Medically ill patients with Congestive Heart Failure (CHF) and Chronic Obstructive Pulmonary
Disease (COPD) are at increased risk for developing symptoms of anxiety and depression and
are among the least frequent users of mental health services and treatments. To address the
needs of chronically ill patients, we created a time-limited psychosocial intervention to
maximize treatment benefits and improve the efficiency and ability of mental health care
practitioners to provide services within medical care settings. This study is separated into
two randomized study groups. The first group of participants will receive the ACCESS
intervention immediately. The second group of participants will be followed for a period of
6 months. After a period of 6 months, those who continue to have symptoms of depression
and/or anxiety will be offered the ACCESS intervention.
1. Age 18+;
2. Confirmation of CHF or COPD diagnosis according to medical chart review;
3. Ongoing symptoms of functional limitations due to CHF (NYHA classification of II ,
III, or IV as obtained by telephone interview) or COPD (Score of 3 or greater on the
Medical Research Council Dyspnoea Scale [MRC] as obtained by telephone interview);
4. Eligible patients must have clinically significant symptoms of either anxiety and/or
depression as measured using patient self report questionnaires. Clinical cutoff
scores for depression will be based on the Beck Depression Inventory - Second Edition
(scores of 14 or more) while anxiety cutoffs will be determined using the State-Trait
Anxiety Inventory - trait subscale (score of 40 or greater);
5. Eligible patients will be English-speaking, as this intervention has not yet been
translated to any other language.
1. History of substance abuse, bipolar disorder, psychosis or active suicidal intent
(obtained from standardized structured clinical interview);
2. NYHA class I, or MRC levels 1 and 2. Class 1 CHF patients and Level 1 and 2 COPD
patients (by definition) will have no significantly limiting CHF or COPD symptoms.
This information will be obtained through patient self-report of CHF and COPD
3. Mental status examination score in the cognitively impaired range on an established
4. Inability to provide informed consent or severe physical limitations restricting
completion of the study protocol (e.g. vision, hearing, or physical functioning);
5. Non-English speaking patients will be excluded from participation, as this
intervention has not yet been translated to any other language.