Two self-management interventions have promise for improving the health and adjustment of people with rheumatoid arthritis (RA): written emotional disclosure (ED) and coping skills training (CST). These approaches have evolved separately and not been compared, and an intervention that integrates ED with CST may be more effective than either one alone. The proposed study combines the expertise of two research teams to conduct a randomized, controlled trial of the integrated and separate effects of ED and CST for people with RA. Adults with RA (N = 280) will be randomized to one of four treatment groups in a 2 X 2 factorial design. One factor is six sessions of either ED (writing about stress, RA, and coping options) or its matched control, neutral writing. The second factor is 6 sessions of therapist-provided CST (teaching six pain and stress coping skills) or its matched control, nurse-provided arthritis education. Thus, the 4 treatments are: a) integrated ED / CST; b) ED (+ arthritis education); c) CST (+ neutral writing); and d) Control (neutral writing + arthritis education). A comprehensive battery of measures (pain, physical disability, psychological impairment, disease activity, physician ratings, C-reactive protein) will be assessed at baseline and 1-month, 3-month, and 12-month follow-ups, and potential mediators (self-efficacy, coping skill use, emotional approach coping) will be assessed via 30-day daily diary recordings prior to each assessment. Analyses will a) test whether the integrated treatment leads to better outcomes than either ED or CST alone; b) directly compare the efficacy of ED alone and CST alone; and c) compare each treatment with a control condition. Process measures will determine whether the integrated treatment enhances the content of patients' emotional disclosure and their participation in CST, and analyses of mediators will indicate whether the interventions have unique or common pathways. This research is key to the goal of developing theoretically-grounded, highly efficacious, and easily implemented self-management strategies to improve adjustment of people with RA and other pain conditions.
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