Effect of mindfulness on patients with rheumatoid arthritis:
a controlled effect study

Rheumatoid arthritis (RA) is a chronic, unpredictable and one of the most
common autoimmune diseases (Symmons, 2002; van Riel, 1996; Krol, 1996). It is
estimated that the prevalence of RA is about 1%, making it a common condition.
RA is typically a progressive illness that has the potential to cause joint
destruction and functional disability. Disability has a significant effect on
quality of life as experienced by people, as well as on depression and anxiety
(Symmons, 2002).

Until now, the most common types of intervention in psychological treatment for
RA-patients were self-management programmes and cognitive-behavioral therapy.
Both approaches emphasize learning new skills helpful in managing one's
disease.

Mindfulness meditation was initially introduced as a clinical intervention for
conditions such as chronic pain and anxiety in 1979. It is currently taught and
studied in many clinical trials as the Mindfulness-Based Stress Reduction
Program (MBSR)

The present study will test the effect of MBSR on RA in comparison to cognitive
behavioral therapy (CBT) and a no-treatment control group. It is hypothesized
that Mindfulness will be at least as effective in changing quality of life,
psychological and social functioning, pain intensity and pain acceptance,
functional ability and disease activity and stress as CBT and more effective
than no therapy (the waiting-list control condition), evaluated at
post-treatment and in follow up. Furthermore, the current study hypothesizes
that MBSR will be at least as effective in changing the complaints of type D
personality RA patients in comparison with non-type D personality RA patients.
Thus, the moderating effect of Type D personality will be examined.

The research design is a randomized controlled trial (RCT). The study time is 2
years, during which patients can be included in the study. Both CBT and MBSR
are administered in patient groups en will consist of 8 weekly gatherings. A
third group, consisting of patients on the waiting list, acts as the control
group. Patients are blindly assigned to one of the therapy groups.

The baseline measurement is defined by the moment of the start of the therapy
or wait list. At this time, they will be asked to fill in a number of
questionnaires at the hospital to assess the baseline measurements. Additional
medical information will be collected in the medical file by the researcher.
Follow-up moments are planned, at two months after the intervention (T1), and
at 6 months after the intervention (T2).

See ''study design''.

Patients are asked, in addition to filling in a number of questionaires, to
participate in an 8 weeks therapy which will teach them to cope with their
complaints. Scientific studies have shown that both forms of therapy have a
postive effect on patients' complaints, both for this and other patient
populations. There are no risks attached and from own experience and other
studies it is known that the additional demands are not problematic, since
patients will notice the beneficial effects right from the start of the
therapy.