Behavioral Treatments for Rheumatoid Arthritis

描述（由申请人提供）：类风湿性关节炎（IRA）的行为干预对患者处理困难症状的能力和这种医学状况的其他需求产生了有益的影响。然而，RA的行为治疗对潜在疾病活动和情绪障碍的影响在很大程度上是不确定的。该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（如无助、应对）、情绪障碍、睡眠质量、促炎细胞因子和类风湿性关节炎疾病严重程度方面的措施。CBT干预的一个重要特征是它结合了改善情绪和减少抑郁症状的策略。TCC最近在增加老年人的身体活动和健康功能方面显示出有效干预的希望。由于强调放松和锻炼，TCC在理论上与CBT形成了有趣的对比。两位博士级别的心理学家将管理CBT和EC干预，而一位经验丰富的TCC讲师将管理TCC协议。总共210名IRA患者将在治疗前评估后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（16-17周）、8个月随访和1年随访时再次进行评估。该研究的主要目的是比较CBT和TCC治疗EC的临床疗效。与EC相比，CBT和TCC有望显著改善心理社会功能和IRA疾病严重程度。反过来，CBT被假设在临床终点上比TCC有更大的改善，因为它教授了患者可以用来治疗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）来介导。

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).