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Cited by 22Cardiac Health and Mental HealthMindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

Open access
Dindo, Lilian, Marchman, James, Gindes, Holly, Fiedorowicz, Jess G.·2015·Psychotherapy and Psychosomatics
DOI 10.1159/000371495PMC PMC4393823
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Abstract

Psychological distress, often manifesting as depression and anxiety, is a risk factor for vascular disease [1]. These states also contribute to withdrawal and avoidance behaviors, which impede the promotion of health [2]. Effective treatments that target these syndromes and related health behaviors are needed for this broad group of distressed patients at risk of vascular disease, who comprise a considerable proportion of clinic visits [3]. Acceptance and commitment therapy (ACT) is an empirically supported behavioral therapy that aims to enhance psychological flexibility through the use of acceptance, mindfulness and behavioral change strategies. When presented as a brief intervention, ACT has produced positive long-term outcomes in those with comorbidity [4,5]. We developed a 1-day ACT plus education (ACT-IM) group workshop and compared it to a treatment as usual (TAU) group for individuals at risk of vascular disease with clinically significant anxiety or symptoms of depression. We hypothesized that this 1-day intervention would improve quality of life (QOL), depression and anxiety over 6 months. Individuals aged 18-75 years, at risk of vascular disease (i.e. with hypertension, diabetes mellitus or impaired fasting glucose, dyslipidemia or obesity), were screened as outlined in the CONSORT diagram (fig. 1). Of 827 individuals screened, 142 scored >10 on either the Patient Health Questionnaire-8 or the GAD-7. Exclusion criteria were (1) brain injury, (2) medication changes within the past month, (3) schizophrenia or bipolar disorder, (4) current substance abuse and (5) active suicidal ideation. Of those included for this IRB-approved study at the University of Iowa, 30 were randomly assigned (2:1) to ACT-IM and 14 to TAU. As a general measure of well-being, our a priori primary outcome was QOL as measured with the World Health Organization QOL-BREF (WHOQOL-BREF) [6]. Our a priori secondary outcomes included the clinician-rated Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA). We also explored self-report measures with the relevant Inventory of Depression and Anxiety Symptoms (IDAS) subscales [7]. An 11-item subscale of the Experiencing Questionnaire (EQ) measured psychological flexibility/decentering [8]. Each 6-hour ACT-IM workshop involved 7-10 participants and emphasized three topics: education (cardiovascular risk factors, diet and lifestyle recommendations and self-monitoring), acceptance (new ways of managing troubling thoughts, feelings and sensations) and behavioral change (how to recognize ineffective patterns, set goals and commit to action). The intervention was manualized and participants received a corresponding workbook. The TAU group received any treatment in the community rather than through the protocol. Linear mixed models for a treatment-by-time interaction assessed the effect of treatment on primary and secondary outcomes for all randomized participants (intention-to-treat). The fixed effects were treatment status (ACT-IM vs. TAU) and time (at baseline, at 12 and at 24 weeks). In analogous models, psychological flexibility (EQ) was assessed as a potential mediator on HRSD. Twenty-six participants completed the ACT-IM intervention and 14 completed TAU. The mean age in both groups was 45 years. A majority of the participants were female (69% ACT-IM, 64% TAU), Caucasian (69% ACT-IM, 86% TAU), had completed college (69% ACT-IM, 71% TAU) and were working (85% ACT-IM, 71% TAU). Nearly half of those assigned to ACT-IM and 64% of those in the TAU condition were on antidepressant medications at study entry. There were no significant differences between the ACT-IM and TAU groups on any baseline variables. In the ACT-IM group, all four WHOQOL-BREF (physical, social, psychological and environment) domains changed significantly from baseline until the follow-up at 24 weeks, but this applied only to the psychological domain in the TAU group. The treatment-by-time interactions were not significant (physical: p = 0.17, psychological: p = 0.67, social: p = 0.18 and environment: p = 0.33). A significant overall group-by-time interaction on HRSD was observed (p < 0.0001, fig. 2a). The mean decrease in HRSD in the ACT-IM condition was 7.1 (95% CI -12.1 to -2.2) greater than in the TAU condition at 12 weeks and 10.8 (95% CI -15.9 to -5.7; effect size = 1.4) greater at 24 weeks. More participants treated with ACT-IM responded (≥50% HRSD reduction) at the 24-week follow-up (ACT-IM: 20/26 or 77%, TAU: 3/14 or 21%, χ2 = 11.5, d.f. = 1, p < 0.01). The self-report IDAS General Depression scale similarly revealed a significant group-by-time interaction (p = 0.0005; effect size = 0.9 at 24 weeks). The HRSA also demonstrated a significant group-by-time interaction (p < 0.0001) (fig. 2b). The mean decrease in HRSA in the ACT-IM condition was 9.4 (95% CI -14.9 to -3.8) greater than in the TAU condition at 12 weeks and 12.7 (95% CI -18.5 to -6.9; effect size = 1.5) greater at 24

Integrity signals

Registry

Crossref · 10.1159/000371495

Cites

9 of 9 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 7 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Interpretationcitation
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The intervention's effects improved qualitatively at each follow-up visit, similar to other ACT trials.

    “The effects of the intervention qualitatively improved at each follow-up visit akin to other ACT treatment trials [5, 9].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [5] source
    • cites [9] source

      The Results (Primary Outcomes and Secondary Outcomes; page unavailable) show that some ACT outcomes were better at follow-up than immediately after treatment. But the Method (Procedure; page unavailable) specifies only one follow-up visit, at four months, so this trial cannot show improvement at each of multiple follow-up visits. The passages do not establish the comparison with other ACT trials. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    Brief ACT has yielded positive long-term outcomes in patients with co-morbidity.

    “When presented as a brief intervention, ACT has produced positive long-term outcomes in those with co-morbidity [4, 5].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [4] source

      The Introduction reports positive long-term outcomes from brief ACT in patients with several conditions and describes a one-day intervention for patients with comorbid depression and migraine. But the Limitations and Future Directions section calls this study’s three-month follow-up relatively short and says longer follow-up is needed. The paper therefore does not establish long-term outcomes for its comorbid patient group. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [5] source

      The Abstract Results and Results > Outcome analyses report positive outcomes at 12 weeks for patients with comorbid depression and migraine who received a brief ACT-based intervention. But the Discussion > Limitations and Future Directions calls the three-month follow-up relatively short and says longer-term persistence remains to be studied. Thus the source supports positive short-term outcomes in this comorbid group, not established long-term outcomes. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    No WHOQOL-BREF domain showed a significant treatment-by-time interaction.

    “The treatment-by-time interactions were not significant (Physical p=0.17; Psychological p=0.67; Social p =0.18; Environmental p=0.33).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    There was a significant group-by-time interaction on HRSD.

    “A significant overall group-by-time interaction on HRSD was observed (p<0.0001, Figure 2).”
    Quote in the paperSubstantial claim
  • Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The intervention produced significant improvements in EQ (p=0.03).

    “The intervention yielded significant improvements in EQ (p=0.03)”
    Quote in the paperNot a substantial claim
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    In ACT-IM, all four WHOQOL-BREF domains improved significantly from baseline to 24 weeks; in TAU, only the psychological domain improved.

    “All four WHOQOL-BREF (physical, social, psychological, environment) domains significantly changed from baseline through the 24-week follow-up with ACT-IM, but only for the psychological domain with TAU.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    At 24 weeks, 77% of ACT-IM participants versus 21% of TAU participants achieved at least a 50% HRSD reduction, a significant difference.

    “More participants treated with ACT-IM responded (≥50% HRSD reduction) at the 24-week follow-up (ACT-IM: 20/26, 77%; TAU: 3/14, 21%; χ2=11.5, df=1, p<0.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    After controlling for changes in EQ, the group-by-time interaction on HRSD remained significant but attenuated, from -1.14 (p=0.0005) to -0.87 (p=0.002).

    “after controlling for changes in EQ, the group-by-time interaction on HRSD remained significant although the standardized parameter estimate was attenuated (−1.14 (p=0.0005) to −0.87 (p=0.002))”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    At 24 weeks, 65% of ACT-IM participants versus 7% of TAU participants responded to treatment on HRSA, a significant difference.

    “More participants treated with ACT-IM responded to treatment at 24 weeks (ACT-IM: 17/26, 65%; TAU: 1/14, 7%; χ2=12.5, p<0.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    At 12 weeks, HRSA decrease was 9.4 points greater in ACT-IM than TAU; at 24 weeks, 12.7 points greater, with an effect size of 1.5.

    “The mean decrease in HRSA in the ACT-IM condition was 9.4 (95% C.I.: −14.9, −3.8) greater than TAU at 12 weeks and 12.7 (95% C.I.: −18.5, −6.9, effect size=1.5) greater at 24 weeks.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    At 12 weeks, HRSD decrease was 7.1 points greater in ACT-IM than TAU; at 24 weeks, 10.8 points greater, with an effect size of 1.4.

    “The mean decrease in HRSD in the ACT-IM condition was 7.1 (95% C.I.: −12.1, −2.2) greater than TAU at 12 weeks and 10.8 (95% C.I.: −15.9, −5.7, effect size=1.4) greater at 24 weeks.”
    Quote in the paperSubstantial claim

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

    Findingown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    Twenty-six ACT-IM and 14 TAU participants completed the intervention.

    “Twenty six participants completed the ACT-IM intervention and 14 completed TAU.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    A one-day workshop is a feasible and acceptable alternative to weekly treatments.

    “A 1-day workshop is a feasible and acceptable alternative to weekly treatments.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    After randomization, more TAU participants were taking antidepressants, which might bias findings opposite the observed direction.

    “After randomization, more TAU participants were taking antidepressants, which might bias findings opposite the direction observed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    Evaluators of secondary outcomes were not blinded to treatment assignment, but self-report measures showed similarly positive results.

    “Evaluators of our secondary outcomes were not blind to treatment assignment; however, self-report measures showed similarly positive results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The sample was generalizable, including various vascular risk factors and psychological distress common in primary care.

    “Our generalizable sample included individuals with various vascular risk factors and manifestations of psychological distress as might be commonly encountered in primary care settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The small sample limited the ability to detect effects, though large effects were observed for anxiety and depression.

    “Our small sample limited our ability to detect but large effects on outcome, which were observed for anxiety and depression.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    Participants were randomly assigned to ACT-IM or TAU.

    “Of those consented for this IRB-approved study at the University of Iowa, 30 were randomly assigned (2:1) to ACT-IM and 14 to TAU.”
    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
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The primary and secondary outcomes were specified a priori.

    “our a priori primary outcome was Quality of Life as measured with the World Health Organization Quality of Life-BREF (WHOQOL-BREF) [6]. Our a priori secondary outcomes included the clinician-rated Hamilton Rating Scale for Depression (HRSD) and Hamilton Anxiety Rating Scale (HRSA).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The brief one-day ACT-IM intervention may be effective for treating psychological distress in this broad at-risk population, with durable effects.

    “suggesting that this brief one-day intervention may be effective in treating psychological distress in this broad at-risk population with durable effects.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    Social desirability and effort justification bias could differentially affect the treatment group.

    “Social desirability and effort justification bias could differentially impact the treatment group.”
    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 conductown data
    § A brief behavioral intervention targeting mental health risk factors for vascular disease: A pilot study

    The intervention was manualized, and participants received a workbook.

    “The intervention was manualized and participants received a corresponding workbook.”
    Quote in the paperNot a substantial claim
17 of 17

  • The paper relies on this without support.

    ACT is an empirically supported behavioral therapy that enhances psychological flexibility through acceptance, mindfulness, and behavioral change.

    “Acceptance and Commitment Therapy (ACT) is an empirically-supported behavioral therapy that aims to enhance psychological flexibility through use of acceptance, mindfulness, and behavioral change strategies.”

  • The paper relies on this without support.

    There is a paucity of clinical studies addressing psychological distress in patients with comorbid vascular risk factors.

    “There is a striking paucity of clinical studies addressing psychological distress with comorbid vascular risk factors.”
2 of 2

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?

  • The one-day ACT workshop produced sustained reductions in anxiety on the BAI over 12 weeks, but this effect did not extend to anxiety measured by the STAI.

    “Consistent with our previous findings [33, 34], the one-day ACT workshop yielded sustained reductions in anxiety as measured by our primary outcome, the BAI, sustained over 12 weeks [20], although this finding was not robust enough to extend to anxiety as measured by the STAI.”

    From One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial. (2021) · cites this paper as [33]

    The Results report that the one-day ACT-IM workshop reduced anxiety relative to treatment as usual at 12 weeks, supporting the general claim of a sustained anxiety benefit. But the paper measured anxiety with the HRSA as a secondary outcome; its stated primary outcome was quality of life. It does not report BAI or STAI results, so it cannot support the claim about those measures. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In the vascular disease RCT, improvements in psychological flexibility mediated the benefits of the ACT intervention on depression and anxiety.

    “Furthermore, improvements in psychological flexibility mediated the benefits of the ACT intervention on depression and anxiety [75].”

    From Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. (2017) · cites this paper as [75]

    The Discussion says improvements in psychological flexibility partially mediated the intervention’s benefits on depression. The Results report benefits for both depression and anxiety, but the mediation analysis assessed depression (HRSD), not anxiety; that part of the claim is unsupported. (LLM, conf=0.91)

    Experimental — accuracy not yet measured

  • Most participants in the vascular study described the workshop as highly valuable, and most reported that they would not have spontaneously sought out help for their mental health struggles.

    “Most participants described the workshop as highly valuable, and most reported that they would not have spontaneously sought out help for their mental health struggles.”

    From One-day acceptance and commitment training workshops in medical populations (2015) · cites this paper as [35]

    The paper describes the one-day workshop as a “feasible and acceptable alternative to weekly treatments” (discussion; page unavailable). It does not report that most participants rated it highly valuable or said they would not otherwise have sought mental-health help; searches for participant feedback and help-seeking found no such passage. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • In a 1-day ACT-IM intervention for patients with cardiovascular risk factors and clinically significant anxiety or depression, the retention rate was excellent, with 100% completing the 12-week follow-up and 98% completing the 24-week visit.

    “The retention rate was excellent, with 100% of participants completing the 12-week follow-up visit and 98% completing the 24-week visit.”

    From One-day acceptance and commitment training workshops in medical populations (2015) · cites this paper as [35]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • In a RCT for a group of distressed patients at risk for vascular disease, a 1-day ACT intervention led to significant improvements in depression and anxiety.

    “In a RCT for a group of distressed patients at risk for vascular disease, a 1-day ACT intervention led to significant improvements in depression and anxiety.”

    From Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. (2017) · cites this paper as [75]

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Related

Authors
Dindo, L., Marchman, J., Gindes, H., & Fiedorowicz, J. G.
Affiliations
  • Baylor College of Medicine (US)
  • University of Iowa (US)
ORCID
Venue
Psychotherapy and Psychosomatics
Publisher
S. Karger AG
Published
2015
Volume
84
Issue
3
Pages
183-185
ISSN
  • 0033-3190 (ISSN-L)
  • 1423-0348
DOI
10.1159/000371495
PMC
PMC4393823
OpenAlex
W2064136393
Cited by
22
References
9
Citations by year
2026: 1 · 2025: 2 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 3 · 2020: 1 · 2019: 4 · 2017: 3 · 2016: 1 · 2015: 1
FWCI
1.00
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychotherapy and Psychosomatics (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
acceptance and commitment therapy, vascular risk factors, depression, anxiety, psychological flexibility, quality of life, brief behavioral intervention, cardiovascular risk behavior
MeSH terms
Adolescent, Adult, Aged, Anxiety, Depression, Female, Humans, Male, Mental Health

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