Acceptance and commitment therapy for co-occurring posttraumatic stress disorder and alcohol use disorders in veterans: pilot treatment outcomes

Meyer, Eric C.; Walser, Robyn; Hermann, Barbara; La Bash, Heidi; DeBeer, Bryann B.; Morissette, Sandra B.; Kimbrel, Nathan A.; Kwok, Oi‐Man; Batten, Sonja V.; Schnurr, Paula P.

doi:10.1002/jts.22322

Cited by 93Posttraumatic Stress Disorder ResearchMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

Acceptance and commitment therapy for co-occurring posttraumatic stress disorder and alcohol use disorders in veterans: pilot treatment outcomes

Meyer, Eric C., Walser, Robyn, Hermann, Barbara, La Bash, Heidi, DeBeer, Bryann B., Morissette, Sandra B., Kimbrel, Nathan A., Kwok, Oi‐Man +2 more·2018·Journal of Traumatic Stress

DOI 10.1002/jts.22322

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Abstract

Abstract Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) frequently co‐occur and are associated with worse outcomes together than either disorder alone. A lack of consensus regarding recommendations for treating PTSD–AUD exists, and treatment dropout is a persistent problem. Acceptance and Commitment Therapy (ACT), a transdiagnostic, mindfulness‐ and acceptance‐based form of behavior therapy, has potential as a treatment option for PTSD–AUD. In this uncontrolled pilot study, we examined ACT for PTSD–AUD in 43 veterans; 29 (67%) completed the outpatient individual therapy protocol (i.e., ≥ 10 of 12 sessions). Clinician‐assessed and self‐reported PTSD symptoms were reduced at posttreatment, ds = 0.79 and 0.96, respectively. Self‐reported symptoms of PTSD remained lower at 3‐month follow‐up, d = 0.88. There were reductions on all alcohol‐related outcomes (clinician‐assessed and self‐reported symptoms, total drinks, and heavy drinking days) at posttreatment and 3‐month follow‐up, dmean = 0.91 (d range: 0.65–1.30). Quality of life increased at posttreatment and follow‐up, ds = 0.55–0.56. Functional disability improved marginally at posttreatment, d = 0.35; this effect became significant by follow‐up, d = 0.52. Fewer depressive symptoms were reported at posttreatment, d = 0.50, and follow‐up, d = 0.44. Individuals experiencing suicidal ideation reported significant reductions by follow‐up. Consistent with the ACT theoretical model, these improvements were associated with more between‐session mindfulness practice and reductions in experiential avoidance and psychological inflexibility. Recommendations for adapting ACT to address PTSD–AUD include assigning frequent between‐session mindfulness practice and initiating values clarification work and values‐based behavior assignments early in treatment.

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These findings corroborate the results of veteran studies implementing ACT as a treatment for PTSD and co-occurring conditions and expand the research base in civilian outpatient populations.
“These findings corroborate the results of veteran studies implementing ACT as a treatment for PTSD and co-occurring conditions (Lang et al., 2017; Meyer et al., 2018b), and expand the research base in civilian outpatient populations.”
From Group-Based Acceptance and Commitment Therapy for PTSD in a HMO Psychiatry Clinic: An Open Trial (2024) · cites this paper as Meyer et al., 2018b
In an uncontrolled pilot study of 43 US veterans with posttraumatic stress disorder and alcohol use, 12 sessions of ACT compared with treatment-as-usual reduced the number of drinks and heavy drinking days at the end of the ACT intervention, but the study was limited by small sample size, lack of a control group, and 33% attrition.
“In an uncontrolled pilot study of 43 US veterans with posttraumatic stress disorder and alcohol use, 12 sessions of ACT as compared to treatment-as-usual showed reduction in the number of drinks and heavy drinking days at the end of the ACT intervention.”
From Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial (2023) · cites this paper as [59]
The efficacy of acceptance and commitment therapy has been confirmed in studies on substance use disorder, post-traumatic stress disorder, and comorbid psychiatric disorders.
“The efficacy of ACT has also been confirmed in studies on substance use disorder [23], post-traumatic stress disorder [24], and comorbid psychiatric disorders that are considered significant challenges for clinicians and practitioners [25].”
From Acceptance and Commitment Therapy for Destructive Experiential Avoidance (ACT-DEA): A Feasibility Study (2022) · cites this paper as [25]
ACT has shown preliminary evidence in improving PTSD symptoms.
“ACT has also shown preliminary evidence in improving interpersonal difficulties [34,35,36] and PTSD symptoms [37,38,39,40].”
From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [40]
An open trial of a 12-session ACT intervention for co-occurring PTSD and alcohol use disorder (n=43) showed an improvement in clinician-assessed and self-reported PTSD symptoms and quality of life post-treatment and at a 3-month follow-up.
“An open trial of a 12-session ACT intervention for co-occurring PTSD and alcohol use disorder (n = 43) showed an improvement in clinician-assessed and self-reported PTSD symptoms and quality of life post-treatment and at a 3-month follow-up [40].”
From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [40]

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Authors: Meyer, E. C., Walser, R., Hermann, B., La Bash, H., DeBeer, B. B., Morissette, S. B., Kimbrel, N. A., Kwok, O., Batten, S. V., & Schnurr, P. P.
Affiliations: Texas A&M Health Science Center (US)
VA Palo Alto Health Care System (US)
VA Burlington Lakeside Clinic Burlington Vermont USA
U.S. Department of Veterans Affairs Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans at Central Texas Veterans Healthcare System Waco Texas USA
The University of Texas at San Antonio (US)
Durham VA Medical Center (US)
Texas A&M University (US)
Booz Allen Hamilton (United States) (US)
Dartmouth College (US)
Corresponding author: Meyer, Eric C.
ORCID: Meyer, Eric C.
Walser, Robyn
DeBeer, Bryann B.
Morissette, Sandra B.
Kimbrel, Nathan A.
Kwok, Oi‐Man
Batten, Sonja V.
Schnurr, Paula P.
Venue: Journal of Traumatic Stress
Publisher: Wiley
Published: 2018-10
Volume: 31
Issue: 5
Pages: 781-789
ISSN: 0894-9867 (ISSN-L)
1573-6598
DOI: 10.1002/jts.22322
OpenAlex: W2896791686
Cited by: 92
References: 26
Citations by year: 2026: 10 · 2025: 12 · 2024: 11 · 2023: 14 · 2022: 13 · 2021: 10 · 2020: 15 · 2019: 6 · 2018: 1
FWCI: 9.40
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 18 d)
Locations: Journal of Traumatic Stress (publishedVersion)
PubMed (publishedVersion)
Funders: Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans.
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: acceptance and commitment therapy, post-traumatic stress disorder, alcoholism, veterans, treatment discontinuation, mindfulness practice, experiential avoidance, psychological inflexibility, quality of life, functional disability, depressive symptoms, suicidal ideation, values clarification, medication adherence
MeSH terms: Alcoholism, Female, Humans, Male, Pilot Projects, Quality of Life, Severity of Illness Index, Stress Disorders, Post-Traumatic, Veterans, Cohort Studies, Treatment Outcome, Mindfulness, Acceptance and Commitment Therapy

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Acceptance and commitment therapy for co-occurring posttraumatic stress disorder and alcohol use disorders in veterans: pilot treatment outcomes

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