Examined the efficacy of a cognitive–behavioral intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis (RA). 23 outpatients (aged 18–75 yrs) with RA completed questionnaires concerning hospital anxiety, depression, coping strategies, pain, and health prior and subsequent to receiving CBT. Other collected data included joint inflammation and disease assessment. Results show that CBT Ss exhibited significant improvements in depressive symptomology and in joint involvement following CBT intervention compared with controls. Additionally, CBT Ss exhibited significant reductions in C-reactive protein levels. Findings suggest that a cognitive–behavioral intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in reducing both psychological and physical morbidity. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVE: This trial was performed to evaluate the efficacy of an adjunctive cognitive-behavioral treatment compared with rheumatological treatment alone in unselected rheumatoid arthritis outpatients. DESIGN: A prospective randomized control design was used. Change in medication during treatment was controlled by matching therapy- and control-group subjects according to this change in medication, sex, age, duration of disease, and functional class. SETTING: A rheumatological outpatient clinic, University of Goettingen, Germany. PATIENTS: Fifty-five consecutive outpatients with a diagnosis of rheumatoid arthritis (age 52.7 years, 74.5% female, duration of disease 9.4 years) finished the study. INTERVENTIONS: Subjects received routine care by the rheumatologists and routine medical treatment. Cognitive-behavioral treatment subjects (n = 19) received adjunctive standardized cognitive-behavioral group treatment with 12 weekly sessions. OUTCOME MEASURES: Outcome measures included disease activity variables, pain variables (pain intensity, affective pain), psychological symptoms, and coping. RESULTS: Subjects mostly demonstrated an increasing disease activity during treatment; change in medication during treatment was necessary in some patients. In the cognitive-behavioral treatment group the course of rheumatoid arthritis seemed less progressive than in the control group. The core effects of cognitive-behavioral treatment pertain more to improved coping, emotional stabilization, and reduced impairment than to reduced pain intensity. Passive, emotion-focused coping, helplessness, depression, anxiety, affective pain, and fluctuation of pain are reduced, "Acceptance of Illness" is improved. CONCLUSIONS: Cognitive-behavioral therapy has proven an effective adjunct to standard treatment of rheumatoid arthritis outpatients. These effects were shown in an unselected sample with increasing disease activity and with comparable changes in medication during treatment. We recommend cognitive-behavioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.
OBJECTIVE: To assess the sustainable benefits of a professional, multidisciplinary training program for patients with rheumatoid arthritis.
DESIGN: Two studies with different observation periods. Study I was a prospective, randomized trial for 1 year. Study II was a noncontrolled observation over 5 years.
SETTING: The 9-day program for eight patient groups encompassed a multidisciplinary cooperation between rheumatologists, orthopedists, physicotherapists, psychologists and social workers.
PATIENTS: Sixty-eight consecutive patients with rheumatoid arthritis participated in an arthritis training program either immediately after enrollment in the program or after 1 year.
INTERVENTIONS: The program covered the following fields: pathogenesis of rheumatoid arthritis, drug therapy, physicotherapy, practical exercise in remedial gymnastics, use of joint protection devices, orthopedic perspectives, psychological counseling, dietetics, information about unproven cures and social assistance.
MAIN OUTCOME MEASURES: Clinical outcome was assessed by self-report questionnaires: (1) Stanford Health Assessment Questionnaire, (2) Freiburg Questionnaire of Coping with Illness, (3) Beck Depression Inventory, and (4) a 21-point scale to evaluate cognitive-behavioral and environmental impact.
RESULTS: A significant and persistent improvement of all investigated parameters was demonstrated in the 1-year controlled trial. Between the end-point of the 1-year study and the 5-year evaluation, this improvement increased even more for functional status and coping with illness, whereas depression returned to baseline values. These effects were seen even without reinforcement of the training.
CONCLUSION: A professional, multidisciplinary approach to educate patients with rheumatoid arthritis leads to a significant and sustained improvement of the clinical outcome and is an approach that should be established as a part of conventional therapy.
The purpose of the study was to investigate the effects of supervised muscle relaxation training in individuals with rheumatoid arthritis (RA). Sixty-eight participants were allocated at random either to a muscle relaxation training group or to a control group. Every participant was evaluated for health-related quality of life, muscle function, pain, and disease activity. The training group exercised 30 minutes, twice a week for 10 weeks, while no intervention was made in the control group. The results indicated improvements in the training group regarding self-care according to the Arthritis Impact Measurement Scales 2, and in recreation and pastimes according to the Sickness Impact Profile-RA (p < 0.05) directly after the intervention. Mobility and arm function (p < 0.01) according to the Arthritis Impact Measurement Scales 2, and muscle function of the lower limbs (p < 0.05) were improved after six months. No improvements remained after twelve months. It thus seems that 10 weeks' relaxation training might have some short-term influence in individuals with RA.
Examined whether writing about stressful experiences affects objective measures of disease status in patients with chronic asthma or rheumatoid arthritis (RA). 107 Ss (58 with asthma, 49 with RA) completed the intervention condition, in which they were asked to write about the most stressful experience they had ever undergone; 41 controls (22 with asthma, 19 with RA) were asked to write about an emotionally neutral topic. Ss wrote for 20 min on 3 consecutive days a week; symptoms were assessed at baseline, 2 wks, 2 mo, and 4 mo after writing. Results showed that, across both diseases, experimental group Ss had greater rates of symptom improvement and lesser rates of worsening on objective measures of health than the control Ss. There were also clinically significant differences in observed changes in health status between experimental and control Ss, with approximately 47% of experimental patients vs 24% of controls meeting criteria for clinically relevant improvement. Time course analysis of changes in primary outcomes showed that asthmatic patients in the experimental group improved within 2 wks, whereas change for the RA patients was not evident until the 4-mo assessment. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVE: To develop and evaluate the effect of a new arthritis education program based on a previous study. METHODS: One hundred individuals with established rheumatoid arthritis randomized to an intervention group or a control group completed self-report questionnaires. RESULTS: Three months after the education program the patients in the intervention group had increased their knowledge about their disease. They reported increased practice of exercise and joint protection and reduction of disability and pain. After 12 months, increased knowledge and practice of joint protection was maintained. However, there was no longer any difference between the intervention group and the control group regarding reported pain, disability, and practice of exercise. At both intervals the individuals in the intervention group reported an increased ability to handle their pain and a reduction of problems with their disease. The control group remained stable except for a slight increase in pain. CONCLUSION: A structured patient education program had positive impact for 3 months, and some improvements were maintained for 12 months. We suggest that patient education should become an integrated part of the total management of rheumatoid arthritis.
This study examined the effects of emotional disclosure of stressful events on the pain, physical and affective dysfunction, and joint condition of patients with rheumatoid arthritis (RA). Patients were randomly assigned to talk privately about stressful events (disclosure group, n = 36) or about trivial topics (control group, n = 36) for 4 consecutive days. Disclosure resulted in immediate increases in negative mood. At 2 weeks the 2 groups did not differ on any health measure, but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities. There was no main effect of disclosure on pain or joint condition, but among the disclosure patients, those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints. This study concludes that, among RA patients, verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning.
OBJECTIVE: To examine the effects of stress-management training on clinical outcomes in persons with rheumatoid arthritis (RA). METHODS: Patients with RA (n = 141) were randomly assigned to 1 of 3 groups: a stress management group, an attention control group, or a standard care control group. The stress management and the attention control groups received a 10-week intervention followed by an additional 15-month maintenance phase. RESULTS: The stress management group showed statistically significant improvements on measures of helplessness, self-efficacy, coping, pain, and health status. Selected beneficial effects were still detectable at the 15-month followup evaluation. CONCLUSION: The data indicated that stress management interventions are capable of producing important clinical benefits for persons with RA.
Tested the effectiveness of a nondirective, telephone-based, person-centered counseling intervention (NTPCI) for improving the psychological status (PSS) of persons with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) who had been attending clinics at a tertiary care center. The design was a parallel-group, randomized, controlled study comparing an NTPCI (8 SLE, 28 RA Ss) with usual care (7 SLE, 30 RA Ss). The Arthritis Impact Measurement Scales were used to measure psychological dysfunction, physical dysfunction and pain at baseline and at follow-up. NTPCI was shown to significantly improve the PSS of the SLE Ss, in contrast to usual care. However, there was no evidence of a benefit for RA Ss or of improvements in physical function or pain for persons with either disease. Thus, person-centered counseling may be an effective intervention for improving the PSS of persons with SLE, but may not be so for those with RA. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVE: The effects of treatment counseling or symptom monitoring telephone intervention strategies on the health outcomes of patients with rheumatoid arthritis (RA) or osteoarthritis (OA), compared with usual care, were assessed. METHODS: A 3-group, randomized, controlled 9-month trial was conducted incorporating 405 patients with RA or OA and using the Arthritis Impact Measurement Scales (AIMS2) as the outcome measure. RESULTS: Analyses of covariance showed that the AIMS2 total health status of the treatment counseling group (effect size = 33, P < 0.01), but not the symptom monitoring group (effect size = 0.21, P = 0.10), was significantly improved, compared with usual care, for both RA and OA patients. The specific types of benefits differed significantly between RA and OA patients. The mean number of medical visits by OA patients in the treatment counseling group was also significantly reduced (P < 0.01). CONCLUSION: Telephone contact using the treatment counseling strategy produced significant, but different, health status benefits for RA and OA patients. The symptom monitoring strategy produced modest benefits.
Examined the efficacy of a cognitive–behavioral intervention (CBT) for patients with recent onset, seropositive rheumatoid arthritis (RA). 23 outpatients (aged 18–75 yrs) with RA completed questionnaires concerning hospital anxiety, depression, coping strategies, pain, and health prior and subsequent to receiving CBT. Other collected data included joint inflammation and disease assessment. Results show that CBT Ss exhibited significant improvements in depressive symptomology and in joint involvement following CBT intervention compared with controls. Additionally, CBT Ss exhibited significant reductions in C-reactive protein levels. Findings suggest that a cognitive–behavioral intervention offered as an adjunct to standard clinical management early in the course of RA is efficacious in reducing both psychological and physical morbidity. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
