CoChat
Sign Up
Cited by 46Mindfulness and Compassion InterventionsPosttraumatic Stress Disorder ResearchTraumatic Brain Injury Research

Development and evaluation of an 1-day Acceptance and Commitment Therapy workshop for Veterans with comorbid chronic pain, TBI, and psychological distress: Outcomes from a pilot study

Open access
Dindo, Lilian, Johnson, Adrienne L., Lang, Brent, Rodrigues, Merlyn, Martin, Lindsey, Jorge, Ricardo·2020·Contemporary Clinical Trials
DOI 10.1016/j.cct.2020.105954PMC PMC8830556
Open this paper in CoChat — free account

Abstract

Objectives: To 1) develop and refine a 1-day trans-diagnostic psychotherapeutic “ACT on Life” workshop tailored for Veterans with mild traumatic brain injury, stress-based psychopathology, and pain; 2) examine the feasibility, acceptability, and preliminary effects of this intervention. Setting: A Veterans Health Administration medical center. Participants: Veterans returning from Operations Iraqi Freedom, Enduring Freedom, and New Dawn with mild TBI, stress-based psychopathology, and chronic pain. Design: Phase I involved development of the intervention by experts and subsequent refinement based on Veteran feedback (N = 11). Phase II was a pilot randomized controlled trial comparing the effects of the revised intervention (N = 20) to treatment as usual (TAU; N = 12). Main measures: For phase I, qualitative feedback at 2 weeks and 3 months post-workshop was obtained from Veterans. For phase II, quantitative measures included the PTSD Checklist, Depression Anxiety and Stress Scale, Military-to-Civilian Questionnaire, WHO-Disability Assessment Schedule, Brief Pain Inventory, Acceptance and Action Questionnaire. Results: Veterans found the workshop acceptable, innovative and useful. Quantitative data from phase II suggested that participants in the ACT group, relative to TAU, showed improvement in psychiatric symptoms, functioning, and reintegration 3 months post-workshop. Unexpectedly, pain interference was lower in the TAU group at follow-up. Conclusions: Preliminary results support the feasibility, acceptability, and promising effects on psychological distress and community reintegration of this 1-day, transdiagnostic workshop for Veterans. Future research examining the effectiveness of this workshop with a larger sample size is necessary. © 2020

Integrity signals

Registry

Crossref · 10.1016/j.cct.2020.105954

Cites

34 of 34 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

12 of 42 cited sources checked · 3 supported · 1 flagged · accuracy not yet measured

  • Interpretationcitation

    The moderate effect sizes for the DASS-21 total score, PCL, M2CQ, and AAQ are similar to those reported in a meta-analysis of ACT for psychological outcomes in acquired brain injury.

    “the moderate effect sizes found for the DASS-21 total score, PCL, M2CQ, and AAQ are similar to those reported in a meta-analysis looking at the effectiveness of ACT compared to other treatments/wait-list on psychological outcomes in those with acquired brain injury [39].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [39] source

      The ‘Evidence base for ACT interventions’ section reports moderate effect sizes from a meta-analysis across clinical and medical conditions, not specifically acquired brain injury (ABI). The paper explicitly states that no study had yet tested ACT’s efficacy in ABI populations, contradicting the claim that it reports a meta-analysis of ACT outcomes in people with ABI. Page numbers are not available in the supplied copy. (LLM, conf=0.90)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    Among Veterans who begin mental health treatment, only a small fraction complete a full course of evidence-based therapy.

    “Even among Veterans who start mental health treatment, only a small minority complete a recommended course of evidence-based therapy.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [9] source

      The Introduction reports that fewer than 10% of OEF/OIF veterans diagnosed with PTSD or depression received the recommended amount of mental health treatment in their first several months of care. It also reports 68% dropout before completion at one VA PTSD clinic. These findings support concern about low treatment completion, but the first figure includes diagnosed veterans who may not have started treatment, and the clinic finding does not establish that only a small minority of veterans who start treatment complete a recommended course of evidence-based therapy. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [10] source
  • Premisecitation

    Inadequate management of comorbid TBI, mental health disorders, and pain leads to higher morbidity, mortality, suicide risk, and lower quality of life.

    “Suboptimal management of comorbid TBI, mental health disorders and pain results in increased morbidity, mortality and suicide risk and significantly decreased quality of life [5–7].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [5] source
    • cites [6] source
    • cites [7] source

      The Discussion reports that TBI, PTSD and pain commonly co-occur and are associated with higher VA medical costs, but explicitly says the study did not examine health outcomes. Our copy does not assess whether suboptimal management increases morbidity, mortality or suicide risk, or decreases quality of life (searched: management, mortality, suicide and quality of life). (LLM, conf=0.79)

      Experimental — accuracy not yet measured
  • Premisecitation

    Practical obstacles to mental health treatment, such as time constraints, distance from facilities, and competing priorities, are common among Veterans.

    “Practical barriers, including time constraints, distance from a treatment facility, and competing priorities, are prevalent [9,10].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [9] source

      The Results and Discussion (page unavailable in our copy) identify work conflicts and being too busy as perceived barriers, particularly among OEF/OIF veterans compared with Vietnam veterans. The paper assesses unreliable transportation but does not establish that distance from a facility is a barrier. Its sample is veterans already receiving VA outpatient mental health care, so it does not establish that all three barriers are prevalent among veterans generally. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [10] source
  • Interpretationcitation

    The findings are consistent with literature on the efficacy of 1-day ACT-based workshops for patients with comorbid medical and psychiatric issues.

    “Findings are consistent with relevant literature on the efficacy of 1-day, ACT-based workshops for patients with comorbid medical and psychiatric issues [15].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • May combine two claims. 36
  • Classified as probably not a substantial claim. 27
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    ACT has demonstrated efficacy in treating depression, anxiety, and pain.

    “With established efficacy in treating depression, anxiety and pain [12–14], ACT has been effectively implemented in both civilians and Veterans and delivered in various formats, including cost- and time-efficient 1-day group workshops [15].”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [12] source
    • cites [13] source

      The Discussion (page unavailable) says the findings support ACT for anxiety disorders and depression, and for somatic health problems more broadly. Our copy does not specifically report efficacy for pain, so it does not establish that part of the attributed claim. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [14]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The qualitative analysis employed rapid qualitative analysis, described as a systematic and rigorous method, to condense and review data for workshop implementation.

    “We used rapid qualitative analysis, a systematic and rigorous process, to succinctly condense and review data to inform workshop implementation [22].”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationcitation

    The severity of the polytrauma clinical triad may warrant additional treatment time.

    “It may be that severity of the polytrauma clinical triad may warrant additional treatment time [33] [7].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [33] source

      The Discussion says veterans with the polytrauma clinical triad need improved treatment planning and integrated care, while the introductory passage describes more severe psychopathology and greater healthcare utilization. Neither passage says that severity warrants additional treatment time; the study did not assess treatment duration. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [7] source

      The Average Costs section (page unavailable) reports that VA medical costs rose with diagnostic complexity and were highest for veterans with TBI, pain, and PTSD. It does not assess the severity of that triad or whether patients need additional treatment time; higher costs alone do not establish either point. (LLM, conf=0.77)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    ACT has been effectively used with both civilians and Veterans and delivered in multiple formats, including cost- and time-efficient 1-day group workshops.

    “With established efficacy in treating depression, anxiety and pain [12–14], ACT has been effectively implemented in both civilians and Veterans and delivered in various formats, including cost- and time-efficient 1-day group workshops [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] source

      In “ACT Meets Implementation Needs” (page unavailable), the paper reports successful delivery in multiple formats, including 1-day group workshops; it also describes the workshops as more accessible and feasible than weekly treatment. The “Empirical Support” section says the Department of Veterans Affairs endorses ACT, but does not establish effective implementation among Veterans specifically. The “Discussion” calls for future cost-effectiveness research, so the claim that the workshops are cost-efficient is not established. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The AAQ-II has good internal consistency and validity and has been shown to mediate behavioral outcomes in ACT interventions.

    “It has been shown to have good internal consistency and validity and also to mediate behavioral outcomes in ACT interventions [31].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] source

      In “Measure Theoretical Processes and Their Relationships to Pathology and Health” (page unavailable), the paper says the AAQ predicts forms of psychopathology and points to a separate review of the AAQ-II. In “Emphasizing Mediation and Moderation in the Analysis of Applied Impact” (page unavailable), it reports that measures of acceptance and psychological flexibility have mediated ACT outcomes. It does not state that the AAQ-II specifically has good internal consistency and validity or that the AAQ-II itself mediated behavioral outcomes. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Study design and conductreasoning

    The use of validated semistructured diagnostic interviews (BAT-L, CAPS, SCID-I) assured that Veterans met eligibility criteria and allowed comprehensive assessment of their mental and physical health.

    “our use of validated, semistructured diagnostic interviews (i., BAT-L [18], Clinician Administered PTSD Scale [20], SCID-I [19]) assured that Veterans met eligibility criteria and allowed comprehensive assessment of their mental and physical health.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [18] source
    • cites [20]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • The quote only partly states this claim.

    Findingown data

    Pilot participants expressed interest in attending future workshops.

    “Veterans expressed interest in attending future workshops.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    At 3 months, many pilot participants reported improved management of their physical and emotional health, though some continued to have difficulties.

    “Overall, many Veterans described better management of their physical and emotional health, but some continued to struggle.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Pilot participants suggested memory aids such as flashcards or motivational magnets.

    “[3] items to help remember key concepts (e.g., flashcards, motivational magnets)”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    After the adaptations, RCT Veterans reported general acceptance of the workshop, increased use of learned skills, and improvements in physical and emotional health.

    “Following these adaptations, Veterans from the RCT phase noted general acceptance of the workshop as presented and increased use of skills learned and reported improvements in physical and emotional health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Pilot qualitative data showed appreciation for the novelty of the treatment and provided suggestions for adapting the intervention for Veterans.

    “Qualitative data from the pilot phase demonstrated an appreciation for the novelty of this treatment and provided important suggestions for adapting the intervention for Veterans.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Pilot participants suggested follow-up sessions or a multiple-session workshop format.

    “[2] follow-up sessions or a multiple-session format”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Pilot participants suggested an alternate workshop venue, such as outside the VAMC or at community-based outpatient clinics.

    “[4] an alternate venue (e.g., outside the VAMC for those who do not like to go to a VAMC; at community-based outpatient clinics for those who live far from the main VAMC).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Veterans took part in the workshop to learn new coping methods for their health issues and to assist other Veterans.

    “Overall, Veterans participated in the workshop because they wanted to learn new ways to cope with their health issues (i.e., PTSD, TBI) and to help other Veterans.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Veterans reported stress levels similar to before the workshop, but they noted greater awareness of stressors and more focus on valued activities.

    “Veterans reported similar levels of stress as before the workshop but noted more awareness of stressors and greater focus on valued activities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Veterans especially valued the camaraderie with fellow Veterans and the male-only group setting.

    “Veterans particularly enjoyed the camaraderie with other Veterans in the group and being in a “male-only” setting.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Veterans perceived the workshop as acceptable, innovative, and useful.

    “Veterans found the workshop acceptable, innovative and useful.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In the RCT phase, 177 Veterans completed screening, 60 were eligible for baseline, 52 completed baseline, and 42 met inclusion criteria.

    “Of 177 Veterans completing screening, 60 met screening criteria and were eligible to complete an in-person baseline assessment. Of these, 52 completed the baseline assessment; and 42 met inclusion criteria.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Veterans felt appreciated and heard by the instructor despite her non-Veteran status, and they felt safe and comfortable sharing experiences and emotions, unlike their typical group experiences.

    “They appreciated and felt heard by the instructor, despite her non-Veteran status and felt “safe” and comfortable expressing experiences and emotions, contrary to their usual experience in groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Positive trends in enhanced psychological flexibility on the AAQ were observed for the ACT group but not for the TAU group.

    “positive trends in enhanced psychological flexibility (AAQ) were observed for the ACT but not for the TAU group.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The goal of ACT interventions is to enhance psychological flexibility.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Of 27 Veterans invited to the ACT workshop, 20 attended, a 74.1% attendance rate.

    “Of 27 Veterans invited to the ACT workshop, 20 attended (74.1% attendance rate; Fig. 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Veterans favored the 1-day duration over a longer course, yet they wanted the workshop extended to allow more thorough coverage and a less rushed pace.

    “They preferred the 1-day length over a longer course but also desired to extend the workshop to better “dissect” content and feel less rushed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Veterans proposed improvements such as a follow-up class, adding a Veteran to the research team, more manual use during the workshop, more military language, and more community resources and complementary medicine options.

    “Suggestions for improvement included 1) a follow-up class to solidify and reinforce concepts learned, 2) inclusion of a Veteran in the research team, 3) greater utilization of manuals during the workshop, 4) greater use of military language, and 4) inclusion of more community resources and complementary medicine treatment options.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At the 3-month follow-up, the pilot qualitative data were organized into six distinct domains.

    “At 3 months, qualitative data were sorted into 6 unique domains”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Pilot participants suggested identifying individual goals and assigning homework at the end of workshops.

    “[3] identification of goals for individual Veterans and homework assignments at the end of workshops”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Veterans considered the workshop helpful, motivational, and informative and would recommend it to other Veterans, though they noted a lack of specific goal-setting strategies.

    “They found the workshop helpful, motivational and informative and would recommend it to other Veterans but noted its lack of specific goal-setting strategies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Pilot participants suggested greater use of military terminology in discussion and materials.

    “Suggestions for improvement included [1] greater use of military terminology in discussion and materials”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    An estimated 42% of all OIF/OEF Veterans have the polytrauma triad of chronic pain, PTSD, and mild TBI.

    “An estimated 42% of all OIF/OEF Veterans have the “polytrauma” of chronic pain, PTSD and mild TBI (mTBI) [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Most individuals with TBI also have a comorbid mental health disorder such as depression, PTSD, or another anxiety disorder, as well as chronic head, neck, or back pain.

    “Among those with TBI, most also experience a comorbid mental health disorder, including depression, posttraumatic stress disorder (PTSD) and/or other anxiety disorders (stress-based psychopathology), as well as chronic head, neck or back pain [2,3].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [2] source
    • cites [3] source

  • May combine two claims.

    Premisecitation

    Veterans frequently avoid seeking mental health treatment because they believe they should handle psychological problems alone and fear negative career consequences.

    “Unfortunately, Veterans are often reluctant to seek treatment for mental health-related issues, due to beliefs that one should overcome psychological difficulties on his/her own and concern that receiving such care would negatively impact their careers [8].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Among OIF/OEF/OND Veterans, TBI is considered the signature wound, and as many as 20% of the 2 million deployed experience post-concussive symptoms.

    “Traumatic brain injury (TBI) is the “signature wound” of Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn (OIF/OEF/OND), with up to 20% of 2 million deployed Veterans experiencing post-concussive symptoms [1].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was registered on clinicaltrials.gov under NCT02844946.

    “The study is also registered in clinicaltrials.gov (NCT02844946).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The study received full Institutional Review Board approval, and all Veteran participants gave written informed consent.

    “This study was fully approved by an Institutional Review Board, and all Veterans provided written informed consent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The BPI demonstrates good reliability and validity.

    “It contains 17 items and demonstrates good reliability and validity [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Veterans face significant challenges adjusting to civilian life following deployment.

    “due to the significant challenges faced by Veterans in adjusting to civilian life following deployment [27,35]”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] source
    • cites [35] source

  • May combine two claims.

    Interpretationown data

    Overall, the results support the feasibility and acceptability of a 1-day transdiagnostic workshop for Veterans with the polytrauma clinical triad.

    “Overall, our results support the feasibility and acceptability of a 1-day, transdiagnostic workshop for Veterans with the polytrauma clinical triad.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Comorbid mental health problems and pain are highly prevalent among combat Veterans with mTBI.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    For the 2-week interviews, two analysts independently summarized transcripts and resolved discrepancies through consensus meetings.

    “Analysts then independently summarized 3 transcripts to test usability of the summary template and met in consensus meetings to resolve discrepancies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The DASS-21 has adequate construct validity and internal consistency and has been used extensively with military personnel and individuals with TBI.

    “It has demonstrated adequate construct validity and internal consistency and has been used extensively with military personnel and individuals with TBI [25] [26].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] source
    • cites [26] source

  • May combine two claims.

    Interpretationreasoning

    This study supports concurrent treatment of coexisting medical and psychiatric conditions, with the potential to decrease patients' burden and cost of attending multiple visits.

    “this study supports concurrent treatment of these coexisting medical and psychiatric conditions, with the potential to decrease patients' burden and cost of attending multiple visits.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The project coordinator produced a summary document for each domain, which the qualitative methodologist reviewed and used to provide feedback for updates.

    “The project coordinator created a summary document for each domain to succinctly present data for review, which was subsequently reviewed by the qualitative methodologist and updated, based on feedback.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Preliminary results support the feasibility, acceptability, and promising effects on psychological distress and community reintegration of the 1-day transdiagnostic workshop for Veterans.

    “Preliminary results support the feasibility, acceptability, and promising effects on psychological distress and community reintegration of this 1-day, transdiagnostic workshop for Veterans.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Veterans at multiple time points reported greater focus on increased functionality within the context of physical limitations and elevated stressors, consistent with ACT model processes.

    “Consistent with core processes in the ACT model of psychological flexibility (e.g., acceptance, attention to the present moment, committed action, and values-based decisions) [32], Veterans at multiple times reported greater focus on increased functionality within the context of physical limitations and elevated stressors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: The goal of ACT interventions is to enhance psychological flexibility.

  • May combine two claims.

    Interpretationown data

    The findings support the feasibility and acceptability of an intensive 1-day ACT workshop for this difficult-to-treat population.

    “Our findings support the feasibility and acceptability of an intensive 1-day ACT workshop in this difficult-to-treat population.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Comorbid mental health problems and pain are highly prevalent among combat Veterans with mTBI.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The M2C-Q has demonstrated good construct validity and high internal consistency.

    “with demonstrated good construct validity and high internal consistency [27]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] source

  • May combine two claims.

    Interpretationown data

    The pilot RCT showed that, compared with TAU, the ACT group had positive trends toward improvements in psychiatric symptoms, overall functioning, and reintegration.

    “the pilot RCT study also showed that Veterans in the ACT group, relative to those in the TAU group, showed positive trends towards improvements in in psychiatric symptoms, overall functioning and reintegration.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The WHODAS-2 demonstrates good reliability, validity, and sensitivity to change after treatment.

    “It demonstrates good reliability, validity and sensitivity to change after treatment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    RCT participants were randomly assigned to ACT (n = 27) or TAU (n = 12).

    “participants were randomly assigned to ACT (n = 27) or to TAU (n = 12).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PCL-C has demonstrated good reliability and validity and is regularly used in clinical practice.

    “It has demonstrated good reliability and validity and is regularly used in clinical practice [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The use of a relatively short 3-month follow-up period is a limitation.

    “Another limitation is the use of a relatively short (3-month) follow-up period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The use of both qualitative and quantitative data allowed collection of feedback on the study's development and feasibility and supported preliminary effects of the treatment.

    “Another strength was our use of qualitative and quantitative data, allowing us to collect feedback on the development and feasibility of this study and support preliminary effects of this novel treatment.”
    Quote in the paperSubstantial claim
50 of 50

  • The paper relies on this without support.

    Providing a 1-day ACT workshop for Veterans with mTBI, mental health disorders, and chronic pain enables unitary, comprehensive care for their emotional, physical, and cognitive symptoms.

    “Providing a 1-day ACT “workshop” for Veterans with mTBI, mental health disorders, and chronic pain allows unitary, comprehensive care for their emotional, physical and cognitive symptoms.”

  • The paper relies on this without support.

    Illness education is beneficial for patients who typically have limited understanding of their illness, its treatment rationale, and their ability to influence its course.

    “Illness education is helpful for patients who often have surprisingly little understanding of their illness, the rationales of its treatment, and their own ability to influence its course.”

  • The paper relies on this without support.

    Educating patients about the characteristics and clinical course of mTBI reduces anxiety and negative expectations about recovery.

    “For example, providing education regarding the characteristics and clinical course of mTBI decreases anxiety and negative expectations of recovery from the event.”

  • The paper relies on this without support.

    No other studies have examined concurrent treatment of mTBI, stress-based psychopathology, and chronic pain.

    “To our knowledge, no other studies examine concurrent treatment of mTBI, stress-based psychopathology and chronic pain.”

  • The paper relies on this without support.

    Comorbid mental health problems and pain are highly prevalent among combat Veterans with mTBI.

    “Given the high prevalence of co morbid mental health problems and pain among combat Veterans with mTBI”

  • The paper relies on this without support.

    The goal of ACT interventions is to enhance psychological flexibility.

    “Given that the goal of ACT interventions is to enhance psychological flexibility”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • ACT significantly reduced PTSD symptoms in parents of children with life-threatening illnesses, combat veterans, and traumatized adults.

    “It has been reported that ACT significantly reduced PTSD symptoms in parents of children with life-threatening illnesses (Muscara et al., 2020), combat veterans (Dindo et al., 2020; Gobin et al., 2019), and traumatized adults (Boals and Murrell, 2016).”

    From Efficacy and mechanisms of mobile application-delivered Acceptance and Commitment Therapy for posttraumatic stress disorder in China: Study protocol for a randomized controlled trial (2022) · cites this paper as Dindo et al., 2020

    The Results (Quantitative results) report a reduction in self-reported posttraumatic symptoms among veterans in the ACT group relative to treatment as usual, but describe it as a positive trend. The difference was not statistically significant (p = .39), so this paper does not support the claim that ACT significantly reduced those symptoms in combat veterans. The other populations in the citing sentence are attributed to other citations. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Only 1 RCT included patients with both depression and anxiety: Dindo and colleagues examined the effect of a one-day ACT workshop on pain severity and interference in patients with current major depression and anxiety disorder or PTSD.

    “Only 1 RCT included patients with both depression and anxiety: Dindo and colleagues 26 examined the ef­ fect of a one-day ACT workshop on pain severity and interference in patients with current major depression and anxiety disorder or PTSD.”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [26]

    The Phase 2 RCT Method describes random assignment to a one-day ACT workshop or treatment as usual, and the Results report pain severity and interference outcomes. But the Phase 1 Participants and procedure section, whose eligibility criteria also applied to Phase 2, required current major depressive disorder, generalized anxiety disorder, or PTSD—not both depression and anxiety. No page numbers are available in our copy. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • Six trials evaluated an MBI, mostly among patients with OUD.

    “In total, 6 trials evaluated an MBI, mostly among pa­ tients with OUD, 24-30”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [26]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Pain-interference confidence interval conflicts with its p-value

    Major

    The reported 95% confidence interval includes zero, whereas the reported two-sided p-value of .03 indicates significance at the .05 level. These cannot both describe the same comparison under the usual corresponding test.

  • Transcript counts exceed the Phase 1 sample

    Minor

    The analysis describes 3 initial transcripts and 9 remaining transcripts, totaling 12. Phase 1 included 11 Veterans, each of whom was to be interviewed.

    Reported 11 · recomputed 12

2 of 2

Cites

Flagged first, then by citations

3 of the 37 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Dindo, 2019, One-day ACT workshops for patients with chronic health problems and associated emotional disorders

Cited by

Sorted by citations

Related

Authors
Dindo, L., Johnson, A. L., Lang, B., Rodrigues, M., Martin, L., & Jorge, R.
Affiliations
  • Michael E. DeBakey VA Medical Center (US)
  • University of Wisconsin–Madison (US)
  • Baylor College of Medicine (US)
Corresponding author
Dindo, Lilian
ORCID
Venue
Contemporary Clinical Trials
Publisher
Elsevier BV
Published
2020-03
Volume
90
Pages
105954
ISSN
1551-7144 (ISSN-L)
DOI
10.1016/j.cct.2020.105954
PMC
PMC8830556
OpenAlex
W3004589700
Cited by
46
References
37
Citations by year
2026: 5 · 2025: 8 · 2024: 9 · 2023: 12 · 2022: 6 · 2021: 5 · 2020: 1
FWCI
2.39
Type
journal article
Language
en
Open access
Licence
Locations
  • Contemporary Clinical Trials (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Center for Innovations in Quality, Effectiveness and Safety (CIN13–413)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
acceptance and commitment therapy, veterans, mild traumatic brain injury, chronic pain, psychological distress, post-traumatic stress disorder, depression, anxiety, community reintegration, transdiagnostic psychotherapy, workshop intervention, feasibility and acceptability, military-to-civilian transition, pain interference
MeSH terms
Armed Conflicts, Brain Injuries, Traumatic, Adult, Female, Humans, Male, Membrane Glycoproteins, Middle Aged, Pilot Projects, Socioeconomic Factors, Stress, Psychological, Veterans, Chronic Pain, Acceptance and Commitment Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review