title: A mindfulness-based group intervention to reduce psychological distress and fatigue in patients with inflammatory rheumatic joint diseases: a randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effects of a mindfulness-based group intervention, the Vitality Training Programme (VTP), in adults with inflammatory rheumatic joint diseases.
  
  
  METHODS
  In a randomised controlled trial, the VTP-a 10-session mindfulness-based group intervention including a booster session after 6 months-was compared with a control group that received routine care plus a CD for voluntary use with mindfulness-based home exercises. The primary outcome was psychological distress measured by the General Health Questionnaire-20. Self-efficacy (pain and symptoms) and emotion-focused coping (emotional processing and expression) were used as co-primary outcomes. Secondary outcomes included pain, fatigue, patient global disease activity, self-care ability and well-being. Effects were estimated by mixed models repeated measures post-intervention and at 12-month follow-up.
  
  
  RESULTS
  Of 73 participants randomised, 68 completed assessments post-intervention and 67 at 12 months. Significant treatment effects in favour of the VTP group were found post-treatment and maintained at 12 months in psychological distress (adjusted mean between-group difference -3.7, 95% CI -6.3 to -1.1), self-efficacy pain (9.1, 95% CI 3.4 to 14.8) and symptoms (13.1, 95% CI 6.7 to 19.3), emotional processing (0.3, 95% CI 0.02 to 0.5), fatigue (-1.1, 95% CI -1.8 to -0.4), self-care ability (1.0, 95% CI 0.5 to 1.6) and overall well-being (0.6, 95% CI 0.1 to 1.2). No significant group differences were found in emotional expression, pain or disease activity.
  
  
  CONCLUSIONS
  The VTP improved most primary and secondary outcomes compared with individual use of CD exercises. Improvements were maintained at 12 months, suggesting that the VTP is a beneficial complement to existing treatments for patients with inflammatory rheumatic joint diseases.
authors.affiliation: National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. heidi.zangi@diakonsyk.no
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Zangi
authors.forename: Petter
authors.initials: P
authors.lastname: Mowinckel
authors.forename: Arnstein
authors.initials: A
authors.lastname: Finset
authors.forename: Liv R
authors.initials: LR
authors.lastname: Eriksson
authors.forename: Turid Ø
authors.initials: TØ
authors.lastname: Høystad
authors.forename: Anne Kristine
authors.initials: AK
authors.lastname: Lunde
authors.forename: Kåre B
authors.initials: KB
authors.lastname: Hagen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D000368:Aged; D001155:Art Therapy / Q000379:methods; D001364:Awareness; D005221:Fatigue / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009147:Music Therapy / Q000379:methods; D011615:Psychotherapy, Group / Q000379:methods*; D012216:Rheumatic Diseases / Q000150:complications / Q000276:immunology / Q000523:psychology*; D020377:Self Efficacy; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult