Cognitive-Behavioral Therapy and Tai Chi Chih for Patients With Rheumatoid Arthritis

April 1, 2013 updated by: Perry Nicassio, University of California, Los Angeles

Behavioral Treatments for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic illness. Patients with RA often experience significant pain and depression. This study will evaluate two programs designed to improve the symptoms of RA: cognitive-behavioral therapy (CBT) and Tai Chi Chih (TCC), compared to a health education seminar.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Rheumatoid arthritis is a progressive inflammatory illness marked by severe functional declines, significant economic and social costs, and significant psychological distress. Environmental and psychosocial factors such as stress, mood disturbance, and coping mechanisms may contribute to changes in important health outcomes, including disability and disease activity in RA. This study will compare CBT with TCC, a relaxation-based intervention, combining elements of slow gentle movement with meditation, against a more traditional health education seminar. Outcome measures will include psychological adaptation, mood disturbance, sleep quality, physiological adaptation, and disease severity.

Two hundred-ten patients will be randomly assigned to either CBT, TCC, or a control group. The CBT intervention will have three phases: 1) education on the nature of the adjustment process in chronic illness, 2) coping skill development, and 3) generalization and application of skills to everyday situations. Participants in the CBT group will attend 12 weekly group sessions of about 2 hours each. Participants in the TCC group will learn to perform 18 movements under the guidance of an expert TCC teacher. TCC participants will have 50 to 60 minute biweekly sessions during the 12-week study. Control group participants will attend weekly group educational sessions; these sessions will provide general knowledge about arthritis health and illness, and will include lectures, demonstrations, and question-and-answer sessions with experts in rheumatology, sleep science, and behavioral medicine.

Participants will be assessed prior to beginning treatment, at mid-treatment (Week 6) and again at the end of treatment (Week 12 to 13). The long term effect of interventions will be assessed at follow-up interviews 4 months and 8 months after the end of formal treatment. Psychosocial adaptation, mood disturbance and sleep quality, self-reported pain, and immune function will be measured at all five assessment periods.

Study Type

Interventional

Enrollment (Actual)

106

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • California
      • Los Angeles, California, United States, 90095
        • Cousins Center for Psychoneuroimmunology, UCLA

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Diagnosis of RA as defined by the American College of Rheumatology (ACR) and consistent with revised criteria for RA
  • Stable disease-modifying drug regimen for 3 months prior to study entry, with no change in drug dosage for at least 3 months prior to study entry
  • Relatively stable disease course for 3 months prior to study entry
  • If treated with corticosteroids, must be on a stable dosage for 3 months prior to study entry
  • If taking prednisone, must be on a dosage less than or equal to 10 mg/day or equivalent
  • Resides in Greater Los Angeles area

Exclusion Criteria:

  • Inactive RA conditions defined as "in remission"
  • Experiencing frequent, severe disease flares that require changes in primary disease-modifying regimen
  • Serious medical conditions, including: diabetes, congestive heart failure, renal failure requiring specific treatment, cancer (unless cured for period of 5 years or more), unregulated endocrine disorders (including thyroid disorders), chronic uncontrolled infection, or any uncontrolled medical condition that may interfere with the study
  • Use of analgesics (e.g., opioids) other than acetaminophen or non-steroidal anti-inflammatory agents prescribed for RA treatment, tramadol (Ultram) or Tylenol with codeine on an as-needed basis, or propoxyphen (Darvocet, Wygesic)
  • Use of oxycodone (Percocet), hydrocodone (Vicodin), morphine, or hydromorphone (Dilaudid)
  • Use of high levels of methotrexate (greater than 7.5 mg)
  • Use of nitrogen mustard, cyclosporine, monoclonal antibodies, or cyclophosphamide within the 6 months prior to study entry
  • Serious psychiatric conditions, such as bipolar disorder, psychotic disorders, or organic brain syndromes
  • At risk for suicide
  • Dependent on canes, walkers, or other assistive devices
  • Unable to commit to study schedule/itinerary or unwilling to be assigned to any of the 3 treatment groups

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: 1
Participants will partake in cognitive behavioral therapy for 12 weeks.
Behavioral: Cognitive Behavioral Therapy
The CBT intervention will have three phases: 1) education on the nature of the adjustment process in chronic illness, 2) coping skill development, and 3) generalization and application of skills to everyday situations. Participants in the CBT group will attend 12 weekly group sessions of about 2 hours each.
Experimental: 2
Participants will partake in tai chi chih for 12 weeks.
Behavioral: Tai Chi Chih
Participants in the TCC group will learn to perform 18 movements under the guidance of an expert TCC teacher. TCC participants will have 50- to 60-minute biweekly sessions during the 12-week study.
Active Comparator: 3
Participants will act as a control and attend educational sessions for 12 weeks.
Behavioral: Health Education Seminar
Control group participants will attend weekly group educational sessions; these sessions will provide general knowledge about arthritis health and illness, and they will include lectures, demonstrations, and question-and-answer sessions with experts in rheumatology, sleep science, and behavioral medicine.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Time Frame
Disease activity
Time Frame: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Health functioning
Time Frame: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Inflammation, measured by levels of IL-1, IL-6, and tumor necrosis factor (TNF)-alpha
Time Frame: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up

Secondary Outcome Measures

Outcome Measure
Time Frame
Mood disturbances
Time Frame: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Coping
Time Frame: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Helplessness
Time Frame: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of California, Los Angeles

Collaborators

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Investigators

  • Principal Investigator: Perry M. Nicassio, PhD, University of California, Los Angeles

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

February 1, 2004

Primary Completion (Actual)

March 1, 2009

Study Completion (Actual)

March 1, 2009

Study Registration Dates

First Submitted

November 7, 2003

First Submitted That Met QC Criteria

November 7, 2003

First Posted (Estimate)

November 10, 2003

Study Record Updates

Last Update Posted (Estimate)

April 4, 2013

Last Update Submitted That Met QC Criteria

April 1, 2013

Last Verified

April 1, 2013

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • R01AR049840 (U.S. NIH Grant/Contract)
  • NIAMS-095

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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