Rheumatoid arthritis (RA), a complex autoimmune disease that affects 1 to 2 percent of adults, requires patients to not only cope with pain, disability and joint disfigurements, but also other stressors such as disrupted work, family life and marital functioning. While many pharmacological advances help some RA patients, residual pain and disability is common. In addition, some patients avoid newer medications due to their high cost or side effects. Because of this, there is interest in psychosocial interventions for RA such as cognitive-behavioural and emotional processing approaches.
A team of researchers from Wayne State University and collaborators from Duke University Medical Center recently published a paper in the Journal of Consulting and Clinical Psychology that explores two psychological interventions separately and in combination to determine their effectiveness in offering relief to RA patients.
The study, “The Effects of Written Emotional Disclosure and Coping Skills Training in Rheumatoid Arthritis: A Randomized Clinical Trial,” led by Mark A. Lumley, Ph.D., professor of psychology in Wayne State University’s College of Liberal Arts and Sciences, revealed cognitive-behavioural coping skills training (CST) had positive effects on the pain and mood of patients that lasted for at least one year, whereas written emotional closure (WED), expressive writing about stress, had only temporary and inconsistent benefits on patients’ joints and functioning, and did not help with pain or mood. The combination of CST and WED had had no unique benefits.
CST trains patients in various cognitive and behavioural techniques or skills to enhance their ability to cope with pain and improve their behavioural and psychological functioning. A few studies have shown that WED can reduce stress and improve health by having patients write privately for 20 minutes each day for three or four days about stressful experiences and their deepest thoughts and feelings.
“Our study revealed that patients with RA receive positive benefits in both the short and long- term using cognitive behavioural techniques such as relaxation, increasing pleasant activities, changing negative thoughts, and problem solving,” said Lumley. “WED, however, was less effective, and an examination of patients’ expressive writings suggests that many patients either did not have much unresolved stress or more likely did not know how to effectively identify important stressors, label and express their negative emotions, and learn from or resolve these conflicts while writing by themselves. We probably need to identify and target those patients with unresolved stress or trauma, and then help them more effectively disclose and work with their unexpressed emotions.”
The research team noted that continued development and integration of therapies that target the full range of processes underlying pain and functioning, not just biological but also behavioural, cognitive, emotional and interpersonal, are critical for helping more RA patients have better health status.