Patients in the ACT-IM group will attend a 1-day group workshop. Each ACT-IM group will be held at the University of Iowa Hospitals and Clinics, include 8-12 patients, and last 6 hours. The ACT-IM group will be conducted by 2 psychologists and the IM portion will be completed by a physician with expertise in vascular disease-psychiatric comorbidity. Three broad areas will be covered: 1) Illness Management will cover the importance of physical and psychological self-care for the management of co-morbid depression/anxiety and vascular problems (e.g. fatigue, stress, poor nutrition management, and inadequate physical activity); 2) Behavioral Change Training will involve i) teaching patients how to recognize ineffective patterns of behavior and habits, ii) exploring and setting life goals and those related to mental and physical health, and iii) promoting effective and committed actions to achieve these goals despite the urge to do otherwise; 3) Mindfulness and Acceptance Training will emphasize new ways of managing troubling thoughts, feelings, and physical sensations (e.g., learning how to recognize, and develop cognitive distance from unhelpful thoughts such as "I can't take this anymore" and learning how to willingly face experiences that cannot be changed). In-session exercises and practice will be heavily emphasized during the group intervention. A manual with information about topics covered during the group will be distributed for home use. Lunch will be provided and breaks will be offered to minimize fatigue.