One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial

• Published in: General hospital psychiatry Vol. 73; pp. 64 - 70
• Main Authors: Fiedorowicz, Jess G., Dindo, Lilian, Ajibewa, Tiwaloluwa, Persons, Jane, Marchman, James, Holwerda, Seth W., Abosi, Oluchi J., DuBose, Lyndsey E., Wooldridge, Nealy, Myers, Janie, Stroud, Amy K., Dubishar, Kaitlyn, Liu, Zhuangzhuang, Pierce, Gary L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021
• Subjects: Acceptance and Commitment Therapy; Adult; Anxiety; Anxiety - therapy; Anxiety Disorders; Arterial stiffness; C-reactive protein; Endothelial function; Humans; Inflammation - therapy; Middle Aged; Pulse Wave Analysis; Tumor necrosis factor-alpha; Tumor necrosis factor-alpha; Anxiety; C-reactive protein; Endothelial function; Acceptance and commitment therapy; Arterial stiffness
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2021.09.009

Acceptance and Commitment Therapy (ACT) is a behavioral intervention demonstrating sustained improvements in anxiety in individuals with chronic anxiety and psychological distress. Because anxiety disorders are associated with the development of cardiovascular disease (CVD), we hypothesized that a novel 1-day ACT workshop would both lower anxiety and improve vascular function in persons with moderate/high anxiety. In a randomized controlled study, 72 adults (age 33.9 ± 8.6 (SD) years) with baseline moderate/high anxiety completed a one-day ACT intervention (n = 44, age 33.9 ± 8.7 years) or control (n = 28, age 37.1 ± 10.1 years). Pre-specified secondary outcomes were measured over 12 weeks: aortic stiffness (carotid-femoral pulse wave velocity [cfPWV]), forearm vascular endothelial function (post-ischemic peak forearm blood flow [FBF] via plethysmography), and brachial artery flow-mediated dilation (FMD). Carotid artery stiffness (β-stiffness index), and inflammatory markers (C-reactive protein and tumor necrosis factor-alpha) were also explored. Although the intervention had a significant and sustained effect on the primary outcome of anxiety as measured by the Beck Anxiety Inventory, the 1-day ACT workshop was not associated with improvement in vascular or inflammatory endpoints. The intervention was unexpectedly associated with increases in β-stiffness index that were also associated with changing trait anxiety. Anxiety improvements did not translate into improvements in any of the vascular function outcomes. This may reflect a less-than-robust effect of the intervention on anxiety, failure in design to select those with vascular dysfunction, or not intervening on a relevant causal pathway. (Trial registration NCT02915874 at www.clinicaltrials.gov). •Anxiety is associated with increased cardiovascular disease (CVD) risk.•Adults with anxiety were randomized to an Acceptance Commitment Therapy (ACT) intervention.•ACT improved anxiety on the Beck Anxiety Inventory as previously reported.•ACT did not result in statistically significant improvements on the State Trait Anxiety Inventory.•ACT did not improve vascular or inflammatory endpoints.