A randomized, controlled trial of emotional disclosure in rheumatoid arthritis: Can clinician assistance enhance the effects?

• Published in: Pain (Amsterdam) Vol. 137; no. 1; pp. 164 - 172
• Main Authors: Keefe, Francis J., Anderson, Timothy, Lumley, Mark, Caldwell, David, Stainbrook, David, Mckee, Daphne, Waters, Sandra J., Connelly, Mark, Affleck, Glenn, Pope, Mary Susan, Weiss, Marianne, Riordan, Paul A., Uhlin, Brian D.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 30-06-2008; Lippincott Williams & Wilkins, Inc; Elsevier
• Subjects: Aged; Analgesics; Arthritis; Arthritis, Rheumatoid - physiopathology; Arthritis, Rheumatoid - psychology; Behavior therapy. Cognitive therapy; Biological and medical sciences; Clinical trial; Clinician-assisted disclosure; Disclosure; Disclosure - trends; Emotional disclosure; Emotions - physiology; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Neuropharmacology; Nurse's Role - psychology; Pain; Pain behavior; Pharmacology. Drug treatments; Psychological intervention; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Randomized; Randomized trial; Rheumatoid arthritis; Stress; Treatments; Emotional disclosure; Pain; Randomized; Rheumatoid arthritis; Pain behavior; Clinical trial; Arthritis; Randomized trial; Disclosure; Psychological intervention; Stress; Clinician-assisted disclosure; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; Disability; Behavior; Human; Immunopathology; Care; Chronic; Experience; Health status; Treatment; Manipulation
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/j.pain.2007.08.031

Emotional disclosure by writing or talking about stressful life experiences improves health status in non-clinical populations, but its success in clinical populations, particularly rheumatoid arthritis (RA), has been mixed. In this randomized, controlled trial, we attempted to increase the efficacy of emotional disclosure by having a trained clinician help patients emotionally disclose and process stressful experiences. We randomized 98 adults with RA to one of four conditions: (a) private verbal emotional disclosure; (b) clinician-assisted verbal emotional disclosure; (c) arthritis information control (all of which engaged in four, 30-min laboratory sessions); or (d) no-treatment, standard care only control group. Outcome measures (pain, disability, affect, stress) were assessed at baseline, 2 months following treatment (2-month follow-up), and at 5-month, and 15-month follow-ups. A manipulation check demonstrated that, as expected, both types of emotional disclosure led to immediate (post-session) increases in negative affect compared with arthritis information. Outcome analyses at all three follow-ups revealed no clear pattern of effects for either clinician-assisted or private emotional disclosure compared with the two control groups. There were some benefits in terms of a reduction in pain behavior with private disclosure vs. clinician-assisted disclosure at the 2-month follow-up, but no other significant between group differences. We conclude that verbal emotional disclosure about stressful experiences, whether conducted privately or assisted by a clinician, has little or no benefit for people with RA.