Acceptance and Commitment Therapy for Patients Undergoing Coronary Artery Bypass Graft Surgery

The TFA is comprised of seven constructs: affective attitude, burden, ethicality, perceived effectiveness, intervention coherence, self-efficacy, and opportunity costs, and also includes an overall acceptability rating. The TFA can be used to generate a single acceptability score and/or to assess the unique domains of acceptability included in the model. Scale scores range from minimum values of 7, and maximum values of 35, with higher scores indicating higher acceptability.

Participants will answer five questions on a 5-point Likert-type scale (1 = not at all, 5 = extremely). Scale scores range from minimum values of 5, and maximum values of 25, with higher scores indicating higher satisfaction.

The extent to which participants adhere to the intervention will be assessed via a self-rated measure in which completion of between-session mindfulness and reflection exercises will be reported. Participants will answer four yes/no items. Scale scores range from minimum values of 0, and maximum values of 4, with higher scores indicating higher adherence.

The number and percentage of patients undergoing CABG who are eligible for the study will be tracked as well as the number of participants enrolled in the study. These values will be used to determine the enrollment rate. Additionally, the investigators will track basic patient characteristics such that representativeness of the enrolled sample may be compared to all eligible patients who were approached.

Treatment fidelity will be assessed via coder-rated evaluation of interventionist adherence to the manualized treatment protocol. The coder will be a licensed therapist with specific expertise in ACT therapeutic principles and psychotherapy. A randomly selected 20% of sessions will be assessed for treatment fidelity and intervention adherence.

Completion of all psychological, acceptance, satisfaction, and adherence measures will also be assessed. This will include completion of the entire measure as well as per-item completion which will be recorded for each participant in order to quantify missing data. Attendance will be recorded by the interventionist at each session.

The investigators will assess retention rate by tracking the proportion of enrolled participants who complete all intervention sessions and study procedures.

The PHQ-9 is a self-administered focused measure of depression based on Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria that is utilized for screening, diagnostic, and treatment monitoring purposes. The measure's nine items range from zero (not at all) to three (nearly every day). PHQ-9 scores greater than or equal to five, 10, 15, and 20 out of 27 represent mild, moderate, moderately severe, and severe depression, respectively.

The Generalized Anxiety Disorder (GAD)-7 survey. The GAD-7 is a self-rated measure designed to screen, measure, and assess the severity of GAD. The seven items range from zero (not at all) to three (nearly every day). Scores greater than or equal to five, 10, and 15 out of 21 represent mild, moderate, and severe anxiety, respectively.

The Mental Health Continuum-Short Form (MHC-SF) is a 14-item scale that is comprised of three subscales: emotional well-being (three items), psychological well-being (six items), and social well-being (five items). Each item measures a distinct dimension of these subscales. The frequency in the past month of each aspect of well-being is rated on a six-point Likert scale (never, once or twice a month, about once a week, two to three times a week, almost every day, every day).

The MacNew Heart Disease HRQoL is a self-administered disease-specific questionnaire designed to measure HRQoL in patients with cardiac disease. The measure consists of 27 items that are categorized within three domains: emotional functioning (14 items), physical limitation (13 items), and social functioning (13 items), with 12 items falling into more than one domain. Five items inquire about symptoms such as angina/chest pain, shortness of breath, fatigue, dizziness, and aching legs. The time frame for the MacNew is the previous two weeks. The measure provides both individual scores for each domain as well as a global HRQoL score. Scores range from one (poor HRQoL) to seven (high HRQoL) in each of the three domains.

The CompACT-15 assesses psychological inflexibility, experiential avoidance, and maladaptive coping that was adapted to fit the three-factor model of psychological flexibility more adequately and efficiently. This fifteen-item measure utilizes a seven-point Likert scale, ranging from one (strongly disagree) to seven (strongly agree). Scores range from 15 to 105, with higher scores indicating greater psychological flexibility. Three domains are captured within the measure including openness to experience, behavioral awareness, and valued action.

Concentrations of IL-6 will be quantified as indicators of inflammatory processes using a commercially available enzyme-linked immunoassay (ELISA).

Concentrations of hs-CRP will be quantified as indicators of inflammatory processes using a commercially available enzyme-linked immunoassay (ELISA).