Behavioral interventions for rheumatoid arthritis (IRA) have had a salutary impact on patients' ability to manage difficult symptoms and other demands of this medical condition. Yet, the effects of behavioral treatments for RA on underlying disease activity and mood disturbance are largely undetermined. The proposed project compares cognitive-behavioral therapy (CBT), Tai Chi Chih (TCC), a form of movement-based meditation, and education control (EC) on measures of psychological adaptation (e.g., helplessness, coping), mood disturbance, sleep quality, pro-inflammatory cytokines, and RA disease severity. An important feature of the CBT intervention is that it incorporates strategies to enhance mood and diminish depressive symptoms. TCC has recently shown promise as an effective intervention in increasing physical activity and health functioning in older adults. Because of its emphasis on relaxation and exercise, TCC offers an interesting theoretical contrast to CBT. Two Ph.D. level psychologists will administer the CBT and EC interventions, while a highly experienced TCC instructor will administer the TCC protocol. A total of 210 IRA patients will be randomly assigned after a pre-treatment evaluation to one of the three interventions and will be assessed again at Week 8 of treatment, at post-treatment (Weeks 16-17), 8-month follow-up, and 1-year follow-up. A primary objective of the study will be to compare the clinical efficacy of CBT and TCC against EC. CBT and TCC are expected to contribute to significantly greater improvement in psychosocial functioning and IRA disease severity than EC. CBT, in turn, is hypothesized to lead to greater improvement than TCC on clinical endpoints because it teaches a variety of skills that patients can use to manage RA. This study will also explore the mechanisms through which CBT and TCC promote improvement in IRA disease severity. We anticipate, for example, that improvement in RA disease severity resulting from CBT and TCC will be mediated by reductions in pro-inflammatory cytokines (IL-1, TNF, IL-6). ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR049840-04
Application #
7117631
Study Section
Special Emphasis Panel (ZRG1-RPHB-3 (01))
Program Officer
Serrate-Sztein, Susana
Project Start
2003-08-01
Project End
2008-07-31
Budget Start
2006-08-01
Budget End
2007-07-31
Support Year
4
Fiscal Year
2006
Total Cost
$326,254
Indirect Cost
Name
University of California Los Angeles
Department
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Ormseth, Sarah R; Draper, Taylor L; Irwin, Michael R et al. (2015) Multidimensional Model of Disability and Role Functioning in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 67:1686-92
Nicassio, Perry M; Ormseth, Sarah R; Custodio, Mara K et al. (2014) Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in rheumatoid arthritis patients. Behav Sleep Med 12:1-12
Nicassio, Perry M; Ormseth, Sarah R; Custodio, Mara K et al. (2012) A multidimensional model of fatigue in patients with rheumatoid arthritis. J Rheumatol 39:1807-13
Nicassio, Perry M; Ormseth, Sarah R; Kay, Morgan et al. (2012) The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis. Pain 153:107-12
Nicassio, Perry M; Kay, Morgan A; Custodio, Mara K et al. (2011) An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis. J Psychosom Res 71:79-85
Nicassio, Perry M (2010) Arthritis and psychiatric disorders: disentangling the relationship. J Psychosom Res 68:183-5
Weinberg, Adriana; Zhang, Jane H; Oxman, Michael N et al. (2009) Varicella-zoster virus-specific immune responses to herpes zoster in elderly participants in a trial of a clinically effective zoster vaccine. J Infect Dis 200:1068-77
Levin, M J; Oxman, M N; Zhang, J H et al. (2008) Varicella-zoster virus-specific immune responses in elderly recipients of a herpes zoster vaccine. J Infect Dis 197:825-35
Irwin, Michael R; Cole, Jason C; Nicassio, Perry M (2006) Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychol 25:3-14
Cole, Jason C; Motivala, Sarosh J; Khanna, Dinesh et al. (2005) Validation of single-factor structure and scoring protocol for the Health Assessment Questionnaire-Disability Index. Arthritis Rheum 53:536-42