Cognitive behavioral therapy benefits people with lupus

Lupus Foundation of America

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What is the topic?

Cognitive Behavioral Therapy (CBT) is a type of psychotherapy that explores the role of thinking in people’s well-being. One previous study investigated the effects of this treatment on stress in people with lupus. That study found that CBT, along with biofeedback, reduced pain and improved coping in people with lupus for up to nine months after the study was conducted.

What did the researchers hope to learn?

The researchers hoped to learn whether CBT could help people with lupus cope with stress, anxiety, and depression, all of which may co-occur with a chronic illness. They wanted to see if they could confirm the results of the previous study and whether benefits could be seen over a longer time period. 

Who was studied?

45 people with lupus, who were found to have a high level of chronic stress by use of a measurement called the Cohen Perceived Stress Scale, participated. The study was conducted at the Systemic Disease Unit in Granada, Spain. People were not included in the study if they were seen for less than a year, or if they were unable to read and write, attend therapy sessions, or receive treatment for a psychiatric condition.   

How was the study conducted?

The lupus patients were interviewed and asked to complete the Perceived Stress Questionnaire to rate their daily stress level. The people with the highest stress levels were randomly divided into two groups.   This study lasted 15 months, during which time one group received CBT and the other group (called the control group) were not offered any special intervention. Patients in the control group received standard medical care, as well as encouragement to participate in moderate exercise, eat a balanced diet, and get plenty of rest. The therapy group had CBT sessions lasting 1.5 – 2 hours once a week for 10 weeks. About six and nine months later, patients in the therapy group participated in “booster sessions” in order to strengthen their newly learned psychological skills.  

The patients were studied at the time of enrollment, as well as at 3, 9, and 15 months later, with measures of disease activity, psychological parameters, and quality of life.

What did the researchers find?

People in the therapy group improved in both the perception of stress and vulnerability to stress, as compared to the control group, at months 3, 9, and 15. 

People in the therapy group also had lower levels of anxiety and depression at months 3 and 15 than they did upon entry into the study, but this was not the case for people in the control group.

People in the therapy group showed improvement in multiple measures of quality of life at some point throughout the study period.

Lupus disease activity (measured by the SLEDAI) was not different in people in the CBT group compared to the control group. Similarly, there was no difference in the number of flares in either group during the year after therapy compared to the year before therapy.

People in both groups were similar in age at lupus diagnosis, duration of illness, level of education, gender, and lupus manifestations.  

What were the limitations of the study?

The number of people who participated in the study was small, which may somewhat limit the applicability of the results. Also, the time at which the “booster” therapy sessions were initiated, as well as their frequency, may not have been ideal in order to optimally observe effects of the therapy sessions, especially after the 10 therapy sessions were complete. 

Editor’s note: “This study suggests the possibility that this type of psychotherapy may be helpful to people with chronic stress, but it is still possible that the extra time spent with the patients in therapy or the special relationships developed with the study doctors were what actually made the difference in their lives.”

What do the results mean for you?

This study suggests that CBT might reduce stress, anxiety, and depression, and improve the quality of life, in people with lupus. 

Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial. 
Authors: Navarrete-Navarrete N, Peralta-Ramírez MI, Sabio-Sánchez JM, Coín MA, Robles-Ortega H, Hidalgo-Tenorio C, Ortego-Centeno N, Callejas-Rubio JL, and Jiménez-Alonso J (2010). 
Psychotherapy & Psychosomatics 79: 107-115.