Comorbid Mental Disorders Research Articles

Evidence base for psychological treatment of personality disorder – a narrative review

AimsThis review critically appraises the up-to-date evidence base for psychological treatment of PD.BackgroundThe prevalence rate of any personality disorder (PD) in the general population has been estimated to be as high as 12% rising to over 70% in prison settings. PD is known to carry significant psychosocial and health burdens with increased mortality, increased suicide, increased substance misuse, increased crime, reduced capacity to work, poorer outcomes for comorbid mental disorders, dysfunctional engagement with services, and high economic costs through a high utilisation of healthcare systems. In the 1990s several manualised treatment strategies emerged, specifically for borderline PD. These include dialectical behaviour therapy, cognitive therapy, cognitive analytic therapy, mentalization-based therapy, transference-focused psychotherapy, and schema-focussed therapy.MethodUsing relevant search criteria, literature was identified through a search of the following databases: PubMed, EMBASE, and PsycINFO. Data were appraised and synthesised to provide a comprehensive overview of the current evidence base for psychological treatment of PD.ResultThe DSM-V defined Cluster B borderline PD has received the majority of attention. Increasing attention has been paid in recent years to the Cluster B antisocial PD. Cluster A (Paranoid, Schizoid, Schizotypal) and Cluster C PDs (Avoidant, Dependent, Obsessive Compulsive) have received relatively little attention with few studies to draw upon regarding the effectiveness of therapy. The remaining Cluster B personality disorders (Narcissistic and Histrionic) have been criticised as having poor construct validity, with a lack of rigorously designed treatment trials.A number of treatment protocols have gained empirical support. However, of those that have empirical support, there appears to be little demonstrable evidence to suggest superiority of any one of the evidence-based interventions over another. While specialised therapies are more efficacious than “treatment as usual” or treatment delivered by expert clinicians, when specialised therapies are compared with well-specified manualised general psychiatric care tailored to personality disorder, the results are different, with little consistent evidence demonstrating the superiority of specialised therapies.ConclusionCurrent evidence suggests that individual therapies do not differ substantially from each other or from structured clinical care that relies on generic change factors. This is in keeping with established psychotherapy outcome literature. Current evidence would indicate that common features across the proven treatment strategies should be emphasised and implemented well. There may be justification for added interventions from specific treatment modalities targeted to specific patient problems.

An audit into the use of psychotropic medications in patients with autism spectrum disorder in a high security psychiatric hospital

AimsAutism Spectrum Disorder (ASD) is a common neurodevelopmental disorder associated with difficulties in social communication and language development, preoccupations, a need for routine, sensory sensitivities and emotional dysregulation. People with autism who have violently offended may be prescribed psychotropic medications to treat comorbidities, or off-license to manage aggressive or challenging behaviours. However, the evidence base for their use remains scarce.MethodThis was a retrospective audit at Broadmoor Hospital, a high security psychiatric hospital in the United Kingdom, into the safe and appropriate prescribing of psychotropic medicines in those with an ASD compared to guidance from the National Institute for Health and Care Excellence (CG142): “Autism spectrum disorder in adults: diagnosis and management”. This first cycle was undertaken during May and June 2020 and included all patients with a confirmed or equivocal diagnosis of ASD in the preceding five years.ResultA total of 22 participants were included in this study. Of these, 17 participants had a confirmed diagnosis of ASD and five participants had a suspected diagnosis of ASD, but without formal confirmation with neurocognitive testing. A total of 13 (76.5%) participants with confirmed ASD were prescribed antipsychotic medication, nine of whom had an established comorbid mental disorder with psychotic symptoms. Of the remaining four, three had a diagnosis of a personality disorder. Three participants in this study had a confirmed diagnosis of ASD without any additional comorbid mental health diagnoses. No patients were prescribed psychotropic medicines for the core symptoms of ASD. The specific documentation of off-license use of antipsychotic medicines in those without a diagnosis of a psychotic disorder was poor. This was not recorded in any such participant in the preceding 12 months.ConclusionThis audit highlighted that dual diagnoses of ASD alongside non-affective psychosis and personality disorder are over-represented in this high security setting. The NICE clinical guidelines CG142 guidelines state that “antipsychotic medications should only be used for behaviour that challenges if …. the risk to the person or others is very severe”. By definition, all patients admitted to high security are deemed to be a grave and imminent risk to the public. Psychotropic medicines may therefore be clinically indicated at a much earlier stage than in community patients, instigated alongside appropriate psychosocial interventions and treatment of comorbid conditions. It may be that catered guidelines need to be formulated to support the safe and appropriate prescribing of psychotropic medicine in forensic settings.

Discovery of Association Rules Patterns and Prevalence of Comorbidities in Adult Patients Hospitalized with Mental and Behavioral Disorders.

The objectives of this study were to identify the prevalence of comorbidities of mental and behavioral disorders and to identify the association rules related to comorbidities as a way to improve patient management efficiently. We extracted comorbidities of 20,690 patients (≥19 years old) whose principal diagnosis was a mental disorder from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) between 2006 and 2016. Association rules analysis between comorbid diseases using the Apriori algorithm was used. The prevalence of comorbidities in all patients was 61.98%. The frequent comorbidities of mental and behavioral disorders were analyzed in the order of hypertensive diseases (11.06%), mood disorders (8.34%), diabetes mellitus (7.98%), and diseases of esophagus, stomach, and duodenum (7.04%). Nine major association pathways were analyzed. Significant pathways were analyzed as diabetes mellitus and hypertensive diseases (IS scale = 0.386), hypertensive diseases, and cerebrovascular diseases (IS scale = 0.240). The association pathway of diabetes mellitus and hypertensive diseases was common in subgroups of mental and behavioral disorders, excluding mood disorders and disorders of adult personality and behavior. By monitoring related diseases based on major patterns, it can predict comorbid diseases in advance, improve the efficiency of managing patients with mental and behavioral disorders, and furthermore, it can be used to establish related health policies.

Participation in Road Traffic and Mobility in People with Alcohol Dependency and Mental Disability

Inclusion in terms of personal mobility (§ 20 of the UN Convention on the Rights of Persons with Disabilities) should be investigated in a sample of people with alcohol dependency and additional mental disability. Interviews with N = 153 individuals, recruited from specific community services for people with alcohol-related disorders and co-morbidity of mental disorders, patients in in-patient treatment, day clinics, and in out-patient treatment. 54.1 % reported loss of their driver's licence due to alcohol, 43.3 % indicated to own a motor vehicle. Personal mobility was realized much more frequently by bicycle or on foot than in the general population. The expansion of public transport and the bicycle network is desirable not only on the background of climate change but also in favour of the inclusion of people with mental disability.

Sex differences in psychiatric comorbidity and clinical presentation in youths with conduct disorder.

Conduct disorder (CD) rarely occurs alone but is typically accompanied by comorbid psychiatric disorders, which complicates the clinical presentation and treatment of affected youths. The aim of this study was to investigate sex differences in comorbidity pattern in CD and to systematically explore the 'gender paradox' and 'delayed-onset pathway' hypotheses of female CD. As part of the FemNAT-CD multisite study, semistructured clinical interviews and rating scales were used to perform a comprehensive phenotypic characterization of 454 girls and 295 boys with CD (9-18 years), compared to 864 sex- and age-matched typically developing controls. Girls with CD exhibited higher rates of current major depression, anxiety disorders, post-traumatic stress disorder and borderline personality disorder, whereas boys with CD had higher rates of current attention-deficit/hyperactivity disorder. In line with the 'gender paradox' hypothesis, relative to boys, girls with CD showed significantly more lifetime psychiatric comorbidities (incl. Alcohol Use Disorder), which were accompanied by more severe CD symptoms. Female and male youths with CD also differed significantly in their CD symptom profiles and distribution of age-of-onset subtypes of CD (i.e. fewer girls with childhood-onset CD). In line with the 'delayed-onset pathway' hypothesis, girls with adolescent-onset CD showed similar levels of dimensional psychopathology like boys with childhood-onset CD, while boys with adolescent-onset CD had the lowest levels of internalizing psychopathology. Within the largest study of CD in girls performed to date, we found compelling evidence for sex differences in comorbidity patterns and clinical presentation of CD. Our findings further support aspects of the 'gender paradox' and 'delayed-onset pathway' hypotheses by showing that girls with CD had higher rates of comorbid lifetime mental disorders and functional impairments, and they usually developed CD during adolescence. These novel data on sex-specific clinical profiles of CD will be critical in informing intervention and prevention programmes.

A mental health professional survey of cognitive-behavioral therapy for the treatment of opioid use disorder.

The objective of this survey was to obtain mental health professional perspectives on cognitive-behavioral therapy (CBT) for opioid use disorder (OUD) treatment. Respondents (N = 84) rated components of CBT for their efficacy in OUD treatment. Ratings were reported for the overall sample, by degree completed, and by clinicians versus nonclinicians. Respondents also ranked additional therapeutic strategies that might enhance the efficacy of CBT for OUD. Respondents rated treatment alliance/rapport, coping skills, and motivational interviewing as the most effective CBT components for OUD. Forms and worksheets were rated as the least effective component. The most beneficial additions to CBT for OUD would be mindfulness, peer support, and medication adherence strategies. Finally, the survey responses suggested that addressing co-morbid mental health disorders and life stressors may be important within CBT treatment for OUD.

Psychopathology and Parental Stress in 3-6-Year-Old Children with Incontinence.

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children's psychopathology especially in young children. Methods: Children's psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children's (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.

Editorial: The Co-Occurrence of Diseases

Editorial: The Co-Occurrence of Diseases

Screening of mental problems and counseling training for primary health care staffs to assess sintren dancer in Pemalang, Central Java, Indonesia

Introduction: Experiences of trance in Sintren dancer with a history of psychosocial problems, it is possible that comorbidity of mental disorders will appear. One of the Primary Health Care programs is dealing with mental disorders. By providing counseling training to Primary Health Care Staffs, it is hoped that there will be guidance and assistance from the Primary Health Care for the Sintren dancer community.Methods: Screening is carried out to recruit synthetic dancers who have psychological problems and are given counseling. This service involves Primary Health Care Staffs. This service includes networking and treatment and providing counseling to Sintren dancers to deal with the problems they are experiencing.Result: Sintren dancers met the category of mental disorders (dysthymia and PTSD). Primary Health Care Staff had bad experiences in helping people with mental disorders, they are afraid of helping people with mental problems. With counseling training, primary health care staff more confident to help people with mental problems.Conclusion: Sintren dancers have a psychosocial and mental disorder background. Counseling training in Primary Health Care Staff provides understanding of stress management and early detection of mental disorders that often occur in society.

Risk Factors and Cognitive Deficits in First Episode Major Depression: A Five-Year Longitudinal Study of Explorative Subgroups

Mood disorders are associated with cognitive deficits, even in remission. There is heterogeneity in prevalence- and severity of such deficits, however. Risk factors like relapse, depressive symptoms, rumination, comorbidity, and family history of mental disorders, could exacerbate cognitive deficits. Longitudinal assessment of first episode depression could elucidate on how such risk factors are related to cognition.

O25 The impact of COVID-19 lockdown on mental health and quality of life in patients with inflammatory arthritis

Background/Aims COVID-19 lockdown has affected the mental health of many people around the world. People with inflammatory arthritis (IA) are at a higher risk of mental health and psychosocial consequences of the pandemic compared with the general population, since they are potentially more vulnerable to COVID-19 and experience higher rates of existing comorbid mental health disorder. Furthermore, vulnerable patients were advised to self-isolate for 12 weeks, which could further exacerbate emotional distress. This study aimed to explore the impacts of lockdown on mental health and wellbeing, and to determine which factors were associated with worse disease outcomes. Methods An online questionnaire was completed by 338 participants in the UK with an IA condition between June and July 2020. The questionnaire, designed with input from a service user, assessed various aspects of the impact of the pandemic on the quality of life of people with IA, including their mental health. Self-reported visual analogue scales (VAS) for patient global assessment (PGA) of disease activity, pain, fatigue, and emotional distress were completed relating to the previous week, and retrospectively for pre-lockdown (March) and early-lockdown (April). Specific mental health outcomes were further captured using the 8-item Patient Health Questionnaire (PHQ8) and the short UCLA loneliness scale. Linear regressions were conducted to determine mental health factors associated with worse outcomes on physical health measures (PGA, pain, and fatigue), controlling for fear of COVID-19 and COVID-19 status. Results Overall, 49% of participants met the PHQ8 criteria for moderate to severe depressive symptoms and 58% reported their mental health had worsened by more than 10 points on the emotional distress VAS during lockdown. Finally, 37% reported they were concerned about loneliness, with 26% indicating this had worsened during lockdown. Emotional distress VAS was significantly associated with PGA (b = 0.21, p< 0.01), pain (b = 0.24, p<0.01), and fatigue (b = 0.36, p<0.01). Similarly, depression was also associated with PGA (b = 0.95, p<0.01), pain (b = 0.92, p<0.01), and fatigue (b = 1.56, p<0.01). However, loneliness was not associated with any of the physical health VAS scores but was associated with the emotional distress VAS (b = 1.83, p=0.00). These results remained consistent for emotional distress, depression, and loneliness as predictors when accounting for fear of COVID-19 and COVID-19 status. Conclusion There has been a clear impact of the pandemic on the mental health of people with IA, and this should be taken into consideration by clinicians, especially as it appears to be related to worse overall reported physical health. The mixed results for loneliness in comparison to other mental health measures may illustrate the inter-relatedness of these aspects of mental and physical health, particularly in the context of lockdown. Disclosure M. Sweeney: None. L. Carpenter: None. S. de Souza: None. H. Chaplin: None. H. Tung: None. E. Caton: None. J. Galloway: None. A. Cope: None. M. Yates: None. S. Norton: None.

LSD use in the United States: Trends, correlates, and a typology of us

BackgroundRecent years have witnessed an increased interest in LSD. This study investigates current information on the trends and correlates of LSD use from years 2002–2018 and seeks to develop an initial typology of use and misuse. MethodsData is taken from the NSDUH (National Survey on Drug Use and Health) collected between 2002 and 2018 and trends and correlates of LSD use were analyzed with a survey adjusted logistic regression. ResultsOur findings indicate that LSD use has increased 200 % over the study period (.23 % 2002−2005 to .72 % 2015−2018, AOR = 1.10, 95 % CI = 1.08, 1.12). Our findings also indicate several correlates of LSD use including higher levels of education (college degrees: AOR = 1.62, 95 % CI = 1.23, 2.13), not being married (divorced or separated, AOR = 2.31, 95 % CI = 1.44, 3.73, and have never been married, AOR = 5.67, f 95 % CI = 4.09, 7.86), as well as higher levels of antisocial behavior (having been arrested AOR = 3.20, 95 % CI = 2.50, 4.09) and comorbid mental health and substance abuse disorders (serious psychological distress, AOR = 2.39, 95 % CI = 2.05, 2.80). Further, four distinct subclasses were also discovered within LSD users and two of these subtypes of LSD users contained comorbid mental health disturbances and heavy involvement in the criminal justice system. ConclusionLSD use has been on the rise within the last decades, particularly among those who are well educated. Two subclasses of LSD use (those with severe comorbid mental health disorders and those with criminal justice involvement) may require further interventions.

Discussion questions about the therapy of nonchemical addictions

Today there are no international standards for the treatment of non-chemical (behavioral) addiction (NA). This is largely due to the vagueness of their existence as nosological units and, as a consequence, their place in international classifications. This article discusses the forms of NA that are or will be included in DSM-V and ICD-11. It has been shown that NA research has sparked discussions about the spectrum of addictive disorders, expands the multidisciplinary understanding of the etiology and pathogenesis of addictive disorders, and promotes the study of new forms and expansion of therapeutic approaches. The criticism of the addictive spectrum concept is analyzed. The modern approaches of non-drug and pharmacological therapy of different forms of NA are presented.&#x0D; The following conclusions are drawn.&#x0D; &#x0D; The existence of NA is confirmed by the inclusion of a part of them in the International Classifications of Diseases.&#x0D; NA have high comorbidity with other mental disorders, in respect of which pharmacotherapy and psychotherapy are not in doubt.&#x0D; Taking into account the general neurobiological mechanisms of the formation of addictive disorders, the possible pharmacotherapy of non-chemical addictions, officially recognized in the ICD and DSM, should proceed from the currently available approaches to the therapy of substance use disorders.&#x0D; Treatment of non-chemical addictions that are not included in the International Classifications can only be carried out within the framework of therapy for confirmed comorbid mental disorders. In its absence, psychological correction seems to be possible.&#x0D; There is an obvious need to continue researching the problem of non-chemical addictions to expand new approaches to their therapy and psychological correction.

Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site

PurposeTo conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness.MethodsData from 543 participants of the At Home Chez Soi study’s Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile.ResultsFour well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity.ConclusionsIndividuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness.Trial registrationAt Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374.

Mental Health Care Costs Among Youth with Comorbid Mental Disorders.

This exploratory study described the distribution of mental health service costs in youth with mental disorder and determined if costs differed for youth with comorbid internalizing and externalizing disorder compared to those with comorbid internalizing disorders. Data come from youth (8-17 years; n=75) receiving mental health services at a children's hospital in Canada. Billing amounts specified in the Health Insurance Act of Ontario were used to estimate costs. Overall, past-year service use costs were $7436.63. Hospitalizations represented the largest cost. Youth with comorbid internalizing and externalizing disorders had higher total (β=0.81 [0.17, 1.45]), hospital (β=0.93 [0.03, 1.84]), and professional (β=0.87 [0.04, 1.69]) costs. These preliminary findings suggest that comorbidity type is associated with the costs of past-year mental health services used by youth. Research is needed to understand the reasons for elevated costs and whether the increased services used by youth with comorbid internalizing and externalizing disorders are effective.

Clinical case of animal hoarding – characterization and management of a new disorder

IntroductionAnimal hoarding is characterized by hoarding of a large number of animals without providing minimum conditions of nutrition and sanitation, accompanied by lack of insight for the behavior and by social isolation. Despite studies detecting an increasing incidence, the behavior is still poorly understood.ObjectivesTo review clinical evidence on animal hoarding and to report a clinical case.MethodsWe report a clinical case based on patient’s history and clinical data, along with a review of the literature on animal hoarding. The terms “Noah syndrome” and “animal hoarding disorder” were searched on PubMed® database.ResultsWe present the case of a 51-years-old woman, living alone, with higher education. His first contact with psychiatry was in August 2019 upon aggravated self-neglect and behavioral disorganization. She was living with around 40 cats, her home was extremely deteriorated. In December 2019 she was admitted to a psychiatric unit. A schizophrenia diagnosis was established and pharmacological treatment was initiated. She was discharged to a chronic psychiatric institution. Studies found out that animal hoarders are typically middle age/older women living alone in squalid conditions. Animal hoarding is characterized by a chronic course and intense emotional attachment to animals. It seems to be associated with traumatic situations, as well as mental disorders such as schizophrenia or dementia. Published data on intervention and treatment is still limited.ConclusionsAnimal hoarding phenomenon requires further investigation, regarding developmental risk factors and co-morbid mental disorders. Comprehensive approaches to clinical intervention and management strategies in animal hoarding are necessary.

Sensory experience in obsessive compulsive disorder - sensiocd: Do they think or feel differently?

IntroductionObsessive-compulsive disorder (OCD) is associated to a wide range of symptomatic expression and treatment response variability [1]. Sensory perception has been identified as an emerging factor in this process [2]. Sensory vulnerability and atypical sensory experience were identified as risk factors for the development of OCD [3] and a sensory subtype of the disease was proposed in which there is a positive correlation with early onset sensory symptoms, male gender and family background [4]. Adding to the atypical sensory profile, obsessions are frequently experienced as partially perceptual.ObjectivesOur main goals are to characterize the sensory perception in OCD patients; assess the prevalence and intensity of the sensory properties of the obsessive thoughts and explore the how sensory perception, obsessive thoughts and obsessive dimensions/clusters are interrelated.MethodsPatients with OCD diagnosis, aged 18 to 65 years and no comorbid mental disorder (except depression) will be recruited. The study battery will include participant form with demographical and clinical features, assessment of depressive and anxiety symptoms (HAM-A and HAM-D) evaluation of clinical outcome measures and obsessive dimensions/clusters (Yale-Brown Obsessive-Compulsive Scale (Y-BOQS) and Obsessive Beliefs Questionnaire-44 (OBQ-44)), assessment of sensory perception and sensory properties of obsessive thoughts (Sensory Perception Quotient (SPQ 21) and Sensory Properties of Obsessive Thoughts Questionnaire (SPOQ)).ResultsThe results will help us understand the interaction between perceptual and cognitive processes in OCD.ConclusionsBetter definition of OCD psychopathology and the establishment of a sensory subtype may indicate the need of specific therapeutic indications or a different escalation of treatment measures.DisclosureNo significant relationships.

Past, present and future of psychiatry

Over the past few decades, psychiatry and mental health sciences have reached several major goals. The importance of mental health and the huge contribution to the burden of disability produced by mental and neurological disorders has been recognized by all and most recently also by the United Nations. Treatment technology has developed and permits the effective management of most mental disorders. Progress has also been made in the recognition of human rights of people with mental illness and those who care for them. More has to be done in these areas but there are also new tasks that are before psychiatry. These include the addition of primary prevention of mental disorders to previous efforts to ensure secondary and tertiary prevention of mental health problems; the development of appropriate ways of work in order to cope with problems of comorbidity of mental and physical disorders; and a fundamental reorientation of training in psychiatry and related sciences.DisclosureNo significant relationships.

The future of psychiatry: The perspectives from a senior psychiatrist

The future of psychiatry as a discipline (and as the main source of knowledge in the construction and functioning o mental health services) can best be grasped on the basis of an examination of the development of psychiatry over the past century in the light of current options for its functioning. Such an examination demonstrates that psychiatrists will have to expand their field of work to include the management of comorbidity of mental and physical disorders and public health approaches to the primary prevention of mental and other brain disorders. Their engagement in research will have to become restricted to psychopathology and participation in the formulation of hypotheses which will be tested in laboratory and field work;; and their involvement in teaching about mental health and illness will have to undergo a fundamental change in terms of content, methods and evaluation of effects of education which they will organize. The presentation will focus on the future tasks of psychiatrists in these areasDisclosureNo significant relationships.

Process-Outcome Associations in an Interdisciplinary Treatment for Chronic Pain and Comorbid Mental Disorders Based on Acceptance and Commitment Therapy.

Numerous studies support the effectiveness of acceptance and commitment therapy (ACT) for chronic pain, yet little research has been conducted about its underlying mechanisms of change, especially regarding patients with comorbid mental disorders. The present investigation addressed this issue by examining associations of processes targeted by ACT (pain acceptance, mindfulness, psychological flexibility) and clinical outcomes (pain intensity, somatic symptoms, physical health, mental health, depression, general anxiety). Participants were 109 patients who attended an ACT-based interdisciplinary treatment program for chronic pain and comorbid mental disorders in a routine care psychiatric day hospital. Pre- to posttreatment differences in processes and outcomes were examined with Wilcoxon signed-rank tests and effect size r. Associations between changes in processes and changes in outcomes were analyzed with correlation and multiple regression analyses. Pre- to posttreatment effect sizes were mostly moderate to large (r between 0.21 and 0.62). Associations between changes in processes and changes in outcomes were moderate to large for both, bivariate correlations (r between 0.30 and 0.54) and shared variances accounting for all three processes combined (R2 between 0.21 and 0.29). The present investigation suggests that changes in pain acceptance, mindfulness, and psychological flexibility are meaningfully associated with changes in clinical outcomes. It provides evidence on particular process-outcome associations that had not been investigated in this way before. The focus on comorbid mental disorders informs clinicians about a population of chronic pain patients who often have a severe course of illness and have seldom been studied.