Although cognitive-behavioral therapy may hold significant benefits as an adjunctive treatment for rheumatoid arthritis (RA), partner participation has negligible additional benefits, according to a team of Dutch researchers whose findings were reported in the September issue of the Journal of Rheumatology.

"It may be argued that participation of the spouse has beneficial effects for the spouse. In this study no such effects were found," the authors wrote. However, these findings do not suggest that education of the spouse is not needed. In order to cope with the demands the disease imposes on their coping skills, spouses have to be well informed about the disease and its consequences.

The authors pointed out that such information is necessary so that they can "communicate about the disease," and they found that participants in the experimental arm reported more improved communication about the disease with their spouse. If anything, the study showed how urgently more research is needed to identify the most effective ways to educate the spouse and improve the couple's communication about RA, they wrote.

Surprisingly, "participation of partners in group based cognitive-behavioral self-management treatment for RA patients has little or no additional beneficial effects," lead author Wim van Lankveld, PhD, told CiaoMed, although cognitive-behavioral self-management group treatment had benefits for both the patients' disease status and psychological functioning. However, the benefits were seen in both the experimental arm, which involved the spouses, and in the control arm, which excluded the spouses. Dr. van Lankveld is a Senior Researcher and Psychologist in the Department of Research and Development in Sint Maartenskliniek in Nijmegen, The Netherlands.

Because of the recent interest in both the benefits of psychological interventions in chronic disease and in partner participation, the investigators wanted to determine if the combination of these approaches would be effective for patients with RA and their spouses. Therefore, they recruited 59 couples in which one member had RA and randomly assigned them to an experimental arm, in which both the patient and spouse were involved in a group program designed to restructure disease-related thinking patterns and to decrease passive coping, or a control group, in which only the patient participated.

The investigators assessed patients at baseline and at 2 weeks and 6 months after the program. At these times, they evaluated patients' disease status, self-reported physical and psychological functioning, coping, and disease-related thinking patterns. In addition, they assessed the couples' marriage characteristics at those time points.

Patients in both groups had similar positive changes regarding disease activity, thinking patterns, coping, and physical and psychological functioning. Interestingly, in both arms, patients reported a decrease in potential support. The investigators found no differences between the groups. However, at the final assessment, those in the experimental group reported that their disease-related communication with their spouse had improved more than did those in the control arm.

These findings suggest that investigators still need to learn effective ways to involve spouses in RA patients' self-management, Dr. van Lankveld told CiaoMed. "Cognitive-behavioral self-management group treatment may have positive effects in addition to the positive effects of regular medical treatment," he said. "Such psychological approaches therefore should be incorporated in ongoing medical treatment of patients with RA." However, until methods are developed that make good use of spousal involvement, "participation of the spouse in such interventions should be discouraged," he said, recommending that those designing self-management programs consider "other methods of involving the spouse in the treatment of the patient."

One way to improve partner participation may be to individualize the intervention so that it meets patients' and partners' specific needs, the authors pointed out. "Another promising line of research is to identify malfunctioning couples," they wrote. "Treatment tailored to the specific problems of individual couples may prove to be more helpful than general treatment of all couples dealing with RA."

Reference

van Lankveld W, van Helmond T , Näring G, et al. Partner participation in cognitive-behavioral self-management group treatment for patients with RA. J Rheumatol. 2004;31:1738-1745.