title: A randomized, controlled trial of emotional disclosure in rheumatoid arthritis: can clinician assistance enhance the effects?
abstract: Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: (a) private verbal emotional disclosure; (b) clinician-assisted verbal emotional disclosure; (c) arthritis information control (all of which engaged in four, 30-min laboratory sessions); or (d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure vs. clinician-assisted disclosure at the 2-month follow-up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.
authors.affiliation: Duke Pain Prevention and Treatment Research Program, Box 3159, Duke University Medical Center, Durham, NC 27708, USA Department of Psychology, Ohio University, Athens, OH 45701, USA Department of Psychology, Wayne State University, Detroit, MI 48202, USA University of Connecticut Health Center, Farmington, CN 06030, USA.
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Timothy
authors.initials: T
authors.lastname: Anderson
authors.forename: Mark
authors.initials: M
authors.lastname: Lumley
authors.forename: David
authors.initials: D
authors.lastname: Caldwell
authors.forename: David
authors.initials: D
authors.lastname: Stainbrook
authors.forename: Daphne
authors.initials: D
authors.lastname: Mckee
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Waters
authors.forename: Mark
authors.initials: M
authors.lastname: Connelly
authors.forename: Glenn
authors.initials: G
authors.lastname: Affleck
authors.forename: Mary Susan
authors.initials: MS
authors.lastname: Pope
authors.forename: Marianne
authors.initials: M
authors.lastname: Weiss
authors.forename: Paul A
authors.initials: PA
authors.lastname: Riordan
authors.forename: Brian D
authors.initials: BD
authors.lastname: Uhlin
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000523:psychology*; D030881:Disclosure / Q000639:trends; D004644:Emotions / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology*