title: Health and physiological effects of an emotional disclosure intervention adapted for application at home: a randomized clinical trial in rheumatoid arthritis.
abstract: BACKGROUND
  The efficacy of emotional disclosure in alleviating psychological and physical stress has been well documented in controlled laboratory studies. A next step is to evaluate its clinical utility in 'real world' settings. We adapted the emotional disclosure intervention for use in home-based settings by stimulating the suggested effective ingredients of cognitive-emotional processing, and evaluated its psychological and clinical effectiveness. Reviews indicated the need to examine the physiological changes brought about by emotional disclosure, which may be particularly relevant in immune-mediated diseases. This study was the first to examine neuroendocrine and immune changes after emotional disclosure in patients with rheumatoid arthritis.
  
  
  METHODS
  Sixty-eight patients were randomly assigned to four weekly oral emotional disclosure or time management sessions. At baseline and 1 week and 3 months after the sessions, depressed and cheerful mood, joint scores, erythrocyte sedimentation rate, cortisol, noradrenaline, interleukin-6 (IL-6), interferon-gamma (IFN-gamma), and IL-10 were evaluated. Repeated measures analyses of variance were performed.
  
  
  RESULTS
  No effect on psychological well-being and clinical outcome was found (p > or = 0.10). Cortisol (p = 0.01) and the serum level of the pro-inflammatory cytokine IFN-gamma (p = 0.05) were differentially affected by the two conditions. The change of IL-6 nearly reached significance (p = 0.07).
  
  
  CONCLUSIONS
  The physiological changes are in agreement with theories on the mechanisms underlying emotional disclosure benefits and are suggestive of better disease control after emotional disclosure. General and study-specific reasons for the absence of psychological and clinical effects are discussed. The findings warn against widespread implementation of this home-based emotional disclosure intervention in unselected rheumatoid arthritis samples.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands. H.vanMiddendorp@uu.nl
authors.forename: Henriët
authors.initials: H
authors.lastname: van Middendorp
authors.forename: Rinie
authors.initials: R
authors.lastname: Geenen
authors.forename: Marjolijn J
authors.initials: MJ
authors.lastname: Sorbi
authors.forename: Lorenz J P
authors.initials: LJ
authors.lastname: van Doornen
authors.forename: Johannes W J
authors.initials: JW
authors.lastname: Bijlsma
mesh_terms: D000339:Affect; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000523:psychology*; D001799:Blood Sedimentation; D003863:Depression / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006304:Health Status; D006699:Home Care Services; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007371:Interferon-gamma / Q000097:blood*; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010446:Peptide Fragments / Q000097:blood*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure
chemical_list: D015850:Interleukin-6; D010446:Peptide Fragments; C069261:interferon gamma (1-39); D016753:Interleukin-10; D007371:Interferon-gamma; D006854:Hydrocortisone; D009638:Norepinephrine