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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 November 2013, 40 (11) 1831-1841; 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.
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  • For correspondence: nshadick@partners.org
Nancy F. Sowell
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Michelle L. Frits
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Suzanne M. Hoffman
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Shelley A. Hartz
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Fran D. Booth
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Martha Sweezy
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Patricia R. Rogers
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Rina L. Dubin
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Joan C. Atkinson
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Amy L. Friedman
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Fernando Augusto
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Christine K. Iannaccone
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Anne H. Fossel
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Gillian Quinn
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Jing Cui
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Elena Losina
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Richard C. Schwartz
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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. ClinicalTrials.gov identifier: NCT00869349.

Key Indexing Terms:
  • RHEUMATOID ARTHRITIS
  • DISEASE ACTIVITY
  • DEPRESSION
  • CLINICAL TRIALS
  • PSYCHOTHERAPY
  • BEHAVIORAL MEDICINE

Footnotes

  • Full Release Article. For details see Reprints/Permissions at jrheum.org

  • Supported by the Bristol Myers Squibb Foundation, ABBVIE, and Genentech.

  • Accepted for publication June 25, 2013.

Free online via JRheum Full Release option

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The Journal of Rheumatology
Vol. 40, Issue 11
1 Nov 2013
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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 Nov 2013, 40 (11) 1831-1841; DOI: 10.3899/jrheum.121465

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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 Nov 2013, 40 (11) 1831-1841; DOI: 10.3899/jrheum.121465
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Keywords

RHEUMATOID ARTHRITIS
DISEASE ACTIVITY
DEPRESSION
CLINICAL TRIALS
PSYCHOTHERAPY
BEHAVIORAL MEDICINE

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