title: Stress management in rheumatoid arthritis: what is the underlying mechanism?
abstract: OBJECTIVE
  To test whether change in cognitive-behavioral variables (such as self-efficacy, coping strategies, and helplessness) is a mediator in the relation between cognitive behavior therapy and reduced pain and depression in persons with rheumatoid arthritis (RA).
  
  
  METHODS
  A sample of patients with RA who completed a stress management training program (n = 47) was compared to a standard care control group (n = 45). A path analysis testing a model including direct effects of comprehensive stress management training on pain and depression and indirect effects via change in cognitive-behavioral variables was conducted.
  
  
  RESULTS
  The path coefficients for the indirect effects of stress management training on pain and depression via change in cognitive-behavioral variables were statistically significant, whereas the path coefficients for the direct effects were found not to be statistically significant.
  
  
  CONCLUSIONS
  Decreases in pain and depression following stress management training are due to beneficial changes in the arenas of self-efficacy (the belief that one can perform a specific behavior or task in the future), coping strategies (an individual's confidence in his or her ability to manage pain), and helplessness (perceptions of control regarding arthritis). There is little evidence of additional direct effects of stress management training on pain and depression.
authors.affiliation: Harry S. Truman Memorial Veterans' Hospital, 800 Hospital Drive, Columbia, MO 65201, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Rhee
authors.forename: J C
authors.initials: JC
authors.lastname: Parker
authors.forename: K L
authors.initials: KL
authors.lastname: Smarr
authors.forename: G F
authors.initials: GF
authors.lastname: Petroski
authors.forename: J C
authors.initials: JC
authors.lastname: Johnson
authors.forename: J E
authors.initials: JE
authors.lastname: Hewett
authors.forename: G E
authors.initials: GE
authors.lastname: Wright
authors.forename: K D
authors.initials: KD
authors.lastname: Multon
authors.forename: S E
authors.initials: SE
authors.lastname: Walker
mesh_terms: D000223:Adaptation, Psychological; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000523:psychology*; D016009:Chi-Square Distribution; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D005163:Factor Analysis, Statistical; D006380:Helplessness, Learned; D006801:Humans; D007389:Internal-External Control; D008875:Middle Aged; D008960:Models, Psychological; D015999:Multivariate Analysis; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D016896:Treatment Outcome