Medically ill patients face unique physical and emotional challenges that place them at increased risk for symptoms of depression and anxiety. Despite high prevalence and significant impact, depression and anxiety are infrequently treated in the medically ill because of a variety of patient, provider, and system factors. The current article describes the development of an innovative, modular-based cognitive-behavioral intervention (Adjusting to Chronic Conditions Using Education Support and Skills [ACCESS]) that integrates treatment for symptoms of anxiety and depression with medical disease self-management in patients with heart failure and chronic obstructive pulmonary disease. Data from 3 patients who participated in an ongoing open clinical trial are reviewed to illustrate the feasibility, acceptability, and potential strengths and limitations of this intervention. (Contains 3 tables.)