The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: A randomized clinical trial
| Autor: | Francis J. Keefe, Sandra J. Waters, Jay L. Cohen, R. Ty Partridge, Ainoa M. Coltri, Jennifer N. Carty, Angelia Mosley-Williams, Yelena B. Bouaziz, Daphne C. McKee, Anita Kalaj, Lynn C. Neely, Paul A. Riordan, John R. Rice, Mark Connelly, Jennifer K. Pahssen, Mark A. Lumley |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Self Disclosure Physical disability Health Status Writing medicine.medical_treatment Emotions Psychological intervention Walking Article law.invention Arthritis Rheumatoid Patient Education as Topic Randomized controlled trial law Intervention (counseling) Adaptation Psychological medicine Humans Health Education Problem Solving Cognitive Behavioral Therapy business.industry Middle Aged medicine.disease Cognitive behavioral therapy Psychiatry and Mental health Clinical Psychology C-Reactive Protein Rheumatoid arthritis Self-disclosure Physical therapy Female Health education business Biomarkers Follow-Up Studies Clinical psychology |
| Zdroj: | Journal of Consulting and Clinical Psychology. 82:644-658 |
| ISSN: | 1939-2117 0022-006X |
| DOI: | 10.1037/a0036958 |
| Popis: | Objective Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. Method We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. Results Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. Conclusions The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients. |
| Databáze: | OpenAIRE |
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