POS0300 DOES COGNITIVE BEHAVIORAL THERAPY IMPROVE PSYCHOSOCIAL OUTCOME IN RHEUMATOID ARTHRITIS: A SYSTEMATIC LITERATURE REVIEW
Authors: Van Breda A. , De Cock D. , Vervloesem C. , Doumen M. , Bertrand D. , Pazmino S. , Westhovens R. , Verschueren P. 
Published: May 2021

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory auto-immune disease impacting both physical and mental wellbeing of patients. Cognitive behavioral therapy (CBT), a psycho-social intervention aiming to revert maladaptive thinking and dysfunctional behavior, could improve psychosocial wellbeing in patients with RA. However, it is unclear which CBT components are most successful in improving wellbeing and if certain subpopulations might be more sensitive to CBT therapy.

Objectives:

To summarize in a systematic literature review, the effect of CBT on psychosocial outcomes in RA, focussing on most successful components and which patient subgroups benefit most from CBT.

Methods:

A search was conducted with the support of a health sciences librarian at the KU Leuven Biomedical Library from inception until 28.06.2020 in 5 electronic databases: PubMed, EMBASE, Web of Science Core Collection, Cochrane Library and Cumulated Index to Nursing and Allied Health Literature (CINAHL). We included studies in English and Dutch involving patients >18 years old with RA, using cognitive behavioral approaches as intervention, with outcomes related to psychosocial variables. Two reviewers (CV&AVB) independently screened first the titles and abstracts of the studies, and later the full texts for eligibility. A third reviewer (DDC) was consulted if no consensus was found. Quality was assessed by the Critical Appraisals Skills Programme (CASP) RCT checklist.

Results:

In total, 18 of 1114 retrieved articles could be included (Table 1). Mean age of the participants ranged between 48-63 years with a mean disease duration between 13-16 years. The most used CBT techniques included relaxation training, attention diversion strategies, problem solving skills, goal setting, communication, and social skills training. CBT resulted in ameliorated psychosocial wellbeing related to more active coping styles, improved self-efficacy and reduced perception of disease stressors. Six/18 studies focused on a Ra patient subgroup with an increased psychosocial risk profile, such as high levels of depression. There was limited evidence for an improved treatment effect in these patients because of the elevated levels of psychological distress, but internal motivation seemed key for success.

Table 1.

Included studies

First AuthorYearCountryPopulationMean ageOutcomes assessedO`Leary1988USAN=3049ySelf-efficacy, Depression, Loneliness, perceived stressRadojevic1992USAN=5954yDepression, Anxiety, Pain copingGermond1993SAN=2449yCoping, Health Control, Stress, Mood, ImpactParker1995USAN=14160yLife stress, Daily stressors, helplessness, depression, anxiety, self-efficacy, impactKraaimaat1995NLN=4357yAnxiety, Depression, Social Support, Pain CopingSharpe2001UKN=5556yAnxiety, Depression, CopingEvers2002NLN=6454yAnxiety, Negative mood, Social functioning, Illness cognitions, coping, pain, complianceParker2003USAN=5456yDepression, Stressors, Stress, Anxiety, Helplessness, Self-efficacyVan Lankveld2004NLN=5850yDepression, Anxiety, Stressors, Coping, Social SupportZautra2008USAN=14252yAffect, Depression, Coping, Pain, CatastrophizingHammond2008UKN=16755ySelf-efficacy, distress, Control, Self-ManagementBarsky2010USAN=16853yDistressHewlett2011UKN=11760yAnxiety, Depression, FatigueSharpe2012AUN=10456yAnxiety, DepressionGarnefski2013NL, BEN=8248yDepression, Anxiety, Self-efficacyLumley2014USAN=26655yAnxiety, DepressionVermaak2015AUN=11354yDepression, Anxiety, Self-Efficacy, Distress, QoLHewlett2019UKN=31963yFatigue, Mood, QoL, Self-Efficacy, Helplessness

Conclusion:

Adding CBT to standard care induces modest improvements in psychosocial outcomes for patients with RA. CBT seems more successful if patients are motivated to reflect on their cognitions and behaviours. However, more research with large-scale studies, focusing also on the critical early disease phase, is needed to investigate the long-term benefits of CBT.

Disclosure of Interests:

None declared