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To examine the effectiveness of a cognitivebehavioral pain management program for patients with rheumatoid arthritis, three patient groups were studied: a cognitive-behavioral group (CB), an attention-placebo group, and a control group. The CB group received a comprehensive, 12-month pain management program that taught coping strategies such as problem-solving techniques, relaxation training, strategies for attention diversion, and training in family dynamics and communication. Dependent measures included pain, coping strategies, psychological status, functional status, and disease status. Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies. Specifically, the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain. The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis.

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Many psychologists are finding new opportunities for practice in primary care settings. These settings challenge many aspects of traditional practice and require adaptation and innovation. Psychologists must consider changes in their site of practice, treatment duration, type of intervention, and role as part of a health care team. This article describes the culture of primary care medicine and offers 10 practical tips for the adaptation of psychological practice to primary care.Primary care is now the linchpin of the new health care delivery system. This focus on primary care creates both threats to the conventional independent practice of psychology and new opportunities for collaboration and direct participation in the delivery of primary care services. In terms of threat, a psychologist whose solo or small-group practice has focused predominately on private, office-based psychological assessment and psychotherapy faces increasing economic pressures created by market-driven reforms, managed care, and other limits to traditional fee-for-service psychological services (Frank & Vandenfios, 1994). Managed care systems increasingly rely on primary care providers (including physicians in family medicine, general internal medicine, pediatrics, and sometimes obstetricsgynecology) to screen and triage patients with a wide range of medical and psychological problems. These physicians are the gatekeepers for referral to all specialists, including psychologists. In terms of opportunity, psychologists who shift their practices to work closely with these providers as part of an integrated delivery system are most likely to continue to deliver services to a wide variety of patients (Shortell, Gillies, & Anderson, 1994).Many patients who present in primary care settings have psy-