Randomized controlled trial of acceptance and commitment therapy for distress and impairment in OEF/OIF/OND veterans.
OBJECTIVE
Acceptance and commitment therapy (ACT) is a widely utilized psychotherapeutic approach, but randomized, controlled studies are lacking in veterans. This study evaluated the efficacy of ACT for emotional distress among veterans of the conflicts in Iraq and Afghanistan.


METHODS
One hundred sixty veterans (80% male, Mage = 34 years) with anxiety or depressive disorder according to theDiagnostic and Statistical Manual of Mental Disorders(4th ed.) were randomized to ACT or present-centered therapy (PCT) and assessed before, during, and after treatment and during 3- to 12-month follow-up. The primary outcome was general distress as measured by the Brief Symptom Inventory-18 Global Severity Index. Additional outcomes included symptomatology, disability, quality of life, acceptability, and satisfaction.


RESULTS
There was improvement following treatment in the whole sample across a variety of measures, including general distress (d = 0.74, 95% confidence interval [CI: 0.52, 0.96]) and functioning (d = 0.71, 95% CI [0.50, 0.93]) and moderate to high levels of satisfaction with treatment. Response to the 2 interventions did not differ on the primary outcome or most secondary outcomes, although ACT led to greater improvement in insomnia than did PCT (ds = 0.63 and 0.08, respectively). Treatment dropout did not differ by condition but was high (41.9%).


CONCLUSIONS
ACT's efficacy in this group was modest and generally did not differ from that for PCT. Additional work is needed to understand the reasons that ACT did not perform as well as predicted in this veteran sample. (PsycINFO Database Record
VA San Diego Healthcare System.
Ariel J
AJ
Lang
National Center for PTSD.
Paula P
PP
Schnurr
Department of Family Medicine and Public Health, University of California, San Diego.
Sonia
S
Jain
Department of Family Medicine and Public Health, University of California, San Diego.
Feng
F
He
National Center for PTSD.
Robyn D
RD
Walser
VAMC Manchester.
Elisa
E
Bolton
Department of Psychiatry, Uniform Services University School of Medicine.
David M
DM
Benedek
VA San Diego Healthcare System.
Sonya B
SB
Norman
VA Puget Sound Health Care System.
Patrick
P
Sylvers
Geisel School of Medicine, Dartmouth and New Hampshire Hospital.
Laura
L
Flashman
Department of Veterans Affairs.
Jennifer
J
Strauss
Department of Neurology, University of California, San Diego.
Rema
R
Raman
Cincinnati VA Medical Center.
Kathleen M
KM
Chard
D064869:Acceptance and Commitment Therapy; D000328:Adult; D055826:Afghan Campaign 2001-; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D013315:Stress, Psychological / Q000628:therapy*; D016896:Treatment Outcome; D014728:Veterans / Q000523:psychology*