Behavioral Treatments for Rheumatoid Arthritis

描述(由申请人提供)：对类风湿性关节炎(IRA)的行为干预对患者管理疑难症状和这种医疗条件的其他要求的能力产生了有益的影响。然而，类风湿性关节炎的行为治疗对潜在的疾病活动和情绪障碍的影响在很大程度上还不确定。这项拟议的项目比较了认知行为疗法(CBT)、太极拳(TCC)(一种基于运动的冥想形式)和教育控制(EC)在心理适应(例如，无助、应对)、情绪障碍、睡眠质量、促炎细胞因子和类风湿关节炎疾病严重程度方面的衡量标准。CBT干预的一个重要特点是，它结合了改善情绪和减轻抑郁症状的策略。TCC最近显示出作为增加老年人体力活动和健康功能的有效干预措施的前景。由于强调放松和锻炼，TCC在理论上与CBT形成了有趣的对比。两名博士级别的心理学家将负责CBT和EC干预，而一名经验丰富的TCC讲师将负责TCC方案。总共210名IRA患者将在治疗前评估后被随机分配到三种干预措施中的一种，并将在治疗第8周、治疗后(第16-17周)、8个月随访和1年随访时再次进行评估。这项研究的一个主要目标是比较CBT和TCC与EC的临床疗效。CBT和TCC预计将比EC在心理社会功能和IRA疾病严重性方面做出更大的贡献。反过来，CBT被认为在临床终点上比TCC有更大的改善，因为它传授了患者可以用来管理RA的各种技能。本研究还将探讨CBT和TCC促进IRA疾病严重程度改善的机制。例如，我们预计，CBT和TCC导致的RA疾病严重程度的改善将通过减少促炎细胞因子(IL-1、TNF、IL-6)来实现。

DESCRIPTION (provided by applicant): Behavioral interventions for rheumatoid arthritis (IRA) have had a salutary impact on patients' ability to manage difficult symptoms and other demands of this medical condition. Yet, the effects of behavioral treatments for RA on underlying disease activity and mood disturbance are largely undetermined. The proposed project compares cognitive-behavioral therapy (CBT), Tai Chi Chih (TCC), a form of movement-based meditation, and education control (EC) on measures of psychological adaptation (e.g., helplessness, coping), mood disturbance, sleep quality, pro-inflammatory cytokines, and RA disease severity. An important feature of the CBT intervention is that it incorporates strategies to enhance mood and diminish depressive symptoms. TCC has recently shown promise as an effective intervention in increasing physical activity and health functioning in older adults. Because of its emphasis on relaxation and exercise, TCC offers an interesting theoretical contrast to CBT. Two Ph.D. level psychologists will administer the CBT and EC interventions, while a highly experienced TCC instructor will administer the TCC protocol. A total of 210 IRA patients will be randomly assigned after a pre-treatment evaluation to one of the three interventions and will be assessed again at Week 8 of treatment, at post-treatment (Weeks 16-17), 8-month follow-up, and 1-year follow-up. A primary objective of the study will be to compare the clinical efficacy of CBT and TCC against EC. CBT and TCC are expected to contribute to significantly greater improvement in psychosocial functioning and IRA disease severity than EC. CBT, in turn, is hypothesized to lead to greater improvement than TCC on clinical endpoints because it teaches a variety of skills that patients can use to manage RA. This study will also explore the mechanisms through which CBT and TCC promote improvement in IRA disease severity. We anticipate, for example, that improvement in RA disease severity resulting from CBT and TCC will be mediated by reductions in pro-inflammatory cytokines (IL-1, TNF, IL-6).