Evaluation of an Acceptance and Commitment Therapy-Based Resilience Training Program for Adults with Congenital Heart Disease

Steele, Bronwyn L. (2016). Evaluation of an Acceptance and Commitment Therapy-Based Resilience Training Program for Adults with Congenital Heart Disease Professional Doctorate, School of Psychology, The University of Queensland.

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Author Steele, Bronwyn L.
Thesis Title Evaluation of an Acceptance and Commitment Therapy-Based Resilience Training Program for Adults with Congenital Heart Disease
School, Centre or Institute School of Psychology
Institution The University of Queensland
Publication date 2016-06-09
Thesis type Professional Doctorate
Supervisor Professor Kenneth Pakenham
Total pages 280
Total colour pages 2
Total black and white pages 278
Language eng
Subjects 1701 Psychology
170106 Health, Clinical and Counselling Psychology
1117 Public Health and Health Services
Abstract/Summary The psychosocial difficulties of adults with congenital heart disease (CHD) warrant increased clinical attention. Up to a third of patients may have a diagnosable mood or anxiety disorder, and many experience social challenges and lifestyle and physical activity restrictions which can have negative quality of life (QoL) implications. Unfortunately, these issues are largely neglected in routine clinical care. Currently, however, there are no published psychosocial intervention studies to inform effective mental health treatment for patients with CHD. Resilience training interventions can promote psychosocial and physical well-being among people with chronic illness. The current study evaluated the effectiveness and acceptability of an empirically supported, Acceptance and Commitment Therapy-based resilience training program (READY: REsilience for Adults every DaY) in promoting resilience, mood, QoL, and heart-healthy behaviours of adult patients with CHD at a local teaching hospital. In view of the characteristics of CHD, a modified, briefer version of the program was trialled (READY-ACHD), with one 2-hour group session and four individual telephone sessions. A mixed-method approach to program evaluation was utilised, comprising an exploratory pre-post single intervention condition treatment design with 3-month follow-up assessment (n = 17) and a series of face-to-face focus group discussions with all relevant stakeholders (n = 12 patients, n = 3 caregivers, and n = 5 clinicians). Results of the intention-to-treat analyses revealed significant pre-post improvement in depression symptoms, T = 11.50, z = -2.17, p = .012, r = -.30, global QoL, T = 1.00, z = -2.49, p = .016, r = -.35, and environmental QoL, T = 13.00, z = -2.69, p = .005, r = -.38. Twenty-four per cent of patients showed clinically meaningful decline in depression at post-intervention. Improved global QoL was strongly associated with corresponding change in the ACT mechanism of cognitive defusion, rs = -.62, p = .014, controlling for pre-intervention effects. Patients indicated high satisfaction with READY-ACHD overall and reported diffuse qualitative improvements in resilience in their everyday lives and in coping with CHD. Caregivers and clinicians viewed the program as helpful and relevant to patients. Recommended modifications to maximise the benefit of the program to patients with CHD were additional group-based sessions, a longer implementation period to review and consolidate resilience-building strategies, and the inclusion of psychoeducation about CHD. This study provides preliminary support for READY-ACHD as an intervention that can be implemented as a group- and tele-based resilience training program in a hospital outpatient setting to improve depression and QoL. Findings can guide the future development and evaluation of interventions targeting the psychosocial needs of patients with CHD.
Keyword Congenital heart disease in adults
Psychosocial adjustment
Resilience training
Acceptance and Commitment Therapy
Additional Notes Colour print (pp. 252 & 253); landscape print (pp. 96-97, 119, 259).

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Created: Thu, 09 Jun 2016, 17:47:19 EST by Ms Bronwyn Steele on behalf of Faculty of Health and Behavioural Sciences