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OBJECTIVE: The purpose of this study was to test the effectiveness of a cognitive-behavioral intervention program designed to affect perceptions of control and coping patterns in women with rheumatoid arthritis (RA). DESIGN: Quasi-experimental. SETTING: Not given. POPULATION: Ninety women with rheumatoid arthritis between the ages of 24 and 80 were recruited and enrolled in the program over an 18-month period. The average length of time since diagnosis with RA was 10.3 years. INTERVENTIONS: After meeting entry criteria and giving written informed consent, participants completed and mailed back a battery of self-report instruments 6 weeks prior to beginning the intervention, labeled Time 1. Participants also completed these same measures during the week prior to beginning the intervention, labeled Time 2, immediately after the intervention, labeled Time 3, and at a 3-month follow-up, labeled Time 4. The intervention program, called Rising Above Arthritis, was designed to help women with RA develop a sense of competence with respect to both arthritis-related problems and other life stressors. Participants watched a videotape and reviewed manual material prior to attending each of the three small-group sessions scheduled 2 weeks apart. A major theme of the intervention program is that individuals have some control over their responses to stressors, even if it is only attitudinal control. MAIN OUTCOME MEASURE(S): The measures were selected because of their conceptual congruency with this investigation and because their reliability and validity for this population have been well established. The Perceived Health Competence Scale is an eight-item measure of the extent to which individuals perceive control over their health status in general. The Arthritis Self-Efficacy Scales for pain were used to assess competency beliefs related to arthritis symptomatology. Other measures used included the five-item Helplessness subscale from the Arthritis Helplessness Index, a shortened version of the Vanderbilt Multidimensional Pain Coping Inventory, the five-item Satisfaction with Life Scale and the 2-item version of the Positive and Negative Affect Schedule (PANAS). RESULTS/CONCLUSIONS: The MANOVA results were significant, indicating that the set of personal coping resources changed significantly over time. All of the gains established during the course of the program were maintained over the subsequent 3 months. The answer to the first research question related to the impact of the program on disease symptomatology depends on which symptom is considered. The program had the greatest impact on personal coping resources such as self-efficacy for controlling arthritis symptomatology. The majority of the significant improvement in the MANOVA of disease symptomatology was due to the highly significant improvement in perceived fatigue. [CINAHL abstract] [ABSTRACT FROM AUTHOR] |
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