A Blind Randomized Controlled Trial of Cognitive versus Behavioral versus Cognitive-Behavioral Therapy for Patients with Rheumatoid Arthritis

Abstract

Background: Despite evidence that cognitive-behavioral therapy (CBT) is effective for rheumatoid arthritis (RA), little is known about which components of therapy are most efficacious. The present study compared the efficacy of CBT with cognitive therapy (CT) and behavioral therapy (BT) for patients with RA. We hypothesized that CBT would be more efficacious on a broader range of outcomes. Methods: Participants (n = 104) with classic or definite RA were randomized to receive one of three active treatments (CBT, CT or BT) or a wait-list control (WLC). Participants were assessed at baseline, post-treatment and 6 months on a range of outcomes. Measures of disease activity, joint function, disability and psychological functioning were included. Results: The results showed that participants who received cognitive components had greater improvements in tender joint counts and C-reactive protein at post-treatment. Those receiving either BT or CT alone improved more on anxiety than CBT or WLC. At 6 months, the three active treatment groups could only be distinguished on tender joints, which favored CT and CBT. Conclusions: CBT did not demonstrate the broader benefits to patients that we expected, nor was there evidence that BT produced effects that were superior to CT alone. CT was superior to at least one of the other two active treatment components on 3 of the 7 outcome measures at post-treatment. Effect sizes for the interventions that included cognitive components were similar to those reported in the literature. These results suggest that CT is an effective treatment for RA and need not necessarily include behavioral strategies.