Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial

Abstract

Recent developments in chronic pain research suggest that effectiveness of cognitive-behavioral therapy (CBT) may be optimized when applying early, customized treatments to patients at risk. For this purpose, a randomized, controlled trial with tailor-made treatment modules was conducted among patients with relatively early rheumatoid arthritis (RA disease duration of <8 years), who had been screened for psychosocial risk profiles. All participants received standard medical care from a rheumatologist and rheumatology nurse consultant. Patients in the CBT condition additionally received an individual CBT treatment with two out of four possible treatment modules. Choice of treatment modules was determined on the basis of patient priorities, which resulted in most frequent application of the fatigue module, followed by the negative mood, social relationships and pain and functional disability modules. Analyses of completers and of intention-to-treat revealed beneficial effects of CBT on physical, psychological and social functioning. Specifically, fatigue and depression were significantly reduced at post-treatment and at the 6-month follow-up in the CBT condition in comparison to the control condition, while perceived support increased at follow-up assessment. In addition, helplessness decreased at post-treatment and follow-up assessment, active coping with stress increased at post-treatment, and compliance with medication increased at follow-up assessment in the CBT condition in comparison to the control condition. Results indicate the effectiveness of tailor-made CBT for patients at risk in relatively early RA, and supply preliminary support for the idea that customizing treatments to patient characteristics may be a way to optimize CBT effectiveness in RA patients.

A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study

“…Our results are consistent with other psychotherapeutic interventions that demonstrate improvement in RA disability, pain, depression, and/or coping efficacy 5,6,7,31,32 . Reductions in disease activity and joint inflammation have been reported after cognitive behavioral therapy (CBT), particularly in those subjects with earlier-onset RA 4,9,10,11,14,32 .…”

“…A number of psychobehavioral interventions have been shown to be effective in improving coping efficacy and other outcomes in patients with RA 4,5,6,7,8,9,10,11 . Cognitive behavioral interventions, in particular, have reduced pain, joint inflammation, physical disability, and depression 5,6,9,10 .…”

“…Cognitive behavioral interventions, in particular, have reduced pain, joint inflammation, physical disability, and depression 5,6,9,10 . The improvements are variable according to the type of intervention, tend to be most effective in newly diagnosed patients, and have limited sustainability 6,9 . For example, effect sizes (ES) for pain and disability in 2 metaanalyses of psychological interventions for RA were modest 12,13 .…”

The role of psychological factors in inflammatory rheumatic diseases: From burden to tailored treatment

“…In case of moderate adjustment problems, self-management interventions could sufficiently improve functioning by combining education with some cognitive-behavioral principles such as relaxation, problem solving, and goal setting [2]. For more severe adjustment problems, different evidence-based personalized therapist-guided treatments have become available for diverse patient groups and also include disease-generic approaches that encompass a broad variety of treatment modules of the most relevant areas of functioning across diseases and different cognitive-behavioral techniques and assignments that can be flexibly applied [68,89,90]. Within such tailored treatments, the content of the treatment (e.g., choice of modules to work on and specific topics or assignments within each module) is based on the elaborate screening in combination with the patient priorities and judgment of the therapist.…”

“…It has been shown that patient education or self-management is sufficient for patients in the early adjustment phase of the disease or who show mild adjustment problems and also strengthens patient empowerment [3,88], whereas more intensive treatments are most beneficial for patients who show heightened distress levels [68,85]. Likewise, there is some evidence that personalized or tailored treatment possibly leads to stronger and longer-lasting effects than standardized treatments in addition to increased treatment motivation, adherence, and patient satisfaction and decreased attrition rates in both mental and physical health conditions and in both face-to-face and internet-based interventions [3,85,89,91e93].…”