A randomized controlled trial of an internal family systems-based psychotherapeutic intervention on outcomes in rheumatoid arthritis: a proof-of-concept study.
OBJECTIVE
To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS) psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status.


METHODS
Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end.


RESULTS
Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects -14.9 (29.1 SD); p = 0.04], and physical function [14.6 (25.3); p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [-0.6 (1.1); p = 0.04], self-compassion [1.8 (2.8); p = 0.01], and depressive symptoms [-3.2 (5.0); p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity.


CONCLUSIONS
An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted. ClinicalTrials.gov identifier: NCT00869349.
From the Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School; Department of Psychiatry, Cambridge Health Alliance, Boston, Massachusetts; Center for Self Leadership, Oak Park, Illinois; and Department of Psychology, Massachusetts School of Professional Psychology, Boston, Massachusetts, USA.
Nancy A
NA
Shadick
Nancy F
NF
Sowell
Michelle L
ML
Frits
Suzanne M
SM
Hoffman
Shelley A
SA
Hartz
Fran D
FD
Booth
Martha
M
Sweezy
Patricia R
PR
Rogers
Rina L
RL
Dubin
Joan C
JC
Atkinson
Amy L
AL
Friedman
Fernando
F
Augusto
Christine K
CK
Iannaccone
Anne H
AH
Fossel
Gillian
G
Quinn
Jing
J
Cui
Elena
E
Losina
Richard C
RC
Schwartz
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012648:Self Care; D020377:Self Efficacy; D012720:Severity of Illness Index; D016896:Treatment Outcome
BEHAVIORAL MEDICINE; CLINICAL TRIALS; DEPRESSION; DISEASE ACTIVITY; PSYCHOTHERAPY; RHEUMATOID ARTHRITIS