title: An acceptance-oriented cognitive-behavioral therapy in multimodal rehabilitation: a pre-post test evaluation in highly distressed patients with rheumatic diseases.
abstract: OBJECTIVE
  To examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases.
  
  
  METHODS
  An observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters.
  
  
  RESULTS
  Significant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ≥ 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients.
  
  
  CONCLUSIONS
  The patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment.
  
  
  CONCLUSIONS
  A randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation.
authors: Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands. j.vriezekolk@maartenskliniek.nl
authors: Johanna E
authors: JE
authors: Vriezekolk
authors: Agnes M M
authors: AM
authors: Eijsbouts
authors: Wim G J M
authors: WG
authors: van Lankveld
authors: Hanneke
authors: H
authors: Beenackers
authors: Rinie
authors: R
authors: Geenen
authors: Cornelia H M
authors: CH
authors: van den Ende
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D055500:Resilience, Psychological; D012216:Rheumatic Diseases / Q000523:psychology* / Q000534:rehabilitation; D013315:Stress, Psychological / Q000628:therapy*; D011795:Surveys and Questionnaires; D055815:Young Adult