A Pilot Study Examining the Initial Effectiveness of a Brief Acceptance-Based Behavior Therapy for Modifying Diet and Physical Activity Among Cardiac Patients

Abstract

Approximately 90% of cardiac events are attributable to a small number of modifiable behavioral risk factors that, if changed, can greatly decrease morbidity and mortality. However, few at-risk individuals make recommended behavioral changes, including those who receive formal interventions designed to facilitate healthy behavior. Given evidence for the potential of specific psychological factors inherent in acceptance-based behavior therapy (ABBT; that is, intolerance of discomfort, mindfulness, and values clarity) to impact health behavior change, the authors evaluated the feasibility and initial effectiveness of an ABBT pilot program designed to increase adherence to behavioral recommendations among cardiac patients. Participants (N = 16) were enrolled in four, 90-min group sessions focused on developing mindfulness and distress tolerance skills, and strengthening commitment to health-related behavior change. Participants reported high treatment satisfaction and comprehension and made positive changes in diet and physical activity. This was the first evaluation of an ABBT program aimed at increasing heart-healthy behaviors among cardiac patients.

A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions

“…Of these 18 studies, six were case studies (or case series) Graham, Gillanders, Stuart, & Gouick, 2014;Masuda, Cohen, Wicksell, Kemani, & Johnson, 2011;Moitra et al, 2011;Nes et al, 2012;Skinta, Lezama, Wells, & Dilley, 2014); four used pre-post designs with no control group (Burke et al, 2014;Feros, Lane, Ciarrochi, & Blackledge, 2013;Goodwin, Forman, Herbert, Butryn, & Ledley, 2011;Sheppard, Forsyth, Hickling, & Bianchi, 2010); and eight were randomised controlled trials (RCT) (Brown, Whittingham, Boyd, McKinlay, & Sofronoff, 2014;Gregg, Callaghan, Hayes, & Glenn-Lawson, 2007;Hawkes, Pakenham, Chambers, Patrao, & Courneya, 2014;Hawkes et al, 2013;Lundgren, Dahl, Melin, & Kies, 2006;Lundgren, Dahl, Yardi, & Melin, 2008;Nordin & Rorsman, 2012;Rost, Wilson, Buchanan, Hildebrandt, & Mutch, 2012;Whittingham, Sanders, McKinlay, & Boyd, 2014). The studies using RCT and pre-post designs involved samples of people with cancer (Feros et al, 2013;Hawkes et al, 2013Hawkes et al, , 2014Rost et al, 2012); epilepsy Lundgren et al, 2008); multiple sclerosis (Nordin & Rorsman, 2012;Sheppard et al, 2010); cardiac disease (Goodwin et al, 2011); type II diabetes (Gregg et al, 2007); paediatric cerebral palsy ); brain injury (Brown et al, 2014): and "life threatening illness" (Burke et al, 2014).…”

“…The studies using RCT and pre-post designs involved samples of people with cancer (Feros et al, 2013;Hawkes et al, 2013Hawkes et al, , 2014Rost et al, 2012); epilepsy Lundgren et al, 2008); multiple sclerosis (Nordin & Rorsman, 2012;Sheppard et al, 2010); cardiac disease (Goodwin et al, 2011); type II diabetes (Gregg et al, 2007); paediatric cerebral palsy ); brain injury (Brown et al, 2014): and "life threatening illness" (Burke et al, 2014). The case studies demonstrate applications to distress and trauma in multiple sclerosis ; distress following stroke (Graham, Gillanders, Stuart, & Gouick, 2014); systemic processes to improve functioning with sickle cell disease (Masuda et al, 2011); improving adherence (Moitra et al, 2011) and reducing stigma in HIV (Skinta et al, 2014); and improving self-management in diabetes (Nes et al, 2012).…”

“…Most (nine) of the included interventions were delivered at least in part within groups (Brown et al, 2014;Burke et al, 2014;Goodwin et al, 2011;Gregg et al, 2007;Lundgren et al, 2006;Lundgren et al, 2008;Nordin & Rorsman, 2012;Sheppard et al, 2010;Whittingham et al, 2014), with just three (Feros et al, 2013;Hawkes et al, 2013Hawkes et al, , 2014Rost et al, 2012) delivered exclusively via one-to-one sessions with a therapist. The number of sessions ranged from 1-12.…”

“…Most interventions were brief (M = 6.5 sessions, SD = 4.06), with seven studies evaluating interventions of no more than five sessions (Burke et al, 2014;Goodwin et al, 2011;Gregg et al, 2007;Lundgren et al, 2006;Lundgren et al, 2008;Nordin & Rorsman, 2012;Sheppard et al, 2010). An average of 81% (SD = 14.99; range 60 -100) of participants completed treatment, indicating low participant drop-out.…”

“…Three studies evaluated ACT for improving disease self-management and/or lifestyle (Goodwin et al, 2011;Gregg et al, 2007;Hawkes et al, 2013Hawkes et al, , 2014. In a lower-quality study, In a higher-quality study, Hawkes et al (2013Hawkes et al ( , 2014) assessed a more intensive intervention (individualised, with more sessions) for improving lifestyle in colorectal cancer survivors.…”