Research ArticleArticle
Open Access
A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study
Nancy A. Shadick, Nancy F. Sowell, Michelle L. Frits, Suzanne M. Hoffman, Shelley A. Hartz, Fran D. Booth, Martha Sweezy, Patricia R. Rogers, Rina L. Dubin, Joan C. Atkinson, Amy L. Friedman, Fernando Augusto, Christine K. Iannaccone, Anne H. Fossel, Gillian Quinn, Jing Cui, Elena Losina and Richard C. Schwartz
The Journal of Rheumatology August 2013, jrheum.121465; DOI: https://doi.org/10.3899/jrheum.121465
Nancy A. Shadick
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Nancy F. Sowell
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Michelle L. Frits
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Suzanne M. Hoffman
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Shelley A. Hartz
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Fran D. Booth
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Martha Sweezy
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Patricia R. Rogers
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Rina L. Dubin
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Joan C. Atkinson
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Amy L. Friedman
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Fernando Augusto
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Christine K. Iannaccone
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Anne H. Fossel
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Gillian Quinn
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Jing Cui
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Elena Losina
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Richard C. Schwartz
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. Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech. N.A. Shadick, MD, MPH, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; N.F. Sowell, MSW, Department of Psychiatry, Cambridge Health Alliance; M.L. Frits, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; S.M. Hoffman, PhD; S.A. Hartz, RN, MSN, CS; F.D. Booth, MSW, Center for Self Leadership; M. Sweezy, PhD, Department of Psychiatry, Cambridge Health Alliance; P.R. Rogers, MSW; R.L. Dubin, Ed.D; J.C. Atkinson, MSW; A.L. Friedman, MSW; F. Augusto, PhD, Center for Self Leadership; C.K. Iannaccone, MPH; A.H. Fossel, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; G. Quinn, Department of Psychology, Massachusetts School of Professional Psychology; J. Cui, PhD; E. Losina, PhD, Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Harvard Medical School; R.C. Schwartz, PhD, Center for Self Leadership. Address correspondence to Dr. N.A. Shadick, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA. E-mail: nshadick@partners.org. Full Release Article. For details see Reprints/Permissions at jrheum.org. Accepted for publication June 25, 2013.
Abstract
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.
Conclusion 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. Clinical Trials.gov identifier: NCT00869349.
In this issue
The Journal of Rheumatology
Vol. 47, Issue 5
1 May 2020
A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study
Nancy A. Shadick, Nancy F. Sowell, Michelle L. Frits, Suzanne M. Hoffman, Shelley A. Hartz, Fran D. Booth, Martha Sweezy, Patricia R. Rogers, Rina L. Dubin, Joan C. Atkinson, Amy L. Friedman, Fernando Augusto, Christine K. Iannaccone, Anne H. Fossel, Gillian Quinn, Jing Cui, Elena Losina, Richard C. Schwartz
The Journal of Rheumatology Aug 2013, jrheum.121465; DOI: 10.3899/jrheum.121465
A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study
Nancy A. Shadick, Nancy F. Sowell, Michelle L. Frits, Suzanne M. Hoffman, Shelley A. Hartz, Fran D. Booth, Martha Sweezy, Patricia R. Rogers, Rina L. Dubin, Joan C. Atkinson, Amy L. Friedman, Fernando Augusto, Christine K. Iannaccone, Anne H. Fossel, Gillian Quinn, Jing Cui, Elena Losina, Richard C. Schwartz
The Journal of Rheumatology Aug 2013, jrheum.121465; DOI: 10.3899/jrheum.121465
