A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study

Summary & key facts

This study randomly assigned 79 people with rheumatoid arthritis to either a 9-month Internal Family Systems (IFS) group therapy or to an education-only control. After treatment, the IFS group showed gains in overall pain and physical function, and one year later they still showed small improvements in self-reported joint pain, self-compassion, and depressive symptoms. There were no lasting improvements in anxiety, self-efficacy, or the doctors’ measure of disease activity. The authors say IFS was feasible and acceptable and that larger efficacy trials are needed.

Key facts:

• 79 people with rheumatoid arthritis were randomized: 39 to the IFS group and 40 to the education (control) group.
• 68 of the 79 participants completed the study assessments. 82% of those assigned to the IFS group completed the IFS protocol.
• The intervention lasted 9 months. The control group received mailed educational materials about RA.
• At the end of treatment, the IFS group had better overall pain scores versus control: mean treatment effect −14.9 (SD 29.1), p = 0.04 (lower = less pain).
• At the end of treatment, the IFS group had better physical function versus control: mean treatment effect 14.6 (SD 25.3), p = 0.04 (higher = better function).
• One year after the intervention ended, the IFS group still showed small improvements in self-reported joint pain (−0.6, SD 1.1; p = 0.04), self-compassion (+1.8, SD 2.8; p = 0.01), and depressive symptoms (BDI change −3.2, SD 5.0; p = 0.01)
• There were no sustained improvements in anxiety scores, self-efficacy scores, or in the blinded rheumatologist-measured disease activity (DAS28-CRP4).
• Rheumatologists who measured joint counts and the DAS28-CRP4 were blinded to which group participants were in, reducing bias in the clinical disease activity measure.
• The authors concluded the IFS-based intervention was feasible and acceptable to patients with RA and recommended future, larger trials to test efficacy.

Abstract

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.

Topics

Autoimmune and Inflammatory Disorders Research Mental Health Treatment and Access Rheumatoid Arthritis Research and Therapies

Categories

Health Sciences Medicine Rheumatology

Tags

Anxiety Beck Depression Inventory Depression (economics) Economics Internal medicine Macroeconomics Medicine Physical therapy Psychiatry Randomized controlled trial Rheumatoid arthritis Visual analogue scale