Evers Andrea W M, Kraaimaat Floris W, van Riel Piet L C M, de Jong Alphons J L
Department of Medical Psychology, University Medical Center St Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Pain. 2002 Nov;100(1-2):141-53. doi: 10.1016/s0304-3959(02)00274-9.
Recent developments in chronic pain research suggest that effectiveness of cognitive-behavioral therapy (CBT) may be optimized when applying early, customized treatments to patients at risk. For this purpose, a randomized, controlled trial with tailor-made treatment modules was conducted among patients with relatively early rheumatoid arthritis (RA disease duration of <8 years), who had been screened for psychosocial risk profiles. All participants received standard medical care from a rheumatologist and rheumatology nurse consultant. Patients in the CBT condition additionally received an individual CBT treatment with two out of four possible treatment modules. Choice of treatment modules was determined on the basis of patient priorities, which resulted in most frequent application of the fatigue module, followed by the negative mood, social relationships and pain and functional disability modules. Analyses of completers and of intention-to-treat revealed beneficial effects of CBT on physical, psychological and social functioning. Specifically, fatigue and depression were significantly reduced at post-treatment and at the 6-month follow-up in the CBT condition in comparison to the control condition, while perceived support increased at follow-up assessment. In addition, helplessness decreased at post-treatment and follow-up assessment, active coping with stress increased at post-treatment, and compliance with medication increased at follow-up assessment in the CBT condition in comparison to the control condition. Results indicate the effectiveness of tailor-made CBT for patients at risk in relatively early RA, and supply preliminary support for the idea that customizing treatments to patient characteristics may be a way to optimize CBT effectiveness in RA patients.
慢性疼痛研究的最新进展表明，对有风险的患者尽早应用定制化治疗，认知行为疗法（CBT）的效果可能会得到优化。为此，在类风湿关节炎相对早期（疾病持续时间<8年）且已筛查心理社会风险状况的患者中进行了一项采用量身定制治疗模块的随机对照试验。所有参与者均接受了风湿病学家和风湿病护理顾问提供的标准医疗护理。接受CBT治疗的患者还额外接受了由四个可能的治疗模块中的两个组成的个体化CBT治疗。治疗模块的选择是根据患者的优先事项确定的，结果最常应用的是疲劳模块，其次是负面情绪、社会关系以及疼痛和功能障碍模块。对完成治疗者和意向性治疗的分析显示，CBT对身体、心理和社会功能有有益影响。具体而言，与对照组相比，在CBT组中，治疗后和6个月随访时疲劳和抑郁显著减轻，而在随访评估时感知到的支持增加。此外，与对照组相比，在CBT组中，治疗后和随访评估时无助感降低，治疗后积极应对压力增加，随访评估时药物依从性增加。结果表明，量身定制的CBT对类风湿关节炎相对早期有风险的患者有效，并为根据患者特征定制治疗可能是优化类风湿关节炎患者CBT效果的一种方法这一观点提供了初步支持。
