Efficacy of Stress Management Intervention on Psychological, Immune Factors and Pain in Rheumatoid Arthritis Patients

Document Type: research

Authors

1 PHD student of Psycholog, Payam Noor University

2 Associate of Psychology, Tehran University

3 Professor of Psychology, Payam Noor University

4 Spatiality of Rheumatology Associate of Bagyat Allah University

Abstract

Abstract
Background: In this survey, the intervention of cognitive behavioral stress management (CBSM) on psychological and immune indices and pain in patients with Rheumatoid Arthritis is studied. Method: Statistical population of the study consisted of patients who referred to the rheumatology clinics in the northern parts of Tehran.  44 participants aged 25–60 using purposive sampling in accordance with inclusion and exclusion criteria selected and in two groups of 22 individuals were examined. Psychological, immune and pain evaluation tests of depression, anxiety and stress scale, blood sample, and McGill pain inventory were conducted in two stages of pretest and posttest using multiple covariance analysis. Results: The results showed a significant effect of the stress management intervention on depression (F1,37=4/318, P= 0/046, η=0/104) among patients with RA. The use of this intervention was effective in reducing the immune parameter (CRP) (F1,38= 17/593, P= 0/001, η=0/316) and their pain (F1,39= 4/885, P= 0/033, η=0/111)Conclusion: According to the results, employing this method for RA patients is very helpful and it can be suggested for improving their psychological and physical conditions.

Keywords


Article Title [Persian]

اثر بخشی روش مداخله مدیریت استرس شناختی-رفتاری بر شاخص های ایمنی ، روانشناختی و میزان درد بیماران مبتلا به آرتریت روماتوئید

Authors [Persian]

  • فاطمه ناظمی 1
  • هادی بهرامی احسان 2
  • احمد علیپور 3
  • نوشین بیات 4
1 دانشجوی دکتری دانشگاه پیام نور
2 دانشیار دانشگاه تهران
3 استاد دانشگاه پیام نور
4 دانشیار دانشگاه بقیه الله
Abstract [Persian]

این پژوهش به بررسی اثربخشی مداخله مدیریت استرس شناختی- رفتاری برشاخص های ایمنی ، روانشناختی   و میزان درد، در بین بیماران مبتلا به آرتریت روماتوئید پرداخ است. جامعه آماری مطالعه مشتمل بر مراجعه کنندگان به دو کلینیک روماتولوژی در مرکز و شمال شهر تهران می باشد. در این بین 44 نفر از بیماران آرتریت روماتوئید با استفاده از نمونه گیری هدفمند با رعایت ملاک های ورود و خروج انتخاب شدند و در قالب دو گروه 22 نفره مورد مطالعه قرار گرفتند. ارزیابی شاخص های روان شناختی ، ایمنی و احساس درد در این دو گروه  به ترتیب با استفاده از آزمون افسردگی ،اضطراب و استرس(DASS) ، نمونه گیری خون و فرم کوتاه ارزیابی درد مکگیل در دو نوبت پیش آزمون و پس آزمون صورت گرفت. با بهره گیری از روش تحلیل کوواریانس چند متغیری ، نتایج حاکی از تأثیر معنی دار مدیریت استرس بر شاخص روان شناختی افسردگی و کاهش احساس درد بیماران RA بود. همچنین استفاده از این روش مداخله در کاهش شاخص ایمنیCRP نیز مؤثر شناخته شد. با توجه به نتایج بدست آمده، پرداختن و مطالعه کردن در این زمینه و تقویت این بعد از سلامت بسیار مهم و ضروری است.

Keywords [Persian]

  • مداخله مدیریت استرس شناختی-رفتاری
  • شاخص های روانشناختی
  • شاخص های ایمنی
  • درد و آرتریت روماتوئید
References Alishiri, GH. (2013). Rheumatoid arteritis and patients. Tehran: Specialized media press, [in Persian] Allan, J.L., Johnston, D.W., Johnston, M.,& Mant, D. (2007). Depression and perceived behavioral control are independent predictors of future activity and fitness after coronary syndrome events. Journal of Psychosomatic Research, 63,501– 8. Antoni, M.H.(2003). Stress management intervention for women with breast cancer. American psychological association: Washington, D.C Astin, J.A., Beckner, W., Soeken, K., Hochberg, M.C., & Berman, B.(2002). Psychological interventions for rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheumatoid, 47, 291–302. Barlow, J.H., Turner, A.P., & Wright, C.C. (2000). A randomized controlled study of the arthritis selfmanagement program in the UK. Health Education Research, 15, 665– 80. Barsky, A.J., Alern, D.K., Orav, E.J., Nestoriuc, Y., Liag, M.H., Berman, I.T.,Wilk, K.G., & etal. (2010). A randomized trail of three psychosocial treatments for the symptoms of rheumatoid arthritis. Semin arthritis rheumatology ,40(3),222-232. doi:10.1016/j.semarthrit.2010.04.001 Ching Lok, E. Y., Mok, C. C., Cheng, C. W., & Chi Cheung, E. F. (2010). Prevalence and Determinants of Psychiatric Disorders in Patients With Rheumatoid Arthritis. Psychosomatics, 51(4), 338- 338.e338. doi: http://dx.doi.org/10.1016/S0033- 3182(10)7005-2 Conrad, A., & Roth, W.T. (2007). Muscle relaxation therapy for anxiety disorders: It works but how? Journal Anxiety Disorder, 21, 243–64. Connelly, M., Keefe, F. J., Affleck, G., Lumley, M. A., Anderson, T., & Waters, S. (2007). Effects of dayto-day affect regulation on the pain experience of patients with rheumatoid arthritis. Pain, 131(1–2), 162-170. doi: http://dx.doi.org/10.1016 /j.pain.2007. 01.002 De Brower, S.J.M., Kraaimaat, F.W., Sweep, F.C.G.,Donders, R.T., Eijsbouts A., Van Koulil, S., & et al.(2011). Psychophysiological responses to stress after stress management training in patients with rheumatoid arthritis.www.plosone. org.6e27432, 6(12),1-10. Dixon, K.E., Keefe, F.J., Scipio, C.D., Perri, L.C., & Abernethy, A.P. (2007). Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychology, 26, 241–50. Daneshvari Fard, A., Mojtabaei, M.(2016). The effect of cognititve behavioral stress management and psychological well-being and adherence to treatment inpatient with coronery heart disease. International journal of humanities and cultural studies,271-283. http://www.ijhcs.com /index. php/ ijhcs/index Evers, A. W. M., Kraaimaat, F. W., Geenen, R., Jacobs, J. W. G., & Bijlsma, J. W. J. (2003). Stress– vulnerability factors as long-term predictors of disease activity in early rheumatoid arthritis. Journal of Psychosomatic Research, 55(4), 293-302. doi: http://dx.doi.org/10.1016/S0022-3999(02)00632- 3 Fauci, A.S.(2008). Harrison’ s principles of internal medicine 17nded.translated by Khatavee F, Zareh E. Tehran:Samat press, 150-190 Fortune, G., Barrowclough, C., & Lobban, F. (2004). Illness representations in depression. British Journal of Clinical Psychology,43, 347– 64. Horowitz,M.J.(1986). Stress response syndromes. Aronson :New York House, J.S., Landis, K.R., Umberson, D.(1988).social relationships and health. science, 241, 540-545 Hammon, A., Bryan, J., & Hardy, A.(2008).effects of a modular behavioral arthritis education program: a pragmatic parallel- group randomized control trial. Rheumatology,47,1712-1718. doi:10.1093/rheumatology/ken380 Holt-Lunstad, J., Steffen, P.R., Sandberg, J., Jensen, B.(2011). Understanding the connection between spiritual well-being and physical health: an examination of ambulatory blood pressure, inflammation, blood lipids and fasting glucose. Journal Behavioral Medicine, 34(6),477-488. doi: 10.1007/ s 10865-011-9343-7. Hall, D.H.(2016).effects of telephone-delivered cognitive-behavioral stress management intervention on fatigue interference and neuroimmune function in chronic fatigue syndromes. Open access dissertation. 1708. http:// scholarly repository.miamai.edu/oadissertations/1708 Herschbach, P., Berg, P., Waadt, S., Duran, G., EngstHastreiter, U., Henrich, G., & et al.(2010). Group of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychotherapy and psychosomatic,79,31-38.Doi:10.1159/000254903 Imran,M.Y., Anwer Khan, S.E., Mir Ahmad, N., Raja, S.F., Saeed, M.A., & Haider, I.I.(2015).Depression in rheumatoid arthritis and in relation to disease activity. Pakistanian journal medical science, 31(2), 393-397. Doi : http:// dx. doi.org/10. 12669/pjms.312.6589 Iwata, M., Ota, K. T., & Duman, R. S. (2013). The inflammasome: Pathways linking psychological stress, depression, and systemic illnesses. Brain, Behavior, and Immunity, 31 (0), 105-114. doi: http://dx.doi.org/10.1016 /j. bbi.2012.12.008 Janoff- Bulman, R.(1992). Shattered assumptions: towards a new psychology, Free press: NewYork Kelley,G.A., Kelley,S.K., & Hootman, J.M. (2015). Effects of exercise on depression in adults with arthritis : a systemic review with meta-analysis of randomized controlled trails. Arthritis research & therapy. http://dx.doi.org /10.11 86/s13075-015- 0533-5 Keshavarz, M., Dadgaree, A., Miri, F.(2009). Evaluation short form MC Gill pain In cancer patient: a brief report .Tehran university medical journal; 71(1):53- 58[in Persian] Khosravi, M., Sedigi, S., Moradi, Sh .(2013). PersianMc Gill pain questionnaire; translation, adaption and reliability questionnaire in prim parous pregnant women to the Fatemiyah hospital. Journal of Knowledge and health; 2(2):1-4[in Persian] Kirby, E.D., Williams, V.P., Hocking, M.C., Lane, BA, J.D., & Williams,R.B. (2006) . Psychosocial benefits of three formats of a standardized behavioral stress management program. Psychosomatic medicine, 68,816-823.http://doi 0033-3174/06/6806-0816 Kinttle, K., Maes, S., & De Gucht, V. (2010). Psychological interventions for rheumatoid arthritis: Examining the role of self-regulation with a systematic review and meta-analysis of randomized controlled trials. Arthritis care & research, 62(10), 1460-1472.doi .10.1002 /acr .20251 Lehrer, P.M. (1972). Physiological effects of relaxation in a double-blind analog of desensitization. Behavior Therapy, 3, 193–208. Lehrer, P.M. (1978). Psychophysiological effects of progressive relaxation in anxiety neurotic patientsand of progressive relaxation and alpha feedback in non-patients. Journal Consulting Clinical Psychology, 46, 389–404. Lutgendorf, S.K., Antoni, M.H., Ironson, G.(1997). Cognitive-behavioral stress management decreases dysphoric mood and herpes simplex virus-Type2 antibody titers in symptomatic HIV-1 seropositive gay men. Journal of consulting and clinical psychology ,65(1),31-43 Lattie, E.G. (2015).The effects of telephone-delivered cognitive-behavioral stress management on inflammation and symptoms in Myalgia encephalomyelitis/chronic fatigue syndroms: A computational immunology approach. Open access dissertations .paper 14 4 5, .http:// scholarly repository. miami.edu/oadissertations/1445 Lutgendorf, S.K., Antoni, M.H., Ironson, G., Starr,K., Costello, N., Zuckerman Mklimas, N., Fletcher, M.A., Schneiderman, N.Changes in cognitive coping skills and social support during cognitive behavioral stress management intervention and distress out comes in symptomatic human immunodeficiency virus (HIV) seropositive gay man .Psychosom meducal,60,204-214 Lu, S., Peng, H., Wang, L., Vasish, S., Zhang, Y., Gao, W,Li, L,& etal (2013). Elevated specific peripheral cytokines found in major depressive disorder patients with childhood trauma exposure: A cytokine antibody array analysis. Comprehensive Psychiatry, 54(7), 953-961. doi: http://dx.doi.org/10.1016 / j . comppsych.2013.03.026 Lerman, C. E. (1987). Rheumatoid arthritis: Psychological factors in the etiology, course, and treatment. Clinical Psychology Review, 7(4), 413-425. doi: http://dx.d oi.org/10.10 16/0272- 7358(87)90019-5 Leibing, E., Pfingsten, M., Bartmann, U., Rueger, U., & Schuessler, G. (1999).Cognitive behavioral treatment in unselected rheumatoid arthritis outpatients. Clinical Journal of Pain, 15, 58–66. Muscatell, K.A., Dedovic, K., Slavic, G.M., Jarcho, M.R., Breen, E.C., Bower, J.E,Irwin, M.R, & etal. (2014).Greater amygdala activity and dorsomedial prefrontal-amygdala coupling are associated with enhanced inflammatory responses to stress .Brain, Behavior, and immunity, Article in press. http:// dx.doi.or g /10 .1016/j.bbi.2014.06.201 Morf, H., Malysheva, O., & Baerwald, C. G. O. (2013). Depression and its determinants in patients with rheumatoid arthritis. Brain, Behavior, and Immunity, 29, Supplement(0), S21. doi: http://dx.doi.org /10.1016/j.bbi.2013 .01.064 Mostafa, H., & Radwan, A. (2013). The relationship between disease activity and depression in Egyptian patients with rheumatoid arthritis. The Egyptian Rheumatologist, 35(4), 193-199. doi: http:// dx.doi.org/10.1016/j.ejr.2013.05.001 McGregor, B.A., & Antoni,M.H.(2009) Psychological intervention and health outcomes among women treated for breast cancer: a review of stress pathways and biological mediators. Brain, behavior, immune journal,23(2),159-166. doi: 10.1016/j. bbi.2008.08.002 McGregor,b.A., AntoniTM.H., Boyer,A., Alfer,S.M., Blomberg,B.B, & Carver, Ch.S.(2004). Cognitive –behavioral stress management increases benefit finding and immune function among women with early –stage breast cancer. Journal of psychosomatic research,56,1-8.doi:10-1016/S0022- 3999(03)00036-9 Nicassio, P. M., Ormseth, S. R., Kay, M., Custodio, M., Irwin, M. R., Olmstead, R., & Weisman, M. H. (2012). The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis. Pain, 153(1), 107-112. doi: http://dx .doi.org/10.1016/j.pain.2011.09.024 Parlar, S., Fadiloglu, C., Argon, G., Tokem, Y., & Keser, G. The Effects of Self–Pain Management on the Intensity of Pain and Pain Management Methods in Arthritic Patients. Pain Management Nursing, 14(3), 133-142. doi: 10.1016/j.pmn.2010.08.002 Paul, G.L., & Trimble, R.W.(1970). Recorded vs. ‘‘Live’’ relaxation training and hypnotic suggestion: Comparative effectiveness for reducing physiological arousal and inhibiting stress response. Behavior Therapy, 1, 285–302. Pawlow, L.A., & Jones, G.E. (2002). The impact of abbreviated progressive muscle relaxation on salivary cortisol. Biology Psychology, 60, 1–16.Paschalides, C., Wearden, A.J., Dunkerley, R., Bundy, C., Davies, R., & Dickens, C.M. (2004). The associations of anxiety, depression and personal illness representations with glycaemic control and health-related quality of life in patients with type 2 diabetes mellitus. Journal of Psychosomatic Research, 57, 557– 64. Pawlow, L.A., & Jones, G.E. (2005). The impact of abbreviated progressive muscle relaxation on salivary cortisol and salivary immunoglobulin a (sIgA). Applied Psycho physiology Biofeedback, 30, 375–87. Russell, D.C., Smith, T.L., Krahn, D.D., Graskamp, P., Singh, D., Kolden, G.G., Sigmund, H.& Zhang, Z.(2015). Effects of cognitive behavioral stress management on negative mood and cardiac autonomic activity in ICD recipients. Pacing and clinical electrophysiology, 38(8), 951-965. Doi.10. 11 11/pace. 12668 Riemsma, R.P., Kirwan, J.R., Taal, E., Rasker, J.J. (2002). Patient education for adults with rheumatoid arthritis. Cochrane Database System Review, 3: CD003688. Scherer, S., Alder, J., Gaab, J., Berger, T., Ihde, K., Urech, C.(2016). Patient satisfaction and psychological well-being after internet-based cognitive behavioral stress management(IB-CBSM) for women with preterm labor: A randomized controlled trail. Journal of psychosomatic research, 80, 37-43. Doi.10. 10 16/j.jpsychores.2015.10.011 Smith, B. W., & Zautra, A. J. (2008). The effects of anxiety and depression on weekly pain in women with arthritis. Pain, 138(2), 354-361. doi: http:// dx.doi.org/10.1 016/j .pain. 2008.01.008 Smyth, J.M., Stone, A.A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA, 281, 1304 –1309. Shearn, M.A., Fireman, B.H. (1985). Stress management and mutual support groups in rheumatoid arthritis. American Journal of Medicine, 78, 771–775. Sarafino, E.P.(2012). Health psychology 5nded. Translated by Abhari Ahmad SA. Tehran: Roshd press; 175-227[in Persian] Sajjadinezhad, M.S., Asgari, K., Molavi, H.,& Adibi, P.(2016). Comparing the Effectiveness of CognitiveBehavioral Stress Management, Optimism Training and Medical Therapy on Somatic Symptoms, Perceived Stress, Illness Perception and Quality of Life in Patients with Ulcerative Colitis. Arak Medical University Journal. ,18(10),40-54 http:// amuj.arakmu.ac.ir/article-1-3205-fa.html Sharpe, L., Sensky, T., & Allard, S. (2001). The course of depression in recent onset rheumatoid arthritis: The predictive role of disability, illness perceptions, pain and coping. Journal of Psychosomatic Research, 51(6), 713-719. doi: http://dx.doi.org/10.1016/ S0022-3999(01)00266-5 Stagl, J.M., Antoni, M.H., Lechner, S.C., Bouchard, L.C., Blomberg, B.B., Cluck, S., & etal.(2015). Randomized controlled trial of cognitive behavioral stress management in breast cancer:A brief report of effects on 5 – year depression symptoms. Health psychology, 34(2), 176-189. http: //dx. doi. org/ 10.1037/ heal0000125. Stagl, J.M., Lechner, S.C., Carver, Ch.S., Bouchard, L.C., Gudenkaul, L.M., Jutagir, D.R., & etal. (2015). A randomized controlled trail of cognitive-behavioral stress management in breast cancer:survival and recurrence at 11 – year follow-up. Breast cancer research treatment,154,319-328. Doi.10,1007/ s10549-3626-6 Samani, S., Jokar, B.(2009).Validity and reliability of short-scale form of depression, anxiety and psychological pressure. Shiraz university of humanities and social science, 26(3):65-76 Uchino, B.N., Cacioppo,J.T., Kiecolt- Glaser, J.K.(1996). The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychobull,119,488-531 Van Middendorp, H., Geenen, R., Sorbi, M.J., van Doornen, L.J.P., & Bijlsma, J.W.J. (2009). Health and physiological effects of an emotional disclosure intervention adapted for application at home: a randomized clinical trial in rheumatoid arthritis. Psychotherapy and Psychosomatics, 78(3), 145- 151.doi: 10.1159 / 000206868