Acceptance and Commitment Therapy Integration for Values Engagement in Consultation-Liaison Psychiatry (ACTIVE CLP): Pilot Study and Method For ACT-Based Skills Training in Medically Hospitalized Patients

Friday, November 11, 2022

2:15 PM – 3:45 PM

Location: Room 203

Presenting Author(s)

Brandon Goodman, MD

Assistant Professor, Consultation Liaison Psychiatry
UNC School of Medicine
Durham, North Carolina

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Co-Author(s)

Jonny Gerkin, MD

Associate Professor, Consultation Liaison Psychiatry
UNC School of Medicine
Chapel Hill, North Carolina
Yasmine Eshera

Clinical Research Coordinator
Duke University Medical Center
Durham, North Carolina

Abstract: Background: Acceptance and Commitment Therapy (ACT) is a transdiagnostic and process-focused psychotherapy which emphasizes increasing awareness of, and engagement with, one’s values (Hayes et. al, 2016). While cognitive behavioral therapy is currently the more prevalent modality in addressing mental health within the medical context, ACT has great potential to be integrated further in the inpatient medical setting to encourage patient psychological flexibility and values-based behaviors related to their medical treatment (Gloster et. al, 2020; Ruiz et. al, 2012). Currently, little is known about the implementation of ACT in medical settings despite research showing it to be particularly successful in outpatient settings with individuals with comorbid medical and psychiatric illness (Dindo et. al, 2017).

Methods: This pilot study examined the feasibility and impact of adapting an ACT-based intervention in an inpatient Consultation-Liaison Psychiatry (CLP) service operating in an academic-medical setting. Fourteen patients with diverse medical and psychiatric diagnoses were provided with brief inpatient ACT intervention. On average, patients received a total of two hours of therapy over ten days from trained counseling students utilizing ACT Matrix Cards (Shoendorff, 2018). Changes in symptom burden were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) for anxiety, the Acceptance and Action Questionnaire (AAQ-2) for psychological flexibility, and a patient satisfaction survey.

Results: Paired t-tests indicated statistically significant decrease in symptom burden across depression, anxiety, and psychological inflexibility. Patients also reported high satisfaction with the intervention and a strong interest in continuing outpatient therapy. The intervention was found to be beneficial across medical and psychiatric diagnoses, and can be implemented with a diverse CLP population.

Discussion/Conclusion: This study illustrated the success and feasibility of implementing a brief, ACT-based psychotherapy intervention in an inpatient medical setting. Further study is needed to understand the full impact of similar psychotherapeutic interventions in the inpatient medical setting.

Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change (2^nd Edition). Guilford Press; 2016.\

Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M. The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science. 2020;18:181-192.

Ruiz FJ: Acceptance and commitment therapy versus traditional cognitive behavioral therapy: a systematic review and meta-analysis of current empirical evidence. Revista internacional de psicología y terapia psicológica [International Journal of Psychology and Psychological Therapy] 2012; 12(3):333.

Dindo L, Van Liew JR, Arch JJ. Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics. 2017;14(3):546-553.

Schoendorff B. putting your values in action. Contextpsy. Published October 1, 2018. Accessed February 25, 2022. https://contextpsy.com/en/putting-your-values-in-action/