary care context and identified organisational factors which may be contributing to these problems. From these interviews, six key themes emerged: (1) The brief model works for most clients but is not suitable for every client, (2) practitioners often struggle to access culturally appropriate fACT congruent exercises and psychoeducation material, (3) practitioners feel that they need additional training to maintain good model fidelity, (4) short session times can negatively impact model delivery, (5) public health employed practitioners have high workloads and are often unable to refer clients to secondary or crisis services, and (6) fACT practitioners are unable to effectively follow up with their clients post-session.

This study is part of a broader project aimed at developing an adjunctive digital tool to support the delivery of fACT in New Zealand primary care. These interviews will help us to understand the problems practitioners face in this service-delivery context, identify context-specific factors that may be causing these problems, and offer insights into the necessary features of an engaging digital tool designed to improve model scalability.

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To address limited access to behavioral health services in primary care, we conducted a preliminary effectiveness study of a novel acceptance and commitment therapy group treatment implemented within pediatric integrated primary care (ACT-IPC) using a retrospective cohort study design. Participants included 110 youth referred after psychological evaluation between 2015 and 2019. ACT-IPC was implemented in nine sessions; participants had a variety of primary psychiatric diagnoses and were predominantly White (93%) and female (81%) with an average age of 15.1 (SD = 1.5). Anxiety (d = −0.71) and depression (d = −0.54) symptoms improved significantly, as did psychological inflexibility (d = −0.52). Additionally, up to three individualized treatment goals were established and tracked weekly. These outcomes also improved significantly (d = −.69 to d = −1.42), and the first two goals evidenced the majority of improvement within approximately the first half of treatment. Reliable and clinically significant change was promising on all outcomes, and few iatrogenic effects were observed. Of note, concurrent individual therapy and psychotropic medication were prevalent within the sample and were not associated with improved outcomes. Overall, findings provide preliminary transdiagnostic effectiveness and feasibility of ACT-IPC and represent a positive example of a reticulated contextual behavioral science approach to treatment development.

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Chronic illnesses and health conditions are among the most frequently diagnosed illnesses and costly in health care systems worldwide. Patients seek simultaneous medical care for multiple chronic illnesses and related symptoms. In this study, a measure of Acceptance commonly utilized in chronic pain populations (Chronic Pain Acceptance Questionnaire) was adapted for application with patients with heterogeneous and often co-morbid chronic illness diagnoses. The online chronic illness support group sample participants (N=413) ranged in age from 20–84 years [Mean age=53.18 (12.39)] and were diagnosed with 1–7 (M=2.36; SD=1.39) chronic illnesses. The Chronic Illness Acceptance Questionnaire (CIAQ) showed adequate-to-good fit to the data. For the two factor CFA model, the RMSEA=0.078 (90% CI=0.071–0.085). The items of the two parallel measures appear to tap similar acceptance dimensions or subscales – Willingness and Activity Engagement. Additionally, the two CIAQ subscales significantly predicted illness-related disability ratings in this sample. Taken together, results suggest further study may yield ecologically valid approaches to ACT based assessment and intervention in medical settings wherein patients seek treatment for multiple health concerns.

To find the full text version of this article and others (as well as download a full text .pdf.), ACBS members can visit the ScienceDirect homepage here.