Two self-management interventions have promise for improving pain, disability, mood, and disease activity for people with rheumatoid arthritis (RA): emotional disclosure (ED) via expressive writing about stressful experiences, and pain coping skills training (CST). Yet, these two interventions have evolved separately, studies have not compared their relative efficacy, and the combination of the two may be more effective than either ED or CST alone. Also, research needs to clarify the processes by which these interventions operate (mediators) and patient characteristics that predict success with each intervention (moderators). This investigation is a randomized, controlled trial of the separate and combined effects of ED and CST. It also examines two potential mediators (intrusive / avoidant thoughts and self-efficacy) and a potential moderator (alexithymia) that are thought to relate differently to each intervention. Adults with RA (N = 280) will be randomly assigned to 1 of 4 treatment groups in a 2 X 2 factorial design. One factor is 4 days of written ED or its matched control, neutral writing, and the second factor is 8 weeks of CST or its matched control, arthritis information. The 4 groups are: a) combined intervention (ED followed by CST); b) ED alone (ED followed by arthritis information); c) CST alone (neutral writing followed by CST); and d) Control Group (neutral writing followed by arthritis information). Patients will complete a comprehensive battery of measures assessing pain, physical disability, psychological impairment, and disease activity at baseline and 1-month, 3-month, and 12-month follow-ups, along with mediator and moderator measures. Analyses will compare each separate intervention with the control condition, directly compare the efficacy of ED with CST, and determine whether the combined treatment leads to better outcomes than either intervention alone. Analyses of mediators will indicate whether the interventions have unique or common pathways, and analyses of the moderator will indicate which patients are most likely to benefit from each approach. This research is key to the goal of developing highly efficacious, patient-matched, and easily implemented self-management strategies to reduce the pain and improve adjustment of people with RA and other rheumatic diseases.
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