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Examining the Efficacy of Acceptance and Commitment Therapy for Reducing Cardiovascular Risk in Patients Diagnosed with Hypertension
AuthorHildebrandt, Mikaela J.
AdvisorHayes, Steven C.
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Hypertension is the most important cardiovascular risk factor worldwide, contributing to half the burden of coronary heart disease (Whitworth, 2003). Recent epidemiological studies have concluded that age-standardized prevalence rates are significantly increasing, despite concurrent improvements in raising cardiovascular disease awareness, prevention and control (Cutler et al., 2008). Several psychological and behavioral factors have been related to increased cardiovascular risk and traditional biobehavioral treatments have shown success in helping patients achieve blood pressure control. However, they are often insufficient in managing the burden of HTN and are often time intensive and costly. For this reason, it has been argued that developing treatments targeting common psychopathogens contributing to cardiovascular risk across multiple pathways may provide one venue for improving clinical outcomes, while keeping treatments brief and cost effective. As a pilot investigation, 64 eligible patients diagnosed with HTN were recruited and randomized to receive ACT-enhanced disease education or disease education with Supportive Instruction. Eligible participants were scheduled for an intake assessment where they provided written informed consent, completed baseline assessments measuring psycho-social, behavioral, and physiological variables of cardiovascular risk, and participated in a thirty-minute didactic disease education training. Individuals were then randomized to either receive four, weekly individual sessions of ACT or supportive instruction. Results revealed that the impact of an ACT intervention combined with disease education demonstrated some additive benefits as compared to disease education with continued supportive instruction. In particular, participants allocated to receive ACT combined with disease education demonstrated greater reductions in negative affectivity and general psychological distress, and greater improvements in quality of life, physical activity, and motivation, while demonstrating equivocal findings to disease education alone with respect to reductions in other behavioral and physiological measures of cardiovascular risk. Statistical evaluation of purported processes of change was also examined. Outcomes suggest that although many of the process variables were related to cardiovascular risk factors at baseline, they failed to independently mediate treatment responses, likely due to the methodological challenges noted with BP administration and measurement and the small sample size retained through follow-up. Given the limitations of this study, continued efforts to elucidate mechanisms of change are warranted.