Stress management in rheumatoid arthritis: What is the underlying mechanism?

Objective. To test whether change in cognitive-behavioral variables (such a s self-efficacy, coping strategies, and helplessness) is a mediator in the relation between cognitive behavior therapy and reduced pain and depression in persons with rheumatoid arthritis (RA). Methods. A sample of patients with RA who completed a stress management tra ining program (n = 47) was compared to a standard care control group (n = 4 5). A path analysis testing a model including direct effects of comprehensi ve stress management training on pain and depression and indirect effects v ia change in cognitive-behavioral variables was conducted. Results. The path coefficients for the indirect effects of stress managemen t training on pain and depression via change in cognitive-behavioral variab les were statistically significant, whereas the path coefficients for the d irect effects were found not to be statistically significant. Conclusion. Decreases in pain and depression following stress management tr aining are due to beneficial changes in the arenas of self-efficacy (the be lief that one can perform a specific behavior or task in the future), copin g strategies tan individual's confidence in his or her ability to manage pa in), and helplessness (perceptions of control regarding arthritis). There i s little evidence of additional direct effects of stress management trainin g on pain and depression.