Arthritis: Behavioral Treatment

Arthritis refers to a group of more than 100 disorders in which the joints become damaged, often as a result of inflammation. There is no known cure for arthritis and as such, it is a common condition that is usually chronic in nature and causes significant pain and disability. Although disability in arthritis is associated with damage to the joints that can be identified through examinations (such as X-rays), damage does not entirely predict the level of function that individuals achieve. Indeed, it has long been recognized that psychological factors, such as attitudes toward illness, coping styles, depression, and anxiety are also important predictors of function over time.

One model that has been adapted to explain the process of adjustment to arthritis is the self-regulation model. According to this model, people have beliefs about arthritis prior to being diagnosed. These beliefs influence the way in which people cope with the illness. For example, if people believe that arthritis is a serious condition, which is likely to be chronic and disabling and over which they have no control, they may be inclined to do little to actively cope with the illness and instead rest. When they rest, the acute pain improves and hence they appraise the coping strategy of resting as helpful, increasing its use. In addition, there is also an emotional response to the symptoms, such as fear or anxiety. People with arthritis will then attempt to cope with these negative emotions, such as through avoidance of activity. Again, avoidance will lead to an immediate reduction in anxiety, promoting its use as a coping strategy in the future.

The importance of attitudes, coping, and subsequent behavior in response to illness has led to the development of psychological treatments for arthritis. On the basis of models that emphasize the role of attitudes and behaviors, the most commonly evaluated of the psychological treatments is known as behavioral or cognitive-behavioral treatment or therapy (CBT). Cognitive-behavioral treatments refer to interventions that aim to help people to change their behavior and/or attitudes toward the illness in a way[Page 66] that will facilitate physical and psychological adjustment to their symptoms. CBT interventions commonly use a range of different strategies with the aim of helping patients to self-manage their symptoms. Although most of the research has been conducted with patients with rheumatoid arthritis, it is likely that these approaches would also be helpful to people with related disorders, such as systemic lupus erythematosus, ankylosing spondylitis, or Sjogren's syndrome.